Sociodemographic and disease-related correlates of depressive morbidity among diabetic patients in Zagreb, Croatia

Iron deficiency in long standing type 1 diabetes mellitus and its association with depression and impaired quality of life

AIMS

Iron deficiency (ID) is the most frequent malnutrition worldwide and often associated with reduced quality of life (QoL) and depression. We aimed to investigate the iron status in middle-aged type 1 diabetes in relation to depression and QoL.

METHODS

109 people with type 1 diabetes (54.1% male, mean age 56.2 years) were enrolled in a cross-sectional study at the diabetes clinic of the Goethe University Hospital. Iron, haemoglobin and ferritin levels were measured. Treatment satisfaction, QoL and depression were assessed using standardized questionnaires (Disease Specific Quality of Life scale, CES-D (Center for Epidemiological Studies Depression Scale) and WHO-5 well-being index.

RESULTS

Decreased serum iron (<60 µg/dl) and ferritin levels (<50 pg/nl) were observed in 18 (16.8%) and 28 (26.7%) patients, respectively. Anemia was present in 20 patients (18.34%). A high rate of depression was observed: 42.2% (WHO-5) and 40.7% (CES-D). The personal goals and current diabetes therapy satisfaction score (PWTSS) was significantly better in patients with sufficient iron status (ferritin level > 50 pg/ml, p = 0.018). Multiple regression analysis revealed iron status (p = 0.03) to be an independent predictor for better PWTSS. Insufficient iron status correlated significantly with depression as measured by WHO-5 (p = 0.044) and CES-D (p = 0.029).

CONCLUSIONS

Type 1 diabetes patients in the current study were frequently depressive and reported an impaired QoL that associated with iron insufficiency. If confirmed a better awareness is needed for depression and ID in long standing disease.

Prevalence and influencing factors of co-morbid depression in patients with type 2 diabetes mellitus: a General Hospital based study

BACKGROUND

Depression and diabetes have been recognized as major public health issues in China, however, no studies to date examined the factors associated with the development of depression in patients with diabetes in China. This study aimed to estimate the prevalence of co-morbid depression among adults with type 2 diabetes mellitus (DM) and to examine the influence factors of co-morbid depression in a group of patients with type 2 DM.

METHODS

The study was conducted from March l to May 31, 2012, in the Department of Endocrinology of the First Affiliated Hospital of the General Hospital of the People's Liberation Army (PLA). A systematic random sample of 412 type 2 DM patients aged over 18 years was selected. A structured questionnaire was used for collecting the information about socio-demographic data, lifestyle factors and clinical characteristics. Depression and social support was evaluated by using the Chinese version of Beck Depression Inventory (BDI) and Social Support Rate Scale (SSRS), respectively. Weights and heights were measured. Hemoglobin A1c (HbA1c) was abstracted from each patient directly after the interview.

RESULTS

Of the total sample, 142 patients had depression according to the BDI scores (BDI scores ≥14), the prevalence of co-morbid depression in this study population was 5.7 % (142/2500). Of which, 56 had major depression (BDI ≥ 21), and 86 had moderate depression (BDI ≥ 14&BDI < 21). Logistic regression analysis indicated that a high HbA1c level, a high BMI, low quality health insurance, and being single, were significantly associated with the development of depression. However, a family history of diabetes and a high social support level are likely protective factors.

CONCLUSIONS

The prevalence of co-morbid depression was 5.7 % among Chinese subjects with type 2 DM in this study. High HbA1c level, high BMI score, being single, low social support level, and low quality health insurance were associated with the presence of depression. These findings support a recommendation for routine screening and management in China for depression in patients with diabetes, especially for those in primary care, to reduce the number of the depressed or the misrecognized depressed diabetic patients.

Epidemiology of depression in diabetes: international and cross-cultural issues

INTRODUCTION

This paper reviews the most up-to-date epidemiological evidence of the relationship between depression and diabetes, and considers the risk factors for the development of depression and the consequences of depression in diabetes with an emphasis on international and cross-cultural data. The difficulties that researchers face when epidemiological studies require assessment of psychological phenomena, such as depression, across different cultural settings are explored.

METHODS

Relevant papers were sought on the epidemiology of diabetes and depression in people with diabetes by undertaking a literature search of electronic databases including MEDLINE, Psych-INFO, CINAHL and EMBASE. These papers were assessed by the authors and a narrative review of the relevant literature was composed.

RESULTS

Systematic reviews of the prevalence of depression in people with diabetes have focused on studies conducted in English speaking countries and emerging data suggest that there may be international variations in prevalence and also in how symptoms of depression are reported. There appears to be a bi-directional relationship between depression and diabetes, with one influencing the other; however, research in this area is further complicated by the fact that potential risk factors for depression in people with diabetes often interact with each other and with other factors. Further research is needed to elucidate the causal mechanisms underlying these associations.

LIMITATIONS

Data from non-English speaking countries remain scarce and so it is difficult to come to any firm conclusions as to the international variation in prevalence rates of co-morbid diabetes and depression in these countries until further research has been conducted.

CONCLUSION

It is important to take a culture-centered approach to our understanding of mental health and illness and consider the key issues related to the development of culturally sensitive depression screening tools. In order to come to any firm conclusions about the international variation in prevalence of co-morbid diabetes and depression, issues of culture and diversity must be taken into account prior to conducting international epidemiological studies.

Depressive symptoms in patients with type 2 diabetes mellitus: do stress and coping matter?

This article examines the relationship among diabetes-related stress, appraisal, coping and depressive symptoms in patients with type 2 diabetes mellitus (T2DM) using the transactional model of stress and coping (TMSC) as the theoretical framework. In this cross-sectional study, a convenience sample of 201 patients with T2DM was recruited from three outpatient clinics. Patients with depressive symptoms reported significantly more diabetes-related stress than patients without depressive symptoms. The results of path analysis suggest that patients who experience greater diabetes-related stress or greater depressive symptoms have a negative appraisal of their diabetes. Negative appraisal is, in turn, associated with greater use of avoidance, passive resignation and diabetes integration coping and lesser use of problem-focused coping. Avoidance, passive resignation and diabetes integration coping are, in turn, related to greater depressive symptoms or greater diabetes-related stress. Overall, the results of this study support the TMSC as a framework to elucidate the relationships among diabetes-related stress, appraisal, coping and depressive symptoms in patients with T2DM. However, given the cross-sectional nature of the study, we are unable to elucidate the directionality of the relationship between stress and depressive symptoms. Implications of the findings and the need for longitudinal studies to evaluate these relationships are discussed.

Neuropathy is associated with depression independently of health-related quality of life in Japanese patients with diabetes

OBJECTIVES

To identify factors independently associated with depression in Japanese patients with diabetes, after controlling for potential confounding factors.

METHODS

Among 197 outpatients with diabetes, 129 (type 1: 24, type 2: 105) completed a questionnaire concerning socio-demographic and health-related variables. Depression screening was done using Zung's Self-Rating Depression Scale test, followed by diagnostic interviews by experienced psychiatrists employing the Diagnostic Statistical Manual of Mental Disorders, 4th edition (DSM-IV).

RESULTS

Forty-seven patients (36.4%) had symptomatological depression. A Self-Rating Depression Scale cut-off score of 40 had good sensitivity (100%) and modest specificity (59%) for detecting major depressive episode, in accordance with the DSM-IV. Diabetic patients suffering from depression were more likely to have neuropathy, retinopathy, body pain, a feeling of poor general health, and lack of social support, than the non-depressed patients. However, age, gender, marital status, diabetes type, insulin requirement, duration of diabetes, hemoglobin A1c (HbA1c) and the presence of nephropathy did not differ between the two groups. In multivariate logistic regression analysis, body pain (OR 3.26, 95% CI 1.31-8.08) and the presence of microvascular complications (OR 2.81, 95% CI 1.13-6.98) were independent factors associated with depression. Specifically, diabetic neuropathy (OR 3.10, 95% CI 1.17-8.22) was associated with depression independently of age, gender, marital status, social supports, quality of life, diabetes type, duration of diabetes, HbA1c, and insulin requirement.

CONCLUSIONS

A diabetic complication, specifically neuropathy, was independently associated with depression in patients with diabetes. The present findings indicate the need to find a biological base common to both depression in diabetes and diabetic neuropathy.

Examining a bidirectional association between depressive symptoms and diabetes

CONTEXT

Depressive symptoms are associated with development of type 2 diabetes, but it is unclear whether type 2 diabetes is a risk factor for elevated depressive symptoms.

OBJECTIVE

To examine the bidirectional association between depressive symptoms and type 2 diabetes.

DESIGN, SETTING, AND PARTICIPANTS

Multi-Ethnic Study of Atherosclerosis, a longitudinal, ethnically diverse cohort study of US men and women aged 45 to 84 years enrolled in 2000-2002 and followed up until 2004-2005.

MAIN OUTCOME MEASURES

Elevated depressive symptoms defined by Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or higher, use of antidepressant medications, or both. The CES-D score was also modeled continuously. Participants were categorized as normal fasting glucose (< 100 mg/dL), impaired fasting glucose (100-125 mg/dL), or type 2 diabetes (> or = 126 mg/dL or receiving treatment). Analysis 1 included 5201 participants without type 2 diabetes at baseline and estimated the relative hazard of incident type 2 diabetes over 3.2 years for those with and without depressive symptoms. Analysis 2 included 4847 participants without depressive symptoms at baseline and calculated the relative odds of developing depressive symptoms over 3.1 years for those with and without type 2 diabetes.

RESULTS

In analysis 1, the incidence rate of type 2 diabetes was 22.0 and 16.6 per 1000 person-years for those with and without elevated depressive symptoms, respectively. The risk of incident type 2 diabetes was 1.10 times higher for each 5-unit increment in CES-D score (95% confidence interval [CI], 1.02-1.19) after adjustment for demographic factors and body mass index. This association persisted following adjustment for metabolic, inflammatory, socioeconomic, or lifestyle factors, although it was no longer statistically significant following adjustment for the latter (relative hazard, 1.08; 95% CI, 0.99-1.19). In analysis 2, the incidence rates of elevated depressive symptoms per 1000-person years were 36.8 for participants with normal fasting glucose; 27.9 for impaired fasting glucose; 31.2 for untreated type 2 diabetes, and 61.9 for treated type 2 diabetes. Compared with normal fasting glucose, the demographic-adjusted odds ratios of developing elevated depressive symptoms were 0.79 (95% CI, 0.63-0.99) for impaired fasting glucose, 0.75 (95% CI, 0.44-1.27) for untreated type 2 diabetes, and 1.54 (95% CI, 1.13-2.09) for treated type 2 diabetes. None of these associations with incident depressive symptoms were materially altered with adjustment for body mass index, socioeconomic and lifestyle factors, and comorbidities. Findings in both analyses were comparable across ethnic groups.

CONCLUSIONS

A modest association of baseline depressive symptoms with incident type 2 diabetes existed that was partially explained by lifestyle factors. Impaired fasting glucose and untreated type 2 diabetes were inversely associated with incident depressive symptoms, whereas treated type 2 diabetes showed a positive association with depressive symptoms. These associations were not substantively affected by adjustment for potential confounding or mediating factors.

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.

Does antidepressant adherence have an effect on glycemic control among diabetic antidepressant users?

OBJECTIVE

To examine the relationship between adherence to antidepressant medications and HbA1c levels among patients with diabetes in a managed care setting.

METHOD

The analysis included measures of HbA1c levels before, during, and after initial antidepressant use among 568 patients with diabetes enrolled in the Harvard Pilgrim Health Care insurance plan from 1991-1995. Adherence was defined as four refills in a six-month period after the first antidepressant prescription. General linear models using SAS PROC MIXED were used to estimate the effects of covariates including antidepressant adherence on HbA1c levels over time, comparing patients who were adherent to antidepressant medications to those patients who were non-adherent to antidepressant medications.

RESULTS

Adherence to antidepressant treatment was not significantly associated with HbA1c levels among diabetic patients who are antidepressant users. Younger age, use of insulin and oral medications, and female gender were all significantly associated with HbA1c levels over time.

CONCLUSIONS

Although we did not observe any association between level of adherence to antidepressant therapy among diabetic patients and levels of glucose control, our results confirm previously established associations between patient characteristics and glycemic control. Further research is needed to disentangle the complex relationship among antidepressant treatment adherence and diabetes outcomes.

Individuals with type 2 diabetes and depressive symptoms exhibited lower adherence with self-care

OBJECTIVE

Our study aimed to determine whether depressive symptoms are associated with poor self-care behaviors among patients with type 2 diabetes.

METHODS

Study subjects were 168 patients with diabetes, aged >30 years, who had a diabetes history of 1-15 years. Using a self-reported questionnaire, we evaluated diabetes self-care behaviors and depressive symptoms. Self-care behaviors were evaluated in five categories: medication taking, self-monitoring of blood glucose (SMBG), diet, exercise, and participation in patient education programs. Depressive symptoms were evaluated using the Centers for Epidemiologic Studies-Depression (CES-D) scales. Multiple logistic regression analyses were used to determine the association between self-care behaviors and depressive symptoms.

RESULTS

Higher depressive-symptom scores were associated with poor self-care behaviors, significantly with poor participation in education programs (odds ratio OR=1.21, 95% confidence interval CI=1.06-1.38) and poor diet (OR=1.11, 95% CI=1.01-1.22), and marginally with poor medication taking (OR=1.14, 95% CI=1.00-1.31). Depressive symptoms were not significantly associated with either SMBG or exercise.

CONCLUSIONS

These data suggest that the evaluation and control of depressive symptoms among diabetic patients would improve their adherence to self-care behaviors.

Depressive symptoms and the risk of type 2 diabetes: the Atherosclerosis Risk in Communities study

OBJECTIVE

The goal of this study was to determine whether depressive symptoms predict type 2 diabetes.

RESEARCH DESIGN AND METHODS

We analyzed data on depressive symptoms (including recent fatigue, sleep disturbance, feelings of hopelessness, loss of libido, and increased irritability) in a longitudinal, biracial cohort study of 11,615 initially nondiabetic adults aged 48-67 years, who were subsequently followed for 6 years for the development of type 2 diabetes.

RESULTS

At baseline, depressive symptoms were positively associated with BMI, fasting insulin, systolic blood pressure, caloric intake, physical inactivity, and current smoking (all P < 0.05). In prospective analyses, after adjusting for age, race, sex, and education, individuals in the highest quartile of depressive symptoms had a 63% increased risk of developing diabetes compared with those in the lowest quartile (relative hazard [RH] 1.63, 95% CI 1.31-2.02). This relation persisted after adjustment for stress-associated lifestyle factors (smoking, physical activity, caloric intake, and adiposity) (1.28, 1.02-1.60) and metabolic covariates (fasting insulin and glucose, lipids, blood pressure, and adiposity) (1.38, 1.10-1.73).

CONCLUSIONS

In this cohort, depressive symptoms predicted incident type 2 diabetes. This relation is only partially explained by demographic, metabolic, and lifestyle factors. Possible neuroendocrine mediators of the stress-obesity-diabetes relationship require further evaluation in prospective cohort studies that use an established tool to assess depression and incorporate neurohormonal measurements.

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.

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 of depression and diabetes complications: a meta-analysis

OBJECTIVE

The objective of this study was to examine the strength and consistency of the relationship between depression and diabetes complications in studies of type 1 and type 2 adult patients with diabetes.

METHOD

MEDLINE and PsycINFO databases were searched for articles examining depression and diabetes complications in type 1 and type 2 diabetes samples published between 1975 and 1999. Meta-analytic procedures were used. Studies were reviewed for diabetes type, sample size, statistical tests, and measures of diabetes complications and depression. Significance values, weighted effect sizes r, 95% confidence intervals (CI), and tests of homogeneity of variance were calculated for the overall sample (k = 27) and for subsets of interest.

RESULTS

A total of 27 studies (total combined N = 5374) met the inclusion criteria. A significant association was found between depression and complications of diabetes (p < .00001, z = 5.94). A moderate and significant weighted effect size (r = 0.25; 95% CI: 0.22-0.28) was calculated for all studies reporting sufficient data (k = 22). Depression was significantly associated with a variety of diabetes complications (diabetic retinopathy, nephropathy, neuropathy, macrovascular complications, and sexual dysfunction). Effect sizes were in the small to moderate range (r = 0.17 to 0.32).

CONCLUSIONS

These findings demonstrate a significant and consistent association of diabetes complications and depressive symptoms. Prospective, longitudinal studies are needed to identify the pathways that mediate this association.

The prevalence of comorbid depression in adults with diabetes: a meta-analysis

OBJECTIVE

To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes.

RESEARCH DESIGN AND METHODS

MEDLINE and PsycINFO databases and published references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used chi(2) statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design.

RESULTS

A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0, 95% CI 1.8-2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%).

CONCLUSIONS

The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.

Menopause in normal and uncomplicated NIDDM women: physical and emotional symptoms and hormone profile

OBJECTIVE

To compare the physical characteristics, emotional symptoms and metabolic conditions of menopausal women with and without non insulin dependent diabetes mellitus (NIDDM).

METHODS

We studied 100 menopausal women 45-72 years of age, 51 with and 49 without NIDDM, in a cross-sectional design. Biological characteristics were collected and emotional symptoms were assessed with a modified Hamilton and Bech-Rafaelsen scale, scoring depression, anxiety, non specific symptoms of depression (NSSD) and the empty nest syndrome (ENS). Weight, body mass index (BMI), waist/hip and abdomen/hip ratios and percent of body fat were registered. The sulfoconjugated form of the dehydroepiandrosterone (DHEAS), follicle stimulating hormone (FSH), cortisol and fasting, as well as postprandial insulin/glucose ratios, were measured in blood.

RESULTS

Women with NIDDM had earlier mean age for menopause, more central obesity and less peripheral fat; they had also more prevalent emotional symptoms than non diabetic menopausal women. In women with NIDDM, symptoms were associated with years since diagnosis and with BMI. In non diabetic menopausal women schooling and attitudes to sexuality were associated with symptoms. FSH was inversely associated with BMI in both diabetic and non diabetic women; postprandial insulin/glucose ratio was correlated with central obesity in the group without NIDDM and cortisol with sitting systolic blood pressure (SBP) in the group with NIDDM.

CONCLUSION

The diagnosis of NIDDM and its metabolic conditions were associated with an increased frequency of some symptoms in menopausal women.

Impact of sociodemographic and diabetes-related characteristics on depressive state among non-insulin-dependent diabetic patients

One hundred and fifty-one non-insulin-dependent diabetic patients were assessed to detect sociodemographic, psychological and disease-related characteristics that were related to depressive state among diabetic patients. Depressive state in the patients was correlated with poor social support and low economic status, premorbid neurotic personality and the presence of complications, retinopathy in particular. However, depressive state did not correlate with age, gender, education, serum level of HbA1C or duration of diabetes. The severity of the depressive state in diabetic patients may vary with the cultural background of the patient and/or the country in which he or she is living. In treating diabetic patients, doctors need to pay special attention to these factors.

Health related quality of life among insulin-dependent diabetics: disease-related and psychosocial correlates

This crossectional questionnaire study examined the associations of health factors and psychosocial factors with Health Related Quality of Life (HRQOL) in a sample of adult type I diabetic patients (n = 385). Health related quality of life was measured by the Finnish version of MOS SF-20. Psychosocial measures were general social support, diabetes-specific social support, diabetes locus of control (DCL), self-efficacy, diabetes health beliefs and self-care practices. In multivariate analyses, limitations in physical functioning showed strong associations with perceived health (beta = -0.33, P < 0.001), role functioning (OR = 38.54, 95% CL 10.73-139.56), social functioning (OR = 7.05, 95% CL 2.88-17.27) and pain (OR = 7.89, 95% CL 4.26-14.47), and was moderately associated to mental health (beta = -0.12, P < .01). Duration of diabetes and glycemic control were not related to HRQOL dimensions. Adequacy of social support was related to all HRQOL domains apart from pain and role functioning. The most important diabetes-related psychosocial factors were self-efficacy, and diabetes-related social support. Diabetes-specific factors were more important among those in good physical condition.

Health behaviour, social integration, perceived health and dysfunction. A comparison between patients with type I and II diabetes and controls

This survey compared diabetic patients (n = 953) and population controls (n = 2366) in terms of socioeconomic and occupational factors, family life, leisure activity, health habits, perceived social support and quality of life. The differences between type I and type II diabetic patients and controls were examined by proportions adjusted for age. Type II diabetic men had a lower educational level and were more often retired, unemployed or unmarried than controls. Type II diabetics were also less likely to have fewer healthy behaviour patterns than controls. Type I diabetics assessed their social support as inadequate slightly more often than controls, though no major differences in perceived availability of social support were detected between study groups. Both diabetic groups reported a lower health-related quality of life than healthy controls. Thus a chronic illness such as diabetes seems to tax the individual's personal resources, leading to lower quality of life.

Diabetes mellitus and psychological well-being. Results of the Nord-Trøndelag health survey

The present study relies on questionnaire data from a diabetes and hypertension screening carried out on the entire adult population of a medium-sized Norwegian county (total number of participants = 74,977). Self-reported diabetic patients were compared with non-diabetics, and with patients with self-reported angina pectoris, previous cardiac infarction, and stroke. The psychological well-being of the known diabetic patients was found to be significantly poorer than that of those without diabetes, but better than that of those with angina and stroke. HbAl level was found to be significantly related to well-being, the low levels of HbAl (below 7.5%) scoring low on well-being and the high levels (above 15%) scoring high. Because of its special design, the present study allowed comparisons between diabetic patients undergoing treatment and newly detected patients who had not yet been treated. Treatment-related interpretations therefore could be rejected.