Independent factors associated with depression in type 1 diabetes mellitus

The Prevalence and Correlates of Diabetes Distress among South Asians Living in New York City (NYC): Baseline Results from a Randomized Trial

Background

Type 2 diabetes (T2D) disproportionately affects South Asians in the United States (US). Living with T2D can be challenging due to the distress it can create for an individual. Distress associated with diabetes, commonly known as diabetes distress (DD), may lead to complications and challenges with the management of diabetes. This study aims to describe the prevalence of DD among a sample of South Asians in New York City (NYC) seeking care in community-based primary care settings and its association with sociodemographic characteristics and clinical measures.

Methods

This study utilized baseline data from the Diabetes Research, Education, and Action for Minorities (DREAM) Initiative, an intervention designed to reduce hemoglobin A1C (HbA1c) among South Asians with uncontrolled T2D in NYC. DD was measured using the Diabetes Distress Scale (DDS). First, descriptive statistics were used to analyze sociodemographic variables. Chi-square tests assessed categorical variables and Wilcoxon Rank Sum tests assessed continuous variables using a Type I error rate of 0.05. Logistic regression was performed to determine if HbA1c and mental health, along with other covariates, were associated with dichotomized DDS subscales.

Results

Overall, 415 participants completed the DDS at baseline. Median age was 56 years (IQR: 48-62). A total of 25.9% had high emotional burden distress, 6.6% had high physician-related distress, and 22.2% had high regimen-related distress based on subscales. In adjusted analyses, individuals with any days of poor mental health had significantly higher odds of overall distress (OR:3.7, p=0.014), emotional burden distress (OR:4.9, p<0.001), and physician-related distress (OR:5.0, p=0.002) compared to individuals with no days of poor mental health. Individuals with higher HbA1c had significantly higher odds of regimen-related distress (OR:1.31, p=0.007).

Conclusions

Findings suggest that DD is prevalent among this sample of South Asians with diagnosed T2D in NYC. Screening for DD in patients with prediabetes/diabetes should be considered by providers to help provide mental and physical health services during primary care visits. Future research can also benefit from a longitudinal analysis of the impact of DD on diabetes self-management, medication adherence, and mental and physical health.

Trial registration

This study uses baseline data from "Diabetes Management Intervention For South Asians" (NCT03333044), which was registered with clinicaltrials.gov on 6/11/2017.

Psychometric validation of diabetes distress scale in Bangladeshi population

Diabetes Distress (DD)-an emotional or affective state arise from challenge of living with diabetes and the burden of self-care-negatively impact diabetes management and quality of life of T2DM patients. Early detection and management of DD is key to efficient T2DM management. The study aimed at developing a valid and reliable instrument for Bangladeshi patients as unavailability such a tool posing challenge in diabetes care. Linguistically adapted, widely used, 17-item Diabetes Distress Scale (DDS), developed through forward-backward translation from English to Bengali, was administered on 1184 T2DM patients, from four diabetes hospitals in Bangladesh. Psychometric assessment of the instrument included, construct validity using principal component factor analysis, internal consistency using Cronbach's α and discriminative validity through independent t-test and test-retest reliability using intraclass-correlation coefficient (ICC) and Kappa statistics. Factor analysis extracted 4 components similar to original DDS domains, confirms the construct validity. The scale demonstrated satisfactory internal consistency (α = 0.838), stability (test-retest ICC = 0.941) and good agreement across repeated measurements (Kappa = 0.584). Discriminative validity revealed that patients with complication (p < 0.001) and those are on insulin (p < 0.001) had significantly higher distress scores in all domains. Bengali version of DDS is a valid and reliable tool for assessing distress among Bangladeshi T2DM patients.

Diabetic ketoacidosis: a canary in the mine for mental health disorders?

BACKGROUND

Recurrent diabetic ketoacidosis (DKA) has been linked to mental health disorders, but less is known about single DKA episodes. Most studies are retrospective, lacking control groups.

AIMS

Prospectively examine psychosocial factors in patients presenting with recurrent or single episode DKA and compare to people who have not had DKA.

METHODS

Case-controlled study (consecutive adult DKA admissions April 2015 to December 2016) at Western Health, Melbourne. Data were prospectively collected regarding: diagnosed mental health disorders, likely depression (PHQ-9 questionnaire), diabetes distress (PAID questionnaire) and presence of adverse social factors. A control group without a history of DKA was also recruited.

RESULTS

Of 123 patients admitted with DKA (164 consecutive episodes), 70 consented to participate and 73 age matched type 1 diabetes controls were recruited. Eleven of 18 (61%) with recurrent DKA had a diagnosed mental health disorder, versus 8 of 42 (19%) in the single episode group (p=0.016). The prevalence of likely depression using PHQ-9 was: recurrent 50%, single 40% and controls 22% (recurrent vs controls, p=0.036, single vs controls, p=0.053). Severe diabetes distress (PAID) was present in 47% of recurrent and 34% of single episode DKA (p=0.387). As a group, DKA patients had significantly more unemployment, illicit drug use and tobacco smoking, a lower level of formal education and less regular medical contact compared to controls.

CONCLUSIONS

Mental health disorders and adverse socio-economic factors appear to be common in patients with DKA. The diagnosis of DKA presents an excellent opportunity to screen for depression and offer appropriate intervention. This article is protected by copyright. All rights reserved.

Quality of life in patients with type 2 diabetes mellitus: a cross-sectional study

Purpose

The purpose of this paper is to investigate certain social and psychological parameters and to compare them with basic demographic information, such as the gender and the education, of patients suffering from Type 2 diabetes mellitus (T2DM).

Design/methodology/approach

A cross-sectional study of Type 2 diabetic patients was conducted. In total, 200 patients with T2DM were enrolled in the study. Psychological factors were assessed with questionnaires, including the Symptom Checklist 90-R (SCL-90-R), the Short-Form Health Survey (SF-36), the Life Orientation Test-Revised (LOT-R) and the Cardiac Anxiety Questionnaire (CAQ). The associations of psychological with socio-demographic factors were assessed through logistic regression analyses.

Findings

Women patients had higher levels of heart-focused anxiety psychopathology than men, and therefore, women tend to avoid activities that burden the heart. Men patients had a significantly higher index of physical functionality than women. No differences were recorded by the SCL-90R questionnaire between men and women. For the patients with elementary education, lower levels of mental health (SF-36-MCS) were observed.

Originality/value

The chronicity of the disease aggravates the psychopathology of the patients thereby creating adverse impact not only on health but also on efforts for compliance. A personalized approach by the health professionals could contribute in addressing the psychological factors that accompany T2DM.

Symptoms of Eating Disorders and Depression in Emerging Adults with Early-Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control

Background

This study analyzed the prevalence of and association between symptoms of eating disorders and depression in female and male emerging adults with early-onset, long-duration type 1 diabetes and investigated how these symptoms are associated with metabolic control.

Methods

In a nationwide population-based survey, 211 type 1 diabetes patients aged 18-21 years completed standardized questionnaires, including the SCOFF questionnaire for eating disorder symptoms and the Patient Health Questionnaire (PHQ-9) for symptoms of depression and severity of depressive symptoms (PHQ-9 score). Multiple linear and logistic regression models were used to analyze the association between eating disorder and depressive symptoms and their associations with HbA1c.

Results

A total of 30.2% of the women and 9.5% of the men were screening positive for eating disorders. The mean PHQ-9 score (standard deviation) was 5.3 (4.4) among women and 3.9 (3.6) among men. Screening positive for an eating disorder was associated with more severe depressive symptoms among women (β_women 3.8, p<0.001). However, neither eating disorder symptoms nor severity of depressive symptoms were associated with HbA1c among women, while HbA1c increased with the severity of depressive symptoms among men (β_men 0.14, p=0.006).

Conclusions

Because of the high prevalence of eating disorder and depressive symptoms, their interrelationship, and their associations with metabolic control, particularly among men, regular mental health screening is recommended for young adults with type 1 diabetes.

Associations between HbA1c and depressive symptoms in young adults with early-onset type 1 diabetes

OBJECTIVE

This study sought to evaluate the associations between metabolic control and each DSM-5 (Diagnostic and Statistical Manual, fifth edition) symptom of depression among young women and men with early-onset long-duration type 1 diabetes.

METHODS

The data of 202 18-21-year-old patients with type 1 diabetes from a population-based, nationwide survey (40.1% male) with a mean age of 19.4 (standard deviation 0.9) years, a mean HbA1c level of 8.3% (1.6%) (i.e., 67 [17.5]mmol/mol), and a mean diabetes duration of 15.7 (1.0) years were included. The German version of the Patient Health Questionnaire (PHQ-9) was used to assess depression symptoms. For each PHQ-9 depressive symptom, the mean HbA1c values of screening-positive and screening-negative patients were compared via t-test. The associations between HbA1c levels and depressive symptoms were analyzed using multiple linear regression analyses and stepwise adjustments for individual, socioeconomic and health-related covariates.

RESULTS

Exactly 43.0% and 33.3% of female and male participants reported at least one depressive symptom, and 5.0% and 2.5% met the DSM-5 criteria for major depressive syndrome. HbA1c levels increased with psychomotor agitation/retardation (women), overeating/poor appetite (men/women), lethargy (men), and sleep difficulty (men). Overeating/poor appetite, lethargy, and total PHQ-9 score (per score increase by one) were associated with increased HbA1c levels of 1.10, 0.96 and 0.09 units (%), respectively.

CONCLUSIONS

The associations between depressive symptoms and HbA1c levels vary by symptom and sex. Differentiating the symptoms of depression and targeted interventions might help to improve metabolic outcomes in young adults with early-onset type 1 diabetes and depression.

Suicidal ideation and suicide attempts among diabetes mellitus: the Korea National Health and Nutrition Examination Survey (KNHANES IV, V) from 2007 to 2012

OBJECTIVE

The present study evaluated the mental health of patients with diabetes mellitus (DM) in Korea and compared it with mental health in the general Korean population.

METHODS

All data included in the final analyses were collected from 34,065 subjects (20years of age or older) who participated in the 2007-2012 Korea National Health and Nutrition Examination Survey (KNHANES). The mental health of 3846 DM patients were compared with that of 30,219 controls.

RESULTS

A depressed mood for 2 or more continuous weeks was reported by 13.6% of subjects with normal glucose tolerance (NGT), 14.3% of those with impaired glucose intolerance (IFG), and 17.6% of DM patients. Suicidal thoughts were reported by 15.3% of individuals with NGT, 15.6% of participants with IFG, and 17.6% of DM patients. Suicidal attempts were reported by 0.8% of people with NGT, 1.0% of those with IFG, and 1.3% of DM patients. In DM patients, the crude odds ratio (OR) for depressive mood was 1.376 (95% confidence interval [CI]: 1.258-1.504), the OR for suicidal ideation was 1.481 (95% CI: 1.361-1.611) and the OR for suicidal attempts was 1.413 (95% CI: 1.021-1.956). A multivariate analysis revealed that the ORs for depression, suicidal ideation, and suicidal attempts in DM patients were 1.178 (95% CI: 1.070-1.297), 1.152 (95% CI: 1.050-1.263), and 1.413 (95% CI: 1.021-1.956), respectively.

CONCLUSIONS

The present study found that DM was associated with a marked increase in suicidal behaviors.

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

AIM

We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabetes (NITDM).

METHODS

We analyzed data for over 500,000 individuals with diagnosed diabetes from the 2008 U.S. MarketScan claims database. We grouped diabetic patients first by treatment mode (ITDM or NITDM), then by MDD status (with or without MDD), and finally by whether those with MDD used antidepressant medication. We estimated annual mean excess outpatient, inpatient, prescription drug, and total expenditures using regression models, controlling for demographics, types of health coverage, and comorbidities.

RESULTS

Among persons having ITDM, the estimated annual total mean expenditure for those with no MDD (the comparison group) was $19,625. For those with MDD, the expenditures were $12,406 (63%) larger if using antidepressant medication and $7322 (37%) larger if not using antidepressant medication. Among persons having NITDM, the corresponding estimated expenditure for the comparison group was $10,746, the excess expenditures were $10,432 (97%) larger if using antidepressant medication and $5579 (52%) larger if not using antidepressant medication, respectively. Inpatient excess expenditures were the largest of total excess expenditure for those with ITDM and MDD treated with antidepressant medication; for all others with diabetes and MDD, outpatient expenditures were the largest excess expenditure.

CONCLUSIONS

Among working-age adults with diabetes, MDD was associated with substantial excess medical expenditures. Implementing the effective interventions demonstrated in clinical trials and treatment guidelines recommended by professional organizations might reduce the economic burden of MDD in this population.

Increased prevalence of mood disorders and suicidal ideation in type 2 diabetic patients

This study evaluated the association of mood disorders, suicidal ideation and the quality of life in patients with type 2 diabetes. We used a case-control study employing 996 patients suffering with type 2 diabetes (using insulin for over 1 year), and 2.145 individuals without diabetes. The groups were then used to evaluate the presence of different mood disorders and suicidal ideation, beyond quality of life. In addition to this, fasting glucose and glycosylated hemoglobin (Hb1C) were also evaluated. The data were analyzed using the Pearson chi-squared test, logistic regression, ANCOVA and Student's t-tests. We showed an association between type 2 diabetes and depressive episodes (adjusted OR = 1.8, CI 95 % 1.7-2.0, p < 0.001), recurrent depressive episodes (adjusted OR = 2.4, CI 95 % 2.2-2.6, p < 0.001), dysthymia (adjusted OR = 5.2, CI 95 % 4.9-5.5, p < 0.001), mood disorder with psychotic symptoms (adjusted OR = 2.5, CI 95 % 1.5-3.4, p < 0.001) and suicidal ideation (adjusted OR = 3.6, CI 95 % 2.5-4.8, p < 0.001, light; adjusted OR = 4.6, CI 95 % 1.5-7.7, p < 0.01, moderate and severe). The recurrent depression (OR = 1.3, CI 95 % 1.1-1.7, p < 0.05) and psychotic symptoms (OR = 4.1, CI 95 % 1.1-15.1, p < 0.05) were associated with higher levels of Hb1C. Dysthymia was associated with high blood glucose (OR = 1.6, CI 95 % 1.1-2.5, p < 0.05). Patients had lower mean scores in the following domains: physical [36.5 (13.6) × 56.0 (4.9), p < 0.001)], psychological [42.6 (8.6) × 47.9 (8.6), p < 0.001] and environmental [40.0 (8.6) × 49.3 (8.3), p < 0.001], but had higher scores in the area of social relations [50.2 (16.9) × 35.7 (27.9), p < 0.001]. The data demonstrated a worse quality of life, a high comorbidity of type 2 DM with depressive disorders and suicidal ideation. In addition, the poor control of DM is associated with the severity of mood disorders.

Are psychopathological features relevant predictors of glucose control in patients with type 2 diabetes? A prospective study

Type 2 diabetes has been associated with an increased prevalence of psychopathology, in comparison with matched non-diabetic controls. However, the cross-sectional design of most studies does not allow causal inferences. The aim of the present study is the exploration of this possible association in patients with type 2 diabetes, in a longitudinal fashion. This prospective observational study was conducted on a consecutive series of 250 type 2 diabetic outpatients and a 1-year follow-up period was performed. At enrollment, a complete medical history was collected and hemoglobin A1c was measured. General psychopathology was assessed using the Symptom Checklist 90-revised and the Eating Disorder Examination Questionnaire. Among the 187 patients available at follow-up, factors associated with unsatisfactory glycemic control at follow-up were baseline hemoglobin A1c, insulin therapy, a longer duration of diabetes, higher scores on the Eating behavior, and Somatization scales. At multivariate analysis, the attainment of hemoglobin A1c ≤ 7 % was associated with baseline hemoglobin A1c (p = 0.01), insulin therapy (p = 0.016), and Eating behavior (p = 0.02), whereas duration of diabetes and Somatization were no longer significant after adjusting for confounders. The results of the present study suggest that clinical features have a much greater impact on attainment of therapeutic goals than psychopathology. However, there are several aspects, such as temperament, motivation, self-efficacy, and well-being, not assessed in the present study, which could be crucial. These areas should be adequately explored for obtaining an overall picture of the psychological determinants of appropriate metabolic control in diabetes.

Predictors of depression symptoms in patients with diabetes in Slovakia

OBJECTIVE

The patterns of relationships between diabetes and depression in countries of central and eastern Europe (CEE) might differ from those in countries of western Europe and the United States. Among the reasons are specifics of transitioning healthcare systems (including mental health) and the general social, cultural, and economic background of these countries. The aim of this article is to analyze the prevalence of depression symptoms in patients with diabetes in Slovakia and to identify its predictors.

METHOD

Diabetes patients (N= 1043) from two diabetes outpatient-care offices were recruited for the study. The Patient Health Questionnaire 9 (PHQ-9) was applied to screen for depression symptoms. Patients were categorized into four categories based on depression symptom severity. Demographic and disease-related factors were analyzed as predictors of depression symptoms.

RESULTS

In the univariate analysis, a number of factors were associated with increasing severity of depression symptoms. In the multivariate analysis, lower education (OR 0.52; Cl 95% 0.33-0.81), and high degree of self-perceived severity of illness (OR 5.33; CI 95% 2.47-12.12) were confirmed as independent predictors of depression symptoms in our patients.

CONCLUSIONS

Demographic and psychological factors have an important role in developing depression symptoms in patients with diabetes in our population. Further studies into the topic are needed to gain further clues on this topic throughout the Central European region. The findings of this study should be considered by mental health service providers and public health authorities to raise awareness about this important issue.