Risk of mortality and complications in people with depressive disorder and co-occurring diabetes mellitus: a systematic review and meta-analysis
4 affiliations
- 1Department of Psychiatry, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong
- 2Department of Psychiatry, United Christian Hospital, Hong Kong
- 3Department of Psychiatry, The University of Hong Kong, Hong Kong
- 4Department of Psychiatry, Queen Mary Hospital, Hong Kong
Abstract
Aims: People with depressive disorder have increased premature mortality and higher rates of diabetes mellitus than general population. Evidence shows that diabetes may further increase their risk of premature death from diabetes-related complications, especially cardiovascular diseases (CVDs). Earlier studies examining depression-associated outcomes in diabetes patients have shown mixed results and were hindered by important limitations, especially the use of self-reported questionnaires to ascertain depression, causing misclassification bias by identifying subclinical symptoms or diabetes distress. Associations of depression with specific diabetes complications have not been systematically evaluated. This meta-analysis aimed to investigate the risk of mortality and complications among patients with depression and co-occurring diabetes (depression-diabetes group) relative to patients with diabetes-only (diabetes-only group), on their all-cause mortality rates, and if applicable cause-specific mortality rates, and occurrence of specific diabetes complications.
Methods: We systematically reviewed and quantitatively synthesized diabetes-related outcomes in patients with depression by searching Embase, MEDLINE, PsycInfo and Web-of-Science from inception to 20 December 2024, and included studies that examined mortality and complication outcomes in depression-diabetes group relative to diabetes-only group. Results were synthesized by random-effects meta-analytic models, with stratified-analyses (subgroup analyses and meta-regression) by study-level characteristics, including age, gender, study period, geographic region, follow-up duration and nature of diabetes sample. The study was registered with PROSPERO (CRD42024595145).
Results: Twenty-six studies were identified from nine geographic regions. Regarding mortality risk, depression-diabetes group exhibited increased risks of all-cause mortality (RR = 1.30 [95% CI: 1.21–1.39]) and CVD-specific mortality (1.15 [1.02–1.29]) relative to diabetes-only group. Regarding complication risk, depression-diabetes group showed increased risk of complications (1.28 [1.18–1.40]) relative to diabetes-only group, especially in incident-diabetes sample signifying advanced disease stage upon presentation, with stratified-analyses showing higher risk of metabolic complications (1.63 [1.33–1.99]) and cardiovascular complications (1.20 [1.11–1.29]), and lower likelihood of retinopathy (0.84 [0.76–0.94]), albeit comparable rates of cerebrovascular complications (1.36 [0.99–1.87]), nephropathy (1.09 [0.93–1.27]) and peripheral-vascular complications (0.97 [0.79–1.18]). Both overall mortality and complication risks were present in various regions and persisted over time. Heterogeneities were noted and could not be entirely explained by stratified analyses.
Conclusions: Our study demonstrated that patients with depression and co-occurring diabetes were associated with elevated overall mortality risk and complication risk (particularly metabolic and cardiovascular-complications) than non-depressed counterparts, suggesting an overall poorer glycemic control that might eventually drive their earlier death. Comprehensive and multipronged interventions are needed for individualized risk estimation of diabetes-related outcomes, with consequent early interventions to minimize the avoidable physical morbidity and premature mortality in this vulnerable population.
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BibTeX
@article{ho2026risk,
title = {{Risk of mortality and complications in people with depressive disorder and co-occurring diabetes mellitus: a systematic review and meta-analysis}},
author = {Matthew Tsz Ho Ho and Kwun Nam Chan and Will Chi Yuen Chiu and Lucy Lo Wah Tsang and Heidi Ka Ying Lo and Steven Yiu Long Wong and Kenneth Shut Wah Chan and Mimi Mei Cheung Wong and Ho Hon Wong and Wai Chung Lam and Pui Fai Pang and Wing Chung Chang},
journal = {Epidemiology and Psychiatric Sciences},
year = {2026},
month = sep,
doi = {10.1017/s2045796026100882},
url = {https://doi.org/10.1017/s2045796026100882},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Risk of mortality and complications in people with depressive disorder and co-occurring diabetes mellitus: a systematic review and meta-analysis
AU - Matthew Tsz Ho Ho
AU - Kwun Nam Chan
AU - Will Chi Yuen Chiu
AU - Lucy Lo Wah Tsang
AU - Heidi Ka Ying Lo
AU - Steven Yiu Long Wong
AU - Kenneth Shut Wah Chan
AU - Mimi Mei Cheung Wong
AU - Ho Hon Wong
AU - Wai Chung Lam
AU - Pui Fai Pang
AU - Wing Chung Chang
PY - 2026
DA - 2026/09/04
JO - Epidemiology and Psychiatric Sciences
DO - 10.1017/s2045796026100882
UR - https://doi.org/10.1017/s2045796026100882
AB - Aims: People with depressive disorder have increased premature mortality and higher rates of diabetes mellitus than general population. Evidence shows that diabetes may further increase their risk of premature death from diabetes-related complications, especially cardiovascular diseases (CVDs). Earlier studies examining depression-associated outcomes in diabetes patients have shown mixed results and were hindered by important limitations, especially the use of self-reported questionnaires to ascertain depression, causing misclassification bias by identifying subclinical symptoms or diabetes distress. Associations of depression with specific diabetes complications have not been systematically evaluated. This meta-analysis aimed to investigate the risk of mortality and complications among patients with depression and co-occurring diabetes (depression-diabetes group) relative to patients with diabetes-only (diabetes-only group), on their all-cause mortality rates, and if applicable cause-specific mortality rates, and occurrence of specific diabetes complications. Methods: We systematically reviewed and quantitatively synthesized diabetes-related outcomes in patients with depression by searching Embase, MEDLINE, PsycInfo and Web-of-Science from inception to 20 December 2024, and included studies that examined mortality and complication outcomes in depression-diabetes group relative to diabetes-only group. Results were synthesized by random-effects meta-analytic models, with stratified-analyses (subgroup analyses and meta-regression) by study-level characteristics, including age, gender, study period, geographic region, follow-up duration and nature of diabetes sample. The study was registered with PROSPERO (CRD42024595145). Results: Twenty-six studies were identified from nine geographic regions. Regarding mortality risk, depression-diabetes group exhibited increased risks of all-cause mortality (RR = 1.30 [95% CI: 1.21–1.39]) and CVD-specific mortality (1.15 [1.02–1.29]) relative to diabetes-only group. Regarding complication risk, depression-diabetes group showed increased risk of complications (1.28 [1.18–1.40]) relative to diabetes-only group, especially in incident-diabetes sample signifying advanced disease stage upon presentation, with stratified-analyses showing higher risk of metabolic complications (1.63 [1.33–1.99]) and cardiovascular complications (1.20 [1.11–1.29]), and lower likelihood of retinopathy (0.84 [0.76–0.94]), albeit comparable rates of cerebrovascular complications (1.36 [0.99–1.87]), nephropathy (1.09 [0.93–1.27]) and peripheral-vascular complications (0.97 [0.79–1.18]). Both overall mortality and complication risks were present in various regions and persisted over time. Heterogeneities were noted and could not be entirely explained by stratified analyses. Conclusions: Our study demonstrated that patients with depression and co-occurring diabetes were associated with elevated overall mortality risk and complication risk (particularly metabolic and cardiovascular-complications) than non-depressed counterparts, suggesting an overall poorer glycemic control that might eventually drive their earlier death. Comprehensive and multipronged interventions are needed for individualized risk estimation of diabetes-related outcomes, with consequent early interventions to minimize the avoidable physical morbidity and premature mortality in this vulnerable population.
SN - 2045-7960
SN - 2045-7979
ER -