Contributions of major diabetes complications to depression onset in elderly patients with diabetes: An 8-year population-based follow-up study

Objectives: To prospectively examine the roles of major diabetes complications in the causation of depression in Taiwan's elderly diabetic population. Methods: A representative sample of elderly diabetic patients (n=160,348) recruited in 2000 were linked to National Health Insurance claims (2000-2007) to identify the episode of primary or secondary diagnoses of depression in both outpatient and inpatient settings. The person-year approach with Poisson assumption was used to estimate the hazard rates. Using Cox proportional hazard regression model, we evaluated the relative risk of depression in relation to selected diabetes complications. The additive effects from major diabetes complications on risk of depression in elderly diabetes were also assessed. Results: The 8-year cumulative risk of depression was 2.48%, representing an incidence density of 4.93 per 1000 patient-years. Hazard ratio (HR) with 95% confidence interval (CI) for the elderly diabetes with lower extremity amputation, hip fracture, and cardiovascular disease were 1.44 (1.01-2.08), 1.33 (1.03-1.71), and 1.20 (1.06-1.35), respectively, and all significantly associated with increased risk of depression. Additionally, we found that the more the complications, the higher the risk of depression onset in elderly diabetes. Conclusion: Major diabetes complications are associated with an increased risk of depression. Further research is needed to look into interventions that can effectively modify the adverse effects from diabetes complications. Additionally, elderly diabetes with major complications should be intensively screened for depression.