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The Cardiovascular Health Study

Mercedes R. Carnethon, PhD; Mary L. Biggs, MPH; Joshua I. Barzilay, MD; Nicholas L. Smith, PhD, MPH; Viola Vaccarino, MD, PhD; Alain G. Bertoni, MD, MPH; Alice Arnold, PhD; David Siscovick, MD

Arch Intern Med. 2007;167(8):802-807.

Background  Prospective studies indicate that a single self-report of high depressive symptoms is associated with an increased risk of developing type 2 diabetes mellitus.

Methods  We tested whether a single report of high depressive symptoms, an increase in depressive symptoms, or persistently high depressive symptoms over time were associated with the development of diabetes in adults 65 years and older. Participants from the Cardiovascular Health Study completed the 10-item Center for Epidemiological Studies–Depression Scale (CES-D) annually from 1989 to 1999. A single report of high depressive symptoms (CES-D score, 8), an increase in symptoms during follow-up (5 from baseline), and persistently high symptoms (2 consecutive scores 8) were each studied in relation to incident diabetes, defined by initiation of diabetes control medications among participants who were free from diabetes at baseline (n = 4681).

Results  The mean CES-D score at baseline was 4.5 (SD, 4.5). The incidence rate of diabetes was 4.4 per 1000 person-years. Following adjustment for baseline demographic characteristics and measures of physical activity, smoking, alcohol intake, body mass index, and C-reactive protein during follow-up, each measure of depressive symptoms was significantly associated with incident diabetes (high baseline CES-D score: hazard ratio, 1.6 [95% confidence interval, 1.1-2.3]; CES-D score increase: hazard ratio, 1.5 [95% confidence interval, 1.1-2.2]; and persistently high symptoms: hazard ratio, 1.5 [95% confidence interval, 1.1-2.3]).

Conclusion  Older adults who reported higher depressive symptoms were more likely to develop diabetes than their counterparts; this association was not fully explained by risk factors for diabetes.

Author Affiliations: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Dr Carnethon); Departments of Biostatistics (Ms Biggs and Dr Arnold) and Epidemiology (Dr Smith), School of Public Health and Community Medicine, Cardiovascular Health Research Unit (Drs Smith and Siscovick) and Collaborative Studies Coordinating Center (Dr Siscovick), University of Washington, Seattle; Kaiser Permanente of Georgia (Dr Barzilay), and Divisions of Endocrinology (Dr Barzilay) and Cardiology (Dr Vaccarino), Department of Medicine, Emory University School of Medicine, Atlanta; and Departments of Epidemiology and Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Bertoni).

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