Depression Linked to Higher Death Rates From All Causes Among Elderly With Diabetes

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Title: Depression Linked to Higher Death Rates From All Causes Among Elderly With Diabetes
URL: http://www.pslgroup.com/dg/22DF82.htm
Doctor's Guide
October 1, 2008

SEATTLE, Wash -- October 1, 2008 -- In a large group of Medicare beneficiaries with diabetes, depression was associated with a higher death rate from all causes during a 2-year study period. The findings are published in the October issue Journal of General Internal Medicine.

Lead author Wayne Katon, MD, University of Washington, Seattle, Washington, noted that previous research indicates that depression and diabetes is a potentially lethal mix among young to middle-aged patients. Depression also puts patients at greater risk of complications from their diabetes.

This more recent study suggests that depression is also a risk factor for mortality in older patients with diabetes. Most Medicare beneficiaries, like the ones in this study, are aged over 65 years. The mean age of the participants was 75.6 years.

The study tracked 10,704 Medicare beneficiaries with diabetes who were enrolled in a disease management program in Florida. They were surveyed at the start of the study with a health assessment questionnaire. Evidence of depression among members of the group came from physician diagnosis, patient reports of having a prescription for an antidepressant in the year before the survey, or patient answers to a brief screening test.

For the next 2 years, the research team recorded the death and cause of death of participants through bi-monthly checks of Medicare claims and eligibility files, or from phone calls with the participants' families.

The research team found that patients with both diabetes and depression had an increased risk of about 36% to 38% of dying from any cause during the 2-year follow-up.

Participants with a physician diagnosis of depression were significantly younger than their cohorts, more likely to be female, had more severe medical illness, were less likely to be African-American, and more likely to be Hispanic. These variables were controlled for in the analysis of increased risk.

A total of 12.1% of participants who had both disorders died during that period. Among those without depression, 10.4% died. Participants who had been treated with one or more antidepressant medications in the year before the study had a 24% increased risk of mortality, compared to nondepressed participants.

According to the study authors, those patients may have been treated with antidepressants because their depressive symptoms were more severe and persistent than those of more mildly depressed patients who were not prescribed antidepressants.

There was no difference in the rate of cardiovascular or cerebrovascular events between those patients treated with antidepressants and those who had no indication of depression.

"Rates of mortality from vascular disease may be decreasing in recent years among patients with diabetes due to more aggressive treatment of high blood pressure, cholesterol, and glucose levels, as well as widespread use of preventative medications such as aspirin and beta-blockers," the authors wrote.

The authors noted that the study had limitations including that all participants were from 1 geographic region of the United States, and the follow-up period was relatively short. Defining depression in part by physician diagnosis and treatment, they added, may have selected for participants with more severe illness.

SOURCE: University of Washington

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