***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Diabetes negatively impacts the health-related quality of life ( HRQOL ) of patients with type 2 diabetes . An earlier analysis showed HRQOL to be associated with mortality , which suggests that measuring HRQOL could have clinical implication s. We studied the association between  HRQOL  and total and cardiovascular mortality in patients with type 2 diabetes during long-term follow-up and specifically focused on old age and sex differences . RESEARCH DESIGN AND METHODS HRQOL was measured in a prospect ively followed cohort of 1,353 patients with type 2 diabetes using the R AND -36 . Cox proportional hazard models were used to measure the independent effect of baseline HRQOL on mortality . RESULTS During a mean follow-up of 9.6 years , 570 ( 42 % ) patients  died , 280 of whom died of cardiovascular disease ( 49 % ) . The Physical Component Score ( PCS ) and the Mental Component Score ( MCS ) were inversely associated with total mortality , with hazard ratios of 0.988 ( 95 % CI 0.983–0.993 ) and 0.990 ( 95 % CI 0.985–0.995 ) , respectively . A 10-point-higher score on the PCS and MCS decreased the risk for total mortality by 11 and 10 % , respectively . An inverse relationship with mortality was also seen for men , women , and for patients aged > 75 years . Mental health was significantly related to mortality in men but not in women . CONCLUSIONS Lower physical and mental HRQOL was associated with a higher total mortality and cardiovascular mortality in patients with type 2 diabetes ; this is also the case when study ing men and women and the elderly separately . The dimension mental health , related to depression and anxiety , was only associated with mortality in men , not in women PURPOSE Recent evidence suggests that depression is linked to increased mortality among patients with diabetes . This study examines the association of depression with all-cause and cause-specific mortality in diabetes . METHODS We conducted a prospect i ve cohort study of primary care patients with type 2 diabetes at Group Health Cooperative in Washington state . We used the Patient Health Question naire ( PHQ-9 ) to assess depression at baseline and review ed medical records supplemented by the Washington state mortality registry to ascertain the causes of death . RESULTS Among a cohort of 4,184 patients , 581 patients died during the follow-up period .  Deaths occurred among 428 ( 12.9 % ) patients with no depression , among 88 ( 17.8 % ) patients with major depression , and among 65 ( 18.2 % ) patients with minor depression . Causes of death were grouped as cardiovascular disease , 42.7 % ; cancer , 26.9 % ; and deaths that were not due to cardiovascular disease or cancer , 30.5 % . Infections , dementia , renal failure , and chronic obstructive pulmonary disease were the most frequent causes in the latter group . Adjusting for demographic characteristics , baseline major depression ( relative to no depression ) was significantly associated with all-cause mortality ( hazard ratio [HR]=2.26 , 95 % confidence interval [ CI ] , 1.79–2.85 ) , with cardiovascular mortality ( HR = 2.00 ; 95 % CI , 1.37–2.94 ) , and with noncardiovascular , noncancer mortality ( HR = 3.35 ; 95 % CI , 2.30–4.89 ) . After additional adjustment for baseline clinical characteristics and health habits , major depression was significantly associated only with all-cause mortality ( HR = 1.52 ; 95 % CI , 1.19–1.95 ) and with death not caused by cancer or atherosclerotic cardiovascular disease ( HR = 2.15 ; 95 % CI , 1.43–3.24 ) . Minor depression showed similar but nonsignificant associations . CONCLUSIONS Patients with diabetes and coexisting depression face substantially elevated mortality risks beyond cardiovascular deaths CONTEXT Depression and diabetes mellitus have been associated with an increased risk of all-cause and cardiovascular disease ( CVD ) mortality . However , data evaluating the joint effects of these 2 conditions on mortality are sparse . OBJECTIVES To evaluate the individual and joint effects of depression and diabetes on all-cause and CVD mortality rate . DESIGN Prospect i ve cohort study . SETTING The 11 states of the Nurses ' Health Study . PARTICIPANTS A total of 78 282 women who participated in the Nurses ' Health Study aged 54 to 79 years at baseline in 2000 were followed up until 2006 . Depression was defined as having self-reported diagnosed depression , treatment with antidepressant medications , or a score indicating severe depressive symptoms ( ie , a 5-item Mental Health Index score ≤52 ) . Self-reported type 2 diabetes was confirmed using a supplementary question naire . MAIN OUTCOME MEASURES All-cause and CVD-specific mortality rate . RESULTS During 6 years of follow-up ( 433 066 person-years ) , 4654 deaths were documented , including 979 deaths from CVD . Compared with participants without either condition , the age-adjusted relative risks ( RRs ) ( 95 % confidence interval ) for all-cause mortality were 1.76 ( 1.64 - 1.89 ) for women with depression only , 1.71 ( 1.54 - 1.89 ) for individuals with diabetes only , and 3.11 ( 2.70 - 3.58 ) for women with both conditions . The corresponding age-adjusted RRs of CVD mortality were 1.81 ( 1.54 - 2.13 ) , 2.67 ( 2.20 - 3.23 ) , and 5.38 ( 4.19 - 6.91 ) , respectively . These associations were attenuated after multivariate adjustment for other demographic variables , body mass index , smoking status , alcohol intake , physical activity , and major comorbidities ( including hypertension , hypercholesterolemia , heart diseases , stroke , and cancer ) but remained significant , with the highest RRs for all-cause and CVD mortality found in those with both conditions ( 2.07 [ 1.79 - 2.40 ] and 2.72 [ 2.09 - 3.54 ] , respectively ) . Furthermore , the combination of depression with a long duration of diabetes mellitus ( ie , > 10 years ) or insulin therapy was associated with a particularly higher risk of CVD mortality after multivariate adjustment ( RRs , 3.22 and 4.90 , respectively ) . CONCLUSIONS Depression and diabetes are associated with a significantly increased risk of all-cause and CVD mortality rate . The coexistence of these conditions identifies women at particularly high risk Context Many patients have both diabetes and depression . Some hypothesize that treating depression might improve diabetes outcomes . Contribution In this r and omized trial , 12 months of depression care management for depressed patients with diabetes improved depression-related outcomes and increased the frequency of exercise . However , care management did not affect diet , diabetes medication adherence , glucose testing , or glycemic control . Caution s The study sample had reasonably good diabetes control at baseline . Whether patients with poorly controlled diabetes would benefit from depression care is not known . The Editors Major depression and dysthymic disorder affect 5 % to 10 % of older adults seen in primary care setting s ( 1 - 3 ) .  Late-life depression  is often chronic or recurrent ( 4 - 6 ) and is associated with substantial suffering , functional impairment , and diminished health-related quality of life ( 7 ) . Diabetes mellitus affects 7.8 % of all adults and almost 1 in 5 of those age 60 years and older ( 8) . Individuals with diabetes mellitus have a 2-fold higher rate of major depression than those without diabetes ( 9 , 10 ) . Depression adversely affects the course of coexisting medical illness , contributing to increased symptom burden , functional impairment , and mortality ( 11 , 12 ) . For patients with diabetes mellitus , depression is associated with decreased glycemic control and increased number of micro- and macrovascular complications ( 13 , 14 ) . The mechanism of effect is not understood but may be related to depression-induced abnormalities in neuroendocrine and neurotransmitter function or decreased self-care behaviors ( 15 - 20 ) . Integrating evidence -based depression care for persons with diabetes may improve both depression and diabetes outcomes . Three small r and omized , controlled trials have studied the effect of treatment for  depression on affective and glycemic outcomes in patients with depression and diabetes mellitus ( 21 - 23 ) . These studies have consistently shown improvements in affective outcomes , but effects on glycemic control have been mixed . Primary care physicians are well positioned to provide integrated care for depression and diabetes mellitus but face many barriers . Controlled trials report that  treatment for depression  is efficacious in approximately 70 % of persons who complete treatment compared with 30 % of those who receive placebo ( 24 ) . However , these results are difficult to replicate in routine primary care practice . Barriers to high- quality care include suboptimal recognition ; inconsistent treatment with lack of close follow-up and monitoring ; and organizational barriers , such as brief visits , poor integration with specialty mental health care , competing clinical priorities , and lack of decision support systems ( 25 - 27 ) . Simple interventions , such as depression screening and physician education , have little impact on these barriers and patient outcomes ( 28 - 30 ) . Treatment models that use a depression specialist working collaboratively with primary care physicians have shown clinical ly important improvement in patient outcomes ( 31 - 37 ) . We recently reported robust effects of such a model for older adults with major depression or dysthymia ( 37 ) . In this preplanned analysis , we evaluate the effects on affective and diabetes-specific outcomes . If effective care for depression also benefits adherence to self-care regimens , functional status , and other medical illness outcomes , it would add powerful quality -of-care and economic incentives for the dissemination and maintenance of these models . In addition , if effective care for depression improves self-care behaviors , it may also positively affect other chronic medical illnesses with important self-care components . For this prespecified subgroup analysis , we focused on older adults with clinical depression and coexisting diabetes mellitus . We hypothesized that the collaborative care intervention would improve affective symptoms , functional status , self-care behaviors , and glycemic control . In addition , we hypothesized that effects on glycemic control would be greatest for patients with baseline hemoglobin A1c values of 8.0 % or greater . Methods The Improving MoodPromoting Access to Collaborative Treatment ( IMPACT ) study is a multisite r and omized , controlled trial of a collaborative care intervention program for late-life depression in primary care ( 37 , 38 ) . Institutional review boards at participating sites approved study protocol s , and all participants gave written informed consent . Patients Seven study sites representing 8 diverse health care organizations with a total of 18 primary care clinics in 5 states participated in the study . From July 1999 to August 2001 , depressed older adults were recruited through referrals from primary care practitioners and other clinic staff or through systematic depression screening with a 2-item depression screener adapted from the Primary Care Evaluation of Mental Disorders ( 39 ) . Of the 2190 patients referred to the study , 308 ( 14 % ) declined the initial eligibility screening or additional interviews , 54 ( 3 % ) had incomplete initial screenings , and 202 ( 9 % ) were ineligible because they were younger than 60 years of age or they did not plan to use the participating clinic over the coming 12 months . Of the 32908 patients approached for screening , 5246 ( 16 % ) declined the initial screening or follow-up interviews . A total of 1791 ( 5 % ) of the initial screenings were incomplete and 23233 ( 71 % ) of those screened were not eligible because they did not have one of the core depression symptoms ( 95 % ) or because of logistic reasons such as lack of transportation or access to a telephone ( 5 % ) . The remaining 1626 ( 74 % ) of those referred and 2638 ( 8 % ) of those screened completed a computer-assisted structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , to assess whether patients met research diagnostic criteria for major depression or dysthymia ( 40 ) . Inclusion criteria were age 60 years or older , plans to use one of the participating clinics as the main source of general medical care in the coming year , and a diagnosis of current major depression or dysthymic disorder according to the structured clinical interview for DSM-IV . Otherwise eligible persons were excluded because of a current drinking problem ( a score of 2 on the CAGE question naire ) ( 41 ) , a history of bipolar disorder or psychosis ( 38 ) , ongoing treatment with a psychiatrist , or 
    Output:
    
Depression significantly increases the risk of mortality among individuals with diabetes .
Early detection and treatment of depression may improve health outcomes in this population