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 The worst outcomes may result when people with diabetes suffer from
both stress and depression at the same time, the study found. This
trifecta of health problems was linked to more than double the risk
of death from heart disease faced by people without any of these
medical issues.
“Our study is one of the first to show a pattern of increased
likelihood of adverse cardiovascular outcomes in those with diabetes
compared to those without diabetes – first with increased likelihood
for either (stress or depression) alone, and then an even higher
likelihood when both behavioral co-morbidities were reported,” lead
study author Doyle Cummings of East Carolina University Brody School
of Medicine, said by email.
To assess the impact of these mental health problems on heart
disease and stroke risk, Cummings and colleagues reviewed data on
nearly 22,000 adults including close to 4,100 with diabetes.
People in the study were 64 years old on average, 58 percent of them
were female, 42 percent were black, and 56 percent lived in the
southeastern U.S. region known as the “Stroke Belt” for its high
prevalence of these cardiovascular events.
At the start of the study, roughly 19 percent of participants had
diabetes, while 10 percent reported increased depressive symptoms
and 28 percent reported elevated stress.
Among subjects with diabetes, those reporting heightened stress or
depression – or both – were more likely to be women, black, poor,
and live in the Stroke Belt.
For people with diabetes, having either stress or depression
increased their risk of death from cardiovascular disease by 53
percent, compared with diabetics without these mental health
problems. Diabetics with both stress and depression had more than
double the death risk.
For those without diabetes in the study, there was a trend toward a
greater risk of death from cardiovascular disease when they had
stress or depression but the difference between people with and
without these problems wasn’t big enough to rule out the possibility
that it was due to chance.
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The study wasn’t designed to prove that stress or depression cause
strokes or death from cardiovascular disease.
Other limitations of the study include a lack of data on how long
people had diabetes, which can influence cardiovascular risk, and
the potential that certain factors not measured in the study might
have influenced deaths, the authors concede in Diabetes Care.
Even so, the findings point to the need for more clinicians to
screen for depression and stress in primary care settings, where
most people with diabetes receive care, Cummings said.
“In our culture, it’s easy to be sidetracked by all the other things
that we commonly think about checking when someone has diabetes,
such as monitoring their blood sugars daily and taking medications,
and watching for things like high blood pressure, foot sores,
cholesterol, and kidney problems,” said Dr. Erik Vanderlip of the
University of Oklahoma School of Community Medicine.
“We often forget to think about depression and stress as
independently contributing to heart disease through mechanisms which
we haven’t yet fully figured out,” Vanderlip, who wasn’t involved in
the study, said by email. “So we rarely screen for it, or diagnose
it, despite having treatments that can change it over time.”
SOURCE: http://bit.ly/1RtVR2P Diabetes Care, online November 17,
2015.
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