Type 2 diabetes and comorbid symptoms of depression and anxiety: longitudinal associations with mortality risk
Abstract
OBJECTIVE: Depression is strongly linked to increased mortality in individuals with type 2 diabetes. Despite high rates of co-occurring anxiety and depression, the risk of death associated with comorbid anxiety in individuals with type 2 diabetes is poorly understood. This study documented the excess mortality risk associated with symptoms of depression and/or anxiety comorbid with type 2 diabetes. RESEARCH DESIGN AND METHODS: Using data for 64,177 Norwegian adults from the second wave of the Nord-Trøndelag Health Study (HUNT2), with linkage to the Norwegian Causes of Death Registry, we assessed all-cause mortality from survey participation in 1995 through to 2013. We used Cox proportional hazards models to examine mortality risk over 18 years associated with type 2 diabetes status and the presence of comorbid affective symptoms at baseline. RESULTS: Three clear patterns emerged from our findings. First, mortality risk in individuals with diabetes increased in the presence of depression or anxiety, or both. Second, mortality risk was lowest for symptoms of anxiety, higher for comorbid depression-anxiety, and highest for depression. Lastly, excess mortality risk associated with depression and anxiety was observed in men with diabetes but not in women. The highest risk of death was observed in men with diabetes and symptoms of depression only (hazard ratio 3.47, 95% CI 1.96, 6.14). CONCLUSIONS: This study provides evidence that symptoms of anxiety affect mortality risk in individuals with type 2 diabetes independently of symptoms of depression, in addition to attenuating the relationship between depressive symptoms and mortality in these individuals.
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Comorbidity with depression and anxiety is associated with an increase in all-cause mortality in men with type 2 diabetes, but not in women, compared to individuals without either type 2 diabetes or affective disorders.
“Comorbidity with depression and anxiety has been associated with an increase in all‐cause mortality in men with T2D (but not in women), compared to individuals without either T2D or affective disorders (Naicker 2017).”
From Mindfulness-based interventions for adults with type 2 diabetes mellitus (2021) · cites this paper as Naicker 2017
Clinically significant mental health diagnoses are considerably more prevalent in people with diabetes than in those without.
“Clinically significant mental health diagnoses are considerably more prevalent in people with diabetes than in those without (316,317).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [316]
Symptoms of emotional distress are associated with mortality risk.
“symptoms of emotional distress are associated with mortality risk (316,323).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [316]
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- Authors
- Naicker, K., Johnson, J. A., Skogen, J. C., Manuel, D., Øverland, S., Sivertsen, B., & Colman, I.
- Affiliations
- University of Ottawa (CA)
- University of Alberta (CA)
- Norwegian Institute of Public Health (NO)
- Ottawa Hospital Research Institute (CA)
- Corresponding author
- Colman, Ian
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2017-01-11
- Volume
- 40
- Issue
- 3
- Pages
- 352-358
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2579148269
- Cited by
- 148
- References
- 38
- Citations by year
- 2026: 6 · 2025: 17 · 2024: 14 · 2023: 9 · 2022: 23 · 2021: 20 · 2020: 20 · 2019: 21 · 2018: 13 · 2017: 5
- FWCI
- 12.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Mental Health Foundation
- Canada Research Chairs
- Alberta Innovates Health Solutions
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, depression, anxiety, comorbidities, all-cause mortality, excess mortality risk, depressive symptoms, anxiety symptoms, sex differences
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anxiety, Depression, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Norway, Surveys and Questionnaires, Risk Factors, Socioeconomic Factors, Comorbidity, Proportional Hazards Models, Young Adult
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