Increased Risk of Cardiovascular Disease and Mortality in Patients with Diabetes and Coexisting Depression: A Nationwide Population-Based Cohort Study

다국어 초록 (Multilingual Abstract)

Background: Previous studies have suggested that depression in patients with diabetes is associated with worse health outcomes.
The aim of this study was to evaluate the risk of cardiovascular disease (CVD) and mortality in patients with diabetes with comorbid depression.
Methods: We examined the general health check-up data and claim database of the Korean National Health Insurance Service (NHIS) of 2,668,615 participants with type 2 diabetes mellitus who had examinations between 2009 and 2012. As NHIS database has been established since 2002, those who had been diagnosed with depression or CVD since 2002 were excluded. The 2,228,443 participants were classified into three groups according to the claim history of depression; normal group (n=2,166,979), transient depression group (one episode of depression, n=42,124) and persistent depression group (at least two episodes of depression, n=19,340). The development of CVD and mortality were analyzed from 2009 to 2017.
Results: Those with depression showed a significantly increased risk for stroke (transient depression group: hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.15 to 1.26) (persistent depression group: HR, 1.54; 95% CI, 1.46 to 1.63). Those with depression had an increased risk for myocardial infarction (transient depression group: HR, 1.25; 95% CI, 1.18 to 1.31) (persistent depression group: HR, 1.38; 95% CI, 1.29 to 1.49). The persistent depression group had an increased risk for all-cause mortality (HR, 1.66; 95% CI, 1.60 to 1.72).
Conclusion: Coexisting depression in patients with diabetes has a deleterious effect on the development of CVD and mortality.
We suggest that more attention should be given to patients with diabetes who present with depressive symptoms.

참고문헌 (Reference)

1 Ko SH, "Trends of antidiabetic drug use in adult type 2 diabetes in Korea in 2002-2013: nationwide population-based cohort study" 95 : e4018-, 2016

2 Ciechanowski PS, "The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes" 25 : 246-252, 2003

3 Sears C, "The relationship between diabetes and mental health conditions in an aging population" 40 : 4-5, 2016

4 Anderson RJ, "The prevalence of comorbid depression in adults with diabetes : a metaanalysis" 24 : 1069-1078, 2001

5 Ducat L, "The mental health comorbidities of diabetes" 312 : 691-692, 2014

6 Badescu SV, "The association between diabetes mellitus and depression" 9 : 120-125, 2016

7 Abdallah Alzoubi, "The Bidirectional Relationship between Diabetes and Depression: A Literature Review" 대한가정의학회 39 (39): 137-146, 2018

8 Kokoszka A, "Serious diabetes-specific emotional problems in patients with type 2 diabetes who have different levels of comorbid depression : a Polish study from the European Depression in Diabetes(EDID)Research Consortium" 24 : 425-430, 2009

9 Lin EH, "Relationship of depression and diabetes self-care, medication adherence, and preventive care" 27 : 2154-2160, 2004

10 de Groot M, "Psychological conditions in adults with diabetes" 71 : 552-562, 2016

11 Kamrul-Hasan AB, "Prevalence and predictors of depression among patients with type 2 diabetes : a multicenter cross-sectional study from Bangladesh" 28 : 23-30, 2019

12 신철민, "Prevalence and Associated Factors of Depression in General Population of Korea: Results from the Korea National Health and Nutrition Examination Survey, 2014" 대한의학회 32 (32): 1861-1869, 2017

13 Laursen TM, "Mortality and life expectancy in persons with severe unipolar depression" 193 : 203-207, 2016

14 Wang B, "Management of endocrine disease : suicide risk in patients with diabetes : a systematic review and meta-analysis" 177 : R169-81, 2017

15 Goldstein BI, "Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease : a scientific statement from the American Heart Association" 132 : 965-986, 2015

16 Kessler RC, "Lifetime and 12-month prevalence of DSMIII-R psychiatric disorders in the United States. Results from the National Comorbidity Survey" 51 : 8-19, 1994

17 Han SJ, "Increased risk of suicidal ideation in Korean adults with both diabetes and depression" 101 : e14-7, 2013

18 Scherrer JF, "Increased risk of myocardial infarction in depressed patients with type 2 diabetes" 34 : 1729-1734, 2011

19 Cho NH, "IDF Diabetes Atlas : global estimates of diabetes prevalence for 2017 and projections for 2045" 138 : 271-281, 2018

20 Turner RC, "Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus : progressive requirement for multiple therapies(UKPDS 49). UK Prospective Diabetes Study(UKPDS)Group" 281 : 2005-2012, 1999

21 Barlinn K, "Exploring the risk-factor association between depression and incident stroke : a systematic review and metaanalysis" 11 : 1-14, 2014

22 Wagner J, "Endothelial dysfunction and history of recurrent depression in postmenopausal women with type 2 diabetes : a case-control study" 23 : 18-24, 2009

23 Egede LE, "Diabetes, major depression, and functional disability among U. S. adults" 27 : 421-428, 2004

24 Holt RI, "Diabetes mellitus and severe mental illness : mechanisms and clinical implications" 11 : 79-89, 2015

25 Kim JL, "Depression symptom and professional mental health service use" 15 : 261-, 2015

26 Black SA, "Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes" 26 : 2822-2828, 2003

27 Knol MJ, "Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis" 49 : 837-845, 2006

28 Mezuk B, "Depression and type 2 diabetes over the lifespan : a meta-analysis" 31 : 2383-2390, 2008

29 van Dooren FE, "Depression and risk of mortality in people with diabetes mellitus : a systematic review and meta-analysis" 8 : e57058-, 2013

30 Park M, "Depression and risk of mortality in individuals with diabetes : a meta-analysis and systematic review" 35 : 217-225, 2013

31 Gonzalez JS, "Depression and diabetes treatment nonadherence : a meta-analysis" 31 : 2398-2403, 2008

32 정종현, "Depression and Mortality in People with Type 2 Diabetes Mellitus, 2003 to 2013: A Nationwide Population-Based Cohort Study" 대한당뇨병학회 41 (41): 296-302, 2017

33 de Groot M, "Depression among adults with diabetes : prevalence, impact, and treatment options" 23 : 15-18, 2010

34 Cruz ADL, "Current updates regarding antidepressant prescribing in cardiovascular dysfunction"

35 Katon WJ, "Clinical and health services relationships between major depression, depressive symptoms, and general medical illness" 54 : 216-226, 2003

36 Chandola T, "Chronic stress at work and the metabolic syndrome : prospective study" 332 : 521-525, 2006

37 Katon WJ, "Cardiac risk factors in patients with diabetes mellitus and major depression" 19 : 1192-1199, 2004

38 Champaneri S, "Biological basis of depression in adults with diabetes" 10 : 396-405, 2010

39 Katon WJ, "Association of depression with increased risk of severe hypoglycemic episodes in patients with diabetes" 11 : 245-250, 2013

40 Pouwer F, "Adverse effects of depression on glycemic control and health outcomes in people with diabetes : a review" 42 : 529-544, 2013

41 Markowitz SM, "A review of treating depression in diabetes : emerging findings" 52 : 1-18, 2011

42 Lu Y, "A regressional analysis of maladaptive rumination, illness perception and negative emotional outcomes in Asian patients suffering from depressive disorder" 12 : 69-76, 2014

43 Levey AS, "A more accurate method to estimate glomerular filtration rate from serum creatinine : a new prediction equation. Modification of Diet in Renal Disease Study Group" 130 : 461-470, 1999