Journal of General Internal Medicine

, Volume 25, Issue 6, pp 524–529 | Cite as

Depression in Relation to Long-term Control of Glycemia, Blood Pressure, and Lipids in Patients with Diabetes

  • Susan R. Heckbert
  • Carolyn M. Rutter
  • Malia Oliver
  • Lisa H. Williams
  • Paul Ciechanowski
  • Elizabeth H. B. Lin
  • Wayne J. Katon
  • Michael Von Korff
Original Article



Little information is available about the association of depression with long-term control of glycemia, blood pressure, or lipid levels in patients with diabetes.


To determine whether minor and major depression at study enrollment compared with no depression are associated with higher average HbA1c, systolic blood pressure (SBP) and LDL cholesterol over the long term in patients with an indication for or receiving drug treatment.


Cohort study.


A total of 3,762 patients with type 2 diabetes mellitus enrolled in the Pathways Epidemiologic Study in 2001–2002 and followed for 5 years.

Main Measures

Depression was assessed at study enrollment using the Patient Health Questionnaire-9 (PHQ-9). SBP and information on cardiovascular co-morbidity were abstracted from medical records, and LDL cholesterol and HbA1c measured during clinical care were obtained from computerized laboratory data during a median of 4.8 years’ follow-up.

Key Results

Among those with an indication for or receiving drug treatment, after adjustment for demographic and clinical characteristics, average long-term HbA1c, SBP, and LDL cholesterol did not differ in patients with comorbid diabetes and minor or major depression compared with those with diabetes alone.


The adverse effect of depression on outcomes in patients with diabetes may not be mediated in large part by poorer glycemic, blood pressure, or lipid control. Further study is needed of the biologic effects of depression on patients with diabetes and their relation to adverse outcomes.


depression diabetes glycemia hypertension hyperlipidemia 



Supported by grant MH073686 from the National Institute of Mental Health, Bethesda, MD.

Conflict of interest

Dr. Ciechanowski is CEO and founder of Samepage, Inc., a consulting company providing services for improving patient-provider relationships; Dr. Lin has received honoraria from Health Star Communications and Prescott Medical; Dr. Katon has received honoraria for lectures from Wyeth, Lilly, Forest, and Pfizer, and is on advisory boards for Lilly and Wyeth; Dr. Von Korff has one grant to Group Health Research Institute funded by Johnson & Johnson and another grant pending.


  1. 1.
    Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care. 2003;26(10):2822–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Katon WJ, Rutter C, Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28(11):2668–72.CrossRefPubMedGoogle Scholar
  3. 3.
    Katon W, Fan MY, Unutzer J, Taylor J, Pincus H, Schoenbaum M. Depression and diabetes: a potentially lethal combination. J Gen Intern Med. 2008;23(10):1571–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Lin EH, Heckbert SR, Rutter CM, et al. Depression and increased mortality in diabetes: unexpected causes of death. Ann Fam Med. 2009;7(5):414–21.CrossRefPubMedGoogle Scholar
  5. 5.
    de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619–30.PubMedGoogle Scholar
  6. 6.
    Lin EH, Katon W, Von Korff M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154–60.CrossRefPubMedGoogle Scholar
  7. 7.
    Katon WJ, Simon G, Russo J, et al. Quality of depression care in a population-based sample of patients with diabetes and major depression. Med Care. 2004;42(12):1222–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596–1602.CrossRefPubMedGoogle Scholar
  9. 9.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737–44.CrossRefPubMedGoogle Scholar
  11. 11.
    Golden SH, Lazo M, Carnethon M, et al. Examining a bidirectional association between depressive symptoms and diabetes. JAMA. 2008;299(23):2751–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Gary TL, Baptiste-Roberts K, Crum RM, Cooper LA, Ford DE, Brancati FL. Changes in depressive symptoms and metabolic control over 3 years among African Americans with type 2 diabetes. Int J Psychiatry Med. 2005;35(4):377–82.CrossRefPubMedGoogle Scholar
  13. 13.
    Richardson LK, Egede LE, Mueller M, Echols CL, Gebregziabher M. Longitudinal effects of depression on glycemic control in veterans with type 2 diabetes. Gen Hosp Psychiatry. 2008;30(6):509–14.CrossRefPubMedGoogle Scholar
  14. 14.
    Von Korff M, Katon W, Lin EH, et al. Work disability among individuals with diabetes. Diabetes Care. 2005;28(6):1326–32.CrossRefGoogle Scholar
  15. 15.
    Egede LE, Ellis C. The effects of depression on diabetes knowledge, diabetes self-management, and perceived control in indigent patients with type 2 diabetes. Diabetes Technol Ther. 2008;10(3):213–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Simon GE, Katon WJ, Lin EH, et al. Diabetes complications and depression as predictors of health service costs. Gen Hosp Psychiatry. 2005;27(5):344–51.CrossRefPubMedGoogle Scholar
  17. 17.
    Joynt KE, Whellan DJ, O'Connor CM. Depression and cardiovascular disease: mechanisms of interaction. Biol Psychiatry. 2003;54(3):248–61.CrossRefPubMedGoogle Scholar
  18. 18.
    Serebruany VL, Glassman AH, Malinin AI, et al. Enhanced platelet/endothelial activation in depressed patients with acute coronary syndromes: evidence from recent clinical trials. Blood Coagul Fibrinolysis. 2003;14(6):563–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Vaccarino V, Johnson BD, Sheps DS, et al. Depression, inflammation, and incident cardiovascular disease in women with suspected coronary ischemia: the National Heart, Lung, and Blood Institute-sponsored WISE study. J Am Coll Cardiol. 2007;50(21):2044–50.CrossRefPubMedGoogle Scholar
  20. 20.
    Everson-Rose SA, Lewis TT, Karavolos K, Dugan SA, Wesley D, Powell LH. Depressive symptoms and increased visceral fat in middle-aged women. Psychosom Med. 2009;71(4):410–16.CrossRefPubMedGoogle Scholar
  21. 21.
    Carney RM, Freedland KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res. 2002;53(4):897–902.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Susan R. Heckbert
    • 1
    • 5
    • 6
  • Carolyn M. Rutter
    • 4
  • Malia Oliver
    • 5
  • Lisa H. Williams
    • 2
  • Paul Ciechanowski
    • 3
  • Elizabeth H. B. Lin
    • 5
  • Wayne J. Katon
    • 3
  • Michael Von Korff
    • 5
  1. 1.Department of EpidemiologyUniversity of WashingtonSeattleUSA
  2. 2.Department of Medicine (Dermatology)University of WashingtonSeattleUSA
  3. 3.Department of PsychiatryUniversity of WashingtonSeattleUSA
  4. 4.Biostatistics UnitGroup Health Research InstituteSeattleUSA
  5. 5.Group Health Research InstituteGroup Health CooperativeSeattleUSA
  6. 6.University of Washington Cardiovascular Health Research UnitSeattleUSA

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