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From the Departments of Psychiatry (R.E.C., P.J.L., K.E.F., L.S.G., R.M.C.) and Medicine (R.E.C., J.B.McG), Washington University School of Medicine, and the Department of Veterans Affairs (P.J.L.), Medical Center, St. Louis, Missouri.
Address reprint requests to: Ray E. Clouse, MD, Professor of Medicine and Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO 63110. Email: rclouse{at}im.wustl.edu
OBJECTIVE: The protective effects of female gender on the appearance and course of coronary heart disease (CHD) in nondiabetic subjects are diminished in the presence of diabetes. Depression predicts onset of and poor outcome from CHD in nondiabetic populations. We hypothesized that the doubled rates of depression in female diabetic patients could help explain the high prevalence of CHD in women with diabetes.
METHOD: Seventy-six female type 1 and type 2 diabetic patients with (N=16) or without (N=60) active major depression (DSM-III) at index evaluation underwent systematic annual investigation of diabetes and its complications for up to 10 years. Occurrences of CHD and other macrovascular complications were examined in relation to depression status using survival analysis statistics. A multivariate model incorporating other CHD risk factors (age, duration of diabetes, body mass index, glycosylated hemoglobin, and presence of hypertension, hyperlipidemia, or tobacco use) was used to determine independent effects of depression on outcome.
RESULTS: Development of CHD was significantly more rapid in the depressed subset (p<0.01 between 10-year curves), an effect that persisted after controlling for base-line differences in body mass index. Depression also was retained as an independent predictor of CHD in the multivariate model with an age-adjusted hazard ratio of 5.2 (95% CI: 1.4–18.9; p=.01). In contrast, depression did not predict the development of clinically apparent peripheral or cerebrovascular disease.
CONCLUSIONS: In this sample of diabetic women, major depression was an independent risk factor that accelerated the development of CHD. Depression recognition and management may improve outcomes from diabetes in this gender subgroup.
Key Words: depression, • coronary heart disease, • diabetes, • peripheral vascular disease, • cerebrovascular disease.
Abbreviations: CHD = coronary heart disease;; DSM-III = Diagnostic and Statistical Manual of Mental Disorders, Version 3;; DIS = Diagnostic Interview Schedule, Version 3.
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