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Diabetes associated with decreased severe depression at time of depression diagnosis

Kurt B Angstman, Allen L Pimienta, Meghan G Theofiles

Abstract


Background: The combined impact of diabetes mellitus and major depressive disorder (MDD) is well defined with significant evidence for a bi-directional relationship.  Prior studies at our institution have demonstrated that the diagnoses of diabetes or the baseline control of diabetes did not independently predict clinical outcomes of depression at 6 months.  Our hypothesis for this study was that the diagnosis of diabetes in depressed primary care patients would have no effect on incidence of severe depression at the time of diagnosis of depression.

Methods: This study was a retrospective chart review analysis of patients who were diagnosed with either MDD or Dysthymia and had a score of ≥ 10 on PHQ-9 at the time of clinical diagnosis.  From 1 January 2008 through 30 September 2012, a cohort of 4,311 patients who authorized research of their medical records and had complete data sets available was then developed. 

Results: With logistic regression modeling, the diagnosis of diabetes was inversely related with the odds of diagnosis of severe depression (PHQ-9 ≥ 20) at index with an odds ratio of 0.649 (95% CI 0.486-0.868, p=0.004).  Obesity was not associated independently with the initial diagnosis of severe depression (p=0.471).

Conclusions: The diagnosis of diabetes was associated with decreased risk for severe depression at the time of diagnosis in our patient population.  Further studies would be beneficial to explore potential reasons for this, with implications for the development of person-centered approaches to care.

Keywords


Clinical outcomes, collaborative care model, depression, diabetes mellitus, diagnosis, healthcare costs, lifestyle modification, obesity, person-centered healthcare, primary care providers, self-care, severity of depression

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References


Menke, A., Casagrande, S., Geiss, L. & Cowie, C.C. (2015). Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. Journal of the American Medical Association 314 (10) 1021-1029.

Pinhas-Hamiel, O. & Zeitler, P. (2005). The global spread of type 2 diabetes mellitus in children and adolescents. Journal of Pediatrics 146 (5) 693-700.

Vandeleur, C.L., Fassassi, S., Castelao, E., Glaus, J., Strippoli, M.F., Lasserre, A.M., Rudaz, D., Gebreab, S., Pistis, G., Aubry, J.M., Angst, J. & Preisig, M. (2017). Prevalence and correlates of DSM-5 major depressive and related disorders in the community. Psychiatry Research 250, 50-58.

Luppino, F.S., de Wit, L.M., Bouvy, P.F., Stijnen, T., Cuijpers, P., Penninx, B.W. & Zitman, F.G. (2010). Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry 67 (3) 220-229.

Anderson, R.J., Freedland, K.E., Clouse, R.E. & Lustman, P.J. (2001). The prevalence of comorbid depression in adults with diabetes - A meta-analysis. Diabetes Care 24 (6) 1069-1078.

Bryan, C., Songer, T., Brooks, M.M., Rush, A.J., Thase, M.E., Gaynes, B., Balasubramani, G.K., Trivedi, M.H., Fava, M. & Wisniewski, S.R. (2010). The impact of diabetes on depression treatment outcomes. General Hospital Psychiatry 32 (1) 33-41.

de Groot, M., Anderson, R., Freedland, K.E., Clouse, R.E. & Lustman, P.J. (2001). Association of depression and diabetes complications: A meta-analysis. Psychosomatic Medicine 63 (4) 619-630.

Lin, E.H., Katon, W., Von Korff, M., Rutter, C., Simon, G.E., Oliver, M., Ciechanowski, P., Ludman, E.J., Bush, T. & Young, B. (2004). Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care 27 (9) 2154-2160.

Ludman, E.J., Katon, W., Russo, J., Von Korff, M., Simon, G., Ciechanowski, P., Lin, E., Bush, T., Walker, E. & Young, B. (2004). Depression and diabetes symptom burden. General Hospital Psychiatry 26 (6) 430-436.

Von Korff, M., Katon, W., Lin, E.H., Simon, G., Ludman, E., Oliver, M., Ciechanowski, P., Rutter, C. & Bush, T. (2005). Potentially modifiable factors associated with disability among people with diabetes. Psychosomatic Medicine 67 (2) 233-240.

Von Korff, M., Katon, W., Lin, E.H., Simon, G., Ciechanowski, P., Ludman, E., Oliver, M., Rutter, C. & Young, B. (2005). Work disability among individuals with diabetes. Diabetes Care 28 (6) 1326-1332.

Simon, G.E., Katon, W.J., Lin, E.H., Ludman, E., Von Korff, M., Ciechanowski, P. & Young, B.A. (2005). Diabetes complications and depression as predictors of health service costs. General Hospital Psychiatry 27 (5) 344-351.

Katon, W.J., Rutter, C., Simon, G., Lin, E.H., Ciechanowski, P., Kinder, L., Young, B. & Von Korff, M. (2005). The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care 28 (11) 2668-2672.

Katon, W., Unutzer, J., Fan, M.Y., Williams, J.W. Jr., Schoenbaum, M., Lin, E.H. & Hunkeler, E.M. (2006). Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes Care 29 (2) 265-270.

Wade, T., Oberhelman, S., Angstman, K., Sawchuk, C.N., Meunier, M.R., Angstman, G.L. & Rohrer, J.E. (2014). Diabetes and obesity not associated with six month remission rates for primary care patients with depression. Psychosomatics 56 (4) 354-361.

Angstman, K., Flinchbaugh, R.T., Flinchbaugh, K., Meunier, M.R. & Angstman, G.L. (2016). Diabetes and depression: does worsening control of diabetes lead to poorer depression outcomes? Journal of Evaluation in Clinical Practice 22 (1) 98-100.

Angstman, K.B., Pietruszewski, P., Rasmussen, N.H., Wilkinson, J.M. & Katzelnick, D.J. (2012). Depression Remission after six months of collaborative care management: role of initial severity of depression in outcome. Mental Health in Family Medicine 9 (2) 99-106.

Angstman, K.B., Shippee, N.D., Maclaughlin, K.L., Rasmussen, N.H., Wilkinson, J.M., Williams, M.D. & Katzelnick, D.J. (2013). Patient self-assessment factors predictive of persistent depressive symptoms 6 months after enrollment in collaborative care management. Depression and Anxiety 30 (2) 143-148.

Takasaki, K., Babazono, T., Ishizawa, K., Miura, J. & Uchigata, Y. (2016). Relationship between diabetic nephropathy and depression: a cross-sectional analysis using the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET). BMJ Open Diabetes Research & Care 4 (1) e000310.

Timar, R., Velea, I., Timar, B., Lungeanu, D., Oancea, C., Roman, D. & Mazilu, O. (2016). Factors influencing the quality of life perception in patients with type 2 diabetes mellitus. Patient Preference and Adherence 10, 2471-2477.

Herring, M.P., Puetz, T.W., O’Connor, P.J. & Dishman, R.K. (2012). Effect of Exercise Training on Depressive Symptoms Among Patients With a Chronic Illness A Systematic Review and Meta-analysis of Randomized Controlled Trials. Archives of Internal Medicine 172 (2) 101-111.

Spitzer, R.L., Kroenke, K. & Williams, J.B. (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association 282 (18) 1737-1744.

Williams, M., Angstman, K., Johnson, I. & Katzelnick, D. (2011). Implementation of a care management model for depression at two primary care clinics. Journal of Ambulatory Care Management 34 (2) 163-173.

Mojtabai, R. & Olfson, M. (2008). National patterns in antidepressant treatment by psychiatrists and general medical providers: results from the national comorbidity survey replication. Journal of Clinical Psychiatry 69 (7) 1064-1074.




DOI: http://dx.doi.org/10.5750/ejpch.v7i1.1611

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