Examining a Bidirectional Association Between Depressive Symptoms and Diabetes

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Abstract
The prevalence of clinical depression and presence of elevated depressive symptoms are higher among persons with diabetes compared with the general population.1,2 These associations may be related to increased risk of depressive symptoms in individuals with diabetes, increased risk of type 2 diabetes in individuals with depressive symptoms, or both. Several but not all3 longitudinal studies have reported that elevated depressive symptoms are associated with incident type 2 diabetes.4-12 Several factors associated with depressive symptoms, including obesity-promoting health behaviors (eg, physical inactivity, hypercaloric diets)6-10,12 and activation of the neuroendocrine13-17 and inflammatory responses18,19 (resulting in increased cortisol, catecholamines, and cytokines), can induce insulin resistance and the development of type 2 diabetes.