Stress and depression in people with diabetes have been tied to an increased risk of strokes and deaths from cardiovascular disease in a new study.

Researchers from East Carolina University Brody School of Medicine found the worst outcomes in diabetics who suffer from both stress and depression at the same time. This trifecta of health problems was linked to more than double the risk of death from heart disease, Fox News reports.

"Our study is one of the first to show a pattern of increased likelihood of adverse cardiovascular outcomes in those with diabetes compared to those without diabetes -- first with increased likelihood for either [stress or depression] alone, and then an even higher likelihood when both behavioral co-morbidities were reported," said lead researcher Doyle Cummings.

To reach their conclusions, Cummings and colleagues reviewed the medical records of nearly 22,000 adults including close to 4,100 with diabetes.

For people with diabetes, having either stress or depression increased their risk of death from cardiovascular disease by 53 percent, compared with diabetics without these mental health problems. Diabetics with both stress and depression had more than double the death risk.