Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 33 (2), 264-9

Depression and Advanced Complications of Diabetes: A Prospective Cohort Study


Depression and Advanced Complications of Diabetes: A Prospective Cohort Study

Elizabeth H B Lin et al. Diabetes Care.


Objective: To prospectively examine the association of depression with risks for advanced macrovascular and microvascular complications among patients with type 2 diabetes.

Research design and methods: A longitudinal cohort of 4,623 primary care patients with type 2 diabetes was enrolled in 2000-2002 and followed through 2005-2007. Advanced microvascular complications included blindness, end-stage renal disease, amputations, and renal failure deaths. Advanced macrovascular complications included myocardial infarction, stroke, cardiovascular procedures, and deaths. Medical record review, ICD-9 diagnostic and procedural codes, and death certificate data were used to ascertain outcomes in the 5-year follow-up. Proportional hazard models analyzed the association between baseline depression and risks of adverse outcomes.

Results: After adjustment for prior complications and demographic, clinical, and diabetes self-care variables, major depression was associated with significantly higher risks of adverse microvascular outcomes (hazard ratio 1.36 [95% CI 1.05-1.75]) and adverse macrovascular outcomes (1.24 [1.0-1.54]).

Conclusions: Among people with type 2 diabetes, major depression is associated with an increased risk of clinically significant microvascular and macrovascular complications over the ensuing 5 years, even after adjusting for diabetes severity and self-care activities. Clinical and public health significance of these findings rises as the incidence of type 2 diabetes soars. Further research is needed to clarify the underlying mechanisms for this association and to test interventions to reduce the risk of diabetes complications among patients with comorbid depression.


Figure 1
Figure 1
Pathways Epidemiologic Follow-Up sample recruitment.

Similar articles

See all similar articles

Cited by 144 PubMed Central articles

See all "Cited by" articles


    1. Hill Golden S, Lazo M, Carnethon M, Bertoni AG, Schreiner PJ, Diez-Roux AV, Lee HB, Lyketsos C. Examining a bidirectional association between depressive symptoms and diabetes. JAMA 2008; 299: 2751– 2759 - PMC - PubMed
    1. Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 2003; 26: 2822– 2828 - PubMed
    1. Lin E, Heckbert S, Rutter C, Katon W, Ciechanowski P, Ludman E, Oliver M, Young B, McCulloch DK, Von Korff M. Depression and increased mortality in diabetes: unexpected causes of death. Ann Fam Med 2009; 7: 414– 421 - PMC - PubMed
    1. Ludman EJ, Katon W, Russo J, Von Korff M, Simon G, Ciechanowski P, Lin E, Bush T, Walker E, Young B. Depression and diabetes symptom burden. Gen Hosp Psychiatry 2004; 26: 430– 436 - PubMed
    1. Von Korff M, Katon W, Lin EH, Simon G, Ciechanowski P, Ludman E, Oliver M, Rutter C, Young B. Work disability among individuals with diabetes. Diabetes Care 2005; 28: 1326– 1332 - PubMed

Publication types

MeSH terms