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Depressive Symptoms in Subjects With Diagnosed and Undiagnosed Type 2 Diabetes

From the Julius Center for Health Sciences and Primary Care (M.J.K., M.I.G., M.E.N., D.E.G., H.B.), University Medical Center Utrecht, Netherlands; Department of Pharmacoepidemiology and Pharmacotherapy (M.J.K., E.R.H., A.C.G.E., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands; Department of Psychiatry and Department of Epidemiology (H.B.), University Medical Center Groningen, Netherlands.

Address correspondence and reprint requests to M. J. Knol, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands. E-mail: m.j.knol{at}umcutrecht.nl

Objective: To investigate if disturbed glucose homeostasis or known diagnosis of diabetes was associated with depressive symptoms. The reason for the increased prevalence of depression in patients with Type 2 diabetes mellitus (DM2) is unknown.

Methods: Within the Utrecht Health Project, an ongoing longitudinal study among inhabitants of a residential area of a large city in The Netherlands, 4747 subjects (age: 39.4 ± 12.5 years) were classified into four mutually exclusive categories: normal fasting plasma glucose (FPG) (<5.6 mmol/l), impaired FPG (5.6 and <7.0 mmol/l), undiagnosed DM2 (FPG 7.0 mmol/l), and diagnosed DM2. Presence of depressive symptoms was defined as a score of 25 on the depression subscale of the Symptom Check List (SCL-90) or self-reported use of antidepressants.

Results: Diagnosed DM2 was associated with an increased risk of depressive symptoms (odds ratio (OR) = 1.69; 95% confidence interval (CI) 1.06–2.72) after adjustment for demographic and lifestyle variables. Additional adjustment for number of chronic diseases reduced the OR to 1.36 (95% CI 0.83–2.23). Impaired fasting glucose and undiagnosed DM2 were not associated with depressive symptoms.

Conclusions: Our findings suggest that disturbed glucose homeostasis is not associated with depressive symptoms. The increased prevalence of depressive symptoms among patients with diagnosed DM2 suggests that depressive symptoms might be a consequence of the burden of diabetes. The number of chronic diseases seems to explain part of the association between DM2 and depressive symptoms.

Key Words: depressive symptoms • diabetes • blood glucose • burden

Abbreviations: DM2 = Type 2 diabetes mellitus; CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth revision; FPG = fasting plasma glucose; OR = odds ratio; SCID = Structured Clinical Interview for DSM-IV; SCL-90 = Symptom Checklist; SD = standard deviation; SPSS = Statistical Package for the Social Sciences; UHP = Utrecht Health Project.

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