Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
College of Medicine, National Taiwan University, Taipei, Taiwan.
Epidemiol Psychiatr Sci. 2020 Jan 29;29:e96. doi: 10.1017/S2045796020000049.
Several studies suggested that depression might worsen the clinical outcome of diabetes mellitus; however, such association was confounded by duration of illness and baseline complications. This study aimed to assess whether depression increases the risk of diabetes complications and mortality among incident patients with diabetes.
This was a population-based matched cohort study using Taiwan's National Health Insurance Research Database. A total of 38 537 incident patients with diabetes who had depressive disorders and 154 148 incident diabetes patients without depression who were matched by age, sex and cohort entry year were randomly selected. The study endpoint was the development of macrovascular and microvascular complications, all-cause mortality and cause-specific mortality.
Among participants, the mean (±SD) age was 52.61 (±12.45) years, and 39.63% were male. The average duration of follow-up for mortality was 5.5 years, ranging from 0 to 14 years. The adjusted hazard ratios were 1.35 (95% confidence interval [CI], 1.32-1.37) for macrovascular complications and 1.08 (95% CI, 1.04-1.12) for all-cause mortality. However, there was no association of depression with microvascular complications, mortality due to cardiovascular diseases or mortality due to diabetes mellitus. The effect of depression on diabetes complications and mortality was more prominent among young adults than among middle-aged and older adults.
Depression was associated with macrovascular complications and all-cause mortality in our patient cohort. However, the magnitude of association was less than that in previous studies. Further research should focus on the benefits and risks of treatment for depression on diabetes outcome.
有几项研究表明，抑郁可能会使糖尿病患者的临床预后恶化；然而，这种关联受到疾病持续时间和基线并发症的影响。本研究旨在评估抑郁是否会增加新发糖尿病患者发生糖尿病并发症和死亡的风险。
这是一项基于人群的匹配队列研究，使用了台湾全民健康保险研究数据库。共随机选取了 38537 例患有抑郁障碍的新发糖尿病患者和 154148 例无抑郁的新发糖尿病患者，两组患者按年龄、性别和队列入组年份进行匹配。研究终点为大血管和微血管并发症、全因死亡率和死因特异性死亡率的发生。
参与者的平均（±SD）年龄为 52.61（±12.45）岁，39.63%为男性。死亡率的平均随访时间为 5.5 年，范围为 0 至 14 年。调整后的危险比（95%置信区间）为大血管并发症 1.35（1.32-1.37），全因死亡率为 1.08（1.04-1.12）。然而，抑郁与微血管并发症、心血管疾病导致的死亡或糖尿病导致的死亡无关。在年轻成年人中，抑郁对糖尿病并发症和死亡率的影响比在中年和老年成年人中更为显著。
在我们的患者队列中，抑郁与大血管并发症和全因死亡率相关。然而，关联的程度小于之前的研究。进一步的研究应关注治疗抑郁对糖尿病结局的获益和风险。
