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Multicenter Study
. 2011 Mar-Apr;52(2):117-26.
doi: 10.1016/j.psym.2010.12.020.

The association of comorbid depression with intensive care unit admission in patients with diabetes: a prospective cohort study

Dimitry S Davydow  1 , Joan E Russo, Evette Ludman, Paul Ciechanowski, Elizabeth H B Lin, Michael Von Korff, Malia Oliver, Wayne J Katon
Affiliations
Multicenter Study

The association of comorbid depression with intensive care unit admission in patients with diabetes: a prospective cohort study

Dimitry S Davydow et al. Psychosomatics. 2011 Mar-Apr.

Abstract

Background: It is unknown if comorbid depression in patients with diabetes mellitus increases the risk of intensive care unit (ICU) admission.

Objective: This study examined whether comorbid depression in patients with diabetes increased risk of ICU admission, coronary care unit (CCU) admission, and general medical-surgical unit hospitalization, as well as total days hospitalized, after controlling for demographics, clinical characteristics, and health risk behaviors.

Method: This prospective cohort study included 3,596 patients with diabetes enrolled in the Pathways Epidemiologic Follow-Up Study. We assessed baseline depression with the Patient Health Questionnaire-9. We controlled for baseline demographics, smoking, BMI, exercise, hemoglobin A(1c), medical comorbidities, diabetes complications, type 1 diabetes, diabetes duration, and insulin treatment. We assessed time to any ICU, CCU, and/or general medical-surgical unit admission using Cox proportional-hazards regression. We used Poisson regression with robust standard errors to examine associations between depression and total days hospitalized.

Results: Unadjusted analyses revealed that baseline probable major depression was associated with increased risk of ICU admission [hazard ratio (HR) 1.94, 95% confidence interval (95% CI)(1.34-2.81)], but was not associated with CCU or general medical-surgical unit admission. Fully adjusted analyses revealed probable major depression remained associated with increased risk of ICU admission [HR 2.23, 95% CI(1.45-3.45)]. Probable major depression was also associated with more total days hospitalized (Incremental Relative Risk 1.64, 95%CI(1.26-2.12)).

Conclusions: Patients with diabetes and comorbid depression have a greater risk of ICU admission. Improving depression treatment in patients with diabetes could potentially prevent hospitalizations for critical illnesses and lower healthcare costs.

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Conflict of interest statement

Potential Conflicts of Interest: Dr. Katon has received honorariums for lectures from Wyeth, Eli Lilly, Forest, and Pfizer pharmaceutical companies and serves on the Advisory Board for Eli Lilly and Wyeth. Dr. Von Korff has received grant funding from Johnson & Johnson. Dr. Ciechanowski is CEO and founder of Same Page, Inc., a consulting company providing services for improving patient-provider relationships. Dr. Lin has received honorariums from Health Star Communications and Prescott Medical. Drs. Davydow, Russo, and Ludman, and Ms. Oliver, have no potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Recruitment of epidemiologic cohort study to assess hospitalizations
Figure 2
Figure 2
Time to first intensive care unit admission for Pathways epidemiologic cohort by depression group Abbreviations: ICU = intensive care unit.
See this image and copyright information in PMC

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