Depression, Diabetes Mellitus and Mortality in Older Adults: A National Cohort Study in Taiwan

Vincent Chin-Hung Chen; Tsu-Nai Wang; Ming-Chia Hsieh; Shih-Yong Chou; Meng-Chih Lee; Roger S McIntyre; Mong-Liang Lu; Yin-To Liao; Chih-Jung Yeh

doi:10.2147/NDT.S379174

Depression, Diabetes Mellitus and Mortality in Older Adults: A National Cohort Study in Taiwan

Neuropsychiatr Dis Treat. 2022 Nov 10:18:2639-2648. doi: 10.2147/NDT.S379174. eCollection 2022.

Authors

Vincent Chin-Hung Chen^{1

2}, Tsu-Nai Wang³, Ming-Chia Hsieh⁴, Shih-Yong Chou¹, Meng-Chih Lee^{5

6}, Roger S McIntyre⁷, Mong-Liang Lu⁸, Yin-To Liao^{9

10}, Chih-Jung Yeh^{11

12}

Affiliations

¹ Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
² School of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ U Come Joint Clinic, Taichung, Taiwan.
⁵ Department of Family Medicine, Taichung Hospital, Taichung, Taiwan.
⁶ College of Management, Chaoyang University of Technology, Taichung, Taiwan.
⁷ University of Toronto, Toronto, ON, Canada.
⁸ Department of Psychiatry, Wan-Fang Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁹ Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹⁰ Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹¹ Institute of Population Health Sciences, National Health Research Institutes, Taipei, Taiwan.
¹² School of Public Health, Chung Shan Medical University, Taichung, Taiwan.

Abstract

Purpose: Diabetes mellitus (DM) increases the risk of cardiovascular and all-cause mortality. The coexistence of depression and DM is associated with an increased risk of DM complications and functional morbidity. The independent effect of depression on mortality in patients with DM is unclear, and relevant Asian studies have provided inconsistent results. Accordingly, this study assessed the independent and additive effects of DM and depression on mortality in a nationally representative cohort of older adults in Taiwan over a 10-year observation period.

Patients and methods: A total of 5041 participants aged 50 years or older were observed between 1996 and 2007. We defined depression as a score of ≥8 on the 10-item Center for Epidemiologic Studies Depression (CES-D 10) scale. Additionally, we defined participants as having type 2 DM if they had received a diagnosis of type 2 DM from a health-care provider. Cox proportional hazard models were applied to analyze predictors of mortality in depression and DM comorbidity groups.

Results: During the 10-year follow-up period, 1637 deaths were documented. After adjustment for potential confounders, the hazard ratios for mortality in participants with both depression and DM, DM only, and depression only were 2.47 (95% confidence interval [CI]: 2.02-3.03), 1.95 (95% CI: 1.63-2.32), and 1.23 (95% CI: 1.09-1.39), respectively.

Conclusion: The co-occurrence of depression with DM in Asian adults increased overall mortality rates. Our results indicate that the increased mortality hazard in individuals with DM and depression was independent of sex.

Keywords: cohort; depression; diabetes mellitus; mortality.

Grants and funding

This study was supported by grants (number CSH-2015-A-003) from Chung Shan Medical University Hospital, Taichung, Taiwan. The funding source had no role in the design, methods, subject recruitment, data collections, analysis, or preparation of the paper.