Cited by 148Diabetes Management and EducationCardiac Health and Mental HealthDiabetes, Cardiovascular Risks, and Lipoproteins

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Type 2 Diabetes and Comorbid Symptoms of Depression and Anxiety: Longitudinal Associations With Mortality Risk

Naicker, Kiyuri, Johnson, Jeffrey A., Skogen, Jens C., Manuel, Douglas, Øverland, Simon, Sivertsen, Børge, Colman, Ian·2017·Diabetes Care

DOI 10.2337/dc16-2018

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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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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
ORCID: Johnson, Jeffrey A.
Skogen, Jens C.
Manuel, Douglas
Øverland, Simon
Sivertsen, Børge
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
DOI: 10.2337/dc16-2018
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
Licence: www.diabetesjournals.org/content/license (vor, 41 d)
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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Type 2 Diabetes and Comorbid Symptoms of Depression and Anxiety: Longitudinal Associations With Mortality Risk

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