Common mental disorders associated with 2-year diabetes incidence: The Netherlands Study of Depression and Anxiety (NESDA)

doi:10.1016/S0165-0327(12)70006-X

Journal of Affective Disorders

Volume 142, Supplement, October 2012, Pages S30-S35

https://doi.org/10.1016/S0165-0327(12)70006-X Get rights and content

Abstract

Background

Few prospective cohort studies describe the risk of type 2 diabetes mellitus associated with depression or anxiety. The aim of this study was to determine the 2-year diabetes incidence and pattern of explanatory factors associated with depressive and/or anxiety disorders.

Methods

A prospective cohort of 2981 participants (aged 18–65 years, 66% women) recruited in the Netherlands Study of Depression and Anxiety (NESDA) from community, primary care and outpatient psychiatric clinics were followed-up for two years. Complete data were analyzed from 2460 participants without baseline diabetes. Lifetime or current (past 6-month) depressive and/or anxiety disorders at baseline were assessed using the Composite Interview Diagnostic Instrument (CIDI) and classified by the DSM-IV. Diabetes was classified by either self-report, medications, or fasting plasma glucose ≥ 7.0mmol/L. Baseline covariates included age, gender, lifestyle factors, and medical conditions. Odds ratios (OR [95% confidence intervals]) for diabetes were determined using exact logistic regression.

Results

The unadjusted 2-year diabetes incidence was 0.2% (1/571), 1.1% (6/548), and 1.8% (24/1340) for no, remitted, and current depressive and/or anxiety disorders, respectively. In comparison to those without psychopathology, current depressive and/or anxiety disorders was associated with diabetes incidence in unadjusted (OR 10.4 [1.7, 429.0]) and age-adjusted (OR 11.9 (1.9, 423.0]) analyses. The strength of this association (beta coefficient) was slightly changed after further adjustments for impaired fasting glucose (11.4%), high triglycerides (–7.8%), and lifestyle cumulative risk score (–5.0%), in contrast to other covariates when assessed in separate models.

Limitations

The low incidence of diabetes resulted in considerable uncertainty for the odds ratios and low statistical power that limited covariate adjustments.

Conclusions

The relative odds of developing diabetes within two years was increased for persons with current depressive and/or anxiety disorders, which was partially explained by, but remained independent of, lifestyle cumulative risk factors.

Introduction

Diabetes mellitus leads to excess economic costs (American Diabetes Association, 2008) and cardiovascular disease (CVD) mortality (Barr et al., 2007). Global prevalence estimates (International Diabetes Federation, 2011), incidence (Magliano et al., 2008) and population trends data (Atlantis et al., 2009; Cowie et al., 2009) suggest that over 10% of adults in many countries may now be affected by diabetes. Existing epidemiological studies suggest that the health and economic burden of diabetes falls disproportionately on persons with common mental disorders, depression or anxiety.

Clinically significant depression (defined by diagnostic interview or elevated symptoms) is consistently associated with an increased diabetes prevalence (Ali et al., 2006) and incidence (Atlantis et al., 2010; Mezuk et al., 2008). Major depressive disorder is often comorbid with anxiety disorders including panic disorder, social phobia, and generalized anxiety disorder (Licht et al., 2008). Clinically significant depression and/or anxiety share several lifestyle risk factors (e.g. smoking, physical inactivity, obesity, and excessive alcohol drinking (Atlantis et al., 2011; Bonnet et al., 2005; Strine et al., 2008), and often coexist with medical conditions (e.g. hypertriglyceridaemia and hypertension (Atlantis et al., 2011; Grimsrud et al., 2009) associated with diabetes (Atlantis et al., 2009; Magliano et al., 2008; Pietraszek et al., 2010). These factors might partially explain how common mental disorders increase the risk of diabetes. Although previous studies have shown an association between anxiety disorders and increased diabetes prevalence (Grigsby et al., 2002), the existing evidence from prospective cohort studies on diabetes incidence associated with clinically significant anxiety is both insufficient and equivocal (Engum, 2007; Eriksson et al., 2008; Kahn et al., 1971). There are no published cohort studies on the risk of diabetes associated with anxiety disorders defined by diagnostic interview, to our knowledge. Whether an increased risk of diabetes associated with either depressive or anxiety disorders is due to their comorbidity is also unknown. We therefore determined the 2-year diabetes incidence and pattern of explanatory factors (lifestyle and medical conditions) associated with depressive and/or anxiety disorders in a large prospective cohort of Dutch adults.

Section snippets

Study cohort

The information source for this report includes the baseline and 2-year follow-up data collections for the Netherlands Study of Depression and Anxiety (NESDA), which is an ongoing prospective cohort study on the prevalence and course of depressive and anxiety disorders. Participants were 2981 men and women, aged 18 to 65 years at the baseline assessment conducted between 2004 and 2007, recruited from community, primary care and outpatient psychiatric clinics. The NESDA sample included 2329

Results

Of the original baseline cohort of 2981 respondents, 13% (n = 385) were lost at the 2-year follow-up. Of the remaining cohort, 136 participants with baseline diabetes were excluded, and longitudinal data were available for 2460 participants. The group lost at follow-up had higher rates of current depressive and/or anxiety disorders (74.7% vs. 54.5%), impaired fasting glucose (21.7% vs. 16.5%), current smoking (51.8% vs. 36.7%), low physical activity (32.3% vs. 21.2%), and cardiovascular

Discussion

Results of this large prospective cohort study show that persons with current depressive and/or anxiety disorders at baseline had a ∼10-fold increased odds of diabetes incidence at 2-years in comparison to those without either of these disorders. This association increased in strength after further adjustment for age, and was partially explained (decreased) by lifestyle cumulative risk score. The strength of this association was also changed after further adjustments for impaired fasting

Limitations

The results reported here should be balanced against several study limitations that need to be addressed in future investigations. First, the overall incidence of diabetes was rather low, and seemed to be slightly lower than that of other nationally representative cohort studies (Magliano et al., 2008), which would have inflated the estimate of effect. This potential limitation is attenuated somewhat because of similarities between groups for characteristics including impaired fasting glucose,

Conclusions

In summary, the relative odds of developing diabetes within two years was increased for persons with current depressive and/or anxiety disorders in comparison to those without either of these disorders. Future studies should determine the reproducibility of our results in other countries. Persons with common mental disorders should be assessed for lifestyle cumulative risk factors in addition to other well-established medical risk factors for diabetes. Clinical trials are needed to determine

Conflict of interest

There are no conflicts of interest to disclose. Study sponsors had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Acknowledgement

The infrastructure for the NESDA study (www.nesda.nl) is funded through the Geestkracht program of the Netherlands Organisation for Health Research and Development (Zon-Mw, grant number 10-000-1002) and is supported by participating universities and mental health care organizations (VU University Medical Center, GGZ inGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Institute for Quality of Health Care

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The present study aimed to examine the association between a subtype of depression that was characterized by comorbid anxiety symptoms and the risk of T2D in a large prospective cohort study of Dutch adults. Prior studies have indicated that MDD or elevated depressive symptoms and anxiety disorders or elevated anxiety symptoms are independently associated with an increased risk of T2D (Atlantis et al., 2012; Boyko et al., 2013; Chien and Lin, 2016; Deschenes et al., 2016; Khambaty et al., 2017; Knol et al., 2006; Mezuk et al., 2008; Rotella and Mannucci, 2013; Smith et al., 2018). We found that when comorbidity between depressive and anxiety symptoms was considered, only those with comorbid depressive and anxiety symptoms had a significantly increased risk of T2D compared to those without depressive or anxiety symptoms, with an approximately twofold increased risk of T2D.
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1,096 participants developed diabetes. Compared to those without depressive or anxiety symptoms (n = 74,467), those with comorbid depressive and anxiety symptoms (n = 743) were more likely to develop T2D (n = 28, OR = 2.12, 95% CI = 1.22–3.68). Depressive symptoms alone (n = 650) and anxiety symptoms alone (n = 2,165) were not significantly associated with T2D (n = 23 and n = 24, respectively, developed diabetes). Those with comorbid symptoms were also more likely to develop T2D compared to those with depressive symptoms alone (OR = 2.86, 95% CI = 1.25–6.54).
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Common mental disorders associated with 2-year diabetes incidence: The Netherlands Study of Depression and Anxiety (NESDA)

Abstract

Background

Methods

Results

Limitations

Conclusions

Introduction

Section snippets

Study cohort

Results

Discussion

Limitations

Conclusions

Conflict of interest

Acknowledgement

Atherosclerosis

J. Psychosom. Res.

J. Psychosom. Res.

The Israel Ischemic Heart Disease Study. J. Chronic Dis.

A review. Nutr. Metab. Cardiovasc. Dis.

Gen. Hosp. Psychiatry

J. Affect. Disord.

J. Psychiatr. Res.

International Diabetes Federation: a consensus on Type 2 diabetes prevention

Diabet. Med.

The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis

Diabet. Med.

Economic Costs of Diabetes in the U.S. in 2007

Diabetes Care

Diagnosis and classification of diabetes mellitus

Diabetes Care

Diagnostic and Statistical Manual of Mental Disorders

Chronic disease trends due to excess body weight in Australia

Obes. Rev.

Diabetes incidence associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA)

Int. J. Geriatr. Psychiatry

Specific medical conditions associated with clinically significant depressive symptoms in men

Soc. Psychiatry Psychiatr. Epidemiol.

Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab)

Circulation