Cited by 1,799Diabetes Management and EducationDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

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Association of Depression and Diabetes Complications: A Meta-Analysis

de Groot, Mary, Anderson, Ryan, Freedland, Kenneth E., Clouse, Ray E., Lustman, Patrick J.·2001·Psychosomatic Medicine

DOI 10.1097/00006842-200107000-00015

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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.

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Association of depression with glycaemic control in people living with diabetes in low- and middle-income countries: a systematic review and meta-analysis
Nguyen, K. A., Daniel, M., Zhao, Y. W., Sekgala, M. D., Kallakuri, S., Hill, J., Joshi, R., Kengne, A. P., & Peer, N. (2025) · BMJ Global Health · doi:10.1136/bmjgh-2025-018939 · Cited by 17
“The relatively small number of studies included for each type of glycaemic control outcome limited the statistical power of the subgroup analyses and meta-regression models.”
Affect school and script analysis versus basic body awareness therapy in the treatment of psychological symptoms in patients with diabetes and high HbA1c concentrations: two study protocols for two randomized controlled trials
Melin, E. O., Svensson, R., Gustavsson, S.-Å., Winberg, A., Olah, E. D., Landin‐Olsson, M., & Thulesius, H. O. (2016) · Trials · doi:10.1186/s13063-016-1347-8 · Cited by 13
“The comorbidity is linked with inadequate glycemic control [4], disturbances in cortisol secretion [3, 5], increased prevalence of diabetes complications [6, 7] and all-cause mortality [7].”
Background
A survey of clinical physician's perceptions of stigma and advocacy in patients with type 2 diabetes in Kanagawa, Japan
Matsuzawa, Y., Azuma, K., Sawa, T., Ono, Y., Hamada, Y., Matsuba, I., & Kanamori, A. (2022) · Journal of Diabetes Investigation · doi:10.1111/jdi.13891 · Cited by 12
Community-based integrated care for patients with diabetes and depression (CIC-PDD): study protocol for a cluster randomized controlled trial
Wang, Y., Guo, D., Wang, M., Hu, M., Zhu, D., Yu, Q., Li, Z., Zhang, X., Ding, R., Zhao, M., et al. (2023) · Trials · doi:10.1186/s13063-023-07561-0 · Cited by 12
“Consequently, depression in people with diabetes negatively affects glycemic control, increases the risks of microvascular and macrovascular complications [17], leads to increased diabetes-related distress [16], reduces quality of life [18], and increases mortality [19].”
Background
Social determinants of health and diabetes: using a nationally representative sample to determine which social determinant of health model best predicts diabetes risk
Cooper, Z., Mowbray, O. P., & Johnson, L. C. M. (2024) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-023-00162-5 · Cited by 13
Neuroróżnorodność na polskich uczelniach. Doświadczenia osób studiujących: w spektrum autyzmu, z ADHD i z dysleksją
Pisula, E., Płatos, M., Banasiak, A., Danielewicz, D., Gosztyła, T., Podgórska-Jachnik, D., Pyszkowska, A., Rumińska, A., & Winczura, B. (2024) · Oficyna Wydawnicza "Impuls" eBooks · doi:10.62634/9788382943139 · Cited by 16
Types of smokers in a community sample of individuals with Type 2 diabetes: a latent class analysis
Gariépy, G., MALLA, A. K., Wang, J., Messier, L., Strychar, I. M., LESAGE, A. D., & Schmitz, N. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03493.x · Cited by 12
Neighborhood Social Environment and Patterns of Depressive Symptoms Among Patients with Type 2 Diabetes Mellitus
O’Donnell, A. J., McClintock, H. F. D. V., Wiebe, D. J., & Bogner, H. R. (2015) · Community Mental Health Journal · doi:10.1007/s10597-015-9855-7 · Cited by 12
Practical telehealth to improve control and engagement for patients with clinic-refractory diabetes mellitus (PRACTICE-DM): Protocol and baseline data for a randomized trial
Kobe, E. A., Edelman, D. E., Tarkington, P. E., Bosworth, H. B., Maciejewski, M. L., Steinhauser, K. E., Jeffreys, A. S., Coffman, C. J., Smith, V. A., Strawbridge, E. M., et al. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106157 · Cited by 13
Serious Psychological Distress and Diabetes Care among California Adults
Williams, S. L., Haskard‐Zolnierek, K. B., Banta, J. E., Haviland, M. G., DiMatteo, M. R., Anderson, D. L., & Werner, L. S. (2010) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.40.3.a · Cited by 12
“Clearly, psychiatric issues can substantially interfere with major life activities and functioning; for example, depression has been shown to be related to poor glycemic control and other diabetes complications [5, 6].”
Background
Diabetes and Men's Health Issues
Jack, L. (2004) · Diabetes Spectrum · doi:10.2337/diaspect.17.4.206 · Cited by 12
Predictors of Depression Symptoms in Patients with Diabetes in Slovakia
Majdán, M., Krajčovičová, L., Pekarčíková, J., Cherecheș, R. M., & O’Mullane, M. (2012) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.44.4.e · Cited by 12
“Depression in patients with diabetes might also accelerate other diabetic complications and increase the disease burden for the individual [3].”
Background
Disease Control Among Patients With Diabetes and Severe Depressive Symptoms
Werremeyer, A. B., Maack, B. J., Strand, M. A., Barnacle, M., & Petry, N. (2016) · Journal of Primary Care & Community Health · doi:10.1177/2150131915627423 · Cited by 12
“Scores are stratified into categories of mild (5-9), moderate (10-14), moderately severe (15-19), or severe depression symptoms (20-27).”
Background
Relationship between diabetic neuropathy and occurrence of depression among diabetic patients
Dziemidok, P., Dąbrowski, M., & Makara‐Studzińska, M. (2015) · Psychiatria Polska · doi:10.12740/pp/onlinefirst/42352 · Cited by 12
Poorer Physical Health is Associated With Greater Mental Health Service Utilization in a Sample of Depressed U.S. Army National Guard Soldiers.
Levine, D. S., Sripada, R., Ganoczy, D., Walters, H. M., Gorman, L. A., & Valenstein, M. (2016) · Military Medicine · doi:10.7205/milmed-d-15-00287 · Cited by 9
Association between depression, glycaemic control and the prevalence of diabetic retinopathy in a diabetic population in Cameroon
Hall, K. K., Tambekou, J., Penn, L., Camara, A., Balde, N. M., & Sobngwi, E. (2017) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v23i0.983 · Cited by 12
Depression and Diabetic Peripheral Neuropathy: Birds of a Feather, But When do They Flock Together?
Vas, P. R. J., & Παπάνας, Ν. (2018) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-0808-4269 · Cited by 11
Differences in the cluster of depressive symptoms between subjects with type 2 diabetes and individuals with a major depressive disorder and without diabetes
Nicolau, J., Simó, R., Conchillo, C., Sanchís, P., Blanco, J., Romerosa, J. M., Fortuny, R., Bonet, A., & Masmiquel, L. (2019) · Journal of Endocrinological Investigation · doi:10.1007/s40618-019-01020-x · Cited by 12
The Percentage of Depressive Symptoms in Patients with Type 2 Diabetes Mellitus in M Djamil General Hospital Padang, Indonesia
Decroli, E., Kam, A., & Dillasamola, D. (2019) · Journal of Research in Pharmacy · doi:10.12991/jrp.2019.136 · Cited by 12
“Previous studies also stated that there is a link between depressive symptoms and macrovascular complications, which was a myocardial infarction [5,19,20].”
Background
Not a Painless Condition: Rheumatological and Musculoskeletal Symptoms in Type 2 Diabetes, and the Implications for Exercise Participation
Cox, E. R., Coombes, J. S., Keating, S. E., Burton, N. W., & Coombes, B. K. (2019) · Current Diabetes Reviews · doi:10.2174/1573399815666190531083504 · Cited by 12
Patient and Health Care Factors Associated With Long-term Diabetes Complications Among Adults With and Without Mental Health and Substance Use Disorders
Schmidt, E. M., Barnes, J. I., Chen, C., Trafton, J. A., Frayne, S. M., & Harris, A. H. S. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.12060 · Cited by 13
Depression and treatment nonadherence in type 2 diabetes: Assessment issues and an integrative treatment approach
Gonzalez, J. S., & Esbitt, S. A. (2010) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x00000798 · Cited by 12
“For example, depression is associated with treatment nonadherence (Gonzalez et al., 2008b), worse glycemic control (Lustman et al., 2000), and higher risk of diabetes complications (de Groot et al., 2001).”
Clinical characteristics of depressed patients with comorbid diabetes mellitus
Petersen, T., Iosifescu, D. V., Papakostas, G. I., Shear, D. L., & D, M. F. M. (2005) · International Clinical Psychopharmacology · doi:10.1097/01.yic.0000182122.36425.b1 · Cited by 12
“…poor glycemic control, noncompliance with therapy (Tun et al., 1990; McGill et al., 1992; De Groot et al., 1994) and diabetic complications such as cardiovascular disease and retinopathy (Kovacs et al., 1995; Lustman et al., 2000a; De Groot et al., 2001) compared to nondepressed diabetic patients.”
Background
Associations between depression and diabetic retinopathy in the National Health and Nutrition Examination Survey, 2011 to 2018
Kalva, P., Shi, A., Kakkilaya, A., Saleh, I. A., Albadour, M., & Kooner, K. (2024) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2024.2301917 · Cited by 13
Elevated Circulating Microparticle Subpopulations in Incidental Cerebral White Matter Hyperintensities: A Multimodal Study
Nassir, C. M. N. C. M., Ghazali, M. M., Safri, A. A., Jaffer, U., Abdullah, W. Z., Idris, N. S., & Mustapha, M. (2021) · Brain Sciences · doi:10.3390/brainsci11020133 · Cited by 12
“Similar findings have also been reported with respect to the association of the presence of WMHs with frontal executive function, memory, and global functioning [69].”
Result
Potential Biomarkers for Predicting Depression in Diabetes Mellitus
Song, X., Zheng, Q., Zhang, R., Wang, M., Deng, W., Wang, Q., Guo, W., Li, T., & Ma, X. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.731220 · Cited by 12
Hormonal determinants of the severity of andropausal and depressive symptoms in middle-aged and elderly men with prediabetes
Rabijewski, M., Papierska, L., Kuczerowski, R., & Piątkiewicz, P. (2015) · Clinical Interventions in Aging · doi:10.2147/cia.s88499 · Cited by 11
Longitudinale Assoziationen zwischen depressiven Symptomen und Typ-2-Diabetes sowie deren Auswirkung auf die Mortalität von Hausarztpatienten
Pieper, L., Dirmaier, J., Klotsche, J., Thurau, C., Pittrow, D., Lehnert, H., März, W., Koch, U., & Wïttchen, H. (2010) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-010-1181-1 · Cited by 11
Chlorella ingestion suppresses resistin gene expression in peripheral blood cells of borderline diabetics
Itakura, H., Kobayashi, M., & Nakamura, S. (2015) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2015.04.002 · Cited by 11
Food restriction and streptozotocin differentially modify sensitivity to the hypothermic effects of direct- and indirect-acting serotonin receptor agonists in rats
Li, J., Koek, W., & France, C. P. (2009) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2009.04.027 · Cited by 11
“N IH -PA Author M anuscript N IH -PA Author M anuscript both type-1 (Barnard et al., 2006; Shaban et al., 2006) and type-2 diabetes (Ali et al., 2006; De Groot et al., 2001).”
Background
Understanding the relationship between depression and diabetic foot ulcers
Steel, A., Reece, J., & Daw, A.-M. (2015) · Journal of Social Health and Diabetes · doi:10.4103/2321-0656.164792 · Cited by 11
“The links between depression and exacerbations of health problems, adverse effects on general functioning and quality of life, lower self-care regimens, and poorer glycemic control in people with diabetes are well-established.([8,9]) The link between depression and DFUs is less clear, and there is clearly a need to in…”
Background
Mental Health Service and Provider Preference among American Indians with Type 2 Diabetes
Aronson, B. D. (2016) · American Indian and Alaska Native Mental Health Research · doi:10.5820/aian.2301.2016.1 · Cited by 12
Home-based diabetes self-management coaching delivered by paraprofessionals: A randomized controlled trial
Pauley, T., Gargaro, J., Chenard, G., Cavanagh, H., & McKay, S. M. (2016) · Home Health Care Services Quarterly · doi:10.1080/01621424.2016.1264339 · Cited by 13
Glycaemic status and depressive symptoms among adults in Germany: results from the German Health Interview and Examination Survey for Adults ( DEGS 1)
Weikert, B., Buttery, A. K., Heidemann, C., Rieckmann, N., Paprott, R., Maske, U., Scheidt‐Nave, C., & Busch, M. A. (2018) · Diabetic Medicine · doi:10.1111/dme.13707 · Cited by 11
Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre
Reynolds, M. C., Driver, S. J., Bennett, M., Patel, S. K., Rainey, E. E., & Warren, A. M. (2018) · Clinical Obesity · doi:10.1111/cob.12264 · Cited by 11
“It is also well documented that mental health outcomes such as depression and PTSD contribute to negative outcomes of trauma patients such as increased hospital length of stay (12, 13), increased healthcare utilization (14) and increased medical symptoms and complications (15, 16).”
Background
Evaluate Factors Influencing Depression in Baghdad: Using Deck-Depression Inventory
Aljuboori, S. B., Azeez, A.-J. A., Mahmood, A. A. R., Fathel, R., & Talab, H. (2019) · INNOVATIONS in Pharmacy · doi:10.24926/iip.v10i3.2036 · Cited by 7
“A meta-analysis found that depression is associated with several complications in patients with diabetes including retinopathy, neuropathy, nephropathy, sexual dysfunction and macrovascular complications (12).”
Background

Authors: de Groot, M., Anderson, R., Freedland, K. E., Clouse, R. E., & Lustman, P. J.
Affiliations: Washington University in St. Louis (US)
ORCID: Freedland, Kenneth E.
Lustman, Patrick J.
Venue: Psychosomatic Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2001-07
Volume: 63
Issue: 4
Pages: 619-630
ISSN: 0033-3174 (ISSN-L)
DOI: 10.1097/00006842-200107000-00015
OpenAlex: W2080312294
Cited by: 1,799
References: 40
Citations by year: 2026: 22 · 2025: 30 · 2024: 54 · 2023: 54 · 2022: 82 · 2021: 69 · 2020: 61 · 2019: 81 · 2018: 83 · 2017: 85 · 2016: 119 · 2015: 107 · 2014: 122 · 2013: 98 · 2012: 111
FWCI: 3.84
Type: journal article
Language: en
Open access: closed
Locations: Psychosomatic Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r01dk053060-05)
National Heart, Lung, and Blood Institute (T32HL007456, 5 T32 HL07456-18)
National Institute of Diabetes and Digestive and Kidney Diseases (DK-36452, DK53060, R01DK036452)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: depression, diabetes complications, type 1 diabetes, type 2 diabetes, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, macrovascular complications, sexual dysfunction, depressive symptoms
MeSH terms: Depressive Disorder, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Diabetic Nephropathies, Diabetic Neuropathies, Diabetic Retinopathy, Humans, Risk Factors, Sick Role, Comorbidity

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Association of Depression and Diabetes Complications: A Meta-Analysis

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