Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis

• Published in: PloS one Vol. 8; no. 3; p. e57058
• Main Authors: van Dooren, Fleur E P, Nefs, Giesje, Schram, Miranda T, Verhey, Frans R J, Denollet, Johan, Pouwer, François
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.03.2013; Public Library of Science (PLoS)
• Subjects: Cardiovascular diseases; Cardiovascular Diseases - complications; Cardiovascular Diseases - mortality; Cohort analysis; Complications; Complications and side effects; Correlation analysis; Demographic variables; Demographics; Depression (Mood disorder); Depression - complications; Depression - mortality; Diabetes Complications - mortality; Diabetes mellitus; Diabetes Mellitus - mortality; Diabetes Mellitus - psychology; Diabetics; Health risk assessment; Health risks; Heterogeneity; Humans; Longitudinal studies; Medicine; Mental depression; Meta-analysis; Mortality; Multivariate Analysis; Odds Ratio; Proportional Hazards Models; Research design; Risk; Risk Factors; Social and Behavioral Sciences; Studies; Systematic review; Type 2 diabetes; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0057058

To examine the association between depression and all-cause and cardiovascular mortality in people with diabetes by systematically reviewing the literature and carrying out a meta-analysis of relevant longitudinal studies. PUBMED and PSYCINFO were searched for articles assessing mortality risk associated with depression in diabetes up until August 16, 2012. The pooled hazard ratios were calculated using random-effects models. Sixteen studies met the inclusion criteria, which were pooled in an overall all-cause mortality estimate, and five in a cardiovascular mortality estimate. After adjustment for demographic variables and micro- and macrovascular complications, depression was associated with an increased risk of all-cause mortality (HR = 1.46, 95% CI = 1.29-1.66), and cardiovascular mortality (HR = 1.39, 95% CI = 1.11-1.73). Heterogeneity across studies was high for all-cause mortality and relatively low for cardiovascular mortality, with an I-squared of respectively 78.6% and 39.6%. Subgroup analyses showed that the association between depression and mortality not significantly change when excluding three articles presenting odds ratios, yet this decreased heterogeneity substantially (HR = 1.49, 95% CI = 1.39-1.61, I-squared = 15.1%). A comparison between type 1 and type 2 diabetes could not be undertaken, as only one study reported on type 1 diabetes specifically. Depression is associated with an almost 1.5-fold increased risk of mortality in people with diabetes. Research should focus on both cardiovascular and non-cardiovascular causes of death associated with depression, and determine the underlying behavioral and physiological mechanisms that may explain this association.