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Depression and Diabetes: A Potentially Lethal Combination

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Abstract

Objective

To assess whether Medicare fee-for-service beneficiaries with depression and diabetes had a higher mortality rate over a 2-year period compared with beneficiaries with diabetes alone.

Design

Evidence of depression was based on a physician diagnosis or self-reported prescription of an antidepressant in the year prior to screening, or a score of ≥3 on the Patient Health Questionnaire two-item questionnaire. Mortality was assessed bi-monthly by checking Medicare claims and eligibility files or from information from telephone contact with the participant’s family. Cox proportional hazard regression models were used to calculate adjusted hazard ratios of death in depressed versus nondepressed beneficiaries with diabetes.

Participants

A total of 10,704 beneficiaries with diabetes enrolled in a disease management program were surveyed with a health assessment questionnaire and followed over a two-year period.

Main Results

Comorbid depression in Medicare beneficiaries with diabetes participating in a disease management program was associated with an increased risk for all-cause mortality over a two-year period of approximately 36% to 38%, depending on the definition of depression that was used. No significant increase in rates of cause-specific mortality from macrovascular disease were found in depressed versus nondepressed beneficiaries.

Conclusion

Among a large Medicare cohort of fee-for-service beneficiaries with diabetes, comorbid depression was associated with an increase in all-cause mortality over a two-year period. Future research will be required to determine whether the increase in mortality associated with depression is due to potential behavioral mediators (i.e., smoking, poor adherence to diet) or physiologic abnormalities (i.e., hypothalamic-pituitary axis dysregulation) associated with depression.

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Acknowledgements

This research has been supported by NIMH grants MH 0751590 (Unützer, Principal Investigator), and K24 MH 069741 (Katon, Principal Investigator)

Conflict of Interest

The authors do not have a conflict of interest with the information contained in this article.

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Correspondence to Wayne Katon MD.

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The views expressed in this article do not necessarily represent the views of the National Institute of Mental Health, the National Institutes of Health, the Department of Health and Human Services or the United States government.

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Katon, W., Fan, MY., Unützer, J. et al. Depression and Diabetes: A Potentially Lethal Combination. J GEN INTERN MED 23, 1571–1575 (2008). https://doi.org/10.1007/s11606-008-0731-9

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  • DOI: https://doi.org/10.1007/s11606-008-0731-9

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