Occurrence of mental disorders in patients with type 2 diabetes melllitus and cardiovascular diseases: health inequalities and identification of vulnerable groupe using health insurance claims data in a time trend between 2005 and 2019

• Applicant: Dr. Jelena Epping
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine ; Epidemiology and Medical Biometry/Statistics
• Term: since 2023
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 515631684

The number of people suffering from type 2 diabetes mellitus (T2D) or cardiovascular diseases is steadily increasing. Depending on the severity and subjective perception of the associated burdens, these diseases have a negative impact on the patients' quality of life and psychological well-being. If a mental disorder develops, the prognosis for the underlying disease worsens. If physicians could better identify and care for patients with T2D or cardiovascular disease who are at increased risk of developing psychiatric sequelae, the morbidity burden for patients and the cost of health care would be reduced. In the first phase of this research project, the risk of developing a mental disorder in the case of existing T2D or cardiovascular diseases will be determined over time between 2005 and 2019 on the basis of anonymised health insurance data (approx. 2 million insured persons annually). The data are available on the basis of long-term cooperation with the AOK Lower Saxony and can also be used for this research project. Depression, anxiety disorders and stress disorders are used as outcomes. In addition to age and gender, characteristics of social status (income, education, occupation) are used to differentiate the risk of disease. For insured persons who are employed, it is also analyzed whether temporary, contract or part-time work is more frequently associated with mental disorders. Changes in job-related factors over time will be analysed as well using them as time-variant predictors. To classify the results of the analysis, a control group without T2D or cardiovascular disease, parallelized according to the sociodemographic and occupational characteristics mentioned above, is built. Risks of the occurrence of depression, anxiety disorders, and stress disorders over time will also be determined for this group of insured persons. In the second part of the project, the care of patients with T2D or cardiovascular diseases and depressive disorders will be analyzed. The goal is to identify vulnerable groups in terms of sociodemographic or occupational characteristics who have been diagnosed with depression in the presence of T2D or cardiovascular disease but have not received guideline-based care. The results of these analyses may help improve care for such vulnerable patient groups with T2D or cardiovascular disease. In addition, target groupspecific psychoeducational programs can be developed to increase the (mental) health literacy of patients with T2D or cardiovascular disease.

• DFG Programme: Research Grants