Community Mental Health Journal

, Volume 51, Issue 2, pp 204–210 | Cite as

Incidence and Risk of Depression Associated with Diabetes in Adults: Evidence from Longitudinal Studies

  • Syed Shahzad HasanEmail author
  • Abdullah A. Mamun
  • Alexandra M. Clavarino
  • Therese Kairuz
Brief Report


This meta-analysis examined depression as a consequence of diabetes by conducting a meta-analysis, using data from longitudinal studies. Databases were systematically searched for relevant studies. Incidence of depression is presented as cumulative incident proportion (CIP). Pooled effect sizes were calculated using random-effects model. The data were reconstructed to compute relative risk (RR) and CIP. The 16 studies selected for review generated 16 datasets of which 11 studies reporting binary estimates (RR) and 5 studies reporting time-to-event estimates [hazard ratio (HR)]. Both RR and HR were significant at 1.27 (95 % CI 1.17–1.38) and 1.23 (95 % CI 1.08–1.40) for incident depression associated with diabetes mellitus. Our observations also revealed greater cumulative incidence of depression in diabetes than in non diabetes groups. Our study shows that diabetes is a significant risk factor for the onset of depression.


Depression Diabetes mellitus Longitudinal Meta-analysis 


Conflict of interest

The authors declare that they have no conflict of interest. The author(s) received no financial support for the research, authorship, and/or publication of this article.


  1. Aarts, S., van den Akker, M., van Boxtel, M. P., et al. (2009). Diabetes mellitus type II as a risk factor for depression: A lower than expected risk in a general practice setting. European Journal of Epidemiology, 24(10), 641–648.PubMedCentralPubMedCrossRefGoogle Scholar
  2. Albers, B., Kruse, J., Giani, G., et al. (2011). Diabetes and incident depression: Is the association mediated or modified by sociodemographic factors or co-morbidities? A systematic review. Exp Clinical Endocrinology Diabetes, 119(10), 591–598.CrossRefGoogle Scholar
  3. Anderson, R. J., Freedland, K. E., Clouse, R. E., et al. (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24, 1069–1078.PubMedCrossRefGoogle Scholar
  4. Arroyo, C., Hu, F. B., Ryan, L. M., et al. (2004). Depressive symptoms and risk of type 2 diabetes in women. Diabetes Care, 27, 129–133.PubMedCrossRefGoogle Scholar
  5. Barbour, K. A., & Blumenthal, J. A. (2005). Exercise training and depression in older adults. Neurobiology of Aging, 26, 119–123.PubMedCrossRefGoogle Scholar
  6. Bisschop, M. I., Kriegsman, D. M. W., Deeg, D. J. H., et al. (2004). The longitudinal relation between chronic diseases and depression in older persons in the community: The Longitudinal Aging Study Amsterdam. Journal of Clinical Epidemiology, 57, 187–194.PubMedCrossRefGoogle Scholar
  7. Bouwman, V., Adriaanse, M. C., van‘t Riet, E., et al. (2010). Depression, anxiety and glucose metabolism in the general Dutch population: The new Hoorn study. PLoS ONE, 5, e9971.PubMedCentralPubMedCrossRefGoogle Scholar
  8. Brayne, C., Gao, L., & Matthews, F. (2005). Challenges in the epidemiological investigation of the relationships between physical activity, obesity, diabetes, dementia and depression. Neurobiology of Aging, 26, S6–S10.CrossRefGoogle Scholar
  9. Brown, L., Majumdar, S., Newman, S., et al. (2006). Type 2 diabetes does not increase risk of depression. CMAJ, 175, 42–46.PubMedCentralPubMedCrossRefGoogle Scholar
  10. Chen, P. C., Chan, Y. T., Chen, H. F., et al. (2013). Population-based cohort analyses of the bidirectional relationship between type 2 diabetes and depression. Diabetes Care, 36(2), 376–382.PubMedCentralPubMedCrossRefGoogle Scholar
  11. de Jonge, P., Roy, J. F., Saz, P., et al. (2006). Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus: Results from the ZARADEMP project. Diabetologia, 49, 2627–2633.PubMedCrossRefGoogle Scholar
  12. Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463.PubMedCrossRefGoogle Scholar
  13. Egberts, A. C., Leufkens, H. G., Hofman, A., et al. (1997). Incidence of antidepressant drug use in older adults and association with chronic diseases: The Rotterdam Study. International Clinical Psychopharmacology, 12, 217–223.PubMedCrossRefGoogle Scholar
  14. Engum, A. (2007). The role of depression and anxiety in onset of diabetes in a large population-based study. Journal of Psychosomatic Research, 62, 31–38.PubMedCrossRefGoogle Scholar
  15. Gallo, J., Anthony, J., & Muthen, B. (1994). Age differences in the symptoms of depression: A latent trait analysis. Journal of Gerontology, 49, 251–264.CrossRefGoogle Scholar
  16. Golden, S. H., Lazo, M., Carnethon, M., et al. (2008). Examining a bidirectional association between depressive symptoms and diabetes. JAMA, 299, 2751–2759.PubMedCentralPubMedCrossRefGoogle Scholar
  17. Golden, S. H., Williams, J. E., Ford, D. E., et al. (2004). Atherosclerosis risk in communities study. Depressive symptoms and the risk of type 2 diabetes. Diabetes Care, 27, 429–435.PubMedCrossRefGoogle Scholar
  18. Goldston, D. B., Kelley, A. E., Reboussin, D. M., et al. (1997). Suicidal ideation and behavior and noncompliance with the medical regimen among diabetic adolescents. Journal of American Academy of Child & Adolescent Psychiatry, 36, 1528–1536.Google Scholar
  19. Harris, E. C., & Barraclough, B. (1997). Suicide as an outcome for mental disorders: Meta-analysis. British Journal of Psychiatry, 170, 205–208.PubMedCrossRefGoogle Scholar
  20. Hasan, S. S., Clavarino, A. M., Mamun, A. A., et al. (2013). Population impact of depression either as a risk factor or consequence of type 2 diabetes in adults: A meta-analysis of longitudinal studies. Asian Journal of Psychiatry, 6(6), 460–472.PubMedCrossRefGoogle Scholar
  21. International Diabetes Federation. (2013). Diabetes Atlas. Accessed March 25, 2013.
  22. Katon, W., Von, K. M., Ciechanowski, P., et al. (2004). Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care, 27, 914–920.PubMedCrossRefGoogle Scholar
  23. Kessler, R. C., Sonnega, A. E., & Bromet, E. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.PubMedCrossRefGoogle Scholar
  24. Kim, J., Stewart, R., Kim, S., et al. (2006). Vascular risk factors and incident late-life depression in a Korean population. British Journal of Psychiatry, 189, 26–30.PubMedCrossRefGoogle Scholar
  25. Kinder, L. S., Kamarck, T. W., Baum, A., et al. (2002). Depressive symptomatology and coronary heart disease in type I diabetes mellitus: A study of possible mechanisms. Health Psychology, 21, 542–552.PubMedCrossRefGoogle Scholar
  26. Kivimaki, M., Tabák, A. G., Lawlor, D. A., et al. (2010). Antidepressant use before and after the diagnosis of type 2 diabetes: A longitudinal modeling study. Diabetes Care, 33, 1471–1476.PubMedCentralPubMedCrossRefGoogle Scholar
  27. Knol, M. J., Geerlings, M. I., Grobbee, D. E., et al. (2009). Antidepressant use before and after initiation of diabetes mellitus treatment. Diabetologia, 52, 425–432.PubMedCrossRefGoogle Scholar
  28. Knol, M. J., Heerdink, E. R., Egberts, A. C. G., et al. (2007). Depressive symptoms in subjects with diagnosed and undiagnosed T2DM. Psychosomatic Medicine, 69, 300–305.PubMedCrossRefGoogle Scholar
  29. Luijendijk, H. J., Stricker, B. H., Hofman, A., et al. (2008). Cerebrovascular risk factors and incident depression in community-dwelling elderly. Acta Psychiatrica Scandinavica, 118, 139–148.PubMedCrossRefGoogle Scholar
  30. Maraldi, C., Volpato, S., Penninx, B., et al. (2007). Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: The health, aging and body composition study. Archives of Internal Medicine, 167, 1137–1144.PubMedCrossRefGoogle Scholar
  31. Mezuk, B., Eaton, W. W., Albrecht, S., et al. (2008). Depression and type 2 diabetes over the lifespan: A meta-analysis. Diabetes Care, 31, 2383–2390.PubMedCentralPubMedCrossRefGoogle Scholar
  32. Nouwen, A., Winkley, K., Twisk, J., et al. (2010). European Depression in Diabetes (EDID) Research Consortium. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia, 53(12), 2480–2486.PubMedCentralPubMedCrossRefGoogle Scholar
  33. O’Connor, P. J., Crain, A. L., Rush, W. A., et al. (2009). Does diabetes double the risk of depression? Annals of Family Medicine, 7, 328–335.PubMedCentralPubMedCrossRefGoogle Scholar
  34. Palinkas, L. A., Barrett-Connor, E., & Wingard, D. L. (1991). Type 2 diabetes and depressive symptoms in older adults: A population-based study. Diabetic Medicine, 8, 532–539.PubMedCrossRefGoogle Scholar
  35. Palinkas, L. A., Lee, P. P., & Barrett-Connor, E. (2004). A prospective study of type 2 diabetes and depressive symptoms in the elderly: The Rancho Bernardo Study. Diabetic Medicine, 21, 1185–1191.PubMedCrossRefGoogle Scholar
  36. Pan, A., Lucas, M., Sun, Q., et al. (2010). Bidirectional association between depression and Type 2 diabetes in women. Archives of Internal Medicine, 170(21), 1884–1891.PubMedCentralPubMedCrossRefGoogle Scholar
  37. Pietrantonj, C. D. (2006). Four-fold table cell frequencies imputation in meta-analysis. Statistics in Medicine, 25, 2299–2322.PubMedCrossRefGoogle Scholar
  38. Polsky, D., Doshi, J., Marcus, S., et al. (2005). Long-term risk for depressive symptoms after a medical diagnosis. Archives of Internal Medicine, 165, 1260–1266.PubMedCrossRefGoogle Scholar
  39. Pompili, M., Lester, D., Innamorati, M., et al. (2009). Quality of life and suicidal risk in patients with diabetes mellitus. Psychosomatics, 50, 16–23.PubMedCrossRefGoogle Scholar
  40. Rotella, F., & Mannucci, E. (2012). Diabetes mellitus as a risk factor for depression. A meta-analysis of longitudinal studies. Diabetes Research in Clinical Practice, 99(2), 98–104.CrossRefGoogle Scholar
  41. Silva, N., Atlantis, E., & Ismail, K. (2012). A review of the association between depression and insulin resistance: Pitfalls of secondary analyses or a promising new approach to prevention of type 2 diabetes? Current Psychiatry Reports, 14(1), 8–14.PubMedCrossRefGoogle Scholar
  42. Talbot, F., & Nouwen, A. (2000). A review of the relationship between depression and diabetes in adults: Is there a link? Diabetes Care, 23, 1556–1562.PubMedCrossRefGoogle Scholar
  43. Talbot, F., Nouwen, A., Gingras, J., et al. (1999). Relations of diabetes intrusiveness and personal control to symptoms of depression among adults with diabetes. Health Psychology, 18, 537–542.PubMedCrossRefGoogle Scholar
  44. Tsoi, K. K. F., Pau, C. Y. Y., Wu, W. K. K., et al. (2009). Cigarette smoking and the risk of colorectal cancer: A meta-analysis of prospective cohort studies. Clinical Gastroenterology and Hepatology, 7(6), 682–688.PubMedCrossRefGoogle Scholar
  45. Wagner, J., Tsimikas, J., Abbott, G., et al. (2007). Racial and ethnic differences in diabetic patient-reported depression symptoms, diagnosis, and treatment. Diabetes Research in Clinical Practice, 75, 119–122.CrossRefGoogle Scholar
  46. World Health Organization. (2000). International Consortium of Psychiatric Epidemiology. Cross-national comparisons of mental disorders. Bulletin W.H.O, 78, 413–426.Google Scholar
  47. Zhang, X., Norris, S. L., Gregg, E. W., et al. (2005). Depressive symptoms and mortality among persons with and without diabetes. American Journal of Epidemiology, 161, 652–660.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Syed Shahzad Hasan
    • 1
    Email author
  • Abdullah A. Mamun
    • 2
  • Alexandra M. Clavarino
    • 1
  • Therese Kairuz
    • 1
  1. 1.School of PharmacyThe University of QueenslandWoolloongabbaAustralia
  2. 2.School of Population HealthThe University of QueenslandHerstonAustralia

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