Complications in Diabetic Patients with and without Mental Illness
H Lin, Center for Health Quality, Outcomes, and Economic Research, S Frayne, VA Palo Alto Health Care System, D Miller, Center for Health Quality, Outcomes, and Economic Research, F Wang, Center for Health Quality, Outcomes, and Economic Research, JH Halanych, Center for Health Quality, Outcomes, and Economic Research, K Skinner, Center for Health Quality, Outcomes, and Economic Research, D Berlowitz, Center for Health Quality, Outcomes, and Economic Research
comorbidity may impair efforts to provide high quality medical care to veterans
with diabetes. The extent of
cardiovascular risk in diabetic patients with comorbid psychiatric illness is
not fully understood. We compared cardiovascular complications of diabetes among
veterans with and without mental illness.
Methods: We studied
140,889 VA patients with diabetes from the Diabetes Epidemiology Cohort (DEpiC)
who had 2+ ICD-9-CM codes for diabetes in FY97-98 or were prescribed
antiglycemic medication in FY98 and who participated in
the 1999 Large Health Survey of Veterans.
Using self-report data from the survey, we conducted multivariate
analyses modeling history of myocardial infarction (MI) and stroke with
depression, post-traumatic stress disorder (PTSD) and schizophrenia. All
models included terms for
age; in a second set we adjusted for age, gender, smoking, hypertension and
Results: After adjusting
for age, depression (N=46,171) was associated with higher risk of MI [OR=1.66
(1.62-1.70)] and stroke [OR=2.02 (1.96-2.08)] . The same was true for PTSD
(N=20,207) [OR=1.60 (1.55-1.65) and 1.73 (1.66-1.79), for MI and stroke,
respectively] and schizophrenia (N=5,464) [OR=1.07 (1.01-1.13) and 1.40
(1.31-1.51)]. These odds ratios were essentially unchanged after further
adjustment for gender, hypertension, smoking and obesity, , except that the
association between schizophrenia and MI did not reach statistical significance.
Conclusions: VA diabetic
patients with mental illness may be at particularly high risk of cardiovascular
complications. Depression and PTSD
contribute independently to cardiovascular risk, even after adjusting for major
known risk factors.
Impact: VA’s efforts to improve quality of disease management for veterans with diabetes should place special emphasis upon those with comorbid mental illness. The clustering of complex medical and psychiatric conditions raises the possibility that interdisciplinary approaches to care may be of particular benefit for this at-risk population.