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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Method
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High risk for cardiovascular disease in Chinese type 2 diabetic patients with major depression—A 7-year prospective analysis of the Hong Kong DiabetesRegistry
Ting, R. Z. W., Lau, E. S. H., Ozaki, R., Lau, W. W. Y., Kong, A. P. S., Luk, A. O. Y., Chow, C., Ronald, C. W., Wing, Y. K., Chan, J. C. N., et al. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.01.012 · Cited by 45
“, 2011) and cardiovascular disease (CVD) by 50% in White populations (Black et al., 2003; Groot et al., 2001; Lin et al., 2010; Scherrer et al., 2011).”
Background
Racial and ethnic differences in diabetic patient-reported depression symptoms, diagnosis, and treatment
Wagner, J. A., Tsimikas, J., Abbott, G., de Groot, M., & Heapy, A. A. (2006) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2006.05.004 · Cited by 45
Depressive Symptoms in Elderly Patients After a Somatic Illness Event: Prevalence, Persistence, and Risk Factors
de Jonge, P., Kempen, G. I. J. M., Sanderman, R., Ranchor, A. V., van Jaarsveld, C. H. M., van Sonderen, E., Scaf-Klomp, W., Weening, A., Slaets, J. P. J., & Ormel, J. (2005) · Psychosomatics · doi:10.1176/appi.psy.47.1.33 · Cited by 46
The association between mindfulness and emotional distress in adults with diabetes: Could mindfulness serve as a buffer? Results from Diabetes MILES: The Netherlands.
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“…Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia J. Speight AHP Research, Hornchurch, Essex, UK multiple comorbidities places people at greater risk of impaired emotional well-being (de Groot et al., 2001; Egede, 2005; Koopmans et al., 2009; Pouwer et al., 2003).”
Background
A randomized controlled trial of cognitive behaviour therapy to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes
Serlachius, A. S., Scratch, S. E., Northam, E. A., Frydenberg, E., Lee, K. J., & Cameron, F. J. (2016) · Journal of Health Psychology · doi:10.1177/1359105314547940 · Cited by 44
“…with T1DM is important, as psychopathology is associated with deteriorating glycaemic control and an increased risk of diabetes-related complications (de Groot et al., 2001), while factors such as enhanced quality of life are associated with better diabetes outcomes (Guttmann-Bauman et al., 1998).”
Background
Welfare stigma as a risk factor for major depressive disorder: Evidence from the Supplemental Nutrition Assistance Program
Pak, T. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.08.079 · Cited by 44
Prefrontal Cortical Deficits in Type 1 Diabetes Mellitus
Lyoo, I. K., Yoon, S. J., Jacobson, A. M., Hwang, J., Musen, G., Kim, J. E., Simonson, D. C., Bae, S., Bolo, N. R., Kim, D. J., et al. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2012.543 · Cited by 43
“expected prevalence of depression among patients with type 1 diabetes mellitus (T1DM).(2-8) The high comorbidity of depression in diabetes has commonly been attributed to increased psychosocial demands of having a chronic medical illness rather than to neurobiological deficits derived from diabetes.”
Healthy Coping: Issues and Implications in Diabetes Education and Care
Kent, D., Haas, L. B., Randal, D., Lin, E. H. B., Thorpe, C. T., Boren, S. A., Fisher, J. A., Heins, J. M., Lustman, P. J., Nelson, J., et al. (2010) · Population Health Management · doi:10.1089/pop.2009.0065 · Cited by 50
Self-citation
Depression and diabetes: unhealthy bedfellows
Katon, W. J. (2010) · Depression and Anxiety · doi:10.1002/da.20683 · Cited by 46
“At the time we began the Pathways Epidemiologic Study, several meta-analysis had reported an association of depression with higher HbA1c levels [8] and both the number of diabetes complications and each individual complication.([9]) However, the vast majority of these studies were cross-sectional, and,”
Associations between HbA1c and depressive symptoms in young adults with early-onset type 1 diabetes
Bächle, C., Lange, K., Stahl‐Pehe, A., Castillo, K., Holl, R. W., Giani, G., & Rosenbauer, J. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.01.026 · Cited by 45
“According to the results of three systematic reviews (Anderson et al., 2001; Groot et al., 2001; Barnard et al., 2006), the prevalence of clinical depression among adults with type 1 diabetes was approximately four times greater than that of a control group without diabetes (12.”
BackgroundResult
Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions
Thabrew, H., Stasiak, K., Hetrick, S. E., Wong, S., Huss, J. H., & Merry, S. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012488 · Cited by 46
The prevalence of comorbid depression in patients with diabetes: A meta-analysis of observational studies
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Perceived Diabetes Task Competence Mediates the Relationship of both Negative and Positive Affect with Blood Glucose in Adolescents with Type 1 Diabetes
Fortenberry, K., Butler, J. M., Butner, J., Berg, C., Upchurch, R., & Wiebe, D. (2009) · Annals of Behavioral Medicine · doi:10.1007/s12160-009-9086-7 · Cited by 43
“been reported in both adult ( 15 ; 16) and adolescent samples (17).”
Background
Are Patients with Diabetes Mellitus Satisfied with Technologies Used to Assist with Diabetes Management and Coping?: A Structured Review
Harrison, S., Stadler, M., Ismail, K., Amiel, S. A., & Herrmann‐Werner, A. (2014) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2014.0062 · Cited by 43
“57 Furthermore, research has shown that online peer support can improve depression in diabetes patients.”
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Jafarinezhad, A., Kalantari, S., & Zohrevand, B. (2014) · Advanced Biomedical Research · doi:10.4103/2277-9175.145753 · Cited by 43
“This is in contrast with some studies, reporting a significant correlation between depression and a variety of diabetes complications, including, diabetic retinopathy, nephropathy, neuropathy, macrovascular complications, and sexual dysfunction[4,19]; and with Eren et al.”
Antidepressant Medication Use for Primary Care Patients with and without Medical Comorbidities: A National Electronic Health Record (EHR) Network Study
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Diabetes mellitus e depressão: uma revisão sistemática
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“[11] de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ.”
Background
Clinical Complexity in Women Veterans: A Systematic Review of the Recent Evidence on Mental Health and Physical Health Comorbidities
Creech, S. K., Pulverman, C. S., Crawford, J. N., Holliday, R. P., Monteith, L. L., Lehavot, K., Olson-Madden, J. H., & Kelly, U. A. (2019) · Behavioral Medicine · doi:10.1080/08964289.2019.1644283 · Cited by 43
Investigating incretin-based therapies as a novel treatment for depression in type 2 diabetes: Findings from the South London Diabetes (SOUL-D) Study
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Background
Vascular depression in older people with diabetes
Bruce, D. G., Casey, G., Davis, W. A., STARKSTEIN, S. E., Clarnette, R., Foster, J. K., Ives, F. J., Almeida, O. P., & Davis, T. M. E. (2006) · Diabetologia · doi:10.1007/s00125-006-0478-y · Cited by 44
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Background
Perceived health status and perceived diabetes control: psychological indicators and accuracy.
Lange, L. J., & Piette, J. (2005) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2004.08.004 · Cited by 54
Depression Among Type 2 Diabetes Rural Appalachian Clinic Attendees
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“Finally, although depression has been consistently linked to increased risk of diabetes complications, there is relatively little research on the role of anxiety and development of complications [32,37].”
Background
Impact of diabetes distress on glycemic control and diabetic complications in type 2 diabetes mellitus
Park, H., Cho, Y., Seo, D. H., Ahn, S. H., Hong, S., Suh, Y. J., Chon, S., Woo, J., Baik, S. H., Lee, K. W., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-55901-0 · Cited by 58
Association of depression and sleep quality with complications of type 2 diabetes in geriatric patients
Öztürk, Z. A., Yeşil, Y., Kuyumcu, M. E., Savaş, E., Uygun, Ö., Sayıner, Z. A., & Kepekçi, Y. (2014) · Aging Clinical and Experimental Research · doi:10.1007/s40520-014-0293-0 · Cited by 44
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BackgroundResult
Psychological Co-morbidities of Physical Illness
Pagoto, S. (2011) · Springer eBooks · doi:10.1007/978-1-4419-0029-6 · Cited by 44
Psychiatric comorbidity in cardiovascular inpatients: Costs, net gain, and length of hospitalization
Hochlehnert, A., Niehoff, D., Wild, B., Jünger, J., Herzog, W., & Löwe, B. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.09.010 · Cited by 42
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Background
Religiosity As a Coping Resource for Depression and Disease Management Among Older Diabetic Patients
Dzivakwe, V. G. (2014) · doi:10.12794/metadc700076 · Cited by 42
Social Pathways in the Comorbidity between Type 2 Diabetes and Mental Health Concerns in a Pilot Study of Urban Middle- and Upper-Class Indian Women
Weaver, L. J., & Hadley, C. (2011) · Ethos · doi:10.1111/j.1548-1352.2011.01185.x · Cited by 41
The signs of stress: Embodiments of biosocial stress among type 2 diabetic women in New Delhi, India
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Wang, L., Song, R., Chen, Z., Wang, J., & Ling, F. (2015) · BMC Public Health · doi:10.1186/s12889-015-1567-y · Cited by 42
“Combined with the findings of previous studies that both micro- and macro-vascular diabetic complications are enhanced by the presence of depression [19] in T2DM patients, and that depression may speed the death of diabetic patients [20,21], future studies will be necessary to investigate more patients from different…”
Result
Development and reach of a web-based cognitive behavioural therapy programme to reduce symptoms of depression and diabetes-specific distress
van Bastelaar, K. M. P., Cuijpers, P. J., Pouwer, F., Riper, H. M., & Snoek, F. J. (2010) · Patient Education and Counseling · doi:10.1016/j.pec.2010.06.013 · Cited by 42
Associations between Depressive Symptoms and Incident ESRD in a Diabetic Cohort
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Prevalence of depression in patients with type 2 diabetes attended in primary care in Spain
Cols-Sagarra, C., López‐Simarro, F., Alonso-Fernández, M., Mancera‐Romero, J., Pérez-Unanua, M. P., Bravo, J. J. M., Barquilla-García, A., & Miravet-Jiménez, S. (2016) · Primary care diabetes · doi:10.1016/j.pcd.2016.02.003 · Cited by 43
Symptoms of Eating Disorders and Depression in Emerging Adults with Early-Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control
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“7) % (corresponding to 70 [19] mmol/mol), women tended to have higher HbA1c values than men (8.”
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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