---
title: "Depression plus Diabetes: Increased Mortality and Complication Risks — Systematic Review and Meta-"
id: "pubmed-42693777"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42693777"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42693777/"
doi: "10.1017/S2045796026100882"
published_at: "2026-09-04T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Depression plus Diabetes: Increased Mortality and Complication Risks — Systematic Review and Meta-
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42693777
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42693777/)
- **DOI:** [10.1017/S2045796026100882](https://doi.org/10.1017%2FS2045796026100882)
- **Published At:** 2026-09-04T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This systematic review and meta-analysis pooled data from 26 studies across nine geographic regions to compare outcomes in people with **depressive disorder and co-occurring diabetes** (depression-diabetes) versus those with diabetes only. - Literature searches covered Embase, MEDLINE, PsycInfo and Web of Science from inception to 20 December 2024; the review was registered on PROSPERO (CRD42024595145). - The depression-diabetes group had higher all-cause mortality (RR 1.30; 95% CI 1.21–1.39) and higher cardiovascular disease (CVD) specific mortality (RR 1.15; 95% CI 1.02–1.29) compared with diabetes-only patients. - Overall risk of diabetes-related complications was elevated in the depression-diabetes group (RR 1.28; 95% CI 1.18–1.40), with particularly increased risks for **metabolic complications** (RR 1.63; 95% CI 1.33–1.99) and **cardiovascular complications** (RR 1.20; 95% CI 1.11–1.29). - The depression-diabetes group had a lower pooled likelihood of retinopathy (RR 0.84; 95% CI 0.76–0.94) and comparable pooled rates for cerebrovascular complications (RR 1.36; 95% CI 0.99–1.87), nephropathy (RR 1.09; 95% CI 0.93–1.27) and peripheral vascular complications (RR 0.97; 95% CI 0.79–1.18). - Elevated mortality and complication risks were observed across regions and persisted over time, though study heterogeneity remained and stratified analyses did not fully explain between-study differences. - The authors note that prior studies were limited by depression ascertainment methods (self-report surveys) that may misclassify subclinical symptoms; this meta-analysis focused on studies comparing clinically identified depressive disorder versus diabetes-only groups. - The findings suggest poorer glycaemic control and greater physical morbidity in patients with co-occurring depression and diabetes and support comprehensive, individualized interventions to reduce avoidable complications and premature mortality in this vulnerable group.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Psychiatry, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong. * 2 Department of Psychiatry, United Christian Hospital, Hong Kong. * 3 Department of Psychiatry, The University of Hong Kong, Hong Kong. * 4 Department of Psychiatry, Queen Mary Hospital, Hong Kong. * PMID: **42693777** * DOI: [ 10.1017/S2045796026100882 ](https://doi.org/10.1017/s2045796026100882) Item in Clipboard Meta-Analysis # Risk of mortality and complications in people with depressive disorder and co-occurring diabetes mellitus: a systematic review and meta-analysis Matthew Tsz Ho Ho et al. Epidemiol Psychiatr Sci. 2026. Show details Display options Display options Format Abstract PubMed PMID Epidemiol Psychiatr Sci Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Epidemiol+Psychiatr+Sci%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Epidemiol+Psychiatr+Sci%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42693777/) . 2026 Sep 4:35:e49. doi: 10.1017/S2045796026100882. ### Authors [Matthew Tsz Ho Ho](https://pubmed.ncbi.nlm.nih.gov/?term=Ho+MTH&cauthor_id=42693777)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-1 "Department of Psychiatry, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-2 "Department of Psychiatry, United Christian Hospital, Hong Kong."), [Kwun Nam Chan](https://pubmed.ncbi.nlm.nih.gov/?term=Chan+KN&cauthor_id=42693777)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-1 "Department of Psychiatry, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong."), [Will Chi Yuen Chiu](https://pubmed.ncbi.nlm.nih.gov/?term=Chiu+WCY&cauthor_id=42693777)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-2 "Department of Psychiatry, United Christian Hospital, Hong Kong."), [Lucy Lo Wah Tsang](https://pubmed.ncbi.nlm.nih.gov/?term=Tsang+LLW&cauthor_id=42693777)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-2 "Department of Psychiatry, United Christian Hospital, Hong Kong."), [Heidi Ka Ying Lo](https://pubmed.ncbi.nlm.nih.gov/?term=Lo+HKY&cauthor_id=42693777)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-1 "Department of Psychiatry, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong."), [Steven Yiu Long Wong](https://pubmed.ncbi.nlm.nih.gov/?term=Wong+SYL&cauthor_id=42693777)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-2 "Department of Psychiatry, United Christian Hospital, Hong Kong."), [Kenneth Shut Wah Chan](https://pubmed.ncbi.nlm.nih.gov/?term=Chan+KSW&cauthor_id=42693777)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-2 "Department of Psychiatry, United Christian Hospital, Hong Kong."), [Mimi Mei Cheung Wong](https://pubmed.ncbi.nlm.nih.gov/?term=Wong+MMC&cauthor_id=42693777)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-2 "Department of Psychiatry, United Christian Hospital, Hong Kong."), [Ho Hon Wong](https://pubmed.ncbi.nlm.nih.gov/?term=Wong+HH&cauthor_id=42693777)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-2 "Department of Psychiatry, United Christian Hospital, Hong Kong."), [Wai Chung Lam](https://pubmed.ncbi.nlm.nih.gov/?term=Lam+WC&cauthor_id=42693777)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-2 "Department of Psychiatry, United Christian Hospital, Hong Kong."), [Pui Fai Pang](https://pubmed.ncbi.nlm.nih.gov/?term=Pang+PF&cauthor_id=42693777)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-2 "Department of Psychiatry, United Christian Hospital, Hong Kong."), [Wing Chung Chang](https://pubmed.ncbi.nlm.nih.gov/?term=Chang+WC&cauthor_id=42693777)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-3 "Department of Psychiatry, The University of Hong Kong, Hong Kong.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42693777/#short-view-affiliation-4 "Department of Psychiatry, Queen Mary Hospital, Hong Kong.") ### Affiliations * 1 Department of Psychiatry, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong. * 2 Department of Psychiatry, United Christian Hospital, Hong Kong. * 3 Department of Psychiatry, The University of Hong Kong, Hong Kong. * 4 Department of Psychiatry, Queen Mary Hospital, Hong Kong. * PMID: **42693777** * DOI: [ 10.1017/S2045796026100882 ](https://doi.org/10.1017/s2045796026100882) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** People with depressive disorder have increased premature mortality and higher rates of diabetes mellitus than general population. Evidence shows that diabetes may further increase their risk of premature death from diabetes-related complications, especially cardiovascular diseases (CVDs). Earlier studies examining depression-associated outcomes in diabetes patients have shown mixed results and were hindered by important limitations, especially the use of self-reported questionnaires to ascertain depression, causing misclassification bias by identifying subclinical symptoms or diabetes distress. Associations of depression with specific diabetes complications have not been systematically evaluated. This meta-analysis aimed to investigate the risk of mortality and complications among patients with depression and co-occurring diabetes (depression-diabetes group) relative to patients with diabetes-only (diabetes-only group), on their all-cause mortality rates, and if applicable cause-specific mortality rates, and occurrence of specific diabetes complications. **Methods:** We systematically reviewed and quantitatively synthesized diabetes-related outcomes in patients with depression by searching Embase, MEDLINE, PsycInfo and Web-of-Science from inception to 20 December 2024, and included studies that examined mortality and complication outcomes in depression-diabetes group relative to diabetes-only group. Results were synthesized by random-effects meta-analytic models, with stratified-analyses (subgroup analyses and meta-regression) by study-level characteristics, including age, gender, study period, geographic region, follow-up duration and nature of diabetes sample. The study was registered with PROSPERO (CRD42024595145). **Results:** Twenty-six studies were identified from nine geographic regions. Regarding mortality risk, depression-diabetes group exhibited increased risks of all-cause mortality (RR = 1.30 [95% CI: 1.21-1.39]) and CVD-specific mortality (1.15 [1.02-1.29]) relative to diabetes-only group. Regarding complication risk, depression-diabetes group showed increased risk of complications (1.28 [1.18-1.40]) relative to diabetes-only group, especially in incident-diabetes sample signifying advanced disease stage upon presentation, with stratified-analyses showing higher risk of metabolic complications (1.63 [1.33-1.99]) and cardiovascular complications (1.20 [1.11-1.29]), and lower likelihood of retinopathy (0.84 [0.76-0.94]), albeit comparable rates of cerebrovascular complications (1.36 [0.99-1.87]), nephropathy (1.09 [0.93-1.27]) and peripheral-vascular complications (0.97 [0.79-1.18]). Both overall mortality and complication risks were present in various regions and persisted over time. Heterogeneities were noted and could not be entirely explained by stratified analyses. **Conclusions:** Our study demonstrated that patients with depression and co-occurring diabetes were associated with elevated overall mortality risk and complication risk (particularly metabolic and cardiovascular-complications) than non-depressed counterparts, suggesting an overall poorer glycemic control that might eventually drive their earlier death. Comprehensive and multipronged interventions are needed for individualized risk estimation of diabetes-related outcomes, with consequent early interventions to minimize the avoidable physical morbidity and premature mortality in this vulnerable population. **Keywords:** depression; diabetes mellitus; epidemiology; health outcomes; meta-analysis; systematic reviews. 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