Authors: (including presenting author): :
HO MTH(1)(2), CHAN JKN(2), CHIU WCY(1), TSANG LLW(1), LO HKY(2), WONG SYL(1), CHAN KSW(1), WONG MMC(1), WONG HH (1), LAM WC(1), PANG PF(1), CHANG WC(2)(3)
Affiliation: :
(1)Department of Psychiatry, United Christian Hospital, Hong Kong SAR, (2)Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, (3)State Key Laboratory of Brain & Cognitive Sciences, University of Hong Kong, Hong Kong SAR
Keyword 2: :
diabetes mellitus
Keyword 3: :
meta-analysis
Keyword 4: :
all-cause mortality
Keyword 5: :
complications
Introduction: :
People with depressive disorder have increased premature mortality and elevated prevalence of diabetes mellitus compared with general population. Evidence indicated that diabetes could heighten their risk of premature death from diabetes-related complications, particularly cardiovascular diseases (CVD). Although earlier studies have examined depression-associated outcomes in patients with diabetes, findings were inconsistent and hampered by several limitations, particularly the use of self-reported questionnaires to define depression that might identify subclinical depressive symptoms or diabetes distress. Moreover, the association of depression with specific diabetes complications has not yet been systematically evaluated.
Objectives: :
We aim to investigate the risk of mortality and complications among patients with depression and co-occurring diabetes (depression-diabetes group) relative to patients with diabetes-only (diabetes-only group), on their all-cause mortality rates, and if applicable cause-specific mortality rates, and occurrence of specific diabetes complications.
Methodology: :
We systematically reviewed and quantitatively synthesized diabetes-related outcomes in patients with depression by searching Embase, MEDLINE, PsycInfo, and Web-of-Science from inception to 20-December-2024, and included studies that examined mortality and complication outcomes in depression-diabetes group relative to diabetes-only group. Results were synthesized by random-effects meta-analytic models, with stratified-analyses (subgroup-analyses and meta-regression) by study-level characteristics, including age, gender, study period, geographic region, follow-up duration, and nature of diabetes sample. The study was registered with PROSPERO (CRD42024595145).
Result & Outcome: :
Twenty-six studies were identified from nine geographic regions. Regarding mortality risk, depression-diabetes group exhibited increased risks of all-cause mortality (RR=1.30[95% CI: 1.21–1.39]) and CVD-specific mortality (1.15[1.02–1.29]) relative to diabetes-only group. Regarding complication risk, depression-diabetes group showed increased risk of complications (1.28[1.18–1.40]) relative to diabetes-only group, especially in incident-diabetes sample signifying advanced disease stage upon presentation, with stratified-analyses showing higher risk of metabolic complications (1.63[1.33–1.99]) and cardiovascular complications (1.20[1.11–1.29]), and lower likelihood of retinopathy (0.84[0.76–0.94]), albeit comparable rates of cerebrovascular complications (1.36[0.99–1.87]), nephropathy (1.09[0.93–1.27]), and peripheral-vascular complications (0.97[0.79–1.18]). Both overall mortality and complication risks were present across different regions and persisted over time. Heterogeneities were noted and could not be entirely explained by stratified-analyses. Our study demonstrated that patients with depression and co-occurring diabetes were associated with elevated overall mortality risk and complication risk (particularly metabolic and cardiovascular-complications) than non-depressed counterparts, suggesting an overall poorer glycemic control that might ultimately drive their earlier death. Comprehensive and multipronged interventions are needed for individualized risk estimation of diabetes-related outcomes, with consequent early interventions to minimize the avoidable physical morbidity and premature mortality in this vulnerable population.
