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The Association of Comorbid Depression With Mortality in Patients With Type 2 Diabetes

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Katon, Wayne J., Rutter, Carolyn, Simon, Greg, Lin, Elizabeth H.B., Ludman, Evette, Ciechanowski, Paul, Kinder, Leslie, Young, Bessie, Von Korff, Michael·2005·Diabetes Care

DOI 10.2337/diacare.28.11.2668

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Abstract

OBJECTIVE—We assessed whether patients with comorbid minor and major depression and type 2 diabetes had a higher mortality rate over a 3-year period compared with patients with diabetes alone. RESEARCH DESIGN AND METHODS—In a large health maintenance organization (HMO), 4,154 patients with type 2 diabetes were surveyed and followed for up to 3 years. Patients initially filled out a written questionnaire, and HMO-automated diagnostic, laboratory, and pharmacy data and Washington State mortality data were collected to assess diabetes complications and deaths. Cox proportional hazards regression models were used to calculate adjusted hazard ratios of death for each group compared with the reference group. RESULTS—There were 275 (8.3%) deaths in 3,303 patients without depression compared with 48 (13.6%) deaths in 354 patients with minor depression and 59 (11.9%) deaths among 497 patients with major depression. A proportional hazards model with adjustment for age, sex, race/ethnicity, and educational attainment found that compared with the nondepressed group, minor depression was associated with a 1.67-fold increase in mortality (P = 0.003), and major depression was associated with a 2.30-fold increase (P < 0.0001). In a second model that controlled for multiple potential mediators, both minor and major depression remained significant predictors of mortality. CONCLUSIONS—Among patients with diabetes, both minor and major depression are strongly associated with increased mortality. Further research will be necessary to disentangle causal relationships among depression, behavioral risk factors (adherence to medical regimens), diabetes complications, and mortality.

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Authors: Katon, W. J., Rutter, C., Simon, G., Lin, E. H. B., Ludman, E., Ciechanowski, P., Kinder, L., Young, B., & Von Korff, M.
Affiliations: University of Washington (US)
Group Health Cooperative (US)
Health Services Research & Development (US)
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington
ORCID: Rutter, Carolyn
Lin, Elizabeth H.B.
Ciechanowski, Paul
Young, Bessie
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2005-11-01
Volume: 28
Issue: 11
Pages: 2668-2672
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.28.11.2668
OpenAlex: W2129010267
Cited by: 640
References: 27
Citations by year: 2026: 6 · 2025: 11 · 2024: 17 · 2023: 21 · 2022: 21 · 2021: 18 · 2020: 25 · 2019: 24 · 2018: 31 · 2017: 30 · 2016: 46 · 2015: 33 · 2014: 41 · 2013: 51 · 2012: 37
FWCI: 15.11
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health (MH01643, MH4-1739, K02MH001643)
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 › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: type 2 diabetes, depression, comorbidities, mortality, minor depression, major depressive disorder, diabetes complications, health maintenance organizations, medication adherence, behavioral risk factors
MeSH terms: Aged, Analysis of Variance, Black or African American, Depression, Major Depressive Disorder, Diabetes Mellitus, Type 2, Educational Status, Female, Health Maintenance Organizations, Humans, Longitudinal Studies, Male, Middle Aged, Surveys and Questionnaires, Time Factors, Washington, Comorbidity, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, White People, Asian People

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The Association of Comorbid Depression With Mortality in Patients With Type 2 Diabetes

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