Review
TYPE 2 DIABETES IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER: A META-ANALYSIS OF PREVALENCE ESTIMATES AND PREDICTORS
Davy Vancampfort Ph.D.,
Alex J. Mitchell M.D.,
Marc De Hert Ph.D., M.D.,
Pascal Sienaert Ph.D., M.D.,
Michel Probst Ph.D.,
Roselien Buys Ph.D.,
Brendon Stubbs Ph.D.,
Corresponding Author
Davy Vancampfort Ph.D.
1UPC KU Leuven, Campus Kortenberg, KU Leuven, Department of Neurosciences, Belgium
KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
Correspondence to: Davy Vancampfort, UPC KU Leuven, Campus Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium. E-mail: [email protected]Search for more papers by this authorAlex J. Mitchell M.D.
Department of Psycho-Oncology, Leicestershire Partnership Trust, Leicester, UK
Department of Cancer and Molecular Medicine, University of Leicester, Leicester, UK
Search for more papers by this authorMarc De Hert Ph.D., M.D.
1UPC KU Leuven, Campus Kortenberg, KU Leuven, Department of Neurosciences, Belgium
Search for more papers by this authorPascal Sienaert Ph.D., M.D.
1UPC KU Leuven, Campus Kortenberg, KU Leuven, Department of Neurosciences, Belgium
Search for more papers by this authorMichel Probst Ph.D.
1UPC KU Leuven, Campus Kortenberg, KU Leuven, Department of Neurosciences, Belgium
Search for more papers by this authorRoselien Buys Ph.D.
KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
Search for more papers by this authorBrendon Stubbs Ph.D.
School of Health and Social Care, University of Greenwich, London, UK
Search for more papers by this authorDavy Vancampfort Ph.D.,
Alex J. Mitchell M.D.,
Marc De Hert Ph.D., M.D.,
Pascal Sienaert Ph.D., M.D.,
Michel Probst Ph.D.,
Roselien Buys Ph.D.,
Brendon Stubbs Ph.D.,
Corresponding Author
Davy Vancampfort Ph.D.
1UPC KU Leuven, Campus Kortenberg, KU Leuven, Department of Neurosciences, Belgium
KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
Correspondence to: Davy Vancampfort, UPC KU Leuven, Campus Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium. E-mail: [email protected]Search for more papers by this authorAlex J. Mitchell M.D.
Department of Psycho-Oncology, Leicestershire Partnership Trust, Leicester, UK
Department of Cancer and Molecular Medicine, University of Leicester, Leicester, UK
Search for more papers by this authorMarc De Hert Ph.D., M.D.
1UPC KU Leuven, Campus Kortenberg, KU Leuven, Department of Neurosciences, Belgium
Search for more papers by this authorPascal Sienaert Ph.D., M.D.
1UPC KU Leuven, Campus Kortenberg, KU Leuven, Department of Neurosciences, Belgium
Search for more papers by this authorMichel Probst Ph.D.
1UPC KU Leuven, Campus Kortenberg, KU Leuven, Department of Neurosciences, Belgium
Search for more papers by this authorRoselien Buys Ph.D.
KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
Search for more papers by this authorBrendon Stubbs Ph.D.
School of Health and Social Care, University of Greenwich, London, UK
Search for more papers by this authorFunding: None.
Declaration of interest: DV, AJM, RB, MP, and BS report no financial relationships with commercial interests. MDH has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory boards of AstraZeneca, Lundbeck JA, Janssen-Cilag, European Diabetes Foundation/Lilly, Otsuka, Pfizer, Sanofi-Aventis, Bristol-Myers Squibb, and Takeda. PS has been a consultant for or received honoraria as an independent speaker from Astra Zeneca, Lundbeck JA, Janssen-Cilag, Eli Lilly, Bristol-Myers Squibb, and Servier.
Abstract
Background
Patients with depression may be at increased risk of type 2 diabetes mellitus (T2DM), which is a risk factor for cardiovascular diseases and premature mortality. We aimed to clarify the prevalence and predictors of T2DM in patients with major depressive disorder (MDD) and where possible compare the prevalence of T2DM in those with MDD versus general population controls.
Methods
We searched major electronic databases until December 2014 for studies reporting T2DM prevalence in patients with MDD. Two independent authors extracted data and completed methodological quality appraisal in accordance with the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. A random effects meta-analysis was utilized.
Results
The initial electronic database search resulted in 145 valid hits and 16 publications with clearly defined MDD (n = 15,8834; 31% male; mean age = 39–78 years) met the eligibility criteria. The overall prevalence of T2DM was 8.7% (95% confidence interval [CI] = 7.3–10.2%). Mean age of the MDD sample predicted a higher prevalence of T2DM (β = 0.0411; 95% CI = 0.0032–0.079, P = .03; R² = .22). A comparative meta-analysis revealed people with MDD (n = 154,366) had a higher risk of T2DM versus general controls (n = 2,098,063; relative risk [RR] = 1.49; 95% CI = 1.29–1.72; P < 0.001, N = 10). The RR (N = 3) focusing on age- and gender-matched general population controls (n = 103,555) was 1.36 (95% CI = 1.28–1.44; P < 0.001, n [MDD] = 10,895).
Conclusions
T2DM is significantly more common in people with MDD compared with the general population. The current meta-analysis indicates that action is needed in order to curb the diabetes epidemic in this high-risk population.
REFERENCES
- 1Vancampfort D, Correll CU, Wampers M, et al. Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables. Psychol Med 2014. doi:10.1017/S0033291713002778.
- 2Seldenrijk A, Vogelzangs N, Batelaan NM, et al. Depression, anxiety and 6-year risk of cardiovascular disease. J Psychosom Res 2015; 78(2): 123–129.
- 3Van der Kooy K, van Hout H, Marwijk H, Marten H, Stehouwer C, Beekman A. Depression and the risk for cardiovascular diseases: systematic review and meta-analysis. Int J Geriatr Psychiatry 2007; 22: 613–626.
- 4Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. J Am Med Assoc 2011; 306(11): 1241–1249.
- 5Meijer A, Conradi HJ, Bos EH, et al Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis. Br J Psychiatry 2013; 203(2): 90–102.
- 6van Dooren FEP, Nefs G, Schram MT, Verhey FRJ, Denollet J, Pouwer F. Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PLoS One 2013; 8(3): e57058.
- 7Sarwar N, Gao P, Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375: 2215–2222.
- 8Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197–2223.
- 9Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes and cardiovascular disease: statement for health professionals from the American Heart Association. Circulation 1999; 100: 1134–1146.
- 10Talbot F, Nouwen A. A review of the relationship between depression and diabetes in adults: is there a link? Diabetes Care 2000; 23(10): 1556–1562.
- 11Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord 2012; 142(Suppl): S8–S21.
- 12Anderson RJ, Freedland KE, Clouse RE, et al. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001; 24(6): 1069–1078.
- 13de Groot M, Anderson RJ, Freedland KE, et al. Association of depression and diabetes complications: a meta-analysis. Psychosom Med 2001; 63: 619–630.
- 14Ali S, Stone MA, Peters JL, et al. The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006; 23(11): 1165–1173.
- 15Knol MJ, Twisk JW, Beekman AT, et al. Depression as a risk factor for the onset of type 2 diabetes mellitus: a meta-analysis. Diabetologia 2006; 49: 837–845.
- 16Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 2008; 31(12): 2383–2390.
- 17Nouwen A, Winkley K, Twisk J, et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia 2010; 53: 2480–2486.
- 18Nouwen A, Nefs G, Caramlau I, et al. Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: a systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium. Diabetes Care 2011; 34: 752–762.
- 19Rotella F, Mannucci E. Depression as a risk factor for diabetes: a meta-analysis of longitudinal studies. J Clin Psychiatry 2013; 74(1): 31–73.
- 20Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009; 374(9690): 609–619.
- 21Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. J Am Med Assoc 2000; 283(15): 2008–2012.
- 22Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6(7): e1000097.
- 23 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Text Revision—DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000.
10.1176/appi.books.9780890423349 Google Scholar
- 24 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders—Diagnostic Criteria for Research. Geneva: World Health Organization; 1993.
- 25Wells G, Shea B, O'Connell D, Peterson J. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
- 26 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33(1): S62–S69.
- 27 World Health Organization (WHO) Consultation. Definition and diagnosis of diabetes and intermediate hyperglycemia. 2006. Available at: http://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pd.
- 28DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7(3): 177–188.
- 29Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50(4): 1088–1101.
- 30Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315(7109): 629–634.
- 31Egede LE. Diabetes, major depression, and functional disability among U.S. adults. Diabetes Care 2004; 27(2): 421–428.
- 32Correll CU, Frederickson AM, Kane JM, Manu P. Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. J Clin Psychiatry 2006; 67: 575–583.
- 33Almeida OP, Flicker L, Norman P, et al. Association of cardiovascular risk factors and disease with depression in later life. Am J Geriatr Psychiatry 2007; 15(6): 506–513.
- 34Patten SB, Williams JV, Lavorato DH, Campbell NR, Eliasziw M, Campbell TS. Major depression as a risk factor for high blood pressure: epidemiologic evidence from a national longitudinal study. Psychosom Med 2009; 71(3): 273–279.
- 35Blank K, Szarek BL, Goethe JW. Metabolic abnormalities in adult and geriatric major depression with and without comorbid dementia. J Clin Hypertens (Greenwich) 2010; 12(6): 456–461.
- 36Gale CR, Kivimaki M, Lawlor DA, Carroll D, Phillips AC, Batty GD. Fasting glucose, diagnosis of type 2 diabetes, and depression: the Vietnam experience study. Biol Psychiatry 2010; 67(2): 189–192.
- 37Fiedorowicz JG, He J, Merikangas KR. The association between mood and anxiety disorders with vascular diseases and risk factors in a nationally representative sample. J Psychosom Res 2011; 70(2): 145–154.
- 38Hatt NH, Shahrul Azhar MH, Chong LL, et al. Factors associated with metabolic syndrome among psychiatric outpatients with major depressive disorder. Malayas J Psychiatry 2011; 20(2): Online only.
- 39Atlantis E, Goldney RD, Eckert KA, Taylor AW. Trends in health-related quality of life and health service use associated with body mass index and comorbid major depression in South Australia, 1998–2008. Qual Life Res 2012; 21(10): 1695–1704.
- 40Chien IC, Wu EL, Lin CH, Chou YJ, Chou P. Prevalence of diabetes in patients with major depressive disorder: a population-based study. Compr Psychiatry 2012; 53(5): 569–575.
- 41Li CT, Bai YM, Tu PC, et al. Major depressive disorder and stroke risks: a 9-year follow-up population-based, matched cohort study. PLoS One 2012; 7(10): e46818.
- 42Amital D, Fostick L, Silberman A, et al. Physical co-morbidity among treatment resistant vs. treatment responsive patients with major depressive disorder. Eur Neuropsychopharmacol 2013; 23(8): 895–901.
- 43Munhoz TN, Santos IS, Matijasevich A. Major depressive episode among Brazilian adults: a cross-sectional population-based study. J Affect Disord 2013; 150(2): 401–407.
- 44Windle M, Windle RC. Recurrent depression, cardiovascular disease, and diabetes among middle-aged and older adult women. J Affect Disord 2013; 150(3): 895–902.
- 45Agyemang AA, Mezuk B, Perrin P, Rybarczyk B. Quality of depression treatment in Black Americans with major depression and comorbid medical illness. Gen Hosp Psychiatry 2014; 36(4): 431–436.
- 46Schoepf D, Uppal H, Potluri R, Chandran S, Heun R. Comorbidity and its relevance on general hospital based mortality in major depressive disorder: a naturalistic 12-year follow-up in general hospital admissions. J Psychiatr Res 2014; 52: 28–35.
- 47Smith DJ, Court H, McLean G, et al. Depression and multimorbidity: a cross-sectional study of 1751841 patients in primary care. J Clin Psychiatry 2014; 75(11): 1202–1208.
- 48Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care 2002; 25: 464–470.
- 49Eren I, Erdi O, Sahin M. The effect of depression on quality of life of patients with type II diabetes mellitus. Depress Anxiety 2008; 25(2): 98–106.
- 50Geulayov G, Goral A, Muhsen K, Lipsitz J, Gross R. Physical inactivity among adults with diabetes mellitus and depressive symptoms: results from two independent national health surveys. Gen Hosp Psychiatry 2010; 32(6): 570–576.
- 51Gale EA, Gillespie KM. Diabetes and gender. Diabetologia 2001; 44(1): 3–15.
- 52Stetler C, Miller GE. Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research. Psychosom Med 2011; 73(2): 114–126.
- 53Au B, Smith KJ, Gariépy G, Schmitz N. C-reactive protein, depressive symptoms, and risk of diabetes: results from the English Longitudinal Study of Ageing (ELSA). J Psychosom Res 2014; 77(3): 180–186.
- 54Atlantis E, Shi Z, Penninx BJ, Wittert GA, Taylor A, Almeida OP. Chronic medical conditions mediate the association between depression and cardiovascular disease mortality. Soc Psychiatry Psychiatr Epidemiol 2012; 47(4): 615–625.
- 55Wilmot EG, Edwardson CL, Achana F, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia 2012; 55(11): 2895–2905.
- 56Knapen J, Vancampfort D, Moriën Y, Marchal Y. Exercise therapy improves both mental and physical health in patients with major depression. Disabil Rehabil 2014. doi:10.3109/09638288.2014.972579.
- 57Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care 2004; 27: 2518-2539.
- 58Mitchell AJ, Malone D, Doebbeling CC. Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies. Br J Psychiatry 2009; 194(6): 491–499.
- 59De Hert M, Cohen D, Bobes J, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, and recommendations at the system and individual levels. World Psychiatry 2011; 10: 138–151.
- 60Lord O, Malone D, Mitchell AJ. Receipt of preventive medical care and medical screening for patients with mental illness: a comparative analysis. Gen Hosp Psychiatry 2010; 32(5): 519–543.
- 61Swardfager W, Herrmann N, Marzolini S, et al. Major depressive disorder predicts completion, adherence, and outcomes in cardiac rehabilitation: a prospective cohort study of 195 patients with coronary artery disease. J Clin Psychiatry 2011; 72(9): 1181–1188.
- 62Barnard K, Peveler RC, Holt RI. Antidepressant medication as a risk factor for type 2 diabetes and impaired glucose regulation: systematic review. Diabetes Care 2013; 36: 3337–3345.
- 63Egede LE, Ellis C, Grubaugh AL. The effect of depression on self-care behaviors and quality of care in a national sample of adults with diabetes. Gen Hosp Psychiatry 2009; 31(5): 422–427.
- 64McIntyre RS, Soczynska JK, Konarski JZ, Kennedy SH. The effect of antidepressants on glucose homeostasis and insulin sensitivity: synthesis and mechanisms. Expert Opin Drug Safety 2006; 5: 157–168.
- 65Hennings JM, Schaaf L, Fulda S. Glucose metabolism and antidepressant medication. Curr Pharm Design 2012; 18: 5900–5919.
- 66Knol MJ, Derijks HJ, Geerlings MI, et al. Influence of antidepressants on glycaemic control in patients with diabetes mellitus. Pharmacoepidemiol Drug Saf 2008; 17(6): 577–586.
- 67Mojtabai R. Antidepressant use and glycemic control. Psychopharmacol 2013; 227(3): 467–477.
- 68Davidson JR. Major depressive disorder treatment guidelines in America and Europe. J Clin Psychiatry 2010; 71(S1): e04.
- 69Farahani A, Correll CU. Are antipsychotics or antidepressants needed for psychotic depression? A systematic review and meta-analysis of trials comparing antidepressant or antipsychotic monotherapy with combination treatment. J Clin Psychiatry 2012; 73: 486–496.
- 70De Hert M, Detraux J, van Winkel R, Yu W, Correll CU. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nature Rev Endocrinol 2011; 8(2): 114–126.
- 71McIntyre RS, Alsuwaidan M, Goldstein BI, et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid metabolic disorders. Ann Clin Psychiatry 2012; 24(1): 69–81.
- 72De Hert M, Dekker J, Wood D, Kahl K, Holt R, Möller H. Cardiovascular disease and diabetes is people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 2009; 24: 412–424.
- 73Gonzalez JS, Peyrot M, McCarl LA, et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 2008; 31(12): 2398–2403.
- 74Stubbs B, Eggermont L, Mitchell AJ, et al. The prevalence of pain in bipolar disorder: a systematic review and large-scale meta-analysis. Acta Psychiatr Scand 2015; 131(2): 75–88.
- 75Stubbs B, De Hert M, Sepehry AA, et al. A meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia. Acta Psychiatr Scand 2014; 130(6): 470–486.
- 76Stubbs B, Vancampfort D, De Hert M, Mitchell AJ. The prevalence and predictors of type 2 diabetes in people with schizophrenia: a systematic review and comparative meta-analysis. Acta Psychiatr Scand 2015. doi: 10.1111/acps.12439.
- 77van Winkel R, De Hert M, Van Eyck D, et al. Screening for diabetes and other metabolic abnormalities in patients with schizophrenia and schizoaffective disorder: evaluation of incidence and screening methods. J Clin Psychiatry 2006; 10: 1493–1500.
10.4088/JCP.v67n1002 Google Scholar
