Diabetes and ischemic heart disease: double jeopardy with regard to depressive mood and reduced quality of life.

Natasha Bergmann,Søren Ballegaard,Åke Hjalmarson,Per Bech,Finn Gyntelberg,Pernille Holmager,Jens Faber

doi:10.1530/ec-14-0083

Abstract

The aim of this study was to test i) whether patients having diabetes and ischemic heart disease (IHD), i.e., patients suffering from two chronic diseases, demonstrate a higher degree of chronic stress when compared with patients suffering from IHD alone, and ii) whether suffering from the two chronic diseases results in an elevation in specific elements of the chronic stress concept. A total of 361 participants with IHD were included, of whom 47 suffered from concomitant diabetes. Stress was measured by pressure pain sensitivity (PPS) and by the following questionnaires: the Major Depression Inventory (MDI), the SF-36 Quality of Life questionnaire (SF-36 QOL), the WHO-5 Well-being Index, and the clinical stress signs (CSSs) scale. Participants with diabetes and IHD had a higher MDI score, a lower SF-36 physical component summary score, and a lower score of several sub-measurements of the SF-36 mental component score when compared with patients with IHD without diabetes. No significant differences were observed regarding stress measured by the PPS measure, the WHO-5 Well-being Index, or the number of CSSs. In conclusion, the combination of diabetes and IHD seems to be associated with increased depressive symptoms, lower overall physical QOL, and reduced mental QOL on several sub-elements of the questionnaire. This should be recognized in the management of patients with double diagnoses.

Highlights

The risk of depression in people with diabetes is two times higher when compared with patients without diabetes, and major depression and elevated depressive symptoms have been found to be present in 11 and 31%, respectively, of individuals suffering from diabetes [1]
This study demonstrates that the combination of diabetes and chronic and stable ischemic heart disease (IHD) seems to be associated with increased depressive symptoms, lower overall physical quality of life (QOL), and reduced mental QOL on several sub-elements of the questionnaire when compared with patients with IHD not suffering from known diabetes
Participants with IHD of this study had a mean Major Depression Inventory (MDI) of 8.0 and participants with both diabetes and IHD an MDI of 11, suggesting a rather large increase in depressive symptoms in patients suffering from both chronic diseases

Summary

Introduction

The risk of depression in people with diabetes is two times higher when compared with patients without diabetes, and major depression and elevated depressive symptoms have been found to be present in 11 and 31%, respectively, of individuals suffering from diabetes [1]. 3 : 157 with stable coronary artery disease have depressive symptoms (Patient Health Questionnaire R10) [3]. Psychosocial stress is increased both in patients with diabetes and in patients with ischemic heart disease (IHD), and stress is generally accepted to be a risk factor for a poor outcome in both patient groups [4, 5, 6]. The combination of suffering from both diabetes and IHD is very common as the presence of diabetes doubles the ageadjusted risk for cardiovascular disease in men and triples it in women [7]. The psychological impact of suffering from both chronic diseases simultaneously still needs to be evaluated

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Conclusion