Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes
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OBJECTIVE—To examine the separate and combined effects of depression and diabetes on the incidence of adverse health outcomes among older Mexican Americans. RESEARCH DESIGN AND METHODS—Longitudinal data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey were used to examine the main effects and interaction effects of diabetes and depressive symptoms (measured with the Center for Epidemiologic Study of Depression) or clinical diagnostic criteria (measured with the Composite International Diagnostic Interview Depression Module) on the development of macrovascular complications (including cardiovascular disease, stroke, and kidney disease), microvascular complications (including nephropathy, neuropathy, retinopathy, and amputations), functional disability, and mortality over 7 years in a sample of 2,830 Mexican Americans aged ≥65 years. RESULTS—The interaction of diabetes and depression was found to be synergistic, predicting greater mortality, greater incidence of both macro- and microvascular complications, and greater incidence of disability in activities of daily living, even when controlling for sociodemographic characteristics such as sex, age, education, acculturation, and marital status. Importantly, this interaction was found to predict not only greater incidence but also earlier incidence of adverse events in older adults. CONCLUSIONS—Whether a marker for underlying disease severity, an indicator of diminished self-care motivation, or the result of physiologic changes, the interaction of depression and diabetes has a synergistic effect on the health of older Mexican Americans, increasing the risk for poor outcomes. This is of particular clinical importance because although depression is often underrecognized in older adults, effective treatment is available and can result in improved medical outcomes.
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In Americans of Mexican origin (n=2,830, 23% with diabetes; 7-year follow-up), depressive symptoms and major depression were associated with increased risk of microvascular and macrovascular complications of diabetes mellitus as well as mortality.
“Americans of Mexican origin ( n = 2,830, 23% with diabetes); 7 year follow-up | Depressive symptoms measured by CES-D, clinical depression assessed by diagnostic interview | *Depressive symptoms and major depression associated with increased risk microvascular and macrovascular complications of diabetes mellitus as well as mortality.”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as Black (2003) 142
Psychological disorders contribute to worsened blood glucose levels in people with diabetes.
“Results from the literature showed that psychological disorders contributed to poor self‐care, worsened blood glucose levels, diminished quality of life and increased healthcare costs 5 , 6 .”
From Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis (2021) · cites this paper as [5]
Psychological disorders contribute to increased healthcare costs in people with diabetes.
“Results from the literature showed that psychological disorders contributed to poor self‐care, worsened blood glucose levels, diminished quality of life and increased healthcare costs 5 , 6 .”
From Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis (2021) · cites this paper as [5]
Psychological disorders contribute to poor self-care in people with diabetes.
“Results from the literature showed that psychological disorders contributed to poor self‐care, worsened blood glucose levels, diminished quality of life and increased healthcare costs 5 , 6 .”
From Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis (2021) · cites this paper as [5]
Psychological disorders contribute to diminished quality of life in people with diabetes.
“Results from the literature showed that psychological disorders contributed to poor self‐care, worsened blood glucose levels, diminished quality of life and increased healthcare costs 5 , 6 .”
From Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis (2021) · cites this paper as [5]
Depressed patients with a chronic medical illness are usually sicker than their counterparts.
“Depressed patients with a chronic medical illness are usually sicker than their counterparts37–46 and have lower treatment adherence.37,47–51”
From Anxiety and Depression in COPD (2008) · cites this paper as [43]
Depression is associated with mortality in patients with diabetes.
“and mortality (4)”
From Depression in diabetes: have we been missing something important? (2011) · cites this paper as [4]
Increased risk of complications and early mortality extends to those with elevated depressive symptoms, even when these elevations are quite modest.
“Furthermore, increased risk of complications and early mortality is not limited to those with MDD but also extends to those with elevated depressive symptoms, even when these elevations are quite modest (4).”
From Depression in diabetes: have we been missing something important? (2011) · cites this paper as [4]
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- Authors
- Black, S. A., Markides, K. S., & Ray, L. A.
- Affiliations
- University of Maryland, Baltimore (US)
- The University of Texas Medical Branch at Galveston (US)
- ORCID
- Black, Sandra A.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2003-10-01
- Volume
- 26
- Issue
- 10
- Pages
- 2822-2828
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2091420496
- Cited by
- 587
- References
- 39
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 12 · 2023: 13 · 2022: 10 · 2021: 16 · 2020: 25 · 2019: 24 · 2018: 25 · 2017: 25 · 2016: 50 · 2015: 30 · 2014: 34 · 2013: 40 · 2012: 44
- FWCI
- 14.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (AG 10939, R01AG010939)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK51261)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- depression, type 2 diabetes, older Mexican Americans, adverse health effects, macrovascular complications, microvascular complications, mortality, functional disability, activities of daily living, cardiovascular disease, stroke, kidney disease, neuropathy, retinopathy, amputation
- MeSH terms
- Aged, Depression, Diabetes Mellitus, Type 2, Disability Evaluation, Female, Humans, Longitudinal Studies, Male, Predictive Value of Tests, Incidence, Prevalence, Multivariate Analysis, Mexican Americans
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