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Watson K, Akil H, Rasgon N. Toward a Precision Treatment Approach for Metabolic Depression: Integrating Epidemiology, Neuroscience, and Psychiatry. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:623-631. [PMID: 37881556 PMCID: PMC10593951 DOI: 10.1016/j.bpsgos.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 10/27/2023] Open
Abstract
Background Individuals with comorbid major depressive disorder and type 2 diabetes represent an important subgroup of patients for whom conventional treatment may be insufficient. A precision treatment approach that addresses insulin resistance with an outcome of a positive response to antidepressants may prove beneficial. Methods This study utilized an emulated target trial on a large dataset from the Optum Clinformatics Data Mart Database. We evaluated the effect of adjuvant pioglitazone, an insulin-sensitizing drug, on antidepressant response among 4696 people with type 2 diabetes, comparing it with DPP4 (dipeptidyl peptidase-4) inhibitors (non-insulin-sensitizing). An additional analysis involving 6518 participants was conducted to assess the efficacy of pioglitazone versus sulfonylureas. Results The instrumental variable analysis indicated that the initiation of an antidepressant with pioglitazone was superior to DPP4 inhibitors in terms of antidepressant response, with fewer treatment shifts and/or additions of new antidepressant or antipsychotic over a 1-year period. This result was consistent when pioglitazone was compared with sulfonylureas in a supplemental analysis. Conclusions Our findings suggest that pioglitazone may be more effective than DPP4 inhibitors or sulfonylureas in enhancing antidepressant response among people with comorbid major depressive disorder and type 2 diabetes. This provides a strong case for the use of pioglitazone in patients with these conditions, emphasizing the potential of precision medicine strategies. The results should be interpreted with caution due to inherent limitations associated with observational data.
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Affiliation(s)
- Kathleen Watson
- Center for Neuroscience in Women’s Health, Stanford University, Palo Alto, California
| | - Huda Akil
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | - Natalie Rasgon
- Center for Neuroscience in Women’s Health, Stanford University, Palo Alto, California
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Lee HJ, Jang J, Lee SA, Oh SS, Park EC. Association between the Type of Diabetes Treatment and Depressive Symptoms among Patients with Diabetes: A Cross-Sectional Study of Korea Community Health Surveys Data, 2011-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224441. [PMID: 31726788 PMCID: PMC6887758 DOI: 10.3390/ijerph16224441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine the association between the different types of treatment for diabetes and depressive symptoms. In particular, this study assessed the presence of depressive symptoms in patients with diabetes who are undergoing pharmacological treatments in terms of sex. This study used data from the 2011-2016 Korea Community Health Survey, which included responses from 50,774 male and 48,978 female participants with diabetes who were receiving pharmacological treatments. Patients aged ≥30 years were included. Logistic regression analysis was conducted to examine the significance of the association. Male participants treated with insulin injection were more likely to experience depressive symptoms than those taking oral hypoglycemic (oral agents) only (odds ratio (OR) = 1.27; 95% confidence interval (CI): 1.04-1.56). Male patients treated with both oral agents and insulin injection had the highest OR value of depressive symptoms among different types of treatments (OR = 1.41, 95% CI: 1.25-1.60). The same tendency was observed in female participants. In female patients, however, the association between depressive symptoms and insulin injection was statistically insignificant (both oral agents and insulin injection OR = 1.35, 95% CI: 1.22-1.50, insulin injection OR = 1.17, 95% CI: 0.98-1.41). The association between depressive symptoms and the type of diabetes treatment was more significant in male than in female patients. Those who were treated with oral agents and insulin injection were more likely to have depressive symptoms than those receiving oral agents of treatment.
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Affiliation(s)
- Hyeon Ji Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Jieun Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Sang Ah Lee
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea
| | - Sarah Soyeon Oh
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-1862
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Khaledi M, Haghighatdoost F, Feizi A, Aminorroaya A. The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol 2019; 56:631-650. [PMID: 30903433 DOI: 10.1007/s00592-019-01295-9] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/02/2019] [Indexed: 02/06/2023]
Abstract
AIMS Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies. METHODS MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11". RESULTS In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%). CONCLUSION Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.
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Affiliation(s)
- Mohammad Khaledi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Prevalence of Depression and Associated Factors among Diabetic Patients in an Outpatient Diabetes Clinic. PSYCHIATRY JOURNAL 2019; 2019:2083196. [PMID: 30775378 PMCID: PMC6350613 DOI: 10.1155/2019/2083196] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/17/2018] [Accepted: 01/08/2019] [Indexed: 11/18/2022]
Abstract
Despite adequate treatment for diabetes, it is estimated that 15%- 20% of people with diabetes are struggling with a moderate to severe form of depression daily. Little is known about depression in diabetes in East Africa, particularly in Tanzania. The study is aimed at determining the prevalence of depression and associated factors among patients with diabetes. A descriptive cross-sectional study was carried out at the diabetes clinic of Muhimbili National Hospital. The 9-item Patient Health Questionnaire (PHQ 9) scale was used to assess presence of depressive symptoms among diabetes patients at the clinic. In addition, patient's sociodemographic and clinical characteristics were obtained and analysed for their association with depression. A total of 353 participants were recruited, of whom 229 (64.9%) patients were female and 156 (44.2%) were aged between 41 and 60 years. The overall prevalence of depression among diabetes patients at the diabetes clinic was 87%. Most (56.7%) had minimal depression, 22.1% had mild depression, and 8.2% had moderate depression. None had severe depression. Factors independently associated with a diagnosis of mild to moderate depression were being on insulin therapy and being a current smoker. There was a high prevalence of depression in this diabetic population. Majority of patients had minimal depression but about 30% had either mild or moderate depression. A holistic approach that focuses on the identification and management of depression among patients with diabetes is recommended.
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Bai X, Liu Z, Li Z, Yan D. The association between insulin therapy and depression in patients with type 2 diabetes mellitus: a meta-analysis. BMJ Open 2018; 8:e020062. [PMID: 30498035 PMCID: PMC6278799 DOI: 10.1136/bmjopen-2017-020062] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Several patients with type 2 diabetes mellitus (T2DM) have depressive disorders. Whether insulin treatment was associated with increased risk of depression remains controversial. We performed a meta-analysis to evaluate the association of insulin therapy and depression. DESIGN A meta-analysis. METHODS We conducted a systematic search of PubMed, PsycINFO, Embase and the Cochrane Library from their inception to April 2016. Epidemiological studies comparing the prevalence of depression between insulin users and non-insulin users were included. A random-effects model was used for meta-analysis. The adjusted and crude data were analysed. RESULTS Twenty-eight studies were included. Of these, 12 studies presented with adjusted ORs. Insulin therapy was significantly associated with increased risk of depression (OR=1.41, 95% CI 1.13 to 1.76, p=0.003). Twenty-four studies provided crude data. Insulin therapy was also associated with an odds for developing depression (OR=1.59, 95% CI 1.41 to 1.80, p<0.001). When comparing insulin therapy with oral antidiabetic drugs, significant association was observed for adjusted (OR=1.42, 95% CI 1.08 to 1.86, p=0.008) and crude (OR=1.61, 95% CI 1.35 to 1.93, p<0.001) data. CONCLUSIONS Our meta-analysis confirmed that patients on insulin therapy were significantly associated with the risk of depressive symptoms.
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Affiliation(s)
- Xiaosu Bai
- Department of Endocrinology, People’s Hospital of Longhua, Shenzhen, China
| | - Zhiming Liu
- Department of Endocrinology, People’s Hospital of Longhua, Shenzhen, China
| | - Zhisen Li
- Department of Endocrinology, People’s Hospital of Longhua, Shenzhen, China
| | - Dewen Yan
- Department of Endocrinology, The Second People’s Hospital of Shenzhen, Shenzhen, China
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Vu HTT, Nguyen TX, Nguyen HTT, Le TA, Nguyen TN, Nguyen AT, Nguyen TTH, Nguyen HL, Nguyen CT, Tran BX, Latkin CA, Pham T, Zhang MW, Ho RC. Depressive symptoms among elderly diabetic patients in Vietnam. Diabetes Metab Syndr Obes 2018; 11:659-665. [PMID: 30425543 PMCID: PMC6204855 DOI: 10.2147/dmso.s179071] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS Depression and diabetes are becoming increasingly prevalent within the Vietnamese elderly population. However, the linkage between these health conditions in the Vietnamese elderly has not yet been fully investigated. This study aimed to assess the level of depressive symptoms and associated factors among elderly diabetic patients. METHODS A cross-sectional study was conducted at National Geriatric Hospital in the elder patients aged ≥60 years with type 2 diabetes mellitus (T2DM). Depressive symptoms were assessed using the Geriatric Depression Scale, with three categories: normal (0-4 points), mild (5-9 points), and moderate/severe depressive symptoms (≥10 points). We obtained information on the patient's sociodemographic, medical history, glycemic control (fasting plasma glucose and HbA1c), daily activities (activities of daily living [ADLs] and instruments activities of daily living [IADLs] scale), and fall risks (Time Up and Go test). Logistic regression was used to analyze the factors associated with the presence of depressive symptoms. RESULTS Among 412 patients, 236 (57.3%) had HbA1c level at 7.0% or higher. There were 327 (79.4%) patients having depressive symptoms. The level of HbA1c was significantly different between the depressive symptom group and the non-depressive symptom group (7.74% and 6.61%, P<0.05). The increased likelihood of having depressive symptoms was associated with having risk of falls (OR: 5.50; 95% CI: 1.88-16.11), suffering from 5-10 years of diabetes (OR: 2.74, 95% CI: 1.28-5.85), uncontrolled fasting plasma glucose (OR: 4.06, 95% CI: 1.81-9.12), and an impairment of IADLs (OR: 5.74, 95% CI: 2.24-14.7). CONCLUSION This study highlights a high prevalence of depressive symptoms among elderly T2DM patients in Vietnam, suggesting an urgent need for screening depressive symptoms and providing mental health care services to this population promptly, particularly to those suffering from diabetes for a long period of time or co-functional impairments.
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Affiliation(s)
- Huyen Thi Thanh Vu
- Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam,
- National Geriatric Hospital, Hanoi, Vietnam,
| | - Thanh Xuan Nguyen
- National Geriatric Hospital, Hanoi, Vietnam,
- Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam,
- National Geriatric Hospital, Hanoi, Vietnam,
| | - Tu Anh Le
- Department of Endocrinology, Nghe An Endocrinology Hospital, Nghe An, Vietnam
| | - Tam Ngoc Nguyen
- Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam,
- National Geriatric Hospital, Hanoi, Vietnam,
| | | | - Thu Thi Hoai Nguyen
- Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam,
- National Geriatric Hospital, Hanoi, Vietnam,
| | - Hoang Long Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Thang Pham
- National Geriatric Hospital, Hanoi, Vietnam,
| | - Melvyn Wb Zhang
- Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore
| | - Roger Cm Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wang J, Wu X, Lai W, Long E, Zhang X, Li W, Zhu Y, Chen C, Zhong X, Liu Z, Wang D, Lin H. Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open 2017; 7:e017173. [PMID: 28838903 PMCID: PMC5640125 DOI: 10.1136/bmjopen-2017-017173] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Depression and depressive symptoms are common mental disorders that have a considerable effect on patients' health-related quality of life and satisfaction with medical care, but the prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties. DESIGN Systematic review and meta-analysis. DATA SOURCES AND ELIGIBILITY CRITERIA The PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2 tests and the I2 statistic. The study protocol has been registered with PROSPERO under number CRD42017054738. RESULTS Eighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ 2 =25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%). CONCLUSION Our study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial heterogeneity between studies was not fully explained by the variables examined.
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Affiliation(s)
- Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Weiyi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Erping Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xiaojian Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Dongni Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
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Chung JO, Cho DH, Chung DJ, Chung MY. An assessment of the impact of type 2 diabetes on the quality of life based on age at diabetes diagnosis. Acta Diabetol 2014; 51:1065-72. [PMID: 25362507 DOI: 10.1007/s00592-014-0677-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/25/2014] [Indexed: 12/22/2022]
Abstract
AIMS This study aimed to determine whether Korean adults diagnosed with type 2 diabetes before the age of 40 have a different perception of the impact of diabetes on their quality of life (QoL) compared with that of patients diagnosed at an older age. METHODS A total of 236 patients were investigated in this cross-sectional study. The patients were classified into two groups based on their age at diagnosis: early type 2 diabetes (age at diagnosis <40 years) and typical type 2 diabetes (age at diagnosis ≥40 years). The QoL was assessed using the latest version of the audit of diabetes-dependent quality of life (ADDQoL). RESULTS The average weighted impact (AWI) of diabetes on QoL was significantly lower in adults with early type 2 diabetes than those diagnosed later. Patients with early type 2 diabetes reported a greater negative impact of diabetes on specific life domains "close personal relationship," "sex life," "self-confidence," "motivation to achieve things," "feelings about the future," "freedom to eat," and "freedom to drink" than patients with typical type 2 diabetes. In multivariate analysis adjusted for demographic and medical variables, a diagnosis of diabetes before the age of 40 was significantly associated with a lower ADDQoL AWI score [OR 3.60 (95 % CI: 1.12-11.55), P < 0.05]. CONCLUSIONS Younger age at type 2 diabetes diagnosis is significantly associated with a poor diabetes-related QoL.
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Affiliation(s)
- Jin Ook Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-Gu, Gwangju, 501-757, Republic of Korea
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Sung HN, Chae HS, Kim ES, Kim JS. Diabetes and depressive symptoms in korean women: the fifth korean national health and nutrition examination survey (2010-2011). Korean J Fam Med 2014; 35:127-35. [PMID: 24921031 PMCID: PMC4040430 DOI: 10.4082/kjfm.2014.35.3.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 04/14/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the association between diabetes and depressive symptoms among Korean women. METHODS We performed an analysis of data for 6,572 women aged 30 or over obtained from the Fifth Korean National Health and Nutrition Examination Survey conducted in 2010 to 2011. We examined the presence of depressive symptoms and the treatment of depression according to diabetes status. RESULTS The presence of depressive symptoms was observed in 22.6% of subjects with diabetes. In the multiple logistic regression model, diabetes was associated with an increased risk of depressive symptoms (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.20 to 1.21) but the treatment of depression among diabetics was less common (OR, 0.54; 95% CI, 0.54 to 0.55). Uncontrolled diabetes (glycosylated hemoglobin ≥ 7%) was associated with an increased risk of depressive symptoms (OR, 1.71; 95% CI, 1.69 to 1.73) among diabetics. CONCLUSION Physicians should manage individuals with diabetes in consideration of the presence of depressive symptoms, especially in those with uncontrolled diabetes.
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Affiliation(s)
- Han Na Sung
- Department of Family Medicine, Yuseong Sun Hospital, Daejeon, Korea
| | - Hong Seok Chae
- Department of Family Medicine, Yuseong Sun Hospital, Daejeon, Korea
| | - Eung Soo Kim
- Department of Family Medicine, Yuseong Sun Hospital, Daejeon, Korea
| | - Jong Sung Kim
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
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Manoudi F, Chagh R, Benhima I, Asri F, Diouri A, Tazi I. [Depressive disorders in diabetic patients]. Encephale 2012; 38:404-10. [PMID: 23062454 DOI: 10.1016/j.encep.2012.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 08/02/2011] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Diabetes is a public health problem. Its global prevalence was 2.8% in 2000 and it will reach 4.4% in 2030 to be 366 million diabetics. In Morocco, this true "epidemic" affects 6.6% of the population. Many epidemiologic studies have shown that patients with diabetes are more susceptible to depression. Diabetes and depression align in a non-accidental way and complicate one another. PATIENTS AND METHODS We report a cross-sectional study conducted in association with the endocrinology department of the Mohammed VI university hospital during the period spread between April and September 2006. The aim was to evaluate the prevalence of depressive disorders in patients with diabetes and to describe their sociodemographic and clinical profile. The study included 187 patients. The scales used were the Mini International Neuropsychiatric Interview (MINI) and Hamilton's depression. Sociodemographics and diabetic characteristics were evaluated by self-questionnaire. RESULTS The average age of our patients was 53±14 years and the percentage of females was high: 71.2%. Diabetes type 2 was the most representative (85.6%), diabetes type 1 (11.8%) and gestational diabetes (2.7%). Half of diabetics were treated with an association of healthy dietary measures (MHD) and oral anti-diabetics; 31.6% were under MHD and insulin therapy; 33.2% of patients had acute complications and 43.5% had degenerative complications. Only 11 patients (5.9%) had antecedents of depression. The prevalence of major depressive episode was 41.2%; 27.8% of patients suffered from dysthymia and 21.9% from double depression. Hamilton's depression scale indicates that all depressed patients had mild depression (total of 17 items from 8 to 17). Major depressive episode and dysthymia were frequent in out patients. Dysthymia was predominant in diabetic patients in the 46 to 55 years age group, never been schooled and without any comorbidity. The vast majority of patients with EDM had type 2 diabetes with 89.6%, 7.8% type 1 diabetes and 2.6% gestational diabetes. Most of dysthymic patients had type 2 diabetes with 94.2% against 5.8% type 1 diabetes. DISCUSSION The association of depression and diabetes was noted in the literature for the first time more than 300 years ago by the English doctor Willis. Compared to the population of non-depressed subjects, patients with depression may be more likely to develop type 2 diabetes. There would be an increase in the release of hyperglycemic hormones in depression, as in the stress response. In addition, patients with depression have insulin resistance during testing tolerance to insulin, and during testing tolerance to glucose. Other hypotheses explain that the depression/diabetes link included biological and genetic resources. CONCLUSION Diabetes and depressive disorders are public health problems due to their prevalence and their cost. The prevalence of major depressive disorders found among our population of diabetics justifies their research by doctors. The literature promotes appropriate care that would improve the prognosis of diabetes, as well as depression-increased mortality among diabetics.
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Affiliation(s)
- F Manoudi
- Équipe de recherche pour la santé mentale, service de psychiatrie, faculté de médecine et de pharmacie, université Caddi Ayyad, hôpital Ibn Nafis, CHU Mohammed VI, Marrakech, Maroc.
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Lin CH, Lee YY, Liu CC, Chen HF, Ko MC, Li CY. Urbanization and prevalence of depression in diabetes. Public Health 2011; 126:104-11. [PMID: 22178148 DOI: 10.1016/j.puhe.2011.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 06/13/2011] [Accepted: 10/27/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To depict recent secular trend (2001-2005) in prevalence of depression among diabetic population in Taiwan, and to explore the influences of urbanization on the prevalence of depression. STUDY DESIGN A descriptive correlation study design relating urbanization and prevalence of depression. METHODS Annual prevalence of depression was calculated as the ratio of number of individuals with depression (ICD-9-CM: 296, 309, or 311) to the size of diabetic population (ICD-9-CM: 250), which were ascertained from ambulatory care claim data of Taiwan's National Health Insurance between 2001 and 2005. Multivariate Poisson regression analysis was used to assess the secular trend in the prevalence of comorbid depression, and to appraise the influence of urbanization on prevalence of depression in diabetic patients. RESULTS The prevalence of depression among diabetic population increased annually from 22.6/10(3) in 2001 to 27.0/10(3) in 2005 with a significantly and linearly rising trend (β = 0.0461, p < 0.0001). Diabetic population living in urban areas showed the largest increase in prevalence (6.3/10(3)), followed by those from rural areas (5.6/10(3)). Compared to the diabetic patients residing in rural areas, those living in urban areas (RR = 1.28, 95% CI = 1.25-1.31) and those from satellite towns (RR = 1.22, 95% CI = 1.19-1.25) both had significantly increased adjusted RR. CONCLUSIONS There is a significant increasing trend in prevalence of depression among diabetic population in recent years in Taiwan. Diabetic patients from urban areas not only had the greatest prevalence of depression but also showed the largest increase in prevalence during the study period, which highlights a need for managing depression in urban diabetes.
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Affiliation(s)
- C H Lin
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan
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Pouwer F, Geelhoed-Duijvestijn PHLM, Tack CJ, Bazelmans E, Beekman AJ, Heine RJ, Snoek FJ. Prevalence of comorbid depression is high in out-patients with Type 1 or Type 2 diabetes mellitus. Results from three out-patient clinics in the Netherlands. Diabet Med 2010; 27:217-24. [PMID: 20546267 DOI: 10.1111/j.1464-5491.2009.02903.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Depression is common in diabetes, but the scope of the problem and associated correlates are not well established in specialist diabetes care. We aimed to determine the prevalence of depression among adult outpatients with Type 1 (T1DM) or Type 2 diabetes (T2DM) using both self-report measures and a diagnostic interview, and to establish demographic and clinical characteristics associated with depressive affect. METHODS A random sample of 2055 diabetes out-patients from three diabetes clinics was invited to participate. Depressive affect was assessed using the World Health Organization-5 Well Being Index (WHO-5), the Centre for Epidemiologic Studies-Depression scale (CESD) using predefined cut-off scores, and depressive disorder with the Composite International Diagnostic Interview (CIDI). Associations between depression and patient characteristics were explored using regression analyses. RESULTS Seven hundred and seventy-two patients completed the depression questionnaires. About one-third of T1DM patients and 37-43% of T2DM patients reported depressive affect (WHO-5). The prevalence of depressive affect (CESD) was 25% and 30% for men and women with T1DM, and 35% and 38% for men and women with T2DM, respectively. Based on the CIDI, 8% of T1DM patients (no gender difference) and 2% of men and 21% of women with T2DM suffered from a depressive disorder. Depressive affect was associated with poor glycaemic control and proliferative retinopathy in T1DM, while non-Dutch descent, obesity and neuropathy were correlates in T2DM. CONCLUSIONS Depressive symptoms and major depressive disorder constitute a common comorbid problem among Dutch out-patients with T1DM or T2DM and appear particularly common in migrants and women with T2DM.
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Affiliation(s)
- F Pouwer
- Diabetes Psychology Research Group, Department of Medical Psychology, EMGO-Institute, VU University Medical Centre, Amsterdam, the Netherlands.
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Yang J, Li S, Zheng Y. Predictors of depression in Chinese community-dwelling people with type 2 diabetes. J Clin Nurs 2009; 18:1295-304. [PMID: 19413557 DOI: 10.1111/j.1365-2702.2008.02703.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To examine levels of perceived social support and depression and to identify the related factors and predictors of depression among Chinese community-dwelling people with type 2 diabetes. BACKGROUND People with type 2 diabetes have a high risk for depression. Depression is a serious issue that leads to poor metabolic control and increased health care costs. However, little is known about the factors contributing to depression in Chinese people with type 2 diabetes. DESIGN A cross-sectional, descriptive correlation design was used. METHODS A convenient sample consisting of 148 people with type 2 diabetes participated. Personal information questionnaire was used to obtain socio-demographic characteristics; Zung Self-Rating Depression Scale and Multidimensional Scale of Perceived Social Support were used to measure depression and perceived social support, respectively. Spearman's correlation and Stepwise multiple regression analysis were used in data analysis. RESULTS The mean index score for depression was 46.53 and 39.2% of the subjects reported depression. The mean score for perceived social support was 5.24. Age, education level, marital status, monthly family income, living status, work status, regular exercise, duration of diabetes, diabetic complications, other chronic diseases and perceived social support were significantly correlated with depression. The best predictors of depression were perceived social support, duration of diabetes, regular exercise, work status and other chronic diseases. CONCLUSIONS Depression was common in people with type 2 diabetes. The people who had lower levels of perceived social support, longer diabetic duration, did not exercise regularly, were unemployed or retired and had other chronic diseases were more likely to report depression. RELEVANCE TO CLINICAL PRACTICE Nurses working in communities should assist people with type 2 diabetes in earlier detecting and treating their depression. Nurses should also design practical interventions to decrease depressive symptoms of those people through improving their diabetic conditions and perceived social support.
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Affiliation(s)
- Juan Yang
- Nursing Faculty, Hunan Traditional Chinese Medical College, Zhuzhou, China.
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Chong SA, Subramaniam M, Chan YH, Chua HC, Liow PH, Pek E, Stahl D, Verma S, Sum CF. Depressive symptoms and diabetes mellitus in an Asian multiracial population. Asian J Psychiatr 2009; 2:66-70. [PMID: 23051031 DOI: 10.1016/j.ajp.2009.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 03/20/2009] [Accepted: 04/10/2009] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Singapore has one of the world's highest rates of diabetes mellitus (DM). DM is also associated with depression, the nature of this relation is possibly bidirectional and complex and there are a number of putative associated factors. AIMS To establish the prevalence of depressive symptoms in an Asian multiracial population with diabetes and identify some of these putative risk factors including ethnicity for depressive symptoms while controlling for multiple confounding variables. METHODS This is a cross-sectional epidemiological study in an Asian multiracial population with DM. The subjects were 537 outpatients (aged 21 years and above) attending a specialist diabetes treatment centre in a general hospital. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) with a cut-off score of 16 or more indicating the presence of depressive symptoms. RESULTS The prevalence of depressive symptoms was 31.1%. Following a logistic regression with depression as the dependent variable, Indian race, type of treatment, activity level and marital status (divorced/separated) were significantly associated with a high risk of depression. CONCLUSIONS This is the first study done among 3 ethnic groups Chinese, Malays and Indians within the same geographical location, and the findings show that depressive symptoms are common among diabetic patients and highest among those of Indian ethnicity.
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Affiliation(s)
- Siow Ann Chong
- Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747, Singapore
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Kim SY, Lee JH, Kim HN, Kim DK, Na Y, Kim GS, Kim MK, Baek KH, Kang MIL, Lee KW, Song KH. Depression and Self-care Behavior in Patients with Diabetes Mellitus. KOREAN DIABETES JOURNAL 2009. [DOI: 10.4093/kdj.2009.33.5.432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Su Yoen Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Ho Lee
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ha Neul Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Kyu Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Na
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Guil Sun Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mee Kyoung Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Hyun Baek
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moo IL Kang
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang Woo Lee
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Ho Song
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Zahid N, Asghar S, Claussen B, Hussain A. Depression and diabetes in a rural community in Pakistan. Diabetes Res Clin Pract 2008; 79:124-7. [PMID: 17692423 DOI: 10.1016/j.diabres.2007.07.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 07/05/2007] [Indexed: 11/25/2022]
Abstract
AIMS To determine the prevalence of depression amongst subjects with diabetes and associated risk factors in a rural area of Pakistan. METHODS One thousand two hundred and ninety rural individuals aged 20 years and above were randomly included in the study. Fasting plasma glucose (FPG), BMI, WHR were recorded. Depression was assessed by Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS The prevalence of depression was 5.4% (95% CI: 4.2-6.6), slightly higher amongst women compared to men. Depression prevalence was 14.7% (6.6-22.8) amongst those with diabetes as opposed to 4.9 (3.7-6.1) amongst those without diabetes. Age, gender, and diabetes were independent risk factors for depression, while obesity had a protective effect. CONCLUSIONS A relatively low prevalence of depression were recorded amongst the rural inhabitants, while a high prevalence was observed amongst diabetic subjects in Pakistan. This may suggest that psychiatric intervention may be required both for improved care and for primary prevention of diabetes.
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Affiliation(s)
- Naeem Zahid
- Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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