The Association Of Depression With Morbidity And Mortality Of Common Chronic Diseases Based On Prospective Cohorts

In the past few decades,the rapid development of economic,dramatic change of lifestyles,and acceleration of population aging have led to a surge in the number of people suffering from chronic non-communicable disease such as cardiovascular disease,diabetes and caner,leading to a huge social and economic burden.Various risk factors have been reported to be associated with the development and progression of those common chronic diseases.Among them,depression has received considerable attention recently.Depression has been a leading cause of disability adjusted life year(DALY)according to the Global Burden of Disease Study.Many studies have been conducted regarding the association between depression and multiple chronic diseases in western countries.However,the evidence is not conclusive due to the low quality,small sample size,and poor controlling of the confounding factors of some previous studies.Besides,there are limited high-quality studies in Chinese populations.Therefore,we aimed to explore the relations of depression with incidence of type 2 diabetes,all-cause mortality and cardiovascular disease mortality based on large,high-quality prospective Chinese cohorts and to provide evidence foundation for prevention and treatment of depression and these chronic diseases in China.Part 1: Association between depression and risk of type 2 diabetes: a large prospective cohort study in Chinese adultsObjective: Depression is a leading cause of disease burden worldwide,and associated with higher risk of incidence of type 2 diabetes(T2D)in western populations.We aimed to prospectively evaluate the association between depression and risk of T2 D in a Chinese population.Methods: We used data from the China Kadoorie Biobank study(2004-2013),in which 461213 participants free of diabetes,coronary heart disease,stroke,and cancer were followed from baseline(2004-2008)to December 31,2013.A modified Chinese version of Composite International Diagnostic Interview Short-Form(CIDI-SF)was used to assess past year depression.Participants who responded positive to depression screening questions but did not meet the diagnosis criteria were considered as having depressive symptoms only.Incident diabetes cases were identified through linkage with established regional disease registries and national health insurance databases.Cox proportional hazards regression model was used to calculate hazard ratio(HR)and 95% confidence interval(95% CI)for the association after adjusting for diabetes risk factors.Results: We documented 8784 incident type 2 diabetes cases during a follow-up of 3291908 person-years.We observed a higher incidence rate of type 2 diabetes in participants with depression(3.36 per 1000 person-years)than those without(2.66 per 1000 person-years),and the multivariable-adjusted HR was 1.31(95% CI 1.04-1.66).Compared with participants without depressive symptoms,the HR(95% CI)was 1.19(1.05-1.35)for participants with depressive symptoms only and 1.32(1.05-1.68)for those with depression.There was no significant change in the association between depression and type 2 diabetes after stratified analysis by age,gender,and BMI.In the sensitivity analyses,the association between depression and risk of type 2 diabetes was not materially changed after excluding incident diabetes cases diagnosed within the first two years of follow-up(HR 1.31,95% CI 1.02–1.70),or excluding participants with baseline psychiatric disorders(HR 1.32,95% CI 1.04–1.68),or additional exclusion of those with neurasthenia disorders(HR 1.27,95% CI 0.99–1.64).In addition,significant association was also found when including those with baseline history of cancer,coronary heart disease and stroke in the analysis(HR 1.34,95% CI 1.07–1.67).Conclusions: In our large prospective cohort study of Chinese adults,depression was significantly and independently associated with an increased risk of type 2 diabetes,and there might be a dose-response relation between depression severity and diabetes risk.Part 2: Association of depression with all-cause and cardiovascular disease mortality among adults in ChinaObjective: Depression is associated with increased disease burden worldwide and with higher risk of mortality in Western populations.To investigate whether depression is a risk factor for all-cause and cardiovascular mortality in adults in China.Methods: This cohort study prospectively followed adults aged 30 to 79 in China Kadoorie Biobank(CKB)study from June 1,2004 to December 31,2016,and adults aged 32 to 104 years in the Dongfeng-Tongji(DFTJ)study from September 31,2008 to December 31,2016.Depression was evaluated using the Chinese version of Composite International Diagnostic Interview Short-Form(CIDI-SF)in the CKB study and a 7-item symptoms questionnaire in the DFTJ study.Multivariable-adjusted Cox proportional hazards regression models were used to estimate hazard ratios(HRs)and 95% confidence intervals(CIs)for the association between depression and mortality.Covariates in the final models included sociodemographic charateristics,lifestyle fators,and personal and family medical history.Results: Among 512712 individuals(age,mean±SD,52.0±10.7 years;302509 [59.0%] women)in the CKB cohort,there were 44065 deaths,including 18273 CVD deaths.Among 26298 individuals(age,mean±SD,63.6±7.8 years;14508 [55.2%] women)in the DFTJ cohort,there were 2571 deaths,including 1013 CVD deaths.In the multivariate model,depression was associated with all-cause mortality(CK cohort: HR,1.32 [95% CI,1.20-1.46];P < 0.001;DFT: HR cohort,1.17 [95% CI,1.06-1.29];P = 0.002)and cardiovascular mortality(CKB cohort: HR,1.22 [95% CI,1.04-1.44];P =0.02;DFTJ cohort: HR,1.32 [95% CI,1.14-1.54];P < 0.001).In both cohorts,men had statistically significantly higher risk of all-cause mortality(CKB cohort: HR,1.53 [95% CI,1.32-1.76];DFTJ cohort: HR,1.24 [95% CI,1.10-1.41])and CVD mortality(CKB cohort: HR,1.39 [95% CI,1.10-1.76];DFTJ cohort: HR,1.49 [95% CI,1.23-1.80]),while the association of derprsssion with mortality among women was only significant for aii-cause mortality in the CKB cohort(HR,1.19 [95% CI,1.03-1.37]).Conclusions: These findings suggest that depression is associated with an increased risk of all-cause and CVD mortality in adults in China,particularly in men.These findings highlight the importance and urgency of depression management as a measure of preventing premature deaths in China.