December 3, 2008

Depression and anxiety are tied to diabetes around the globe

Group Health researchers find link in part of WHO World Mental Health Survey

Seattle—All over the world, people with diabetes are more likely to have depression or anxiety than are others. This is according to the first large-scale population-based assessment of common mental disorders with diabetes.

The December 2008 issue of the Journal of Psychosomatic Research is publishing an article reporting this finding. It is part of the World Health Organization (WHO) World Mental Health Survey. More than 85,000 adults in households in 17 nations gave face-to-face interviews in the rigorous, standardized Survey. The first authors in the international team that wrote this article were Elizabeth Lin, MD, MPH, a family practice doctor at Group Health who is also an affiliate investigator at Group Health Center for Health Studies; and Michael Von Korff, ScD, a senior investigator at Group Health Center for Health Studies.

"What surprised us was how diabetes was linked to these mental health problems across such a diverse range of developed and developing countries," said Lin. "The burden of the combination of diabetes and depression or anxiety can be poignant," she added, "with patients feeling helpless and hopeless."

The researchers found that people with diabetes tended to be about 40 percent more likely to have depression and about 30 percent more likely to have some form of anxiety. These percentages were lower than those reported before for some patients. "But we expected that," she said, "because this community-based population is probably less sick on average than are people who have all sought medical care for diabetes, mental health problems, or both."

With age, mood disorders tend to become less common, while diabetes type 2 becomes more common, Lin said. That is why the research team adjusted their results for age, which varied across the countries surveyed. Across the Americas, Europe, Africa, Asia, the Middle East, and the South Pacific, findings varied only as much as would be expected by chance variation.

WHO World Mental Health Survey leaders chose Group Health researchers for this work because they’ve long studied mental and physical conditions occurring together in Group Health patients, including depression, diabetes, obesity, and chronic pain. One of their ongoing studies is trying new ways to integrate medical and psychological care with social and behavioral interventions for Group Health patients who have the "double whammy" of diabetes and depression.

Which comes first: Diabetes? Or depression or anxiety? That’s not even the right question, according to Von Korff, because it falsely splits body from mind. "Although the relationship probably goes both ways, we think chronic physical and mental health problems are intertwined," he said. "They seem to influence each other continually."

As part of the U.S. National Comorbidity Survey Replication, this study was supported by the National Institute of Mental Health, with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation, and the John W. Alden Trust. The WHO World Mental Health Survey received support from a variety of sources.

Group Health Center for Health Studies
Group Health Research Institute does practical research that helps people like you and your family stay healthy. The Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Since 1983, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.