The Association of Comorbid Depression with Intensive Care Unit Admission in Patients with Diabetes: A Prospective Cohort Study

Background: It is unknown if comorbid depression in patients with diabetes mellitus increases the risk of intensive care unit (ICU) admission. Objective: This study examined whether comorbid depression in patients with diabetes increased risk of ICU admission. coronary care unit (CCU) admission. and general medical-surgical unit hospitalization, as well as mal days hospitalized, after controlling for demographics. clinical characteristics, and health risk behaviors. Method: This prospective cohort study included 3.596 patients with diabetes enrolled in the Pathways Epidemiologic Follow-Up Study. We assessed baseline depression with the Patient Health Questionnaire-9. We controlled for baseline demographics, smoking. BMI, exercise. hemoglobin A(lc), medical comorbidities. diabetes complications. type I diabetes, diabetes duration. and insulin treatment. We assessed time to any ICU. CCU, and/or general medical-surgical unit admission using Cox proportional-hazards regression. We used Poisson regression with robust standard errors to examine associations between depression and total days hospitalized. Results: Unadjusted analyses revealed that baseline probable major depression was associated with increased risk ICU admission [hazard ratio (HI?) 1.94, 95% confidence interval (95% CI)(1.34-2.81)] but was not associated with CCU or general medical-surgical unit admission. Fully adjusted analyses revealed probable major depression remained associated with increased risk of ICU admission [HR 2.23, 95% CI(1.45-3.45)]. Probable major depression was also associated with more total days hospitalized (Incremental Relative Risk 1.64, 95%CI(1.26-2.12)). Conclusions: Patients with diabetes and comorbid depression have a greater risk of ICU admission. Improving depression treatment in patients with diabetes could potentially prevent hospitalizations for critical illnesses and lower healthcare costs. (Psychosomatics 2011; 52:117-126)