School of Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Diabetes Care. 2017 Mar;40(3):352-358. doi: 10.2337/dc16-2018. Epub 2017 Jan 11.
Depression is strongly linked to increased mortality in individuals with type 2 diabetes. Despite high rates of co-occurring anxiety and depression, the risk of death associated with comorbid anxiety in individuals with type 2 diabetes is poorly understood. This study documented the excess mortality risk associated with symptoms of depression and/or anxiety comorbid with type 2 diabetes.
Using data for 64,177 Norwegian adults from the second wave of the Nord-Trøndelag Health Study (HUNT2), with linkage to the Norwegian Causes of Death Registry, we assessed all-cause mortality from survey participation in 1995 through to 2013. We used Cox proportional hazards models to examine mortality risk over 18 years associated with type 2 diabetes status and the presence of comorbid affective symptoms at baseline.
Three clear patterns emerged from our findings. First, mortality risk in individuals with diabetes increased in the presence of depression or anxiety, or both. Second, mortality risk was lowest for symptoms of anxiety, higher for comorbid depression-anxiety, and highest for depression. Lastly, excess mortality risk associated with depression and anxiety was observed in men with diabetes but not in women. The highest risk of death was observed in men with diabetes and symptoms of depression only (hazard ratio 3.47, 95% CI 1.96, 6.14).
This study provides evidence that symptoms of anxiety affect mortality risk in individuals with type 2 diabetes independently of symptoms of depression, in addition to attenuating the relationship between depressive symptoms and mortality in these individuals.
抑郁症与 2 型糖尿病患者的死亡率升高密切相关。尽管焦虑和抑郁共病的发生率很高，但 2 型糖尿病患者共病焦虑与死亡风险的关系仍知之甚少。本研究记录了与 2 型糖尿病共病的抑郁和/或焦虑症状相关的额外死亡风险。
利用来自挪威第二次诺德特罗格健康研究（HUNT2）的 64177 名成年人的数据，以及与挪威死因登记处的链接，我们评估了 1995 年至 2013 年期间通过调查参与的全因死亡率。我们使用 Cox 比例风险模型来检查 18 年期间与 2 型糖尿病状态和基线时存在共病情感症状相关的死亡率风险。
我们的研究结果有三个明显的模式。首先，有抑郁或焦虑或两者并存的糖尿病患者的死亡率风险增加。其次，焦虑症状的死亡率风险最低，共病抑郁-焦虑的死亡率风险较高，而单纯抑郁的死亡率风险最高。最后，在男性糖尿病患者中观察到与抑郁和焦虑相关的额外死亡风险，但在女性糖尿病患者中则没有。仅患有糖尿病和抑郁症状的男性观察到最高的死亡风险（风险比 3.47，95%CI 1.96，6.14）。
本研究提供了证据表明，焦虑症状除了减弱这些个体中抑郁症状与死亡率之间的关系外，还独立于抑郁症状影响 2 型糖尿病患者的死亡率风险。
