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Epidemiology/Health services research
Diabetes mellitus is associated with a higher risk for major depressive disorder in women than in men
  1. Carola Deischinger1,
  2. Elma Dervic2,3,
  3. Michael Leutner1,
  4. Lana Kosi-Trebotic1,
  5. Peter Klimek2,3,
  6. Alexander Kautzky4,
  7. Alexandra Kautzky-Willer1,5
  1. 1Department of Medicine III, Endocrinology and Metabolism, Medical University of Vienna, Wien, Austria
  2. 2Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria
  3. 3Complexity Science Hub Vienna, Vienna, Austria
  4. 4Department of Psychiatry and Psychotherapy, Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
  5. 5Gender Institute, Gars am Kamp, Austria
  1. Correspondence to Dr Alexandra Kautzky-Willer; alexandra.kautzky-willer{at}meduniwien.ac.at

Abstract

Introduction Both diabetes mellitus and being female significantly increase the risk of being diagnosed with major depressive disorder (MDD). The diagnosis of MDD, combined with diabetes mellitus, can be detrimental in terms of mortality and morbidity. We aimed at investigating the impact of diabetes mellitus on the gender gap in MDD over the course of a human lifetime.

Research design and methods In a cross-sectional study over the course of 17 years, medical claims data of the general Austrian population (n=8 996 916) between 1997 and 2014 was analyzed. Of these, 123 232 patients with diabetes mellitus were extracted and compared with non-diabetic controls.

Results In a cohort of 123 232 patients with diabetes mellitus and 1 933 218 controls (52% females, 48% males), women with diabetes had 2.55 times increased ORs to be diagnosed with MDD compared with women without diabetes (95% CI 2.48 to 2.62, p<0.001) between the age of 30 and 69 years. The effect of diabetes mellitus on the prevalence of MDD was significantly smaller in men (OR=1.85, 95% CI 1.80 to 1.91, p<0.001). Between 0 and 30 years and after age 70 years, the gender gap of MDD was not different between patients with and without diabetes mellitus. The peak of the gender gap in MDD in patients with diabetes mellitus was around the age of 40–49 years. A sensitivity analysis identified overweight, obesity and alcohol dependence as the most potent influencing factors of the widening of the gender gap among patients with diabetes mellitus.

Conclusions Diabetes mellitus is a stronger risk factor for MDD in women than in men, with the greatest width of the gender gap between 40 and 49 years. High-risk patients for MDD, such as overweight female patients with diabetes, should be more carefully assessed and monitored.

  • diabetes mellitus
  • type 2
  • depression
  • sex characteristics
  • obesity
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2020-001430

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    Footnotes

    • CD and ED are joint first authors.

    • Contributors CD wrote the manuscript and researched data. ED researched data, compiled graphs and tables, reviewed/edited the manuscript. ML contributed to the methods and reviewed/edited the manuscript LK-T contributed to the discussion and reviewed the manuscript. PK researched data and reviewed/edited the manuscript. AK contributed to the discussion and reviewed/edited the manuscript AK-W contributed to the discussion and reviewed/edited the manuscript. AK-W is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding Funding was received from the WWTF – Vienna Science and Technology Fund (MA16-045).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The analysis is based on secondary use of a research database of medical claims records, which is safeguarded and maintained by the Austrian National Institute for Public Health (GÖG).This is a consolidated research database that is only accessible for selected partners under a strict data protection policy. Use of the data takes place in agreement and cooperation with the GÖG.