Relationship between depressive symptoms and diabetes among native Hawaiians

Native Hawaiians' Views on Depression and Preferred Behavioral Health Treatments: a Preliminary Qualitative Investigation

Behavioral health issues, especially depression, are a major health disparity concern for Native Hawaiians in Hawai'i. Following the cultural safety framework and contextual behavioral science approach to intervention development, the present preliminary qualitative investigation aimed to gather better insight into Native Hawaiians' views of depression and its causes as well as their preferred forms of behavioral health services. Data were initially collected from a 2-hour virtual focus group with three behavioral health service providers working with Native Hawaiians, followed by a total of 38 online one-on-one in-depth interviews with Native Hawaiian clients with depression (n = 19), behavioral health service providers working with Native Hawaiian adults (n = 9), and Native Hawaiian cultural leaders (n = 10). Our qualitative data suggested that Native Hawaiians tend to view depression contextually and socioculturally as the manifestation of one's vital connection to the 'āina (land), 'ohana (family; continuity from ancestry and future generations), community, culture/spirituality, and one's authentic self being disrupted. Our findings also suggested that Native Hawaiians often attribute these disruptions to disparities due to the ongoing impact of colonization, historical trauma, and cultural loss. As a preferred form of treatment for depression, participants recommended various Hawaiian cultural practices to be integrated into existing behavioral health services to nurture the above-mentioned vital connection.

Is there a Relation between Depression and Anxiety to Clinical Characteristics among Patients with T2D in Greece?

BACKGROUND

Diabetes is a chronic disease that may be related to various periods of an individual's life.

AIM

The aim of the present study is the investigation of the existence of depression and anxiety among patients suffering from type 2 diabetes as well as the factors that influence these variables (depression and anxiety).

MATERIALS AND METHODS

The Hospital Anxiety and Depression Scale (HADS) for mental health assessment was used in the context of the collection of the research data. The study involved 100 patients (42 men and 58 women) with an average age of 63.72 ± 9.84 years of life.

RESULT

The results showed that there was a positive correlation between HbA1c value and anxiety as well as HADS questionnaire total score, and a positive correlation between blood glucose value and anxiety as well as HADS questionnaire total score.

CONCLUSION

Both depression and anxiety of these patients are influenced by different clinical factors.

American Indian Alcohol Use from a Sex-Specific Wellness Approach: Exploring Its Associated Physical, Behavioral, and Mental Risk and Protective Factors

PURPOSE

The top causes of death for American Indians (AIs), including heart and liver disease, are associated with alcohol use. Using the culturally based Framework of Historical Oppression, Resilience, and Transcendence (FHORT), the purpose of this article was to examine AI alcohol use from a sex-specific wellness approach, exploring its associated physical, behavioral, and mental risk and protective factors.

METHOD

Data were drawn from a cross-sectional survey with 479 AI adults in South Dakota. We employed a series of multiple hierarchical regression analyses to assess the associations of demographic (sex, age, marital status, income, and educational attainment), physical (Body Mass Index and cardiovascular risk), behavioral (smoking and health self-efficacy) and mental (depressive symptoms) factors with alcohol use.

RESULTS

Results indicated that surveyed males tended to drink three times that of females, and depressive symptoms were associated with higher levels of alcohol use.

DISCUSSION

This study highlights the need to examine AI alcohol use with sex in mind.

Cardiovascular Health among U.S. Indigenous Peoples: A Holistic and Sex-Specific Systematic Review

PURPOSE

The purpose of this systematic review is to examine mental, sociocultural, behavioral, and physical risk and protective factors related to cardiovascular disease (CVD) and related outcomes among U.S. Indigenous peoples.

METHODS

A total of 51 articles met the inclusion criteria of research focusing factors for CVD among U.S. Indigenous peoples (Mental n= 15; Sociocultural, n =17; Behavioral/Physical, n =19).

RESULTS

This review reveals clear risks for CVD, which tended to be elevated for females. Mental health problems (depression, anxiety, PTSD/trauma, alcohol and other drug (AOD) abuse) were clearly associated with CVD, along with enculturation, social support, and the social environment-including discrimination and trauma. Poor diet and obesity, diabetes, hypertension, cholesterol were behavioral or physical factors.

DISCUSSION

Overall, identified research was limited and in beginning stages, lacking more information on etiology of the interconnections across sex and the mental, sociocultural, and behavioral determinants of CVD.

Food insecurity is an important risk factor for type 2 diabetes: a case-control study of new referrals to the University clinics, Shiraz, Southern Iran

BACKGROUND

The prevalence of food insecurity (FI) as "the limited or uncertain availability of enough food for an always active and healthy life" and diabetes as "the most common metabolic disease" are rising in Iran. The aim was to assess the FI, depression, and socioeconomic status as risk factors for type 2 diabetes (T2D).

METHODS

This case-control study was conducted on 135 patients with T2D as cases (99 females, 36 males, mean age 46.83 years) and 135 subjects without diabetes (89 females, 46 males, mean age 45.93 years) as controls. They had been referred to clinics of Shiraz University of Medical Sciences, Shiraz, Iran. The prior major inclusion criterion for diabetes was fasting blood sugar (FBS) ≥126 mg/dl. General, demographic, and socioeconomic characteristics and FI status were assessed using the general and 18-items United States Department of Agriculture (USDA) household food security questionnaires, respectively. Chi-square, t-test, and uni-and multi-variate logistic regression tests and SPSS16 statistical software were used.

RESULTS

The prevalence of FI was 66.7% in cases and 41.5% in controls. According to final analysis model, FI (Odds Ratio [OR] = 1.9, P = 0.016), depression (OR = 2.0, P = 0.018), body mass index (BMI) ≥ 25 kg/m2 (OR = 1.8, P = 0.025), number of children ≥4 (OR = 1.7, P = 0.046), and having children under 18 years. (OR = 2.1, P = 0.011) were significant independent risk factors for T2D.

CONCLUSION

The prevalence of FI in patients with T2D was significantly higher compared to the controls. FI was an important risk factor for T2D, even after controlling for the potential confounders. Further studies are suggested.

Prevalence of Diabetes, Prediabetes, and Obesity in the Indigenous Kuna Population of Panamá

BACKGROUND

Diabetes is a burgeoning disease affecting more than 8% of the world population. Indigenous communities are disproportionately impacted by diabetes; however, limited data is available on prevalence and correlates of diabetes.

METHODS

Data was collected from 211 Indigenous Kuna adults off the coast of Panamá in the San Blas region of the Caribbean. Diabetes and prediabetes were measured by HbA1c. Obesity was defined using the US BMI categories as well as categories defined by the WHO to assess obesity among Asian populations. Univariate analyses (chi2 tests) were used to investigate diabetes status and obesity by demographic factors. Logistic regression was used to examine the correlates of diabetes and obesity.

RESULTS

Of the 211 adults, 13% had diabetes, 35% had prediabetes, and approximately 39% were obese. Using the Asian cut point for obesity, this number increased to 61%. Income was statistically significantly related to an HbA1c cut point of 6.5 (p = 0.005). Individuals who reported a monthly income of greater than $250 had increased odds of prediabetes and diabetes nearly sixfold for HbA1c of > 6.5 (OR 6.3; CI 1.43-28.45) and HbA1c of > 5.7 (OR 5.1; CI 1.03-26.14).

CONCLUSIONS

These findings represent one of the first studies examining diabetes and prediabetes in indigenous Kuna of the San Blas region. Our findings suggest Kuna Indians may be at an increased risk for diabetes and prediabetes. Current national estimates for diabetes is considered low in this population. Greater understanding of determinants of diabetes and obesity are needed in order to address diabetes in this indigenous community.

Association of depression with type 2 diabetes and relevant factors

BACKGROUND

Based on the high prevalence of diabetes and depression in Rasht, we conducted a study to evaluate the prevalence of depression in type 2 diabetic patients, and its association with glycemic control, chronic complications, and some clinical and paraclinical parameters in this northern state of Iran.

MATERIALS AND METHODS

Beck depression inventory was used for evaluating depression on 90 type 2 diabetics and 90 healthy controls selected. Information on demographic and clinical and paraclinical characteristics was collected by interviews and from medical records.

RESULTS

This cross-sectional study was performed on 90 type 2 diabetic patients (63 female and 27 male with a mean age of 54.17 ± 10.57 years) and 90 healthy matched controls. Overall, depression was significantly more prevalent in case group [37.8% vs. 16%, odds ratio (OR) = 3.29, P = 0.001]. The prevalence of depression in diabetic women was significantly higher than nondiabetic ones (39.7% vs. 15%, P = 0.002). We could not find any significant correlation between depression and positive family history of depression, duration of diabetes, HBA1c level, and body mass index. The prevalence of depression was prominently more in diabetic patients with retinopathy than in those without this complication (55.6% vs. 24%, P = 0.015). Logistic regression analysis indicated that diabetes itself was the only significant determinant of having depression (OR = 3.29, P = 0.005, 95% confidence interval: 0.118-0.667).

CONCLUSION

There was a prominent prevalence of depression in type 2 diabetics overall. Depression was not correlated with duration of diabetes and glycemic control. There was a significant association between depression and retinopathy in diabetic patients. Diabetes itself was the only significant determinant of having depression after matching with other variables.

Screening tools used for measuring depression among people with Type 1 and Type 2 diabetes: a systematic review

BACKGROUND

Depression is common in patients with Type 1 or Type 2 diabetes, has a strong negative impact on the quality of life of patients and is associated with poor outcomes and higher mortality rates. Several guidelines encourage screening of patients with diabetes for depression. It is unclear which depression screening tools are currently being used in people with diabetes and which are most appropriate.

METHODS

A systematic review was conducted to examine which depression screening instruments are currently being used in diabetes research, and the operating characteristics of these tools in diabetes populations. Literature searches for the period January 1970 to October 2010 were conducted using MEDLINE, PSYCH-INFO, ASSIA, SCOPUS, ACADEMIC SEARCH COMPLETE, CINAHL and SCIENCE DIRECT.

RESULTS

Data are presented for the 234 published studies that were examined. The Beck Depression Inventory and the Centre for Epidemiologic Studies Depression Scale were the most popular screening tools (used in 24% and 21% of studies). Information on the cultural applicability of screening tools was mostly unavailable and, where reported, included only details of the language translation process. A small number of studies reported reliability data, most of which showed moderate-good sensitivity and specificity but a high rate of false positives.

CONCLUSIONS

Although a range of depression screening tools have been used in research, there remains few data on their reliability and validity. Information on the cultural applicability of these instruments is even scantier. Further research is required in order to determine the suitability of screening tools for use in clinical practice and to address the increasing problem of co-morbid diabetes and depression.

Cardiometabolic health disparities in native Hawaiians and other Pacific Islanders

Elimination of health disparities in the United States is a national health priority. Cardiovascular disease, diabetes, and obesity are key features of what is now referred to as the "cardiometabolic syndrome," which disproportionately affects racial/ethnic minority populations, including Native Hawaiians and other Pacific Islanders (NHOPI). Few studies have adequately characterized the cardiometabolic syndrome in high-risk populations such as NHOPI. The authors systematically assessed the existing literature on cardiometabolic disorders among NHOPI to understand the best approaches to eliminating cardiometabolic health disparities in this population. Articles were identified from database searches performed in PubMed and MEDLINE from January 1998 to December 2008; 43 studies were included in the review. There is growing confirmatory evidence that NHOPI are one of the highest-risk populations for cardiometabolic diseases in the United States. Most studies found increased prevalences of diabetes, obesity, and cardiovascular risk factors among NHOPI. The few experimental intervention studies found positive results. Methodological issues included small sample sizes, sample bias, inappropriate racial/ethnic aggregation of NHOPI with Asians, and a limited number of intervention studies. Significant gaps remain in the understanding of cardiometabolic health disparities among NHOPI in the United States. More experimental intervention studies are needed to examine promising approaches to reversing the rising tide of cardiometabolic health disparities in NHOPI.

A longitudinal analysis of depressive symptoms among Asian and Pacific Islander mothers at-risk for child maltreatment

This longitudinal study examined racial differences in depressive symptoms at three time points among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers at-risk for child maltreatment (n = 616). The proportion of mothers with depressive symptoms ranged from 28 to 35% at all time points. Adjusted analyses revealed that Asian and NHOPI mothers were significantly more likely than white mothers to have depressive symptoms but this disparity was present only among families at mild/moderate risk for child maltreatment. Future research should identify ways to reduce this disparity and involve the Asian and NHOPI communities in prevention and treatment program design and implementation.

The comorbidity of diabetes mellitus and depression

Several factors, including sedentary lifestyle, obesity, and an aging population, contribute to epidemic rates of type 2 diabetes mellitus. Depression frequently occurs comorbidly with diabetes although it is unrecognized and untreated in approximately two thirds of patients with both conditions. The course of depression in patients with both diabetes and depression is chronic and severe. Up to 80% of patients with diabetes and depression will experience a relapse of depressive symptoms over a 5-year period. Depression is associated with nonadherence to diabetes self-care--including following dietary restrictions, medication compliance, and blood glucose monitoring--resulting in worse overall clinical outcomes. Due to potential negative health consequences associated with comorbid diabetes and depression, both conditions should be optimally treated to maximize patient outcomes.

Type 2 diabetes and impaired glucose tolerance in aboriginal populations: a global perspective

OBJECTIVE

To perform a systematic review of the prevalence of type 2 diabetes and impaired glucose tolerance (IGT) in aboriginal populations worldwide.

RESEARCH DESIGN AND METHODS

A Medline search from 1966 to 2005 was conducted. Studies were selected if they utilized accepted diagnostic criteria for type 2 diabetes. Year of study, sample size, response rate, age range, and prevalence of type 2 diabetes and IGT were documented.

RESULTS

Forty-two studies were selected, comprising 59 populations. Although the majority demonstrated a several-fold elevation of type 2 diabetes prevalence as compared to non-aboriginal populations, this was not a universal finding; a small number of populations studied actually had a low prevalence of type 2 diabetes and IGT. Lower prevalences were found in rural compared with urban populations. Interestingly, we were also able to document an inverse relationship between the ratio of IGT/type 2 diabetes and type 2 diabetes prevalence. These data are consistent with the hypothesis that those populations with the very highest rates of type 2 diabetes appear to have progressed past the prediabetes stages in the natural history of this metabolic disorder.

CONCLUSIONS

Type 2 diabetes and IGT prevalence rates vary widely amongst the world's aboriginal populations. Despite very different histories and cultures, the consequences of rapid changes in nutrition and exercise appear to have very similar metabolic consequences on aboriginal populations, the magnitude of which may be determined by the strength of the genetic susceptibility.

Disparities in use of mental health and substance abuse services by Asian and Native Hawaiian/other Pacific Islander women

The purpose of this study was to determine if disparities exist in lifetime utilization of mental health/substance abuse services among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers. The study sample was comprised of mothers assessed to be at-risk (n = 491) and not at-risk (n = 218) for child maltreatment in the Hawaii Healthy Start Program study. Multiple logistic regression models were used to test the effects of predisposing, need, and enabling factors on utilization of services. Results revealed that, among mothers with depressive symptoms, compared with whites, Asians and NHOPI were significantly less likely to have received services. There were no significant racial differences in use of mental health/substance use services by other factors. These results suggest that racial disparities exist in utilization of mental health/substance abuse services among mothers with depressive symptoms. Future research is needed to identify barriers and facilitators to accessing needed services for Asian and NHOPI women.

Depression and type 2 diabetes mellitus: the multiethnic study of atherosclerosis

OBJECTIVE

To assess the cross-sectional association between depression and glucose tolerance status.

METHODS

We conducted a study of 6754 White, Black, Hispanic, and Chinese men and women aged 45 to 84 years in the Multiethnic Study of Atherosclerosis (MESA). Depression was defined as Center for Epidemiologic Studies Depression scale score of > or =16 and/or antidepressant use. Glucose tolerance status was defined as normal, impaired fasting glucose (IFG) or Type 2 diabetes mellitus (untreated and treated).

RESULTS

In the minimally adjusted model, although depression was not associated with a greater odds of IFG (odds ratio (OR) = 1.01; 95% confidence interval (CI): 0.87-1.18) or untreated diabetes (OR = 1.03; 95% CI: 0.74-1.45), it was associated with a greater odds of treated diabetes (OR = 1.57; 95% CI: 1.27-1.96). This persisted following adjustment for body mass index (OR = 1.52; 95% CI: 1.22-1.90), metabolic (OR = 1.54; 95% CI: 1.23-1.93), and inflammatory (OR=1.53; 95% CI: 1.21-1.92) factors, daily caloric intake and smoking (OR = 1.48; 95% CI: 1.16-1.88), and socioeconomic markers (OR = 1.47; 95% CI: 1.17-1.85). Among individuals with treated diabetes, median depression scores were higher in those with microalbuminuria compared with those without microalbuminuria (median = 7; interquartile range: 3-13 versus median = 6; interquartile range: 2-11; p = .046). Depression scores were not associated with homeostatic model assessment of insulin resistance among individuals without diabetes.

CONCLUSIONS

In MESA, depression was significantly associated with treated diabetes. Further studies are needed to determine the temporality of this association.

An examination of the moderating effect of treatment with anti-depressants on the association of heart disease with depression in males with type 2 diabetes attending a Veterans Affairs Medical Center

OBJECTIVE

To examine the association of heart disease with depression and the impact of treatment with anti-depressants on this association in older males with type 2 diabetes.

RESEARCH DESIGN AND METHODS

In this cross-sectional study, data were collected from the electronic medical record system of the Veterans Affairs Medical Center (VAMC) in a large mid-western city in the United States. Subjects were 8185 males older than 40, with a history of type 2 diabetes, who had visited the VAMC within the previous 6 years. Odds ratios were used to measure bivariate associations; multivariate logistic regression was used to adjust for potential confounding factors.

RESULTS

After adjustments for confounding variables, significant associations were found between depression and any adverse heart event (OR=1.34, p=0.001), coronary artery disease (OR=1.23, p=0.039), myocardial infarction (MI; OR=1.77, p<0.001), and angioplasty (OR=1.36, p=0.034). Examination of the interaction between depression and anti-depressant prescription status indicated that, except for MI, these associations were no longer significant among those who had been prescribed anti-depressants, but remained significant and were increased in magnitude among those who had not been prescribed anti-depressants.

CONCLUSIONS

These findings support the premise that co-morbid depression in diabetics is associated with the occurrence of adverse heart events, and further suggest that treatment of depression with anti-depressants moderates this association.

The relationship of guideline-concordant depression treatment and patient adherence to oral diabetes medications

BACKGROUND

Many patients with diabetes experience depression, yet it is unclear if the treatment of depression in diabetic patients is concordant with national guidelines, and whether appropriate antidepressant use is associated with better diabetes self-care behaviors.

OBJECTIVES

The purpose of this study was to (1) determine whether antidepressant medication use for managed care enrollees with type 2 diabetes was concordant with The Agency for Healthcare Research and Quality depression treatment guidelines; and (2) examine the relationship between guideline concordance and oral diabetes medication adherence.

METHODS

Retrospective analyses were conducted using medical/pharmacy claims for 2001 from a managed care organization in the midwestern United States. Subjects were adults with type 2 diabetes treated with oral medications only. The subjects were divided into 3 groups: (1) guideline-concordant users of antidepressants; (2) those who received antidepressants not in concordance with the guidelines; and (3) nonusers of antidepressants. Antidepressant users were determined to be in concordance with the acute phase treatment guidelines if they filled at least 90 days supply of antidepressant drugs within 118 days of the first fill. Adherence to diabetes medications was measured by the medication possession ratio. A 1-way analysis of variance with Scheffe's test was used to compare the antihyperglycemic medication possession ratio across the three groups.

RESULTS

One hundred eighty-two (12.5%) of the 1454 subjects initiated treatment with antidepressants. Eighty-nine (48.9%) of the 182 antidepressant users were in concordance with the acute phase treatment guidelines. Subjects with subconcordant antidepressant use had a lower mean diabetes medication possession ratio than those with either guideline-concordant use or no use (F=14.3, P<.01).

CONCLUSION

Over half of the diabetic patients initiating treatment for depression did not receive therapy in concordance with the Agency for Healthcare Research and Quality guidelines. Patients whose antidepressant use was not concordant with the guidelines were also less adherent to diabetes medications.

Depression treatment and satisfaction in a multicultural sample of type 1 and type 2 diabetic patients

OBJECTIVE

To assess rates of depressive symptoms, depression treatment, and satisfaction in a multicultural sample of individuals with type 1 and type 2 diabetes.

RESEARCH DESIGN AND METHODS

This study was conducted with a cross-sectional community-based survey design.

RESULTS

The sample (n = 221) was predominantly female (60.3%), had type 2 diabetes (75%), and was middle class with a mean (+/-SD) age of 54 +/- 12 years. A total of 53% were white. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD) (mean 16.4 +/- 11.3). Using conservative thresholds (CESD score > or =22), 25.3% of participants reported clinically significant depression. Rates of depression did not differ by ethnic group or diabetes type. The majority (76%) of depressed participants reported treatment (52% antidepressants, 63% mental health providers, 19% alternative healers, and 15% herbal remedies). African Americans were less likely to report any depression treatment, to receive antidepressant medications, or receive treatment from a mental health professional compared with whites. Participants with high depressive symptoms reported general satisfaction with depression treatment experiences.

CONCLUSIONS

High rates of depressive symptoms were observed across ethnic groups, yet significant differences in use of depression treatment existed across ethnic groups. Those seeking depression treatment reported satisfaction with a variety of depression treatment modalities. Increased depression screening and treatment may be beneficial for ethnically diverse patients with type 1 and type 2 diabetes.

Ethnic differences in the relationship between depressive symptoms and health-related quality of life in people with type 2 diabetes

OBJECTIVE

To examine ethnic differences in the relationship between depressive symptoms and specific aspects of heath-related quality of life in people with type 2 diabetes.

DESIGN

Cross-sectional data from 190 people with type 2 diabetes of Native Hawaiian (50%), Filipino (16%), Japanese (18%), and mixed-ethnic (16%) ancestries from the rural community of North Kōhala, Hawai'i were examined in this study. Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) scale. Health-related quality of life was measured with the Short Form-36 Health Survey (SF-36). Eight health-related quality of life constructs were examined: Physical Functioning, Role-Physical Functioning, Role-Emotional Functioning, Social Functioning, Bodily Pain, Vitality, General Health, and Health Transition.

RESULTS

Hierarchical regression analyses of the interaction between ethnicity and the SF-36 subscales of Physical Functioning, Role-Emotional Functioning, Bodily Pain, Vitality, and General Health indicated statistically significant associations with CES-D scores after controlling for sociodemographic factors, glycemic status, and social support.

CONCLUSION

Ethnicity moderated the relationship between depressive symptoms and the health-related quality of life aspects of physical and role-emotional functioning, bodily pain, vitality, and general health perception in people with type 2 diabetes. This relationship was strongest for Filipinos followed by Native Hawaiians and people of mixed-ethnic ancestries.

The role of medical comorbidity in outcome of major depression in primary care: the PROSPECT study

OBJECTIVE

The authors described the influence of specific medical conditions on clinical remission and response of major depression (MDD) in a clinical trial evaluating a care-management intervention among older primary-care patients.

METHODS

Adults age 60 years and older were randomly selected and screened for depression. Participants were randomly assigned to Usual Care or to an Intervention with a depression care-manager offering algorithm-based care for MDD. In all, 324 adults meeting criteria for MDD were included in these analyses. Remission and response was defined by a score on the Hamilton Rating Scale for Depression <10 and by a decrease from baseline of > or =50%, respectively. Medical comorbidity was ascertained through self-report. Cognitive impairment was defined by a score <24 on the Mini-Mental State Exam (MMSE).

RESULTS

In Usual Care, rates of remission were faster in persons who reported atrial fibrillation (AF) than in persons who did not report AF and slower in persons who reported chronic pulmonary disease than in persons who did not report chronic pulmonary disease; rates of response were less stable in persons with MMSE <24 than in those with MMSE > or =24. In the Intervention condition, none of the specific chronic medical conditions were significantly associated with outcomes for MDD.

CONCLUSIONS

Because disease-specific findings were observed in persons who received Usual Care but not in persons who received more intensive treatment in the Intervention condition, our results suggest that the association of medical comorbidity and treatment outcomes for MDD may be determined by the intensity of treatment for depression.

Biological, psychosocial, and sociodemographic variables associated with depressive symptoms in persons with type 2 diabetes

Studies have found an association between glycemic status and indices of health-related quality of life in people with diabetes mellitus and comorbid depression. No study to date has examined the relative strength of influences of glycemic status and health-related quality of life on depression in people with diabetes mellitus, nor have important moderators in this relationship been examined. This study examined the relative strength of correlations between glycemic status and health-related quality of life and depressive symptoms and the degree to which those correlations were moderated by sociodemographic variables in 146 people with type 2 diabetes. Depressive symptoms were measured with the Centers for Epidemiological Studies--Depression (CES-D) scale. Health-related quality of life was measured with the SF-36 Health Survey. Hemoglobin A1c (HbA1c) was used as a measure of glycemic status and body mass index and waist-hip ratio were measured. Results indicated that SF-36 scores accounted for a greater proportion of the variance in CES-D scores. The association between CES-D and SF-36 scores was moderated by HbA1c, sex, education, marital status, and social support. The implications and limitations of these results were discussed in the context of past studies.

Prevention and treatment of type 2 diabetes mellitus in children, with special emphasis on American Indian and Alaska Native children. American Academy of Pediatrics Committee on Native American Child Health

The emergence of type 2 diabetes mellitus in the American Indian/Alaska Native pediatric population presents a new challenge for pediatricians and other health care professionals. This chronic disease requires preventive efforts, early diagnosis, and collaborative care of the patient and family within the context of a medical home.

Type 2 diabetes and its association with hypertension and depression in an Iraqi population

BACKGROUND

The association of type 2 diabetes mellitus and hypertension is so high that it cannot be explained on the basis of diabetic nephropathy. This phenomenon has been attributed to a condition known as metabolic syndrome. Depression may be another aspect of metabolic syndrome.

PATIENTS AND METHODS

We conducted a cross-control study with 110 patients with type 2 diabetes mellitus (DM) and 110 control subjects of comparable age and sex. We determined the time since diagnosis of diabetes, the presence of hypertension (HT), coronary heart disease, cerebrovascular insufficiency, and depression, and took several anthropometric measurements, including height, weight, body mass index (BMI) waist circumference (WC), waist-to-hip circumference ratio (WHR), triceps skin fold thickness (TSFT), mid-upper arm circumference (MUAC), and mid-upper arm muscle area (MAMA). We also investigated depression in metabolic syndrome by comparing patients with type 2 diabetes alone and with type 2 diabetes and hypertension who attended a diabetes clinic.

RESULTS

The prevalence of depression in hypertensive diabetics was 57% whereas in diabetics alone it was 40% (X2=4.3, P is less than 0.05). Likewise, combined hypertension and depression was more common among diabetics than controls (66% vs 25% respectively P is less than 0.01).

CONCLUSION

The presence of combined hypertension and type 2 diabetes should alert the clinician to look for other features of the metabolic syndrome and for associated depression, which should be treated in most cases by pharmacotherapy.

Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment

This article reviews the rapidly accumulating literature on the relationship between mood disorders and diabetes mellitus. Recent studies have demonstrated that depression and its associated symptoms constitute a major risk factor in the development of type 2 diabetes and may accelerate the onset of diabetes complications. Since the mid-1980s, multiple longitudinal and cross-sectional studies have scrutinized the association of diabetes with depressive symptoms and major depression. Utilizing the search terms depressive disorders, psychiatry, diabetes, and pathophysiology in MEDLINE searches (1966-2003), this article reviews studies investigating pathophysiological alterations related to glucose intolerance and diabetes in depressed patients. The few randomized, controlled studies of treatment of depression in patients with diabetes are also described. Short-term treatment of depression in patients with diabetes improves their dysphoria and other signs and symptoms of depression. Future research will confirm whether response to psychotherapy and/or psychopharmacologic treatment improves glucose control, encourages compliance with diabetes treatment, and perhaps even increases longevity.

Diabetes mellitus e depressão: uma revisão sistemática

A presença de depressão no paciente com diabetes mellitus (DM) parece relacionar-se a alterações no curso clínico da doença. O objetivo deste trabalho é realizar uma revisão sistemática sobre a associação entre o DM e depressão. Foi realizada uma pesquisa bibliográfica utilizando as bases de dados MEDLINE e LILACS para identificar artigos relevantes, publicados entre 1990 e 2001, que avaliassem esta associação. Foram analisadas informações referentes à prevalência, ao impacto e ao tratamento da depressão no DM. A prevalência de depressão no DM variou de 0 a 60,5%. Sintomas depressivos relacionaram-se a um pior controle glicêmico, a um aumento e a uma maior gravidade das complicações clínicas, a uma piora da qualidade de vida e ao comprometimento de aspectos sociais, econômicos e educacionais ligados ao DM. O tratamento da depressão está relacionado à melhora dos níveis glicêmicos, podendo contribuir para um melhor controle de diversos aspectos relacionados ao DM.

Association between medical comorbidity and treatment outcomes in late-life depression

OBJECTIVES

Previous studies have demonstrated an association between major depression and physical disability in late life. The objectives of this study were to examine the relationship between specific medical illnesses and the outcomes of treatment for late-life depression.

DESIGN

The study was a longitudinal assessment of medical illness, depression, and disability. Patients were assessed during an initial inpatient psychiatric hospitalization and 3 months postdischarge.

SETTING

All patients were initially evaluated after admission to one of 71 inpatient psychiatric treatment facilities.

PARTICIPANTS

A sample of 671 older patients who received inpatient treatment for depression was evaluated at entry into the hospital and 3 months after discharge.

MEASUREMENTS

Depressive symptoms were measured using the Geriatric Depression Scale. Disability was measured using the instrumental activities of daily living scale and the Medical Outcomes Study 36-item short form. Medical illness was assessed using the medical illness checklist.

RESULTS

As previously reported, physical disability and the total number of medical illnesses were significantly related to change in depressive symptoms. In this study, we find that arthritis, circulatory problems, a speech disorder, or a skin problem, but not other general medical conditions, were related to a worse outcome with respect to depression symptoms. The effect of these problems was statistically and clinically significant. After controlling for pretreatment disability, arthritis and skin problems continued to predict a worse outcome. However, the apparent effect of each of these conditions was mediated by the residual disability after treatment.

CONCLUSION

The results of this study support the hypothesis that certain somatic disorders play a role in the treatment response of late-life depression and suggest that the effect of specific illnesses on depression may be mediated by the presence of functional disability.

Association between symptoms of depression and glycaemic control may be unstable across gender

AIMS

Lloyd and colleagues (Diabetic Med 2000; 17, 198-202) have described an association between poor glycaemic control and moderate to severe depression in male but not in female diabetes patients. However, the validity of this study may be limited by its small sample size and the influence of uncontrolled confounders. Therefore, we set out to replicate this study by investigating the associations between depression and glycaemic control in larger samples, while controlling for potential confounders.

METHODS

Out-patients with diabetes (n = 174) and 1437 patient members of the Dutch Diabetes Association (DDA) completed the Hospital Anxiety and Depression Scale. Demographic and clinical characteristics were obtained using medical records (out-patients) or self-report (DDA).

RESULTS

After controlling for number of complications, years of education and body mass index, depression showed significant, low positive correlations with HbA(1c) in three of the four female samples and in one of the four male samples. Only for out-patients with Type 2 diabetes was the correlation between HbA(1c) and depression significantly higher for women when compared with men (0.19 vs. 0.04; P = 0.02).

CONCLUSIONS

The association between depression and HbA1c may be stronger in women with Type 2 diabetes. Oestrogen levels and self-care behaviours may play a mediating role in this association. Further research is required before we can conclude that the association between symptoms of depression and glycaemic control differs across gender. Diabet. Med. 18, 595-598 (2001)

The nonskeletal consequences of osteoporotic fractures. Psychologic and social outcomes

The prevalence of osteoporosis is rising as the population of the United States and other developed countries ages. These increasing numbers of people have motivated pharmaceutical companies to develop and market several antiresorptive medications that can slow down the bone loss associated with osteoporosis. Although these are not cures for this disease, they are an important first step in a vital ongoing public health effort to prevent osteoporosis in the future and to manage osteoporosis now. We cannot expect to remediate the problems caused by this disease if we attend only to its skeletal implications. Like any other chronic disease, osteoporosis has significant psychologic and social consequences. From anxiety and depression to social withdrawal and isolation, if these problems are left unresolved, they can have a significant negative impact not only on health issues but also on overall quality of life. No quick fixes exist for the numerous ways in which osteoporosis can transform an autonomous person into a dependent and hopeless patient. In part, responsibility for helping this patient rests with the medical community. Referrals to appropriate providers can improve a patient's physical and emotional well-being. Physician specialists can help the patient manage comorbid conditions. Physical and occupational therapists can teach exercises, home safety, and safe movement. Social workers can provide a framework for coping that enables individuals to improve their interpersonal interactions and minimize stress in their lives. Nutritionists, pharmacists, nurses, and other health care professionals can make major contributions to the quality of life of people with osteoporosis and should be encouraged to do so. Unfortunately, managed care has set policies that deprive patients with osteoporosis of the kinds of care that would be most useful to them. As we have advocated for the last 15 years, a multidisciplinary approach offers patients the most positive overall way to manage osteoporosis. Therefore, new alternatives need to be examined, alternatives that provide both low-cost and high-quality care. In the long run, patients who practice self-management, that is, those who take responsibility for their own calcium and vitamin D intake, are compliant with medications, exercise, and practice home safety, and who have a healthy outlook, can control their osteoporosis. The most effective intervention for the future may be to teach individuals how to use self-management strategies so that they can take charge of their osteoporosis and positively influence their quality of life.