Depression as a risk factor for mortality in individuals with diabetes: a meta-analysis of prospective studies

PLoS One. 2013 Nov 21;8(11):e79809. doi: 10.1371/journal.pone.0079809. eCollection 2013.

Abstract

Objective: To quantify the impact of depression measured by self-reports and depression measured by clinical interview on all-cause mortality in individuals with diabetes and to analyze the strength of both associations, the influence of covariates, and possible differences between studies assessing self-rated depressive symptoms and those using a clinical interview to measure depression as predictors of mortality.

Research design and methods: PUBMED and PsycINFO were searched up to July 2013 for prospective studies assessing depression, diabetes and mortality. The pooled hazard ratios were calculated using random-effects models.

Results: Sixteen studies met the inclusion criteria. After adjustment for demographic variables depression measured by self-reports was associated with an increased all-cause mortality risk (pooled HR = 2.56, 95% CI 1.89-3.47), and the mortality risk remained high after additional adjustment for diabetes complications (HR = 1.76, 95% CI 1.45-2.14,). Six studies reporting adjusted HRs for depression measured by clinical interviews supported the results of the other models (HR = 1.49, 95% CI 1.15-1.93).

Conclusions: Both depression measured by self-report and depression measured by clinical interview have an unfavorable impact on mortality in individuals with diabetes. The results, however, are limited by the heterogeneity of the primary studies. It remains unclear whether self-reports or clinical interviews for depression are the more precise predictor.

Publication types

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

MeSH terms

  • Depression / complications*
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / etiology
  • Diabetes Mellitus / mortality*
  • Humans
  • Risk Factors

Grant support

The work was funded by grants of the department of Psychosomatic Medicine and Psychotherapy, University of Giessen. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.