• Mood Disorders
• Diabetes & Endocrinology Clinical Trials Diabetes Mellitus

• Mood Disorders
• Diabetes & Endocrinology Clinical Trials
• Endocrinology
• Diabetes & Metabolic Syndrome
• Diabetes Mellitus

The presence of depressive symptoms at baseline and over time was associated with an increased risk of mortality in men and women with type 1 diabetes mellitus (T1DM) in an analysis of data from the Epidemiology of Diabetes Complications study [EDC; Pambianco G et al. Diabetes 2006], presented by Catherine E. Fickley, MPH, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

The prevalence of clinical depression in patients with T1DM was 12% compared with 3% in healthy controls in a meta-analysis [Barnard KD et al. Diabet Med 2006]. The existing literature on the relation between depression and depressive symptoms and diabetes outcomes in patients with T1DM appears to be limited to one study that showed a relation between depression, as measured by antidepressant use, and an increased risk of mortality in women but not in men [Ahola AJ et al. Diabetologia 2012]. A relationship between depression and increased mortality in the general population and in patients with type 2 diabetes mellitus (T2DM) has been reported.

The EDC is a prospective cohort study of 658 participants with childhood-onset T1DM who have been followed since 1986. At baseline, their mean age was 28 years (range, 8 to 48 years) and diabetes duration was 19 years (range, 7 to 37 years). At baseline, the Beck Depression Inventory (BDI) questionnaire was completed by participants. The BDI includes items related to symptoms of depression, cognition, and physical symptoms.

In total, 458 (235 women, 223 men) participants who completed the BDI at baseline were eligible for this analysis, in which investigators examined whether the incidence of all-cause mortality varied according to reported depressive symptoms over time while controlling for relevant covariates.

During the 20-year follow-up, 94 deaths (43 women, 51 men) occurred. The BDI score was associated with mortality on univariate analysis (HR, 1.39; 95% CI, 1.23 to 1.58; p< .001).

The association between depressive symptoms and mortality persisted (HR, 1.35; 95% CI, 1.17 to 1.56; p< .001) on multivariable analysis, adjusted for T1DM duration, calories consumed, total cholesterol, waist-to-hip ratio, HbA1C, education, hypertension, blood pressure medication, type A behavior, coronary artery disease, white blood cell count, and calories consumed, among others.

The use of antidepressants was not a confounding variable and only slightly diminished the association between depressive symptoms and mortality risk (HR, 1.32; 95% CI, 1.14 to 1.54; p< .001). No association was found between depressive symptoms and mortality risk between women and men (p = .02) or between sex and antidepressant use (p = .81).

When a cut point of 16 for clinically important depression was used, a significant relation between mortality and a BDI 16 or higher was found compared with a BDI less than 16 (HR, 2.87; 95% CI, 1.83 to 4.50; p< .001).

A strength of this analysis was that the self-reported BDI captured depressive symptoms in patients who were and were not taking antidepressants, stated Fickley. Depressive symptoms over time predicted mortality in both women and men in this analysis, regardless of antidepressant use. These data support the need to evaluate efforts to improve screening and treatment of depression in T1DM.

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