Institute of Biometrics and Epidemiology, Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
PLoS One. 2013;8(2):e56300. doi: 10.1371/journal.pone.0056300. Epub 2013 Feb 18.
The objective of this study was to determine the risk for the development of high depressive symptoms in study participants with diagnosed and previously undetected diabetes mellitus compared to those without diabetes in a prospective population-based cohort study in Germany.
We estimated the 5-year cumulative incidence of high depressive symptoms in participants without high depressive symptoms at baseline (n = 3,633, 51.4% men, mean age (SD) 59.1 (7.6) years, 7.0% diagnosed diabetes, 5.3% previously undetected diabetes) from the population-based Heinz Nixdorf Recall study. Diabetes was assessed by self-report, medication, and blood glucose. High depressive symptoms were assessed using CES-D. We calculated odds ratios and their corresponding 95% confidence interval, using multiple logistic regression analyses.
Cumulative 5-year incidences (95% CI) of high depressive symptoms in participants with diagnosed, undetected, and without diabetes were 7.1 (4.2-10.9), 4.1 (1.8-8.0), and 6.5 (5.6-7.4), respectively. The age-sex-adjusted OR for developing high depressive symptoms was 1.22 (0.74-2.03) in participants with diagnosed compared to those without diabetes, and 1.00 (0.59-1.68) after adjustment for BMI, physical activity, education, stroke, and myocardial infarction. The age-sex adjusted OR for developing high depressive symptoms in participants with previously undetected diabetes compared to those without diabetes was 0.72; 0.35-1.48; and fully adjusted 0.62; 0.30-1.30.
We found no significant associations, maybe due to low power. However, our results are in line with a recent meta-analysis suggesting that risk of developing high depressive symptoms in patients with diagnosed diabetes may be moderately higher than in those without diabetes, and that comorbidity may explain in part this association. In participants with previously undetected diabetes, this first longitudinal study indicates that the risk is not increased or may even be decreased. These results support the hypothesis that high depressive symptoms develop due to diabetes-related burden and comorbidity and not due to hyperglycemia or hyperinsulinaemia.
本研究旨在通过德国一项前瞻性基于人群的队列研究，确定与无糖尿病参与者相比，已确诊和先前未被发现的糖尿病患者在研究期间出现重度抑郁症状的风险。
我们评估了基线时无重度抑郁症状的参与者（n=3633，51.4%为男性，平均年龄（标准差）59.1（7.6）岁，7.0%被诊断患有糖尿病，5.3%为先前未被发现的糖尿病）在 5 年内出现重度抑郁症状的累积发生率。糖尿病通过自我报告、药物治疗和血糖水平进行评估。使用 CES-D 评估重度抑郁症状。我们使用多因素逻辑回归分析计算了比值比（OR）及其对应的 95%置信区间。
患有已确诊、未被发现和无糖尿病的参与者在 5 年内出现重度抑郁症状的累积发生率（95%CI）分别为 7.1%（4.2-10.9）、4.1%（1.8-8.0）和 6.5%（5.6-7.4）。与无糖尿病的参与者相比，诊断为糖尿病的参与者出现重度抑郁症状的调整年龄和性别后的 OR 为 1.22（0.74-2.03），调整 BMI、体育活动、教育程度、中风和心肌梗死后为 1.00（0.59-1.68）。与无糖尿病的参与者相比，患有先前未被发现的糖尿病的参与者出现重度抑郁症状的调整年龄和性别后的 OR 为 0.72；0.35-1.48；完全调整后的 OR 为 0.62；0.30-1.30。
我们没有发现显著的关联，这可能是由于效力不足。然而，我们的结果与最近的一项荟萃分析一致，该分析表明，与无糖尿病的患者相比，确诊糖尿病患者出现重度抑郁症状的风险可能略高，而合并症可能部分解释了这种关联。在患有先前未被发现的糖尿病的参与者中，这是第一项纵向研究，表明风险没有增加，甚至可能降低。这些结果支持了这样一种假设，即重度抑郁症状是由于与糖尿病相关的负担和合并症引起的，而不是由于高血糖或高胰岛素血症引起的。
