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Depressive Symptoms, Antidepressant Use, and Risk of Diabetes in African-American Women

Use of antidepressants was associated with a 26% higher risk of diabetes…. 

The number of African American women with type 2 diabetes is two times more than that of white women, and approximately 40% more than that of African American men. Some factors associated with the high risk of diabetes in African American women include obesity and depression. Even though previous studies reveal a strong association between depressive symptoms and diabetes risk, the association between antidepressant use and incident diabetes among African American women remains unknown.

To investigate the relationship between depressive symptoms, antidepressant use, and the incidence of diabetes in African American women, Dr. Varsha Vimalananda from Boston University School of Medicine and her colleagues conducted a prospective cohort study involving 35,898 women from 1999 to 2011 who had not been diagnosed with diabetes and who had completed the Center for Epidemiologic Studies Depression Scale (CES-D) in 1999. CES-D scores were divided into four levels according to increased number of depressive symptoms: <16, 16-22, 23-32, and ≥33. Antidepressant medication use was ascertained by questionnaires, and validation of self-reported diabetes was randomly confirmed using medical records. Incidence rate ratios (IRRs) and 95%CIs were calculated using age- and time-stratified Cox proportional hazards regression model.

After 12 years of follow up, 3,372 incident diabetes cases had been documented. Compared to CES-D scores <16, IRRS (95%CIs) of incident diabetes for CES-S 16-22, 23-32 and ≥33 were 1.23 (1.12-1.35), 1.26 (1.12-1.41) and 1.45 (1.24-1.69). There was a strong positive relationship between the number of depressive symptoms and the risk of type 2 diabetes. This relationship was partially influenced by demographic factors, lifestyle factors and BMI of the women. After adjusting for lifestyle factors and BMI, the IRRs for diabetes for CES-D 16-22, 23-32 an ≥33 were lightly decreased to 1.11 (1.01-1.22), 1.08 (0.96-1.22), and 1.22 (1.04-1.43). In addition, the use of antidepressant medication was found to be highly associated with the number of diabetes incidence regardless of the level of depressive symptoms. "In the final multivariate model, use of antidepressants was associated with a 26% higher risk of diabetes."

Compared to other studies, this study has several strengths which included the large sample size, the long term and high rate of follow up, and information on other important risk factors for diabetes.

Practice Pearls:
  • There is a correlation between antidepressant use and the risk of diabetes in African American women.
  • The risk of diabetes tends to be higher with increased number of depressive symptoms.
  • The risk of diabetes is also associated with lifestyle and BMI.

Vimalananda V, Palmer J, Gerlovin H, et al. Depressive Symptoms, Antidepressant Use, and the Incidence of Diabetes in the Black Women"s Health Study. Diabetes Care 2014; 37:2211-2217.