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Depressive symptoms and glycated hemoglobin A1c: a reciprocal relationship in a prospective cohort study

Published online by Cambridge University Press:  01 December 2015

N. Schmitz ,
S. Deschênes ,
R. Burns  and
K. J. Smith
N. Schmitz*
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada Douglas Mental Health University Institute, Montreal, Quebec, Canada Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada Montreal Diabetes Research Centre, Montreal, Quebec, Canada
S. Deschênes
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada Douglas Mental Health University Institute, Montreal, Quebec, Canada
R. Burns
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada Douglas Mental Health University Institute, Montreal, Quebec, Canada
K. J. Smith
Affiliation:
Department of Life Sciences, Brunel University London, Uxbridge, Middlesex, UK
*
*Address for correspondence: N. Schmitz, PhD, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada. (Email: norbert.schmitz@mcgill.ca)
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Abstract

Background

The aim of this study was to evaluate the dynamic association between depressive symptoms and glycated hemoglobin A1c (HbA1c) levels using data from the English Longitudinal Study of Ageing (ELSA).

Method

The sample was comprised of 2886 participants aged ⩾50 years who participated in three clinical assessments over an 8-year period (21% with prediabetes and 7% with diabetes at baseline). Structural equation models were used to address reciprocal associations between depressive symptoms and HbA1c levels and to evaluate the mediating effects of lifestyle-related behaviors and cardiometabolic factors.

Results

We found a reciprocal association between depressive symptoms and HbA1c levels: depressive symptoms at one assessment point predicted HbA1c levels at the next assessment point (standardized β = 0.052) which in turn predicted depressive symptoms at the following assessment point (standardized β = 0.051). Mediation analysis suggested that both lifestyle-related behaviors and cardiometabolic factors might mediate the association between depressive symptoms and HbA1c levels: depressive symptoms at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted HbA1c levels 4 years later. A similar association was observed for the other direction: HbA1c levels at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted depressive symptoms 4 years later.

Conclusions

Our results suggest a dynamic relationship between depressive symptoms and HbA1c which might be mediated by both lifestyle and cardiometabolic factors. This has important implications for investigating the pathways which could link depressive symptoms and increased risk of diabetes.

Keywords

diabetesdepressive symptomsglycated hemoglobincommunity study
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 5 , April 2016 , pp. 945 - 955
Copyright
Copyright © Cambridge University Press 2015 

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