Alzheimer's, Dementia & Mental Health
Those Treating Diabetes More Likely Get Depressed
Than Those Who Ignore It
Research also suggests possibility of depression
increasing risk of type 2 diabetes
June 17, 2008 – Researchers have found a link, or maybe
two, between type 2 diabetes and depression. It is not too surprising
that they found people with treated type 2 diabetes are at increased
risk for developing depression. It is surprising, however, that those
not treating their diabetes are less likely to get depressed. More
surprising is a modest association between persons with depression and
the risk of developing diabetes.
It has been established that clinical depression
and the presence of elevated depressive symptoms are higher among
persons with diabetes compared with the general population, says the
study in the June 18 issue of the Journal of the American Medical
Association (JAMA).
These associations may be related to increased risk
of depressive symptoms in individuals with diabetes, increased risk of
type 2 diabetes in individuals with depressive symptoms, or both.
It is unclear whether type 2 diabetes is a risk
factor for increased symptoms of depression.
“A diagnosis of diabetes or the burden of dealing
with its complications might also lead to symptoms of depression,” the
authors write.
Sherita Hill Golden, M.D., M.H.S., of Johns Hopkins
University, Baltimore, and colleagues used measures of fasting blood
glucose and depressive symptoms to test whether elevated depressive
symptoms predicted incident type 2 diabetes and whether participants
with type 2 diabetes at the beginning of the study were more likely to
develop increased symptoms of depression than participants without
diabetes.
The study included men and women age 45 to 84 years
who enrolled in 2000-2002 and were followed up until 2004-2005.
Elevated depressive symptoms were defined by high
scores on the Center for Epidemiologic Studies Depression Scale (CES-D;
a questionnaire given to participants), use of anti-depressant
medications, or both. Participants were categorized as having normal
fasting glucose, impaired fasting glucose or type 2 diabetes.
Analysis 1 included 5,201 participants without type
2 diabetes at baseline and estimated the relative risk of incident type
2 diabetes over 3.2 years for those with and without depressive
symptoms.
Analysis 2 included 4,847 participants without
elevated depressive symptoms at baseline and calculated the relative
odds of developing depressive symptoms over 3.1 years for those with and
without type 2 diabetes.
The researchers found that treated type 2 diabetes
was associated with a 52 percent higher risk of developing elevated
depressive symptoms.
Individuals with untreated type 2 diabetes were not
at increased risk.
In examining the development of type 2 diabetes
among individuals with and without elevated depressive symptoms, the
incidence of type 2 diabetes over 3.2 years was 22.0 per 1,000-person
years for those with elevated depressive symptoms and 16.6 for those
without elevated depressive symptoms.
Thus, there was a significant association between
higher levels of symptoms of depression and incident diabetes; however,
the association was no longer statistically significant following
adjustment for lifestyle factors.
Maybe it is stress of dealing with it
“Our findings of an association in participants
with treated but not untreated type 2 diabetes suggests that the
psychological stress associated with diabetes management may lead to
elevated depressive symptoms,” the authors write.
Regarding the link between depression and the
development of diabetes, “depressive symptoms are associated with
several metabolic and behavioral risk factors for type 2 diabetes. …
depressed individuals are less likely to comply with dietary and weight
loss recommendations and more likely to be physically inactive,
contributing to obesity, a strong risk factor.”
“...the present study contributes to a growing body
of literature indicating a bidirectional association between these 2
serious long-term diseases.
“Future studies should determine whether
interventions aimed at modifying behavioral factors associated with
depression will complement current type 2 diabetes prevention
strategies.
“Finally, these findings suggest that clinicians
should be aware of increased risk of elevated depressive symptoms in
individuals with treated type 2 diabetes and consider routine screening
for depressive symptoms among these patients,” the authors conclude.
