Examining a Bidirectional Association Between Depressive Symptoms and Diabetes

CONTEXT Depressive symptoms are associated with development of type 2 diabetes, but it is unclear whether type 2 diabetes is a risk factor for elevated depressive symptoms. OBJECTIVE To examine the bidirectional association between depressive symptoms and type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS Multi-Ethnic Study of Atherosclerosis, a longitudinal, ethnically diverse cohort study of US men and women aged 45 to 84 years enrolled in 2000-2002 and followed up until 2004-2005. MAIN OUTCOME MEASURES Elevated depressive symptoms defined by Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or higher, use of antidepressant medications, or both. The CES-D score was also modeled continuously. Participants were categorized as normal fasting glucose (