Depression is a major risk factor for cardiovascular diseases. According to Yusuf and colleages, psychosocial factors are the stronger riskfactors for incident of myocardial infarction than diabetes, smoking, hypertension,and obesity (Yusuf, Hawken et al. 2004). Depression is not only an important risk factor for developing coronary heart disease not only in healthy patients, but also for recurrent events in patients with previous coronary heart disease and for adverse outcomes following heart surgery (Whooley, de Jonge et al. 2008).
Deperssion is also a risk factor for diabetes. Several studies showed that depression increases risk of diabetes signficantly with a relative risk ranging from 1.23 to 2.3 (Eaton 2002). Mezuk et al. (2008) conducted a meta-analysis of the association between diabetes and depression and reported a relative risk of 1.60 for incidence of diabetes associated with baseline depression (Mezuk, Eaton et al. 2008).The life time risk of depression among patients with diabetes is 2-3 times higher than the life time risk of depression in the general population . In the Medicaid population the rates of depression were higher among people with diabetes (10%) than among people without diabetes (7%).
Depression increases the risk of low adherence to self-care regimens, such as glucose monitoring, diet, exercise regimens and taking medications as prescribed. Lin et al. (2004) showed that diabetic patients with depression has a 19.5% nonadherence rate to oral hypoglycemic medicines.
Depression also increases the risk of obesity and smoking. Depression also has been shown to affect various biochemical pathways which adversely affect diabetes. Depression in diabetic patients also increases the risk of cardiovascular diseases and all-cause mortality. Katon et al. (2008) showed that patients with depression compared to those without depression had an approximately 36% increased risk of death in the 2-years after screening for depression.
Deperssion is also a strong risk factor for suicide. Patients with major depressive disorder are 20 times more likely to commit suicide than in the general population.
Overall, depression increases risk of dying with a relative risk range from 1.6 to 2.0. Most of the increase in all-cause mortality in patients with MDD can be attributed to suicide and cardiovascular deaths.
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