Epidemiology of depression and diabetes: A systematic review

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Abstract

Background

Research suggests that co-morbid diabetes and depression is common; however, the implications for clinical practice remain unclear. This paper reviews the current epidemiological evidence on comorbid diabetes and depression, in order to identify the key publications which could both inform practice and identify gaps in knowledge and research.

Methods

A systematic review was conducted to identify published literature on the epidemiology of diabetes and depression. In order to review evidence on up-to-date knowledge of recent research and innovations in care literature searches for the last five years (August 2006–August 2011) were conducted. To identify relevant literature, electronic databases MEDLINE, Psych-INFO and EMBASE were searched for English language articles in peer-reviewed journals.

Results

High rates of co-morbidity of depression and diabetes have been reported. The prevalence rate of depression is more than three-times higher in people with type 1 diabetes (12%, range 5.8–43.3% vs. 3.2%, range 2.7–11.4%) and nearly twice as high in people with type 2 diabetes (19.1%, range 6.5–33% vs. 10.7%, range 3.8–19.4%) compared to those without. Women with diabetes and also women without diabetes experience a higher prevalence of depression than men. Reviewed studies provide support for a modest relationship between diabetes and depressive symptoms, but the exact direction of this relationship remains unclear.

Limitations

Most studies reviewed were cross-sectional and this limits any conclusions about the causal nature and direction of the relationship between diabetes and depression. Variation in measurement methods, lack of longitudinal data and few studies outside Europe and America limit the generalizability of the findings of this review.

Conclusions

Current research suggests that the risk of developing depression is increased in people with diabetes; however, further studies are required in order to establish the nature of the relationship between depression, glycaemic control and the development of diabetes complications, and make appropriate recommendations for treatment and to support self-management of diabetes.

Section snippets

Background

The association between depression and diabetes has been recognized for many years (Anderson et al., 2001), but the nature of this relationship remains uncertain. Diabetes and depression are both serious chronic conditions that negatively affect quality of life, increase functional disability, and reduce life expectancy (Goetzel et al., 2003; O'Connor et al., 2009). People with diabetes have an increased risk of developing depressive symptoms and people with depression also have an increased

Methods

A systematic review was conducted to identify published literature on the epidemiology of diabetes and depression. In order to review evidence on recent research and innovations in care, literature searches only for last five years (August 2006 to August 2011) were conducted using MEDLINE, Psych-INFO and EMBASE. The searches were performed in three steps for specific terms included under the MeSH terms and supplemented with a keywords or title search. The three search steps and corresponding

Results

Using the databases described above, we identified 1,015 papers through the three search strategies (Fig. 1). Of these, 1,012 were available in English. Screening of the title of each paper identified 193 potentially relevant citations for abstract review. After reviewing abstracts 48 relevant papers were selected for full text review. Based on full text review a total of 20 key papers were finally identified to be included for annotated bibliography (see online appendices 1).

Table 1 summarises

Summary

This systematic review has considered the recent epidemiological evidence on diabetes and depression in terms of prevalence, risk factors, and the possible association with glycaemic control. Whilst there is a plethora of published data on depression and T2DM, there is a significant shortage of data available on the prevalence and characteristics of depression in people with T1DM. The evidence suggests that the prevalence of depression is nearly twice as high in people with diabetes compared to

Limitations

Whilst there has been increased interest in diabetes and depression and the potential risk factors associated with co-morbidity, many studies have been cross-sectional (Knol et al., 2007; Katon et al., 2008; Holt et al., 2009; Collins et al., 2009) and are not able to examine the temporal relationship between the two conditions. This limits conclusions about the causal nature and direction of the co-morbidity. Even where studies have used longitudinal research designs (Brown et al., 2006;

Conflict of interest statement

TR received financial support from the Dialogue on Diabetes and Depression (DDD) for conducting the systematic review and writing the paper. There are no other conflicts of interest for either of the authors of this paper.

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