Association of depression and diabetes complications: a meta-analysis

Psychosom Med. Jul-Aug 2001;63(4):619-30. doi: 10.1097/00006842-200107000-00015.

Abstract

Objective: The objective of this study was to examine the strength and consistency of the relationship between depression and diabetes complications in studies of type 1 and type 2 adult patients with diabetes.

Method: MEDLINE and PsycINFO databases were searched for articles examining depression and diabetes complications in type 1 and type 2 diabetes samples published between 1975 and 1999. Meta-analytic procedures were used. Studies were reviewed for diabetes type, sample size, statistical tests, and measures of diabetes complications and depression. Significance values, weighted effect sizes r, 95% confidence intervals (CI), and tests of homogeneity of variance were calculated for the overall sample (k = 27) and for subsets of interest.

Results: A total of 27 studies (total combined N = 5374) met the inclusion criteria. A significant association was found between depression and complications of diabetes (p < .00001, z = 5.94). A moderate and significant weighted effect size (r = 0.25; 95% CI: 0.22-0.28) was calculated for all studies reporting sufficient data (k = 22). Depression was significantly associated with a variety of diabetes complications (diabetic retinopathy, nephropathy, neuropathy, macrovascular complications, and sexual dysfunction). Effect sizes were in the small to moderate range (r = 0.17 to 0.32).

Conclusions: These findings demonstrate a significant and consistent association of diabetes complications and depressive symptoms. Prospective, longitudinal studies are needed to identify the pathways that mediate this association.

Publication types

  • Meta-Analysis
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Comorbidity
  • Depressive Disorder / complications*
  • Depressive Disorder / diagnosis
  • Depressive Disorder / psychology
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / psychology
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetic Angiopathies / diagnosis
  • Diabetic Angiopathies / psychology
  • Diabetic Nephropathies / diagnosis
  • Diabetic Nephropathies / psychology
  • Diabetic Neuropathies / diagnosis
  • Diabetic Neuropathies / psychology
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / psychology
  • Humans
  • Risk Factors
  • Sick Role