Depression and All-Cause Mortality in Persons with Diabetes Mellitus: Are Older Adults at Higher Risk? Results from the Translating Research Into Action for Diabetes Study

Authors

  • Lindsay B. Kimbro MPP,

    1. Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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  • Carol M. Mangione MD, MSPH,

    Corresponding author
    1. Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
    2. Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
    • Address correspondence to Carol M. Mangione, UCLA General Internal Medicine/Health Services Research, 10940 Wilshire Blvd., Suite 700, Los Angeles, CA 90025. E-mail: cmangione@mednet.ucla.edu

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  • W. Neil Steers PhD,

    1. Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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  • O. Kenrik Duru MD, MSHS,

    1. Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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  • Laura McEwen PhD,

    1. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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  • Andrew Karter PhD,

    1. Epidemiology and Health Services Research, Division of Research, Kaiser Permanente, Oakland, California
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  • Susan L. Ettner PhD

    1. Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
    2. Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
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Abstract

Objectives

To compare the strength of the association between depression and mortality between elderly and younger individuals with diabetes mellitus.

Design

A survival analysis conducted in a longitudinal cohort study of persons with diabetes mellitus to test the association between depression and mortality in older (≥65) and younger (18–65) adults.

Setting

Managed care.

Participants

Persons aged 18 and older with diabetes mellitus who participated in the Wave 2 survey of the Translating Research Into Action for Diabetes (TRIAD) Study (N = 3,341).

Measurements

The primary outcome was mortality risk, which was measured as days until death using linked data from the National Death Index. Depression was measured using the Patient Health Questionnaire.

Results

After controlling for age, sex, race and ethnicity, income, and other comorbidities, mortality risk in persons with diabetes mellitus was 49% higher in those with depression than in those without, although results varied according to age. After controlling for the same variables, mortality risk in persons aged 65 and older with depression was 78% greater than in those without. For those younger than 65, the effect of depression on mortality was smaller and not statistically significant.

Conclusion

This analysis suggests that the effect of depression on mortality in persons with diabetes mellitus is most significant for older adults. Because there is evidence in the literature that treatment of depression in elderly adults can lead to lower mortality, these results may suggest that older adults with diabetes mellitus should be considered a high-priority population for depression screening and treatment.

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