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Andrea Icks,1– 3 Charlotte Wittgens,1 Burkhard Haastert,2,4 Karl-Heinz Jöckel,5 Miriam Engel,5 Raimund Erbel,5 Silke Andrich,1,2 Johannes Kruse,6 Bernd Kulzer,7 Norbert Hermanns,7 Christian Herder,3,8,9 Susanne Moebus,5 Andreas Stang,5 Bernd Kowall5 1Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; 2Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; 3German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany; 4mediStatistica, Neuenrade, Germany; 5Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany; 6Institute for Psychosomatics and Psychotherapy, University Hospital Gießen, Gießen, Germany; 7Research Institute of the Diabetes Academy Mergentheim and Diabetes Centre Mergentheim, Bad Mergentheim, Germany; 8Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; 9Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, GermanyCorrespondence: Andrea IcksInstitute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Auf’m Hennekamp 65, Düsseldorf, D-40225, GermanyTel +49 211 33 82 400Fax +49 211 33 82 677Email andrea.icks@uni-duesseldorf.deAim: To determine the 10-year cumulative incidence of high depressive symptoms in people with diagnosed and, in particular, previously undetected diabetes compared to those without diabetes in a population-based cohort study in Germany.Materials and Methods: We included 2813 participants (52.9% men, mean age (SD) 58.9 (7.7) years, 7.1% diagnosed diabetes, 5.6% previously undetected diabetes) from the Heinz Nixdorf Recall study. We calculated the odds ratios (OR) with 95% confidence intervals (CI) using multiple logistic regression analyses for diagnosed and undetected diabetes.Results: Cumulative 10-year incidences (95%-CI) of high depressive symptoms in participants with diagnosed diabetes, previously undetected diabetes, and without diabetes were 15.4% (10.7– 21.2), 10.1% (5.9– 15.9), and 12.4% (11.1– 13.8), respectively. Age-sex-adjusted ORs were 1.51 (1.01– 2.28) in participants with diagnosed diabetes compared to those without, 1.40 (0.92– 2.12) after adjustment for BMI, physical activity, education, and smoking, and 1.33 (0.87– 2.02) after further adjustment for stroke and myocardial infarction. ORs in participants with previously undetected diabetes were 0.96 (0.56– 1.65), 0.85 (0.49– 1.47), and 0.85 (0.49– 1.48), respectively, and lower in men than in women.Conclusion: As expected, we found an increased odds of developing high depressive symptoms in participants with diagnosed diabetes. However, the odds ratios decreased when we considered comorbidities and other covariates. Interestingly, in participants with previously undetected diabetes, the odds was not increased, even 10 years after detection of diabetes. These results support the hypothesis that high depressive symptoms develop due to diabetes-related burdens and comorbidities and not due to hyperglycemia or hyperinsulinemia.Keywords: diabetes, undetected diabetes, depressive symptoms, prospective population-based cohort study