A prospective study of depression and mortality in patients with type 2 diabetes: the Fremantle Diabetes Study
A prospective study of depression and mortality in patients with type 2 diabetes: the Fremantle Diabetes Study
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DOI：
10.1007/s00125-005-0024-3
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发表时间：
2005-12-01
期刊：
影响因子：
8.2
通讯作者：
Davis, TME
中科院分区：
文献类型：
--
作者：
Bruce, DG;Davis, WA;Davis, TME
目的/假设：抑郁症与2型糖尿病患者死亡率过高相关。我们调查了抑郁症对2型糖尿病患者全因死亡率和心源性死亡率的影响及其可能的因果机制。方法：我们从一个邮政编码定义的社区招募了1,273例2型糖尿病患者（平均年龄64.1 ± 11.2岁，48.7%为男性，糖尿病中位病程4年[范围1.0-9.0]），并对他们进行了7.8 ± 2.4年的随访。抑郁症是通过生活质量问卷调查获得的数据进行评估的，死亡原因和日期是从州登记处获得的。结果：在招募时，31.5%的受试者存在抑郁症。抑郁受试者基线时糖尿病病程较长，心血管危险因素、CHD、脑血管疾病和糖尿病微血管并发症较多，随访期间全因和心源性死亡率较高。在考克斯比例风险模型中，在调整人口统计学和糖尿病相关变量以及心血管危险因素后，抑郁症与过多的全因死亡率和心源性死亡率显著相关。当糖尿病微血管和大血管并发症被添加到考克斯模型中时，抑郁症与过多的全因或心源性死亡率没有显著相关性。结论/解释：2型糖尿病患者的抑郁与并发症的发生率较高相关，但不是全因或心源性死亡率的独立预测因素。抑郁可能有助于糖尿病重要预后变量的进展，特别是大血管和微血管疾病。
Aims/hypothesis: Depression is associated with excess mortality in patients with type 2 diabetes. We investigated the impact, and possible causal mechanisms, of depression on all-cause and cardiac mortality in patients with type 2 diabetes. Methods We recruited 1,273 patients with type 2 diabetes from a postcode-defined community (average age 64.1 +/- 11.2 years, 48.7% males, median duration of diabetes 4 years [range 1.0-9.0]) and followed them for 7.8 +/- 2.4 years. Depression was assessed using data obtained using a quality-of-life questionnaire, and cause and date of death were obtained from the state registry. Results: Depression was present in 31.5% of subjects at recruitment. Depressed subjects had a longer duration of diabetes, more cardiovascular risk factors, CHD, cerebrovascular disease and diabetic microvascular complications at baseline, and higher all-cause and cardiac mortality rates during follow-up. In Cox proportional hazards models and after adjustment for demographic and diabetes-related variables and cardiovascular risk factors, depression was significantly associated with excess all-cause and cardiac mortality. When diabetic microvascular and macrovascular complications were added to the Cox models, depression was not significantly associated with excess all-cause or cardiac mortality. Conclusions/interpretation: Depression in patients with type 2 diabetes is associated with a greater prevalence of complications but is not an independent predictor of all-cause or cardiac mortality. Depression may contribute to the progression of important prognostic variables in diabetes, particularly macrovascular and microvascular disease.