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Benton M, Cleal B, Prina M, Baykoca J, Willaing I, Price H, Ismail K. Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis. Gen Hosp Psychiatry 2023; 80:1-16. [PMID: 36493531 DOI: 10.1016/j.genhosppsych.2022.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Type 1 diabetes is associated with increased prevalence of individual categories of mental disorders. We aimed to systematically synthesise the prevalence of all the different categories of mental disorders to estimate the overall burden of psychiatric morbidity in the type 1 diabetes population. METHOD The electronic database of OVID was searched, and retrieved papers were screened for eligibility by two independent reviewers. Data were extracted using a standardised data extraction form and the quality of included papers was assessed. Where possible, comparisons with control groups without type 1 diabetes were made. Prevalence data were synthesised into Diagnostic and Statistical Manual of Mental Disorders version 5 categories, a narrative data-synthesis, and a subsequent meta-analysis where possible was conducted for mental disorder categories. RESULTS Thirty-eight articles were included. Depressive, anxiety, and feeding and eating disorders were the most examined mental disorders. Studies utilising diagnostic interviews reported higher prevalence of mental disorders than in studies utilising clinical registers, with an up to 24-fold difference respectively. In studies with a control group, the prevalence for nearly every mental disorder were increased for the type 1 diabetes samples. CONCLUSIONS There appears to be a high prevalence of mental disorders and associated need among people with type 1 diabetes, although the quality of research needs to improve. SYSTEMATIC REVIEW REGISTRATION This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020221530).
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Affiliation(s)
- Madeleine Benton
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom
| | - Bryan Cleal
- Steno Diabetes Center, Borgmester Ib Juuls Vej 83, 2730 Herlev, Copenhagen, Denmark
| | - Mathew Prina
- Social Epidemiology Research Group, King's College London, 18 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Jeni Baykoca
- Southern Health NHS Foundation Trust, Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom
| | - Ingrid Willaing
- Steno Diabetes Center, Borgmester Ib Juuls Vej 83, 2730 Herlev, Copenhagen, Denmark
| | - Hermione Price
- Southern Health NHS Foundation Trust, Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
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Genis-Mendoza AD, González-Castro TB, Tovilla-Vidal G, Juárez-Rojop IE, Castillo-Avila RG, López-Narváez ML, Tovilla-Zárate CA, Sánchez-de la Cruz JP, Fresán A, Nicolini H. Increased Levels of HbA1c in Individuals with Type 2 Diabetes and Depression: A Meta-Analysis of 34 Studies with 68,398 Participants. Biomedicines 2022; 10:biomedicines10081919. [PMID: 36009468 PMCID: PMC9405837 DOI: 10.3390/biomedicines10081919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 01/10/2023] Open
Abstract
Glycosylated hemoglobin is used to diagnose type 2 diabetes mellitus and assess metabolic control. Depression itself has been associated with high levels of HbA1c in individuals with T2DM. The association between diabetes and depression suggests the usefulness of determining HbA1c as a biological marker of depressive symptoms. The aim of this study was to determine HbA1c levels in individuals with T2DM with vs. without depression. Additionally, we analyzed the influence of pharmacological treatments, time of evolution, and complications of disease. We performed a literature search in different databases published up to January 2020. A total of 34 articles were included. Our results showed that individuals with T2DM with depression showed increased levels of HbA1c in comparison to individuals with T2DM without depression (d = 0.18, 95% CI: 0.12−0.29, p(Z) < 0.001; I2 = 85.00). We also found that HbA1c levels remained elevated in individuals with T2DM with depression who were taking hypoglycemic drugs (d = 0.20 95% CI: 0.11−0.30, p(Z) < 0.001; I2 = 86.80), in individuals with less than 10 years of evolution (d = 0.17 95% CI: 0.09−0.26, p(Z) = 0.001; I2 = 66.03) and in individuals with complications of the disease (d = 0.17, 95% CI: 0.07−0.26, p(Z) < 0.001; I2 = 58.41). Our results show that HbA1c levels in individuals with T2DM with depression are significantly increased compared to controls with T2DM without depression. Additionally, these levels remained elevated in individuals who were taking hypoglycemic drugs, those with less than 10 years of disease evolution, and those with complications related to diabetes. It is necessary to examine the existence of a diabetes−HbA1c−depression connection.
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Affiliation(s)
- Alma Delia Genis-Mendoza
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Ciudad de México 14610, Mexico
| | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86040, Tabasco, Mexico
| | - Gisselle Tovilla-Vidal
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Tabasco, Mexico
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Tabasco, Mexico
| | - Rosa Giannina Castillo-Avila
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86100, Tabasco, Mexico
| | - María Lilia López-Narváez
- Hospital Chiapas Nos Une “Dr. Gilberto Gómez Maza”, Secretaría de Salud de Chiapas, Tuxtla Gutiérrez 29045, Chiapas, Mexico
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86040, Tabasco, Mexico
- Correspondence: (C.A.T.-Z.); (H.N.); Tel.: +52-993-358-1500 (ext. 6901) (C.A.T.-Z.); +52-5350-1900 (ext. 1197) (H.N.)
| | - Juan Pablo Sánchez-de la Cruz
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86040, Tabasco, Mexico
| | - Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México 14370, Mexico
| | - Humberto Nicolini
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Ciudad de México 14610, Mexico
- Correspondence: (C.A.T.-Z.); (H.N.); Tel.: +52-993-358-1500 (ext. 6901) (C.A.T.-Z.); +52-5350-1900 (ext. 1197) (H.N.)
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Beverly EA, Hughes AS, Saunders A. Examination of Health Care Providers' Use of Language in Diabetes Care: A Secondary Qualitative Data Analysis. Clin Diabetes 2022; 40:434-441. [PMID: 36385976 PMCID: PMC9606549 DOI: 10.2337/cd21-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this secondary qualitative data analysis was to assess the frequency and context of stigmatizing language used by health care providers (HCPs). The authors conducted content and thematic analysis of in-depth face-to-face and telephone interviews with HCPs in southeastern Ohio. Participants frequently used labeling language, such as "diabetic" and "noncompliant," as well as language with negative connotations, such as "control," "testing," and "regimen." These findings offer a real-world glimpse of how HCPs communicate about people with diabetes in this region of the country.
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Affiliation(s)
- Elizabeth A. Beverly
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- Ohio University Diabetes Institute, Athens, OH
| | - Allyson S. Hughes
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- Ohio University Diabetes Institute, Athens, OH
| | - Amy Saunders
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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Riaz BK, Selim S, Neo M, Karim MN, Zaman MM. Risk of Depression among Early Onset Type 2 Diabetes Mellitus Patients. Dubai Diabetes Endocrinol J 2021. [DOI: 10.1159/000515683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Methodology:</i></b> Biochemically confirmed type 2 diabetes mellitus (T2DM) patients (<i>n</i> = 1,114) were recruited from the outpatient department of 2 tertiary care hospitals in Dhaka, Bangladesh. Face-to-face interview was conducted using a semi-structured questionnaire containing sociodemographic parameters and relevant information about depression and diabetes. Biochemical test results and treatment-related information were taken from patients’ records. The Hospital Anxiety and Depression Scale (HADS) was used to screen all patients for psychiatric manifestation. Those diagnosed by HADS were subsequently reassessed using structured clinical interview for DSM-5 Disorders – Clinician Version. T2DM diagnosed at age <40 years were considered as early onset T2DM. Association between age of onset category and depression was assessed using multivariable mixed-effect logistic regression adjusting for random variation of the area of residence and plausible confounders. <b><i>Results:</i></b> Around a third of the participants (32.5%) were diagnosed with T2DM before the age of 40 years. Early onset T2DM patients were found to have 57% increase in the risk of developing depression (OR 1.57; 95% CI 1.13–2.28; <i>p</i> = 0.011) in comparison to those with usual onset T2DM (≥40 years). Among other factors a positive family history for diabetes (OR 1.33; 95% CI 1.03–1.78; <i>p</i> = 0.038), poor glycemic control (OR 1.31; 95% CI 1.03–1.68; <i>p</i> = 0.028), presence of 1, or more diabetic complications (OR 1.37; 95% CI 1.03–1.78; <i>p</i> = 0.011) also showed increased risk of depression. <b><i>Conclusion:</i></b> Early onset T2DM patients are at greater risk of developing depression. The finding is likely to help in setting preventive strategies aiming to reduce the presence of concomitant depression symptoms among diabetes.
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Malliarou M, Desikou C, Lahana E, Kotrotsiou S, Paralikas T, Nikolentzos A, Kotrotsiou E, Sarafis P. Diabetic patient assessment of chronic illness care using PACIC. BMC Health Serv Res 2020; 20:543. [PMID: 32546232 PMCID: PMC7296774 DOI: 10.1186/s12913-020-05400-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background The Patient Assessment of Chronic Illness Care plus is used in order to assess whether provided care is congruent with the Chronic Care Model, according to patients. The purpose of this study was to correlate PACIC+ and the revised 5As “ask, advise, agree, assist and arrange” scoring of a sample of DM patients, with their QoL, depressive symptomatology, demographic and disease characteristics, self-management behaviours of healthy eating and physical activity. Methods This is a cross-sectional study where data were collected between January and April 2018 by using three questionnaires (PACIC+, SF-36, CES-D) from a sample of 90 DM patients treated at a Public General Hospital of Central Greece. Anonymous self-completed questionnaires were used to collect the data. Data was processed in the Statistical Package for the Social Sciences (SPSS). Results The mean age of the participants with DM was 52.8 years (SD = 21.2 years), with cardiovascular disease and arterial hypertension scoring as the most frequently reporting chronic comorbidities. The healthcare received by DM patients has been correlated with their QoL. More specifically SF – 36 and PACIC+ scale scores showed a positive and low correlation in several subscales. The total score of PACIC+ scale as well as the Patient activation score were increased in higher scores of vitality (p = 0.034 & p = 0.028 respectively), hence both scores correlate significantly with latter. In addition, Delivery System / Practice Design score was increased in higher scores of mental health (p = 0.01) and MCS (p = 0.03). Conclusions The shift from hospital care focusing on the disease to a more patient-oriented approach puts forward a dynamic holistic approach to chronic diseases and the reduction of their impact. Finding evidence-based and effective strategies to promote health, prevent and manage chronic diseases such as diabetes mellitus is deemed to be crucial and necessary. PACIC+, which is a tool of a patient-level assessment of CCM implementation, can be used by countries which intend to apply changes in the way their health systems provide chronic care and specifically wish to improve the quality of chronic disease care and the QoL of their patients.
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Affiliation(s)
- Maria Malliarou
- Department of Nursing, University of Thessaly, Perifreiakh Odos Larisas, Trikalon, TK 41110, Larisa, Greece
| | - Christina Desikou
- General Public Hospital of Volos "Achillopouleio", Athanasaki 3, TK 38222, Volos, Greece
| | - Eleni Lahana
- University of Thessaly, Perifreiakh Odos Larisas, Trikalon, TK 41110, Larisa, Greece
| | - Styliani Kotrotsiou
- University of Thessaly, Perifreiakh Odos Larisas, Trikalon, TK 41110, Larisa, Greece
| | - Theodosios Paralikas
- University of Thessaly, Perifreiakh Odos Larisas, Trikalon, TK 41110, Larisa, Greece
| | | | - Evangelia Kotrotsiou
- University of Thessaly, Perifreiakh Odos Larisas, Trikalon, TK 41110, Larisa, Greece
| | - Pavlos Sarafis
- Department of Nursing, Cyprus University of Technology, 30 Archbishop Street, 3036, Limassol, Cyprus.
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Hussain A, Wani ZA, Shah H, Zargar AH, Margoob MA, Qureshi W. Depression and diabetes: An experience from Kashmir. Indian J Psychiatry 2020; 62:167-171. [PMID: 32382176 PMCID: PMC7197822 DOI: 10.4103/psychiatry.indianjpsychiatry_46_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/06/2019] [Accepted: 12/25/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a common chronic metabolic disorder characterized by hyperglycemia. Minimal attention has been paid toward the relationship between diabetes and depression in developing countries such as India, despite a number of studies in developed countries, exploring casual pathway between the two highly prevalent conditions. The aim of this study was to estimate the prevalence and severity of depression among patients of diabetes attending the endocrinology department of a tertiary care hospital of Kashmir. METHODOLOGY A total of 527 patients having diabetes of ≥6 months with age ranging from 18 years to 60 years were screened for major depressive disorder (MDD) using Diagnostic and Statistical Manual IV-based criteria. Severity of depression was assessed by the Montgomery-Asberg Depression Rating Scale. RESULTS Depression was present in 39.65% of patients. Depression was more prevalent in the age group of 29-38 years, in females as compared to males, among literates and government employees. Prevalence of depression among Type 1 diabetic patients was 60%, while as in case of Type 2, it was 37.75%. Depressed patients had higher fasting blood glucose levels as compared to nondepressed diabetic patients. CONCLUSION MDD is inordinately high among adult diabetic patients, and majority of the depressive patients have moderate intensity of MDD.
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Affiliation(s)
- Arshad Hussain
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Zaid Ahmad Wani
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Hamidullah Shah
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Abdul Hamid Zargar
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mushtaq Ahmad Margoob
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Waseem Qureshi
- Department of Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
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Wong JJ, Addala A, Abujaradeh H, Adams RN, Barley RC, Hanes SJ, Iturralde E, Lanning MS, Naranjo D, Tanenbaum ML, Hood KK. Depression in context: Important considerations for youth with type 1 vs type 2 diabetes. Pediatr Diabetes 2020; 21:135-142. [PMID: 31644828 DOI: 10.1111/pedi.12939] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/01/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Youth with diabetes are at increased risk for depression. However, severity and correlates of depressive symptoms may differ by diabetes type. OBJECTIVE Associations of depressive symptoms with global health, diabetes duration, and gender were compared between youth with type 1 and type 2 diabetes. METHODS A sample of 149 youth ages 12 to 21 diagnosed with either type 1 (n = 122) or type 2 (n = 27) diabetes were screened during routine clinic appointments. Regression models were constructed to examine differences by diabetes type. RESULTS Adolescents with type 2 diabetes had significantly higher depressive symptom scores (4.89 vs 2.99, P = .025) than those with type 1 diabetes. A significant interaction between global health and diabetes type on depressive symptoms revealed inverse associations between global health and depressive symptoms that was stronger among youth with type 2 diabetes (β = -.98, P < .001) than type 1 (β = -.48, P < .001). Further probing revealed that among youth with better global health, adolescents with type 1 had more depressive symptoms than those with type 2 diabetes (β = .33, P = .035). Diabetes duration and depressive symptoms were positively associated among individuals with type 2 (β = .86, P = .043), but not type 1 diabetes. No gender differences were detected. CONCLUSION These findings suggest that correlates of depressive symptoms in youth with diabetes differ by diabetes type. Global health appears to be an important correlate among youth with both types, whereas diabetes duration was only a significant factor among those with type 2 diabetes. The current findings can inform future psychosocial intervention efforts within both these populations.
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Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Ananta Addala
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Hiba Abujaradeh
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca N Adams
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Regan C Barley
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Sarah J Hanes
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Esti Iturralde
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Monica S Lanning
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Diana Naranjo
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Korey K Hood
- Department of Pediatrics, Stanford University, Palo Alto, California
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Nicolau J, Simó R, Conchillo C, Sanchís P, Blanco J, Romerosa JM, Fortuny R, Bonet A, Masmiquel L. Differences in the cluster of depressive symptoms between subjects with type 2 diabetes and individuals with a major depressive disorder and without diabetes. J Endocrinol Invest 2019; 42:881-888. [PMID: 30788770 DOI: 10.1007/s40618-019-01020-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depressive disorder encompasses a wide spectrum of somatic and psychological symptoms. It is not known whether there are differences regarding the cluster of depressive symptomatology between subjects with depression with and without T2DM. PURPOSE To explore whether the cluster of depression that prevails among depressive subjects with T2DM differs from individuals with depression, but without T2DM. METHODS 87 T2DM patients with a pathological Beck Depression Inventory test (BDI) were compared with 50 age- and gender-matched individuals with a major depressive disorder. All 21 items expressed in the BDI were compared between the two groups. RESULTS The score obtained after administering the BDI was comparable between patients with T2DM and significant depressive symptoms and the control group (18.8 ± 2.7 vs 18.9 ± 3.4; p = 0.9). Subjects with T2DM had higher scores compared with the control group in the following items: sadness (1.4 ± 0.9 vs 0.9 ± 0.9; p = 0.011), difficulty in concentration (1.3 ± 0.8 vs 0.8 ± 0.8; p = 0.01), indecisiveness (1.1 ± 0.8 vs 0.5 ± 0.9; p = 0.012), worries about their health (1.3 ± 0.9 vs 0.6 ± 0.9; p < 0.0001), fatigue (1.2 ± 0.6 vs 0.8 ± 0.7; p = 0.003) and loss of sexual appetite (2.7 ± 0.6 vs 1.2 ± 1.3; p = 0.0001). Suicidal ideation was significantly lower among subjects with T2DM compared with the control group (0.1 ± 0.3 vs 0.6 ± 0.8; p = 0.0001). CONCLUSIONS Subjects with T2DM and a positive screening for depression presented a different cluster of depression compared with depressed subjects without T2DM, with a predominance of somatic-biological depressive symptoms rather than psychological-cognitive cluster and negative emotions, such as suicidal ideation.
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Affiliation(s)
- J Nicolau
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain.
| | - R Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Barcelona, Spain
| | - C Conchillo
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - P Sanchís
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - J Blanco
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - J M Romerosa
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - R Fortuny
- Hormonal Laboratory Department, Hospital Son Llàtzer, Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - A Bonet
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - L Masmiquel
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
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Abstract
BACKGROUND The changes in dietary habits can affect mental health problems, such as depressive disorder, due to the occurrence of diabetes. OBJECTIVE This study aimed to determine the effects of diabetes on mental health (Patient Health Questionnaire-9: PHQ-9). METHODS A secondary data analysis of cross-sectional design based on the raw data from KNHANES VII-1 was performed, which were disclosed by MOHW and KCDC. Of 8,150 respondents, 5,661 respondents aged ⩾ 20 years were included, thus excluding 2,489 respondents. Data were analyzed using an SPSS version 20.0 program. RESULTS The respondents scored high for diabetes diagnosis status (3.65), suicide planning status for a year (8.56), mental problem counseling for a year (7.80), and the degree of daily stress awareness (8.27) in PHQ-9. They scored higher for suicide planning status for a year, mental problem counseling for a year, and the degree of daily stress awareness than for diabetes diagnosis status in PHQ-9. Positive correlation was found among diabetes diagnosis status, suicide planning status for a year, mental problem counseling for a year, and daily stress awareness in PHQ-9 (p< 0.01). Diabetes diagnosis status (p< 0.01), suicide planning status for a year (p< 0.001), mental problem counseling for a year (p< 0.001), and the degree of daily stress awareness (p< 0.001) affected PHQ-9. CONCLUSION PHQ-9 for screening depressive disorder based on diabetes diagnosis status had low scoring distribution. However, because diabetes diagnosis status significantly affected PHQ-9 for depression screening, it is necessary to pay attention to health care related to diabetes. Further research should be conducted on the association with diverse causes of the low scoring distribution in PHQ-9 in relation to diabetes.
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Affiliation(s)
- Yoon-Ho Lee
- Department of Faculty Food and Nutrition, ChungCheong University, Heungdeok-Gu, Cheongju-Si, Chungbuk 28171, Korea
| | - Sang-Sub Park
- Department of Emergency Medical Technology, ChungCheong University, Heungdeok-Gu, Cheongju-Si, Chungbuk 28171, Korea
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Mansori K, Shiravand N, Shadmani FK, Moradi Y, Allahmoradi M, Ranjbaran M, Ahmadi S, Farahani A, Samii K, Valipour M. Association between depression with glycemic control and its complications in type 2 diabetes. Diabetes Metab Syndr 2019; 13:1555-1560. [PMID: 31336521 DOI: 10.1016/j.dsx.2019.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/04/2019] [Indexed: 02/07/2023]
Abstract
AIMS This study aims to determine the association between depression with glycemic control (HbA1c) and its complications. MATERIALS AND METHODS This was a cross-sectional study that included 514 diabetic patients. The patients were randomly selected from among all type 2 diabetes patients referred to health and medical centers in Khorramabad town (Iran). Two questionnaires used for data collection. The first questionnaire included demographic information, diabetes and its complications and the second questionnaire was Beck Depression Inventory (BDI-II) which was used to assess depression. The stata software version 14 was used for data analysis. Then, for evaluate the association between depression with glycemic contol and its complications, Univariate and multiple logistic regression analysis were employed. RESULTS The prevalence of depression in diabetic patients under study was 46.3% and for female and male was 49.6 and 36.8%; respectively. The results showed that 48.6% of diabetic patients did not have appropriate glycemic control status (HbA1c > 8). There was no significant association between glycemic control expressed as HbA1c levels and depression (OR: 1.11, 95% CI: 0.87-1.57). By contrast, sex (OR: 2.03, CI 95%: 1.03-3.99), residence (OR: 1.92, 95% CI: 1.28-2.91) and sexual complications (OR: 5.54, 95% CI: 1.07-27.87) have a significant statistical association with depression. CONCLUSION The study highlights the high prevalence of depression in diabetic patients. However, there was no significant association between depression and glycemic control. The implementation of mental health screening for rapid diagnosis and timely treatment of depression seems essential in diabetic patients.
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Affiliation(s)
- Kamyar Mansori
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Epidemiology, School of Public Heath, Iran University of Medical Sciences, Iran
| | - Narges Shiravand
- Department of Communicable Disease Control and Prevention, Deputy of Health, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Khosravi Shadmani
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yousef Moradi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Ranjbaran
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Shiler Ahmadi
- School of Nursing and Midwifery Islamic Azad University, Sanandaj Branch, Sanandaj, Iran
| | - Abbas Farahani
- School of Public Health, Lorestan University of Medical Sciences, Khorramabad, Islamic Republic of Iran
| | - Kobra Samii
- School of Public Health, Lorestan University of Medical Sciences, Khorramabad, Islamic Republic of Iran
| | - Mehrdad Valipour
- Department of Epidemiology, School of Public Heath, Iran University of Medical Sciences, Iran; School of Public Health, Lorestan University of Medical Sciences, Khorramabad, Islamic Republic of Iran.
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Ahmadieh H, Itani H, Itani S, Sidani K, Kassem M, Farhat K, Jbeily M, Itani A. Diabetes and depression in Lebanon and association with glycemic control: a cross-sectional study. Diabetes Metab Syndr Obes 2018; 11:717-728. [PMID: 30519066 PMCID: PMC6233908 DOI: 10.2147/dmso.s179153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a chronic noncommunicable disease characterized by hyperglycemia and is associated with chronic complications affecting the overall quality of life. As of 2017, the prevalence of diabetes in Lebanon is estimated to be 14.6%. Depression is noted to be common among Lebanese citizens, present in around 17.3%. This study aims to investigate the prevalence of depression among the diabetic Lebanese citizens and to study its relationship with poor glycemic control and diabetes complications. METHODS In total, 436 diabetic patients participated in this cross-sectional study. Patients with diabetes mellitus attending several private clinics and health care centers were asked to fill out a well-structured questionnaire developed by an expert. Depression was assessed using Beck Depression Inventory (BDI). The study collected demographic information about the participants including their lifestyles, their last reported glycosylated hemoglobin values, and their reported microvascular and macrovascular complications. Data were collected, entered, and analyzed on SPSS software version 23.1. A descriptive analysis is carried out by calculating the mean and standard deviation for continuous variables and number and percentage for categorical ones. Association between categorical variables is evaluated using a chi-squared test. A P-value of <0.05 is considered to be significant. RESULTS Depression was prevalent among 28.8% of the patients with diabetes mellitus. The average age of participants was 64.08 years. In total, 280 (64.2%) of the participants were females and the average diabetes duration was 8.89 years. There was no significant relationship found between depression and glycemic control. By contrast, a significant association between retinopathy, nephropathy, and stroke and depression was found. CONCLUSION Depression was found to be present among 28.8% of the patients with diabetes mellitus in Lebanon; however, no association was established between depression and glycemic control.
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Affiliation(s)
- Hala Ahmadieh
- Department of Internal Medicine, Faculty of Medicine, Beirut Arab University, Beirut, Lebanon,
| | - Hadi Itani
- Department of Internal Medicine, Faculty of Medicine, Beirut Arab University, Beirut, Lebanon,
| | - Sanaa Itani
- Department of Internal Medicine, Faculty of Medicine, Beirut Arab University, Beirut, Lebanon,
| | - Khaled Sidani
- Department of Internal Medicine, Faculty of Medicine, Beirut Arab University, Beirut, Lebanon,
| | - Mona Kassem
- Department of Internal Medicine, Faculty of Medicine, Beirut Arab University, Beirut, Lebanon,
| | - Kassem Farhat
- Department of Internal Medicine, Faculty of Medicine, Beirut Arab University, Beirut, Lebanon,
| | - Mohammad Jbeily
- Department of Internal Medicine, Faculty of Medicine, Beirut Arab University, Beirut, Lebanon,
| | - Abdallah Itani
- Department of Internal Medicine, Faculty of Medicine, Beirut Arab University, Beirut, Lebanon,
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Ahola AJ, Forsblom C, Groop PH. Association between depressive symptoms and dietary intake in patients with type 1 diabetes. Diabetes Res Clin Pract 2018; 139:91-99. [PMID: 29475022 DOI: 10.1016/j.diabres.2018.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/25/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
Abstract
AIMS Depressive mood negatively affects self-care practices, and thereby increases the risk of long-term complications. Not much is known about the association between depressive symptoms and dietary intake in patients with type 1 diabetes, a population with high risk of cardiovascular disease. METHODS Subjects (n = 976, 41% men, age 48 ± 14 years) were participants in the Finnish Diabetic Nephropathy Study. Depressive symptomatology was assessed with the Beck Depression Inventory (BDI). Dietary patterns were derived from food frequency questionnaire-entries by exploratory factor analysis. Energy and macronutrient intakes were calculated from food records. In the same record, participants also reported the results of their daily blood glucose monitoring. Associations between BDI score and self-care variables were analysed using generalized linear regression. For macronutrients, a substitution model was applied. RESULTS Two dietary patterns ("Fish and vegetables", and "Traditional") negatively associated with the BDI score. Instead, an increase in the "Sweet" pattern score was positively associated with depressive symptomatology. Of the macronutrients, favouring protein over carbohydrates or fats associated with lower depression scores. Higher blood glucose self-monitoring frequency and higher variability of the measurements were positively associated with the BDI score. However, no association was observed between depressive symptoms and the mean of the blood glucose measurements. CONCLUSIONS Depressive symptoms are reflected in the dietary intake and the self-monitoring of blood glucose, in type 1 diabetes. Whether depression, via compromised self-care practices, negatively affect long-term outcomes in this patient group has to be the subject of future studies.
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Affiliation(s)
- Aila J Ahola
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Finland; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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Abstract
Type 2 diabetes mellitus (T2DM) is associated with depressive symptoms, and comorbid depression in those with T2DM has been associated with adverse clinical profiles. Recognizing and addressing psychological symptoms remain significant clinical challenges in T2DM. Possible mediators of the reciprocal relationship between T2DM and depression may include physical activity levels, effectiveness of self-management, distress associated with a new T2DM diagnosis, and frailty associated with advanced diabetes duration. The latter considerations contribute to a "J-shaped" trajectory from the time of diagnosis. There remain significant challenges to screening for clinical risks associated with psychological symptoms in T2DM; poorer outcomes may be associated with major depressive episodes, isolated (eg, anhedonic), or subsyndromal depressive symptoms, depressive-like symptoms more specific to T2DM (eg, diabetes-related distress), apathy or fatigue. In this review, we discuss current perspectives on depression in the context of T2DM with implications for screening and management of these highly comorbid conditions.
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Affiliation(s)
- Lina Darwish
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada,
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada,
- Cardiac Rehabilitation Program, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada,
- Canadian Partnership for Stroke Recovery, Toronto, ON, Canada,
| | - Erika Beroncal
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada,
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada,
- Cardiac Rehabilitation Program, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada,
| | - Ma Veronica Sison
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada,
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada,
- Cardiac Rehabilitation Program, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada,
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada,
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada,
- Cardiac Rehabilitation Program, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada,
- Canadian Partnership for Stroke Recovery, Toronto, ON, Canada,
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15
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Ehrmann D, Schmitt A, Reimer A, Haak T, Kulzer B, Hermanns N. The affective and somatic side of depression: subtypes of depressive symptoms show diametrically opposed associations with glycemic control in people with type 1 diabetes. Acta Diabetol 2017; 54:749-756. [PMID: 28555338 DOI: 10.1007/s00592-017-1006-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/19/2017] [Indexed: 01/26/2023]
Abstract
AIMS While depression has been linked to serious adverse outcomes in diabetes, associations with glycemic control are not conclusive. Inconsistencies could be due to the complex symptomatology of depression. Aim of this study was to analyze the associations of depressive subtypes with glycemic control in people with type 1 and type 2 diabetes. METHODS Patients completed the Center for Epidemiological Studies-Depression scale which comprises affective, somatic, and anhedonic symptoms. These subtypes were analyzed in a joint linear regression analysis with glycemic control as a dependent variable. Subtype scores were calculated as mean item scores. Separate analyses for people with type 1 and type 2 diabetes were conducted. All analyses were controlled for demographic and medical confounders. RESULTS The sample comprised 604 patients with type 1 and 382 patients with type 2 diabetes. In people with type 1 diabetes, the somatic and affective subtype showed diametrically opposed associations with glycemic control (somatic: β =+0.23, p < .05; affective: β = -0.23, p < .05). Anhedonia was not significantly associated with glycemic control. In people with type 2 diabetes, none of the depressive subtypes was significantly associated with glycemic control. CONCLUSIONS For people with type 1 diabetes, the distinction of subtypes offered a detailed picture of the associations of depressive symptoms with glycemic control. However, due to the cross-sectional design, inferences about the direction of these associations cannot be made. In clinical practice, instead of focusing on overall depression, healthcare providers should examine the nature of depressive symptoms and how they might be related to having diabetes.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany.
| | - Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - André Reimer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
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Abstract
BACKGROUND Relationship between type 1 diabetes and Eating disorders is well-known, less information exists on the relationship between type 2 diabetes (T2DM) people and eating disorders. AIM Review information on the prevalence and impact of type 2 diabetes and eating disorders comorbidity. METHODS Search in Medline and PubMed relevant articles on the aforementioned co-morbidity. Review includes articles on epidemiological, clinical and therapeutics aspects. CONCLUSIONS Disordered eating behaviours may affect around 40% of T2DM people, being the predominant clinical forms: Eating Disorders Non otherwise specified (EDNOS), Night Eating Syndrome (NES) and Binge Eating Disorder (BED), however, population-based estimates of T2DM and ED comorbidity are mandatory to determine the prevalence of ED in T2DM people. The association between both entities has a consequence which is an impairment of metabolic control, associated to increase risk of vascular complications and difficult body weight loss, basis of T2DM treatment.
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Affiliation(s)
- Ricardo V García-Mayor
- South Galician Biomedical Foundation, University Hospital of Vigo, P.O. Box 1691, Vigo 36201, Spain.
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Sestile CC, Maraschin JC, Rangel MP, Cuman RKN, Audi EA. Antidepressant-like Effect of Insulin in Streptozotocin-induced Type 2 Diabetes Mellitus Rats. Basic Clin Pharmacol Toxicol 2016; 119:243-8. [DOI: 10.1111/bcpt.12563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/02/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Caio C. Sestile
- Department of Pharmacology and Therapeutics; State University of Maringa; Maringa Brazil
| | - Jhonatan C. Maraschin
- Department of Pharmacology and Therapeutics; State University of Maringa; Maringa Brazil
| | - Marcel P. Rangel
- Department of Pharmacology and Therapeutics; State University of Maringa; Maringa Brazil
| | - Roberto K. N. Cuman
- Department of Pharmacology and Therapeutics; State University of Maringa; Maringa Brazil
| | - Elisabeth A. Audi
- Department of Pharmacology and Therapeutics; State University of Maringa; Maringa Brazil
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Lynch CP, Strom Williams J, Voronca D, Walker RJ, Egede LE. Meaning of Illness and Cardiovascular Risk Factors in Patients With Type 2 Diabetes. Diabetes Educ 2016; 42:220-7. [PMID: 26879460 DOI: 10.1177/0145721716631430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to examine the relationship between meaning of illness and cardiovascular disease risk factors in patients with type 2 diabetes. METHODS The sample population was recruited from primary care clinics in the southeastern United States. The meaning of illness was assessed by a validated questionnaire with 5 subscales. The primary outcomes were cardiovascular disease (CVD) risk factors, assessed by A1C, systolic and diastolic blood pressure (SBP and DBP, respectively), and low-density lipoprotein cholesterol (LDL-C). Multivariate linear regression models investigated associations between the clinical outcomes and the 5 MIQ factors, controlling for possible confounders. RESULTS The sample comprised 302 black and white participants of whom more than half were elderly (65+ years) and the vast majority were male (98%). Systolic blood pressure was positively associated with non-anticipated vulnerability. Diastolic blood pressure was negatively associated with degree of stress/change in commitments and positively associated with challenge/motivation/hope and non-anticipated vulnerability. Low-density lipoprotein cholesterol was significantly and negatively associated with degree of stress/change in commitments. CONCLUSIONS Meaning of illness had a significant effect on measured outcomes of CVD risk. The specific factor included in the overarching concept of meaning of illness differed in its influence, with more positive views of stress/commitments associated with lower blood pressure and LDL but more positive views of the challenge/hope/motivation and negative views of non-anticipated vulnerability associated with diabetes associated with higher systolic and diastolic blood pressure.
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Affiliation(s)
- Cheryl P Lynch
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Lynch, Dr Walker, Dr Egede),Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede),Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Egede)
| | - Joni Strom Williams
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede),Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Egede)
| | - Delia Voronca
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede),Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Egede)
| | - Rebekah J Walker
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Lynch, Dr Walker, Dr Egede),Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede)
| | - Leonard E Egede
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Lynch, Dr Walker, Dr Egede),Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Walker, Dr Egede),Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Lynch, Dr Williams, Ms Voronca, Dr Egede)
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Abstract
TOPIC Medication nonadherence is prevalent in transplant recipients and is a major reason for graft loss. The present review discusses the measurement of adherence in transplant recipients and strategies to improve adherence. SOURCES REVIEWED: Since adherence research is not confined to transplant recipients, our literature review included studies relevant to transplant recipients as well as adherence to medical recommendations more generally. We reviewed manuscripts in the English language indexed in PubMed Central, as well as ancillary sources of information such as textbook chapters that are not indexed. CONCLUSION There is no consensus in the literature about an optimal way to monitor adherence, nor is there agreement about a preferred management strategy. Until definitive studies demonstrate the effectiveness of intervention strategies, knowledge of the monitoring as well as intervention methods that are described in this review is expected to give practitioners the initial tools to deal with nonadherence as an important aspect of patient care.
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Takasaki K, Babazono T, Ishizawa K, Miura J, Uchigata Y. Relationship between diabetic nephropathy and depression: a cross-sectional analysis using the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET). BMJ Open Diabetes Res Care 2016; 4:e000310. [PMID: 28074142 PMCID: PMC5179608 DOI: 10.1136/bmjdrc-2016-000310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/21/2016] [Accepted: 11/06/2016] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE We conducted this cross-sectional study to investigate the relationship between stage of diabetic nephropathy and likelihood or severity of depression in patients with diabetes. RESEARCH DESIGN AND METHODS We studied 2212 patients with diabetes (mean age 60.9 years; 928 women; 1838 patients with type 2 diabetes). Presence and severity of depression was examined using the Patient Health Questionnaire-9 (PHQ-9). Patients were classified into 5 stages of nephropathy, according to albuminuria and estimated glomerular filtration rate (eGFR); patients in stage 5 undergoing dialysis and kidney transplantation were analyzed separately (stages 5D and 5T). The relationship between stage of nephropathy and depression was examined using analysis of covariance and multivariate logistic regression analysis. RESULTS Both least square mean PHQ-9 scores and prevalence of patients with PHQ-9 scores ≥5 points (mild depression) and ≥10 points (moderate or severe depression) increased from stage 1 to 5D, and then declined in stage 5T. Multivariate ORs for mild or greater depression increased in patients in stages 3, 4, and 5D in reference to those in stage 1, which declined in patients in stage 5T. Albuminuria was significantly, but eGFR was not, associated with higher PHQ-9 scores and the PHQ-9 scores ≥5 or ≥10 after adjustment for clinical findings. CONCLUSIONS In patients with diabetes, progression of nephropathy is likely to be associated with increased risk and severity of depression, which may be reduced after successful kidney transplantation. Albuminuria may be more strongly associated with depression than eGFR.
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Affiliation(s)
- Keiko Takasaki
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
| | - Tetsuya Babazono
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
| | - Kaya Ishizawa
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
| | - Junnosuke Miura
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
| | - Yasuko Uchigata
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
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Mohsen NM, Khalil SA, Abu Shelbaya SEA, Abushady MM, Makboul KM, Maher MM, Mostafa AA. The biochemical profile for diabetes mellitus type I patients with comorbid depression. Middle East Current Psychiatry 2015; 22:193-197. [DOI: 10.1097/01.xme.0000470973.77553.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Morgan TO, Everett DL, Dunlop AL. How Do Interventions That Exemplify the Joint Principles of the Patient Centered Medical Home Affect Hemoglobin A1C in Patients With Diabetes: A Review. Health Serv Res Manag Epidemiol 2014; 1:2333392814556153. [PMID: 28462247 PMCID: PMC5289069 DOI: 10.1177/2333392814556153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To review the impact of the Joint Principle of the Patient Centered Medical Home (PCMH) on hemoglobin A1C (HbA1C) in primary care patients with diabetes. Methods: Systematic review of English articles using approximate terms for (1) the 7 principles of the PCMH, (2) primary care, and (3) HbA1C. We included experimental and observational studies. Three authors independently extracted data and obtained summary estimates for concepts with more than 2 high-quality studies. Results: Forty-three studies published between 1998 and 2012 met inclusion criteria, 33 randomized and 10 controlled before–after studies. A physician-directed medical practice (principle 2) lowered HbA1C values when utilizing nursing (mean difference [MD] −0.36, 95% confidence interval [CI] −0.43 to −0.28) or pharmacy care management (MD −0.76; 95% CI −0.93 to −0.59). Whole-person orientation (principle 3) also lowered HbA1C (MD −0.72, 95% CI −0.98 to −0.45). Studies of coordinated and integrated care (principle 4) and quality and safety interventions (principle 5) did not consistently lower HbA1C when reviewed in aggregate. We did not identify high-quality studies to make conclusions for personal physician (principle 1), enhanced access (principle 6), and payment (principle 7). Conclusion: Our review found individual interventions that reduced the HbA1C by up to 2.0% when they met the definitions set by of the Joint Principles of the PCMH. Two of the principles—physician-led team and whole-person orientation—consistently lowered the HbA1C. Other principles had limited data or made little to no impact. Based on current evidence, PCMH principles differentially influence the HbA1C, and there are opportunities for additional research.
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Affiliation(s)
- Toyosi O Morgan
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darcie L Everett
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Anne L Dunlop
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
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24
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Abstract
A potentially underappreciated member of the multidisciplinary approach to diabetic limb salvage is that of psychiatry. Diabetic patients are more likely to experience depression, and diabetic patients with depression are more likely to undergo an amputation. Also, both diabetes and depression independently increase the healthcare costs in the United States. The objective of the present investigation was to increase knowledge among diabetic foot practitioners with respect to psychiatric and other mental health patient-care issues, specifically the potential application of the 5 stages of grief to diabetic limb loss and amputation. We enlisted the assistance of a clinical professor from the psychiatry department at our institution to review the 5 stages of grief, provide context specific for application to diabetic limb loss, and offer clinically relevant guidelines for surgeons to better understand and communicate with their patients at each stage. The 5 stages reviewed were denial, anger, bargaining, depression, and acceptance. We hope that the present review will increase the body of knowledge with respect to relevant psychiatric issues and the diabetic foot and provide a starting point for increased awareness with respect to this important, yet underappreciated, aspect of patient care.
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Affiliation(s)
- Kerianne E Spiess
- Resident, Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, PA
| | - Anna McLemore
- Resident, Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, PA
| | - Priscilla Zinyemba
- Resident, Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, PA
| | - Natalia Ortiz
- Assistant Professor, Department of Psychiatry, Temple University Hospital, Philadelphia, PA
| | - Andrew J Meyr
- Associate Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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Sweileh WM, Abu-Hadeed HM, Al-Jabi SW, Zyoud SH. Prevalence of depression among people with type 2 diabetes mellitus: a cross sectional study in Palestine. BMC Public Health 2014; 14:163. [PMID: 24524353 PMCID: PMC3929146 DOI: 10.1186/1471-2458-14-163] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 02/11/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a common chronic metabolic disorder and one of the main causes of death in Palestine. Palestinians are continuously living under stressful economic and military conditions which make them psychologically vulnerable. The purpose of this study was to investigate the prevalence of depression among type II diabetic patients and to examine the relationship between depression and socio-demographic factors, clinical factors, and glycemic control. METHODS This was a cross-sectional study at Al-Makhfiah primary healthcare center, Nablus, Palestine. Two hundred and ninety-four patients were surveyed for the presence of depressive symptoms using Beck Depression Inventory (BDI-II) scale. Patients' records were reviewed to obtain data pertaining to age, sex, marital status, Body Mass Index (BMI), level of education, smoking status, duration of diabetes mellitus, glycemic control using HbA1C test, use of insulin, and presence of additional illnesses. Patients' medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). RESULTS One hundred and sixty four patients (55.8%) of the total sample were females and 216 (73.5%) were < 65 years old. One hundred and twenty patients (40.2%) scored ≥ 16 on BDI-II scale. Statistical significant association was found between high BDI-II score (≥ 16) and female gender, low educational level, having no current job, having multiple additional illnesses, low medication adherence and obesity (BMI ≥ 30 kg/m2). No significant association between BDI score and glycemic control, duration of diabetes, and other socio-demographic factors was found. Multivatriate analysis showed that low educational level, having no current job, having multiple additional illnesses and low medication adherence were significantly associated with high BDI-II scores. CONCLUSION Prevalence of depression found in our study was higher than that reported in other countries. Although 40% of the screened patients were potential cases of depression, none were being treated with anti-depressants. Psychosocial assessment should be part of routine clinical evaluation of these patients at primary healthcare clinics to improve quality of life and decrease adverse outcomes among diabetic patients.
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Affiliation(s)
- Waleed M Sweileh
- Department of Pharmacology/ Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | | | - Samah W Al-Jabi
- Department of Clinical and Comunity Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sa’ed H Zyoud
- Department of Pharmacology/ Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Abstract
Comorbidity of depression and diabetes is common, and each disorder has a negative impact on the outcome of the other. The direction of causality is not certain as each disorder seems to act as both a risk factor and consequence for the other in longitudinal studies. This bidirectional association is possibly mediated by shared environmental and genetic risk factors. Comorbid depression is associated with reduced adherence to medication and self-care management, poor glycaemic control, increased health care utilization, increased costs and elevated risk of complications, as well as mortality in patients with diabetes. Psychological and pharmacological interventions are shown to be effective in improving depression symptoms; however, collaborative care programs that simultaneously manage both disorders seem to be most effective in improving diabetes-related outcomes.
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Affiliation(s)
- Bibilola D Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
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Go Y, Kitaoka H, Hanafusa T. Effects of diabetes and diabetes control on susceptibility to learned helplessness in streptozotocin-induced diabetic rats. Diabetol Int 2013. [DOI: 10.1007/s13340-013-0132-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Joseph N, Unnikrishnan B, Raghavendra Babu YP, Kotian MS, Nelliyanil M. Proportion of depression and its determinants among type 2 diabetes mellitus patients in various tertiary care hospitals in Mangalore city of South India. Indian J Endocrinol Metab 2013; 17:681-688. [PMID: 23961486 PMCID: PMC3743370 DOI: 10.4103/2230-8210.113761] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Depression is found to be common among patients with diabetes and it is associated with poor outcomes in disease control. This study was carried out to find out the proportion and determinants associated with depression among patients with established type 2 diabetes mellitus (T2DM) in various tertiary care hospitals in Mangalore city of south India. MATERIALS AND METHODS This study was conducted in one government and three private tertiary care hospitals in Mangalore in December 2010. All consenting patients with confirmed diagnosis of T2DM were interviewed and screened for depression by administering the 9-item PRIME-MD Patient Health Questionnaire (PHQ-9). RESULTS Of the 230 T2DM patients, 119 (51.7%) were males. The mean age of all participants was 53.61 ± 10.7 years. The median duration of T2DM was found to be 12.1 ± 7.35 years. Among the participants, 71 (30.9%) met the criteria for moderate depression, 33 (14.3%) for severe depression, and the remaining 126 (54.8%) had no clinically significant depression. Only 26 (11.3%) patients were already aware that they were depressed, of whom just 3 had taken medical consultation. Among the risk factors, depression was found to be significantly associated with older age, female gender, low socioeconomic status, unskilled and retired employment status, having complications due to T2DM or comorbidities like hypertension and coronary artery disease, being overweight and being on insulin syringe injections. CONCLUSION This study found a high proportion of depression among patients with T2DM. Therefore the care of individuals with diabetes mellitus (DM) should include the screening and possible treatment of depression in order to achieve and sustain treatment goals.
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Affiliation(s)
- Nitin Joseph
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
| | - Y. P. Raghavendra Babu
- Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal University, Mangalore, India
| | - M. Shashidhar Kotian
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
| | - Maria Nelliyanil
- Department of Community Medicine, A. J. Institute of Medical Sciences, Mangalore, India
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Divaris K, Mafla AC, Villa-Torres L, Sánchez-Molina M, Gallego-Gómez CL, Vélez-Jaramillo LF, Tamayo-Cardona JA, Pérez-Cepeda D, Vergara-Mercado ML, Simancas-Pallares MÁ, Polychronopoulou A. Psychological distress and its correlates among dental students: a survey of 17 Colombian dental schools. BMC Med Educ 2013; 13:91. [PMID: 23802917 PMCID: PMC3702479 DOI: 10.1186/1472-6920-13-91] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 06/17/2013] [Indexed: 05/21/2023]
Abstract
BACKGROUND Links between the demanding nature of studies in the health sciences, students' personality traits and psychological distress have been well-established. While considerable amount of work has been done in medicine, evidence from the dental education arena is sparse and data from Latin America are lacking. The authors conducted a large-scale investigation of psychological distress among dental students in Colombia and sought to determine its curriculum and student-level correlates. METHODS The Spanish version of the Derogatis' Symptoms Checklist Revised (SCL-90-R) was administered to all students officially registered and attending classes or clinics in 17 dental schools in 4 geographic districts of Colombia between January and April 2012. Additional information was collected on participants' socio-demographic information and first career choice, as well as school's characteristics such as class size. The Global Severity Index (GSI) score, a measure of overall psychological distress, served as the primary analytical endpoint. Analyses relied on multilevel mixed-effects linear and log-binomial regression, accounting for study design and sample characteristics. RESULTS A total of 5700 dental students completed the survey, a response rate of 67%. Pronounced gradients were noted in the association between socio-economic status and psychological distress, with students in higher strata reporting fewer problems. After adjustment for all important covariates, there was an evident pattern of increasing psychological distress corresponding to the transition from the didactic, to the preclinical and clinical phases of training, with few differences between male and female students. Independent of other factors, reliance on own funds for education and having dentistry as the first career choice were associated with lower psychological distress. CONCLUSIONS Levels of psychological distress correlated with students' socio-economic and study-level characteristics. Above and beyond the influence of person-level factors, variations in levels of distress paralleled specific transitional stages of the 5-year dental curriculum, providing opportunities for targeted interventions.
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Affiliation(s)
- Kimon Divaris
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, Brauer 228, CB#7450, Chapel Hill NC 27599, USA
| | - Ana Cristina Mafla
- Grupo de Investigaciones en Odontología (GIOD), Facultad de Odontología, Universidad Cooperativa de Colombia–Pasto, Calle 18 No. 47-150, Pasto, Nariño, Colombia
| | - Laura Villa-Torres
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, CB #7440, Chapel Hill, North Carolina, USA
| | - Marisol Sánchez-Molina
- Facultad de Odontología, Universidad Metropolitana, Calle 76 No. 42-78, Barranquilla, Atlántico, Colombia
| | - Clara Liliana Gallego-Gómez
- Facultad de Odontología, Universidad Cooperativa de Colombia - Medellín, Carrera 47 No. 37 Sur 18, Medellín, Antioquia, Colombia
| | | | - Julián Andrés Tamayo-Cardona
- Institución Universitaria Colegios de Colombia sede Cali, Transversal 25 No. 18-21, Cali, Valle del Cauca, Colombia
| | - David Pérez-Cepeda
- Facultad de Odontología, Fundación Universitaria San Martín, Carrera 15ª No. 60-80, Bogotá, Colombia
| | - Martha Ligia Vergara-Mercado
- Facultad de Odontología, Universidad del Sinú – Montería, Campus Elías Bechara Zainúm, Calle 38 Carrera 1 W Barrio Juan XXIII. Bloque 5 Piso 2 PBX, Montería, Córdoba, Colombia
| | - Miguel Ángel Simancas-Pallares
- Facultad de Odontología, Universidad del Sinú - Cartagena, Av. Pedro de Heredia, Sector Amberes, Cartagena de Indias, Colombia
| | - Argy Polychronopoulou
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Goudi 11527, Greece
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Shrestha SS, Zhang P, Li R, Thompson TJ, Chapman DP, Barker L. Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008. Diabetes Res Clin Pract 2013; 100:102-10. [PMID: 23490596 PMCID: PMC5304910 DOI: 10.1016/j.diabres.2013.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/04/2013] [Accepted: 02/14/2013] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Sundar S Shrestha
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA 30341, United States.
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Hirai FE, Tielsch JM, Klein BEK, Klein R. Relationship between retinopathy severity, visual impairment and depression in persons with long-term type 1 diabetes. Ophthalmic Epidemiol 2012; 19:196-203. [PMID: 22775274 DOI: 10.3109/09286586.2012.692006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Our aim was to investigate the proportion of individuals with depression and its association with diabetic retinopathy and visual impairment in a cohort with 25 or more years of type 1 diabetes. METHODS This was a cross-sectional analysis at the 25-year follow-up of the population-based cohort of the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Examinations followed standardized protocols and included clinical and ophthalmic evaluations and questionnaires to assess current and past medical history, use of medications, and cigarette smoking. The Center for Epidemiologic Studies Depression Scale (CES-D) was administered to all participants. Depression was defined as use of antidepressant or CES-D score ≥16. RESULTS A total of 484 individuals were included in the analysis. The proportion of depression was 37.8% (95% confidence interval 33.4-42.3%). A higher proportion of individuals with depression was observed among those with more severe diabetic retinopathy and visual impairment. However these associations were not statistically significant while controlling for other factors in the multivariable analyses. CONCLUSIONS Diabetic retinopathy severity and visual acuity in persons with long duration of type 1 diabetes were not cross-sectionally associated with depression in this cohort.
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Affiliation(s)
- Flavio E Hirai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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Papelbaum M, Moreira RO, Coutinho W, Kupfer R, Zagury L, Freitas S, Appolinário JC. Depression, glycemic control and type 2 diabetes. Diabetol Metab Syndr 2011; 3:26. [PMID: 21978660 PMCID: PMC3212883 DOI: 10.1186/1758-5996-3-26] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 10/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Comorbid depression in diabetes has been suggested as one of the possible causes of an inadequate glycemic control. The purpose of this study was to investigate the association between major depression and the glycemic control of type 2 diabetes mellitus (T2DM). METHODS Seventy T2DM patients were evaluated. They underwent a psychiatric examination using the following instruments: Structured Clinical Interview for DSM-IV and Beck Depression Inventory. The diabetes status was assessed in the short-term (glycemia, glycated hemoglobin) clinical control. RESULTS The presence of current depression was observed in 18.6% (13/70). In addition, type 2 diabetes patients who displayed depression evidenced higher levels of glycated hemoglobin (8.6 ± 2.0 vs. 7.5 ± 1.8; p = 0.05) when compared to those who did not exhibit a mood disorder. CONCLUSIONS In our sample, the presence of depression seems to impact on the short-term control of T2DM. The authors discuss the clinical utility of these findings in the usual treatment of diabetes.
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Affiliation(s)
- Marcelo Papelbaum
- Obesity and Eating Disorders Group, Psychiatry Institute of the Federal University of Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Rodrigo O Moreira
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - Walmir Coutinho
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - Rosane Kupfer
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - Leão Zagury
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - Silvia Freitas
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - José C Appolinário
- Obesity and Eating Disorders Group, Psychiatry Institute of the Federal University of Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
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Zagarins SE, Allen NA, Garb JL, Welch G. Improvement in glycemic control following a diabetes education intervention is associated with change in diabetes distress but not change in depressive symptoms. J Behav Med 2012; 35:299-304. [DOI: 10.1007/s10865-011-9359-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 06/02/2011] [Indexed: 01/28/2023]
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Fonagy P, Jacobson AM, McCarley RW, Reiss D. Reflections on the Legacy of Stuart T. Hauser: Scientist, Colleague, and Mentor. Research in Human Development 2010. [DOI: 10.1080/15427609.2010.527270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sacco WP, Bykowski CA. Depression and hemoglobin A1c in type 1 and type 2 diabetes: the role of self-efficacy. Diabetes Res Clin Pract 2010; 90:141-6. [PMID: 20673594 DOI: 10.1016/j.diabres.2010.06.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 06/10/2010] [Accepted: 06/21/2010] [Indexed: 01/22/2023]
Abstract
AIMS To examine a self-efficacy explanation of the finding that depression is related to hemoglobin A1c (A1c) level in people with type 1 but not type 2 diabetes. METHODS Cross-sectional design involving 124 participants with type 1 (n=32) and type 2 (n=92) diabetes. Participants completed measures of depression and diabetes-related self-efficacy. A1c was obtained from medical records. RESULTS Replicating prior findings, A1c was significantly correlated with depression in type 1 participants (r=.51, p<.01), but not in type 2 participants (r=.11, ns). As hypothesized, A1c was significantly correlated with self-efficacy among type 1 participants (r=-.42, p<.05) but not among type 2 participants (r=-.01, ns). Self-efficacy also mediated the effect of A1c on depression among the type 1 participants (Z=2.21, p<.05). CONCLUSION In people with type 1, but not type 2 diabetes, A1c levels are related to diabetes adherence mastery (self-efficacy), which mediates the link between A1c and depression. Results are discussed with regard to the proposal that perceptions of ineffective control over one's health play a role in the development of depression (a consequence model of depression in diabetes).
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Affiliation(s)
- William P Sacco
- Department of Psychology, University of South Florida, Tampa, FL 33620, USA.
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Abstract
Diabetes has been associated with depression since Thomas Willis' work in 1684 (Rubin and Peyrot in Diabetes Metab Rev 18:173-175, 2002). The aim of this study is to identify social and clinical factors independently associated with depression in individuals with type 1 diabetes. We carried out a descriptive transversal study with 110 type 1 diabetes patients, administered a questionnaire and obtained demographical and diabetes-related data (number of years from diagnosis, initial admission at diagnosis, glycated hemoglobin, number of complications, insulin dose, number of insulin injections per day, admission for ketoacidosis or hypoglycemia at diagnosis, and specific diabetes complications such as nephropathy, retinopathy, peripheral neuropathy, coronariopathy, and amputation). Depressive symptoms were quantified using the Hamilton Score. We used T tests to investigate potential relations between the covariates and depression (Hamilton score). We concluded the following: as few as 10% of our patients had glycated hemoglobin under 7%; women had more symptoms of depression, and there are four independent factors associated with depression in individuals with type 1 diabetes mellitus: age, Graffar score, admission for ketoacidosis, and insulin dose.
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van der Feltz-Cornelis CM, Nuyen J, Stoop C, Chan J, Jacobson AM, Katon W, Snoek F, Sartorius N. Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. Gen Hosp Psychiatry 2010; 32:380-95. [PMID: 20633742 DOI: 10.1016/j.genhosppsych.2010.03.011] [Citation(s) in RCA: 211] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown. OBJECTIVE This systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes. DATA SOURCES PubMed, Psycinfo, Embase and Cochrane library. Study eligibility criteria, participants, interventions: randomized controlled trials (RCTs) evaluating the outcome of treatment by psychotherapy, pharmacotherapy or collaborative care of depression in persons with Type 1 and Type 2 diabetes mellitus. STUDY APPRAISAL risk of bias assessment; data extraction. Synthesis methods: data synthesis, random model meta analysis and publication bias analysis. RESULTS Meta analysis of 14 RCTs with a total of 1724 patients show that treatment is effective in terms of reduction of depressive symptoms: -0.512; 95% CI -0.633 to -0.390. The combined effect of all interventions on clinical impact is moderate, -0.370; 95% CI -0.470 to -0.271; it is large for psychotherapeutic interventions that are often combined with diabetes self management: -0.581; 95% CI -0.770 to -0.391, n=310 and moderate for pharmacological treatment: -0.467; 95% CI -0.665 to -0.270, n=281. Delivery of collaborative care, which provided a stepped care intervention with a choice of starting with psychotherapy or pharmacotherapy, to a primary care population, yielded an effect size of -0.292; 95% CI -0.429 to -0.155, n=1133; indicating the effect size that can be attained on a population scale. Pharmacotherapy and collaborative care aimed at and succeeded in the reduction of depressive symptoms but, apart from sertraline, had no effect on glycemic control. LIMITATIONS amongst others, the number of RCTs is small. CONCLUSION The treatment of depression in people with diabetes is a necessary step, but improvement of the general medical condition including glycemic control is likely to require simultaneous attention to both conditions. Further research is needed.
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Affiliation(s)
- Christina M van der Feltz-Cornelis
- Research Program for Diagnosis and Treatment of Mental Disorder, Trimbos Instituut/Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Frei A, Chmiel C, Schläpfer H, Birnbaum B, Held U, Steurer J, Rosemann T. The Chronic CARe for diAbeTes study (CARAT): a cluster randomized controlled trial. Cardiovasc Diabetol 2010; 9:23. [PMID: 20550650 PMCID: PMC2902433 DOI: 10.1186/1475-2840-9-23] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 06/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes is a major challenge for the health care system and especially for the primary care provider. The Chronic Care Model represents an evidence-based framework for the care for chronically ill. An increasing number of studies showed that implementing elements of the Chronic Care Model improves patient relevant outcomes and process parameters. However, most of these findings have been performed in settings different from the Swiss health care system which is dominated by single handed practices. METHODS/DESIGN CARAT is a cluster randomized controlled trial with general practitioners as the unit of randomization (trial registration: ISRCTN05947538). The study challenges the hypothesis that implementing several elements of the Chronic Care Model via a specially trained practice nurse improves the HbA1c level of diabetes type II patients significantly after one year (primary outcome). Furthermore, we assume that the intervention increases the proportion of patients who achieve the recommended targets regarding blood pressure (<130/80), HbA1c (=<6.5%) and low-density lipoprotein-cholesterol (<2.6 mmol/l), increases patients' quality of life (SF-36) and several evidence-based quality indicators for diabetes care. These improvements in care will be experienced by the patients (PACIC-5A) as well as by the practice team (ACIC). According to the power calculation, 28 general practitioners will be randomized either to the intervention group or to the control group. Each general practitioner will include 12 patients suffering from diabetes type II. In the intervention group the general practitioner as well as the practice nurse will be trained to perform care for diabetes patients according to the Chronic Care Model in teamwork. In the control group no intervention will be applied at all and patients will be treated as usual. Measurements (pre-data-collection) will take place in months II-IV, starting in February 2010. Follow-up data will be collected after 1 year. DISCUSSION This study challenges the hypothesis that the Chronic Care Model can be easily implemented by a practice nurse focused approach. If our results will confirm this hypothesis the suggestion arises whether this approach should be implemented in other chronic diseases and multimorbid patients and how to redesign care in Switzerland.
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Affiliation(s)
- Anja Frei
- Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
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Abstract
PURPOSE In this study, we compared the rate of depression diagnoses in adults with and without diabetes mellitus, while carefully controlling for number of primary care visits. METHODS We matched adults with incident diabetes (n = 2,932) or prevalent diabetes (n = 14,144) to nondiabetic control patients based on (1) age and sex, or (2) age, sex, and number of outpatient primary care visits. Logistic regression analysis was used to assess the association between various predictors and a diagnosis of depression in each diabetes cohort relative to matched nondiabetic control patients. RESULTS With matching for age and sex alone, patients with prevalent diabetes having few primary care visits were significantly more likely to have a new depression diagnosis than matched control patients (odds ratio [OR] = 1.46, 95% confidence interval [CI], 1.19-1.80), but this relationship diminished when patients made more than 10 primary care visits (OR = 0.95, 95% CI, 0.77-1.17). With additional matching for number of primary care visits, patients with prevalent diabetes mellitus with few primary care visits were more likely to have a new diagnosis of depression than those in control group (OR = 1.32, 95% CI, 1.07-1.63), but this relationship diminished and reversed when patients made more than 4 primary care visits (OR = 0.99, 95% CI, 0.80-1.23). Similar results were observed in the subset of patients with incident diabetes and their matched control patients. CONCLUSIONS Patients with diabetes have little or no increase in the risk of a new diagnosis of depression relative to nondiabetic patients when analyses carefully control for the number of outpatient visits. Studies showing such an association may have inadequately adjusted for comorbidity or for exposure to the medical care system.
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Stuckey HL, Dellasega C, Graber NJ, Mauger DT, Lendel I, Gabbay RA. Diabetes nurse case management and motivational interviewing for change (DYNAMIC): study design and baseline characteristics in the Chronic Care Model for type 2 diabetes. Contemp Clin Trials 2009; 30:366-74. [PMID: 19328244 PMCID: PMC2740652 DOI: 10.1016/j.cct.2009.03.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/06/2009] [Accepted: 03/12/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite evidence that diabetes is costly and devastating, the health care system is poorly equipped to meet the challenges of chronic disease care. The Penn State Institute of Diabetes & Obesity is evaluating a model of managing type 2 DM which includes nurse case management (NCM) and motivational interviewing (MI) to foster behavior change. The primary care intervention is designed to improve patients' self care and to reduce clinical inertia through provider use of standardized clinical guidelines to achieve better diabetes outcomes. METHODS This RCT tests the efficacy of an enhanced NCM intervention on type 2 DM (n=549) patient outcomes mediated by changes in self-care behavior and diabetes management. Outcome measures include: (a) effect on clinical parameters such as HbA1c (<7), BP (<130/80), and LDL (<100), depression scores and weight; (b) process measures such as complication screening; (c) patient psychological and behavioral outcomes as measured by emotional distress (PAID), diabetes-specific quality of life (ADDQoL), patient satisfaction (DTSQ), self-care activities (SDSCA); and (d) physician satisfaction and cost-effectiveness of the intervention. CONCLUSIONS Baseline includes (mean) age=58; BMI=34.4; 57% females; 47% Caucasian, and 39% Hispanic. Patients had elevated HbA1c (8.4), BP (137/77) and LDL (114). Overall, patients were depressed (CES-D=21.6) and had an extremely negative quality of life (ADDQoL=-1.58). We believe that enhanced NCM will both improve self-care and reduce emotional distress for patients with diabetes. If proven effective, enhanced NCM may be translated to other chronic illnesses.
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Affiliation(s)
- Heather L Stuckey
- Department of Medicine, Pennsylvania State University College of Medicine, M.S. Hershey Medical Center, Hershey, PA 17033, United States
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Veronelli A, Mauri C, Zecchini B, Peca MG, Turri O, Valitutti MT, Dall'Asta C, Pontiroli AE. Sexual Dysfunction Is Frequent in Premenopausal Women with Diabetes, Obesity, and Hypothyroidism, and Correlates with Markers of Increased Cardiovascular Risk. A Preliminary Report. J Sex Med 2009; 6:1561-1568. [DOI: 10.1111/j.1743-6109.2009.01242.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Zhang CX, Chen YM, Chen WQ. Association of psychosocial factors with anxiety and depressive symptoms in Chinese patients with type 2 diabetes. Diabetes Res Clin Pract 2008; 79:523-30. [PMID: 18023910 DOI: 10.1016/j.diabres.2007.10.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Accepted: 10/05/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate association of psychosocial factors with anxiety and depressive symptoms in Chinese type 2 diabetes patients. METHODS Three hundred and four type 2 diabetes patients were inquired with a structured questionnaire about socio-demographic characteristics, psychological stress, coping styles, social support, and anxiety and depressive symptoms. Multiple regression analysis was performed to assess the association of these psychosocial factors with anxiety and depressive symptoms after controlling for potential confounding factors of sex, age, educational level, etc. RESULTS After adjusting for the potential confounding factors, multiple stepwise regression analysis found that anxiety symptoms were significantly positively associated with "worrying about to be harmed by the disease", "social/family crisis caused by the disease", "worrying about declining in body/physical function", "declined economic condition caused by the disease" and "negative coping styles"; and depression symptoms were significantly positively associated with "worrying about to be harmed by the disease", "worrying about declining in body/physical function", "social/family crisis caused by the disease", "declined economic condition", "negative coping styles", but negatively with "active coping styles" and "subjective social support". CONCLUSION Our findings show that perceived stress from disease, coping styles, social support are the independent determinants of anxiety and depressive symptoms among Chinese patients with type 2 diabetes.
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Affiliation(s)
- Cai-Xia Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74, Zhongshan Road 2, Guangzhou, China
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Abstract
AIMS To determine the prevalence of psychological distress in young adults with Type 1 diabetes and to explore associated factors. METHODS Ninety-two participants with Type 1 diabetes (46 male, 46 female) attending a young adult clinic completed two psychological self-report assessments; the Centre for Epidemiological Studies-Depression Scale (CES-D) and Adult Self-Report Scale (ASR). The mean age was 21.6 +/- 2.8 years (sd) and mean duration of diabetes was 9.3 +/- 5.4 years. A questionnaire identified the method of insulin delivery, the frequency of blood glucose monitoring and hypoglycaemia requiring third-party assistance. HbA(1c) was measured. RESULTS Of the participants, 35.2% reported depressive symptoms (CES-D > or = 16), 23.1% indicating severe depressive symptoms (CES-D > or = 24), and 32.2, 40.4 and 35.5% of participants reported significant distress (ASR > or = 60) on the ASR total problem scales, ASR internalizing and ASR externalizing scores, respectively. Mean HbA(1c) levels were higher in participants with depressive symptoms compared with those with normal scores (CES-D > or = 16, HbA(1c)= 9.4% vs. CES-D < 16, HbA(1c)= 8.4%, P = 0.01). Factors associated with psychological distress included use of continuous subcutaneous insulin infusion (CSII) (P = 0.02) and increased frequency of hypoglycaemic episodes (P = 0.03). CSII users had higher CES-D (21.3 vs. 11.9, P = 0.001) and ASR-Total (59.7 vs. 53.0, P = 0.02) scores than non-CSII users. CONCLUSIONS Approximately one-third of young adults with Type 1 diabetes experience psychological distress, which is associated with poorer glycaemic control. Psychological distress was related to frequency of hypoglycaemic episodes and method of insulin administration, with significantly greater distress being observed in those using CSII. These findings support inclusion of a psychologist in the diabetes team.
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Affiliation(s)
- A L Hislop
- Diabetes Education Unit, Fremantle Hospital, Fremantle, Western Australia, Australia
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Amsterdam JD, Shults J, Rutherford N, Schwartz S. Safety and efficacy of s-citalopram in patients with co-morbid major depression and diabetes mellitus. Neuropsychobiology 2007; 54:208-14. [PMID: 17337914 DOI: 10.1159/000100369] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 12/17/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The presence of co-morbid depressive symptoms may have a negative impact on the management of diabetes mellitus. Moreover, some antidepressants may adversely affect glycemic control. Selective serotonin reuptake inhibitors (SSRIs) may improve glycemic control and may be beneficial for patients with co-morbid depression and diabetes. We examined the safety and efficacy of s-citalopram therapy in patients with co-morbid depression and diabetes, and its ability to improve glycemic control. RESEARCH DESIGN AND METHODS 17 patients were enrolled into the trial and 14 patients received open-label s-citalopram therapy for up to 16 weeks. Clinical outcome measures included the 17-item Hamilton depression rating (HAM-D 17) and the clinical global impressions severity (CGI/S) and change (CGI/C) ratings. In addition, fasting glucose, fructosamine, and glycosylated hemoglobin-A(1C) measures were obtained before and during s-citalopram therapy. RESULTS We observed a significant reduction in mean HAM-D 17 (p<0.001), CGI/S (p=0.001) and CGI/C (p=0.001) ratings during s-citalopram therapy. We also observed a modest, non-significant reduction in fasting glucose, fructosamine, and glycosylated hemoglobin-A(1C) levels during s-citalopram therapy. LIMITATION Limitations of this study include a modest patient sample size and a 16-week treatment duration which may have been insufficient to demonstrate the full effect of SSRI therapy on glycemic control. CONCLUSION We observed a significant reduction in depressive symptoms and modest, non-significant reductions in fasting glucose, fructosamine, and glycosylated hemoglobin-A(1C) levels during SSRI therapy of co-morbid depression and diabetes.
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Affiliation(s)
- Jay D Amsterdam
- Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, USA.
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Abstract
OBJECTIVE To investigate if changes in depressive symptoms would be associated with changes in glycemic control over a 12-month period in patients with Type 1 and Type 2 diabetes. METHODS Ninety (Type 1 diabetes, n = 28; Type 2 diabetes, n = 62) patients having Beck Depression Inventory (BDI) levels of >10 were enrolled in the study. Of those 90 patients, 65 patients completed a 12-week cognitive behavioral therapy intervention. BDI was assessed at baseline and thereafter biweekly during 12 months. Hemoglobin (HbA1c) and fasting blood glucose levels were assessed at baseline and at four quarterly in-hospital follow-up visits. Linear mixed-model analysis was applied to determine the effects of time and diabetes type on depressive symptoms, HbA1c levels, and fasting glucose levels. RESULTS Mean and standard deviation baseline BDI and HbA1c levels were 17.9 +/- 5.8 and 7.6 +/- 1.6, respectively, with no significant difference between patients with Type 1 and Type 2 diabetes. Mixed-model regression analysis found no difference between the groups with Type 1 and Type 2 diabetes in the within-subject effect of BDI score on HbA1c or fasting glucose levels during the study. Depressive symptoms decreased significantly (p = .0001) and similarly over a 12-month period in both patients with Type 1 and Type 2 diabetes, whereas HbA1c and fasting glucose levels did not change significantly over time in either group. CONCLUSION Changes in depressive symptoms were not associated with changes in HbA1c or fasting glucose levels over a 1-year period in either patients with Type 1 or Type 2 diabetes.
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Affiliation(s)
- Anastasia Georgiades
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3842, Durham, NC 27710, USA
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Zhao W, Chen Y, Lin M, Sigal RJ. Association between diabetes and depression: Sex and age differences. Public Health 2006; 120:696-704. [PMID: 16828130 DOI: 10.1016/j.puhe.2006.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Revised: 02/04/2006] [Accepted: 04/05/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the association between diabetes and the prevalence of depression in different sex and age groups by analysing the cross-sectional data from the National Population Health Survey, conducted in Canada in 1996-1997. STUDY DESIGN A total of 53072 people aged 20-64 years were included in the analysis. Depression was defined as depression scale 5, based on the Composite International Diagnostic Interview Short-Form (CIDI-SF). Respondents who answered the following question affirmatively were considered to have diabetes: 'do you have diabetes diagnosed by a health professional?'. METHODS A multiple logistic regression model was used to adjust for potential confounding effects, and a bootstrap procedure was used to take sampling weights and design effects into account. RESULTS The prevalence of diabetes was much higher in people aged 40-64 years than in people aged 20-39 years (men: 4.7% vs. 0.5%; women: 3.5% vs. 0.8%, respectively). In contrast, people aged 20-39 years had a slightly higher prevalence of depression than those aged 40-64 years (men: 3.1% vs. 2.9%; women: 6.6% vs. 5.4%, respectively). Diabetes was significantly associated with depression in women aged 20-39 years (odds ratio [OR]=2.52, 95% confidence interval [CI]=1.19, 5.32), but not in women aged 40-64 years (OR=1.62, and 95% CI=0.65, 4.06). The association was not significant in both age groups in men, but it tended to be stronger in the younger age group. CONCLUSIONS The data suggest that diabetes is significantly associated with depression, particularly in young adults.
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Affiliation(s)
- W Zhao
- Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada, K1 H 8M5.
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Elsenbruch S, Benson S, Hahn S, Tan S, Mann K, Pleger K, Kimmig R, Janssen OE. Determinants of emotional distress in women with polycystic ovary syndrome. Hum Reprod 2006; 21:1092-9. [PMID: 16459352 DOI: 10.1093/humrep/dei409] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The goals were to analyse the incidence of mental distress in women with untreated polycystic ovary syndrome (PCOS) using self-report measures, to characterize PCOS patients at risk for psychiatric disease with regard to sociodemographic and clinical characteristics, and to assess the impact of emotional distress on quality of life. METHODS AND RESULTS Complete metabolic, hormonal, clinical and self-report psychological data [emotional distress, Symptom Check List 90 (SCL-90-R); quality of life, Short-Form Health Survey 36 (SF-36); sexual satisfaction, visual analogue scales; sociodemographic data] were obtained from n = 143 untreated women with PCOS. Prior psychiatric diagnoses were exclusionary. Twenty-two patients (15.4%) had a possible psychological disorder, based on SCL-90-R global severity index (GSI) scores > or =63 (SCL cases). SCL cases had significantly elevated body mass index (BMI), but did not differ from SCL non-cases in other clinical, endocrine, metabolic or sociodemographic variables. Stepwise multiple regression analyses identified GSI as a significant predictor of SF-36 Psychological Sum score, along with age and current wish to conceive (R2 = 0.47); the SF-36 Physical Sum score was predicted by BMI and education (R2 = 0.27), but not GSI. CONCLUSIONS Psychiatric illness may go undetected in a proportion of PCOS patients. Although the majority of patients exhibit subclinical levels of psychological disturbances, emotional distress together with obesity lead to large decrements in quality of life in PCOS.
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Affiliation(s)
- Sigrid Elsenbruch
- Department of Medical Psychology, Endokrinologikum Ruhr, Center for Endocrine and Metabolic Diseases, Bochum, Germany.
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Abstract
OBJECTIVE The objective of this randomized controlled study was to determine the effects of biofeedback and relaxation on blood glucose and HbA1c (A1C) in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes were randomized to either 10 sessions of biofeedback (electromyograph and thermal) and relaxation or 3 sessions of education. All sessions were individual. A total of 39 participants were entered, and 30 completed the 3-month protocol. Average blood glucose, A1C, forehead muscle tension, and peripheral skin temperature were assessed, and inventories measuring depression and anxiety were administered pre-randomization and after completion of treatment/control. RESULTS Biofeedback and relaxation were associated with significant decreases in average blood glucose, A1C, and muscle tension compared with the control group. At 3-month follow-up, the treatment group continued to demonstrate lower blood glucose and A1C. Both groups decreased scores on the depression and anxiety inventories. Patients with depression had higher blood glucose levels and tended to drop out of the study. CONCLUSIONS This study supports the use of biofeedback and relaxation in patients with type 2 diabetes for up to 3 months after treatment. Further research is necessary to determine the long-term effects of biofeedback and the effects of mood on patients' responses to treatment.
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Affiliation(s)
- Ronald A McGinnis
- Department of Psychiatry, Medical University of Ohio, 3120 Glendale Ave., RHC-0079, Toledo, Ohio 43614-5809, USA.
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