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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Depression and Chronic Medical Illness: Diabetes as a Model
Culpepper, L. (2002) · Psychiatric Annals · doi:10.3928/0048-5713-20020901-08 · Cited by 17
The Unmet Needs of the Elderly with Diabetes in Home Health Care
Lee, J. S. (2007) · Social Work in Health Care · doi:10.1300/j010v45n03_01 · Cited by 17
Mental Health Status and Diabetes among Whites and Native Americans: Is Race an Effect Modifier?
Sahmoun, A. E., Markland, M., & Helgerson, S. D. (2007) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2007.0067 · Cited by 17
Consultation-liaison psychiatry: How far have we come?
Ali, O., Ernst, C. L., Pacheco, M. A., & Fricchione, G. L. (2006) · Current Psychiatry Reports · doi:10.1007/s11920-006-0026-y · Cited by 17
“Associations have been found between depression and glycemic control and microvascular and macrovascular complications [ 21 ], through mechanisms not fully understood.”
Background
Treatment persistence, healthcare utilisation and costs in adult patients with major depressive disorder: a comparison between escitalopram and other SSRI/SNRIs
Wu, E. Q., Greenberg, P. E., Yang, E., Yu, A. P., Ben-Hamadi, R., & Erder, M. H. (2009) · Journal of Medical Economics · doi:10.3111/13696990903093537 · Cited by 18
Comorbidity of psychiatric disorders and symmetric distal polyneuropathy among type II diabetic outpatients
Moreira, R. O., Papelbaum, M., Fontenelle, L. F., Appolinário, J. C., Ellinger, V., Coutinho, W. F., & Zagury, L. (2007) · Brazilian Journal of Medical and Biological Research · doi:10.1590/s0100-879x2007000200015 · Cited by 16
“(12), which demonstrated that neuropathy was the diabetic complication with the weaker evidence for a relationship”
Background
Relationships between lifestyle patterns and cardio-renal-metabolic parameters in patients with type 2 diabetes mellitus: A cross-sectional study
Ogihara, T., Mita, T., Osonoi, Y., Osonoi, T., Saito, M., Tamasawa, A., Nakayama, S., Someya, Y., Ishida, H., Gosho, M., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0173540 · Cited by 16
Prevalence and correlates of depressive symptoms in older adults across the glycaemic spectrum: the Atherosclerosis Risk in Communities ( ARIC ) study
Rawlings, A. M., Sharrett, A. R., Golden, S. H., Windham, B. G., & Selvin, E. (2018) · Diabetic Medicine · doi:10.1111/dme.13593 · Cited by 16
Barriers and enablers to screening and diagnosing depression and diabetes distress in people with type 2 diabetes mellitus; protocol of a qualitative evidence synthesis
McGrath, N., McHugh, S., Kearney, P. M., & Toomey, E. C. (2019) · HRB Open Research · doi:10.12688/hrbopenres.12947.1 · Cited by 14
“Qualitative evidence syntheses of patient and health professional factors consolidate findings from multiple primary studies carried out in different contexts in order to; (1) identify the full spectrum of factors which support and hamper guideline implementation, and (2) highlight gaps in knowledge, and areas of satu…”
Prevalence and risk factors of depression, anxiety, and stress in an Ecuadorian outpatient population with type II diabetes mellitus: A cross-sectional study (STROBE)
Cárdenas, L., Cabezas, M., Muñoz, A., Proaño, J. L., Miño, C., & Aguirre, N. G. (2022) · Medicine · doi:10.1097/md.0000000000030697 · Cited by 23
The mediating role of dietary inflammatory index on the association between eating breakfast and depression: Based on NHANES 2007–2018
Wang, F., Sun, M., Wang, X., Wu, Z., Guo, R., Yang, Y., Wang, Y., Liu, Y., Dong, Y., Wang, S., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.12.015 · Cited by 16
Diabetes severity and the risk of depression: A nationwide population-based study
Cho, Y., Kim, B., Kwon, H., Han, K., & Kim, M. K. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.01.181 · Cited by 16
Bidirectional Associations Between Mental Health Disorders and Chronic Diabetic Complications in Individuals With Type 1 or Type 2 Diabetes
Watanabe, M., Reynolds, E. L., Banerjee, M., Charles, M., Mizokami‐Stout, K., Albright, D. K., Ang, L. P., Lee, J. M., Pop‐Busui, R., Feldman, E. L., et al. (2024) · Diabetes Care · doi:10.2337/dc24-0818 · Cited by 17
Insulin resistance in bipolar disorder: relevance to routine clinical care
Calkin, C., & Alda, M. (2015) · Bipolar Disorders · doi:10.1111/bdi.12330 · Cited by 17
Activity Level, Activity Enjoyment, and Weather as Mediators of Physical Health Risks in Seasonal and Nonseasonal Depression
Sigmon, S. T., Schartel, J. G., Boulard, N. E., & Thorpe, G. L. (2010) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-010-0106-0 · Cited by 16
Predicting Depression among Jordanian Patients Diagnosed with Physical Illnesses
Hamdan‐Mansour, A. M., Ghannam, B. M., Abeiat, D. D. A., Badawi, T. H. A., Thultheen, I. N., & Shamali, I. M. (2014) · Psychology · doi:10.4236/psych.2014.519214 · Cited by 16
THE RELATIONSHIPS AMONG HEALTH FUNCTIONING INDICATORS AND DEPRESSION IN OLDER ADULTS WITH DIABETES
Hu, J., Amoako, E., Gruber, K. J., & Rossen, E. K. (2007) · Issues in Mental Health Nursing · doi:10.1080/01612840601096305 · Cited by 16
Depressive Symptoms and Type 2 Diabetes Mellitus in Rural Appalachia: an 18-Month Follow-Up Study
de Groot, M., Doyle, T. A., Averyt, J. C., Risaliti, C. M., & Shubroo, J. (2014) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.48.4.c · Cited by 17
“Depression is associated with worsened blood glucose levels [3] and diabetes complications [4], including the acceleration of coronary heart disease in women [5].”
Background
The Biopsychosocial Milieu of Type 2 Diabetes: An Exploratory Study of the Impact of Social Relationships on a Chronic Inflammatory Disease
Olson, M. M., Trevino, D. B., Islam, J., & Denner, L. A. (2010) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.40.3.e · Cited by 16
“The PCS has two items; 1) how critical do you think you are of [name of relative]? and 2) how critical do you think [name of relative] is of you? Answers range from “1” (not at all critical) to “10” (very critical indeed) with the cut-off for high criticism set at 4 or more out of 10 [57].”
Background
Does a Depression Management Program Decrease Mortality in Older Adults with Specific Medical Conditions in Primary Care? An Exploratory Analysis
Bogner, H. R., Joo, J. H., Hwang, S., Morales, K. H., BRUCE, M. L., Reynolds, C. F., & Gallo, J. J. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13711 · Cited by 18
“For individuals with diabetes mellitus, depression has been specifically linked to prognostic variables such as micro- and macrovascular complications.(16) Depression has been found to increase all-cause mortality even in the context of good glucose control.”
Background
Erectile dysfunction, diabetes and cardiovascular risk
Hackett, G. I. (2016) · British Journal of Diabetes · doi:10.15277/bjd.2016.076 · Cited by 16
Apathy and Type 2 Diabetes among American Indians: Exploring the Protective Effects of Traditional Cultural Involvement
Carlson, A., Aronson, B. D., Unzen, M. E., Lewis, M. E., Benjamin, G. J., & Walls, M. L. (2017) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2017.0073 · Cited by 16
“Responses were 0 times (0), 1–3 times (1), 4–6 times (2), 7–12 times (3), and more than 12 times (4).”
Evaluation of the effectiveness of Persian diabetes self-management education in older adults with type 2 diabetes at a diabetes outpatient clinic in Tehran: a pilot randomized control trial
Saghaee, A., Ghahari, S., Nasli‐Esfahani, E., Sharifi, F., Alizadeh-Khoei, M., & Rezaee, M. (2020) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-020-00684-0 · Cited by 16
Depression and Associated Risk Factors Among Type 2 Diabetic Patients: A Cross Sectional Study on a Convenience Sample from the Diabetic Center, Khamis Mushait; Saudi Arabia
Abuhegazy, H., Mujairi, A., Banah, F., Agdi, Y., Elkeshishi, H., Kamel, A., Abdullah, A., & Elsheikh, M. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s374752 · Cited by 17
Impact of diabetic retinopathy on patients' beliefs about diabetes
Rees, G., Sasongko, M. B., Fenwick, E., Nicolaou, T., Wong, T. Y., & Lamoureux, E. L. (2012) · Clinical and Experimental Optometry · doi:10.1111/j.1444-0938.2012.00745.x · Cited by 16
“Knowing That You’re Not the Only One”: Perspectives on Group-Based Cognitive-Behavioral Therapy for Adherence and Depression (CBT-AD) in Adults With Type 1 Diabetes
Esbitt, S. A., Batchelder, A., Tanenbaum, M. L., Shreck, E., & Gonzalez, J. S. (2014) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2014.02.006 · Cited by 19
Depresión en la diabetes mellitus tipo 1 y factores asociados
Carreira, M., Ortiz, M. T. A., de Adana, M. S. R., Caballero, F. F., Machado, A., Domínguez‐López, M., González-Molero, I., Esteva, I., Valdés, S., González‐Romero, S., et al. (2010) · Medicina Clínica · doi:10.1016/j.medcli.2010.02.027 · Cited by 16
Who Benefits from Diabetes Self-Management Interventions? The Influence of Depression in the Latinos en Control Trial
Wang, M. L., Lemon, S. C., Whited, M. C., & Rosal, M. C. (2014) · Annals of Behavioral Medicine · doi:10.1007/s12160-014-9606-y · Cited by 16
Depression and Anxiety in Older and Middle‐aged Adults With Diabetes
Poulsen, K., & Pachana, N. A. (2011) · Australian Psychologist · doi:10.1111/j.1742-9544.2010.00020.x · Cited by 17
Obstructive Sleep Apnoea and Type 2 Diabetes
Tahrani, A. A., & Ali, A. (2010) · touchREVIEWS in Endocrinology · doi:10.17925/ee.2014.10.01.43 · Cited by 19
Perception of Quality of Life among People with Diabetes.
Cheah, W. L., Lee, P. Y., Lim, P., Fatin Nabila, A., Luk, K., & Nur Iwana, A. (2012) · Europe PMC (PubMed Central) · Cited by 16
Subjective well-being before and after the onset of diabetes mellitus
Næss, S. C. K., Eriksen, J., Midthjell, K., & Tambs, K. (2005) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2004.05.003 · Cited by 16
Association between the use of selective serotonin reuptake inhibitors and multiple sclerosis disability progression
Zhang, T., Kingwell, E., de Jong, H. J. I., Zhu, F., Zhao, Y., Carruthers, R. L., Petkau, J., Gustafson, P., Oger, J., & Tremlett, H. L. (2016) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4031 · Cited by 15
Association between triglyceride-glucose (TyG) index and the incidence of depression in US adults with diabetes or pre-diabetes
Shi, P., Fang, J., & Lou, C. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116328 · Cited by 15
Association of higher carbohydrate intake with depressive mood in elderly diabetic women
Umegaki, H., Iimuro, S., Araki, A., Sakurai, T., Iguchi, A., Yoshimura, Y., Ohashi, Y., & Ito, H. (2009) · Nutritional Neuroscience · doi:10.1179/147683009x423463 · Cited by 15
Mind–body medicine: Effect of the mind on gene expression
Takimoto‐Ohnishi, E., Ohnishi, J., & Murakami, K. (2012) · Personalized Medicine Universe · doi:10.1016/j.pmu.2012.05.001 · Cited by 15
Independent factors associated with depression in type 1 diabetes mellitus
Manarte, L., Dias, S., Góis, C., & Boavida, J. M. (2009) · Acta Diabetologica · doi:10.1007/s00592-009-0110-y · Cited by 14
“The other result shows that patients with less depression symptoms have more episodes of ketoacidosis (Table 3), which is in opposition to other studies [5, 6].”
Result

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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