Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2024; 12(18): 3428-3437
Published online Jun 26, 2024. doi: 10.12998/wjcc.v12.i18.3428
Association of total bilirubin with depression risk in adults with diabetes: A cross-sectional study
Man-Li Ye, Jie-Ke Wang
Man-Li Ye, Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Jie-Ke Wang, Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Author contributions: Wang JK analyzed and interpreted the data; Ye ML wrote the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the National Center for Health Statistics Institutional Review Board/Ethics Review Board (NCHS IRB/ERB).
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: The authors declare that they have no competing interests in this section.
Data sharing statement: The datasets analyzed in this study can be found on the NHANES website, available here: https://www.cdc.gov/nchs/nhanes/.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Man-Li Ye, MD, MSc, Chief Technician, Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuanxi Road, Lucheng District, Wenzhou 325000, Zhejiang Province, China. aikoye1207@126.com
Received: March 10, 2024
Revised: April 30, 2024
Accepted: May 17, 2024
Published online: June 26, 2024
Processing time: 100 Days and 1.6 Hours
Abstract
BACKGROUND

Individuals with diabetes mellitus are more likely to experience depression, although most patients remain undiagnosed. The relation between total bilirubin and depression has been increasingly discussed, but limited studies have examined the association of total bilirubin with depression risk in adults with diabetes, which warrants attention.

AIM

To investigate the association between total bilirubin levels and the risk of depression in adults with diabetes.

METHODS

The study included adults with diabetes from the National Health and Nutrition Examination Survey 2007-2018. Depression was determined using the Patient Health Questionnaire-9. Multivariable logistic regression, propensity score-matched analysis and restricted cubic spline models were utilized to investigate the association between total bilirubin levels and depression risk in adults with diabetes.

RESULTS

The study included 4758 adults with diabetes, of whom 602 (12.7%) were diagnosed with depression. After adjusting for covariates, we found that diabetic adults with lower total bilirubin levels had a higher risk of depression (OR = 1.230, 95%CI: 1.006-1.503, P = 0.043). This association was further confirmed after propensity score matching (OR = 1.303, 95%CI: 1.034-1.641, P = 0.025). Subgroup analyses showed no significant dependence of age, body mass index, sex, race or hypertension on this association. Restricted cubic spline models displayed an inverted U-shaped association of total bilirubin levels with depression risk within the lower range of total bilirubin levels. The depression risk heightened with the increasing levels of total bilirubin, reaching the highest risk at 6.81 μmol/L and decreasing thereafter.

CONCLUSION

In adults with diabetes, those with lower levels of total bilirubin were more likely to have depressive symptoms. Serum total bilirubin levels may be used as an additional indicator to assess depression risk in adults with diabetes.

Keywords: Depression; Total bilirubin; Diabetes; National health and nutrition examination survey; Mental health; Patient health questionnaire-9

Core Tip: Diabetic adults with lower total bilirubin levels had a higher risk of depression. We adjusted for confounders that might affect the association between total bilirubin and depression risk by analyzing the detailed covariate data. After propensity score matching, this association was further confirmed. Subgroup analyses illustrated that there was no significant dependence of age, body mass index, gender, race and hypertension on this association. Restricted cubic spline models displayed an inverted U-shaped association of total bilirubin with depression risk within the lower range of total bilirubin.