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Ismail L, Materwala H, Al Kaabi J. Association of risk factors with type 2 diabetes: A systematic review. Comput Struct Biotechnol J 2021; 19:1759-1785. [PMID: 33897980 PMCID: PMC8050730 DOI: 10.1016/j.csbj.2021.03.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022] Open
Abstract
Diabetes is the leading cause of severe health complications and one of the top 10 causes of death worldwide. To date, diabetes has no cure, and therefore, it is necessary to take precautionary measures to avoid its occurrence. The main aim of this systematic review is to identify the majority of the risk factors for the incidence/prevalence of type 2 diabetes mellitus on one hand, and to give a critical analysis of the cohort/cross-sectional studies which examine the impact of the association of risk factors on diabetes. Consequently, we provide insights on risk factors whose interactions are major players in developing diabetes. We conclude with recommendations to allied health professionals, individuals and government institutions to support better diagnosis and prognosis of the disease.
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Affiliation(s)
- Leila Ismail
- Intelligent Distributed Computing and Systems Research Laboratory, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, Abu Dhabi, 15551, United Arab Emirates
| | - Huned Materwala
- Intelligent Distributed Computing and Systems Research Laboratory, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, Abu Dhabi, 15551, United Arab Emirates
| | - Juma Al Kaabi
- College of Medicine and Health Sciences, Department of Internal Medicine, United Arab Emirates University, Al Ain, Abu Dhabi 15551, United Arab Emirates
- Mediclinic, Al Ain, Abu Dhabi, United Arab Emirates
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Sayın S, Sayın S, Bursalı B, Bilen İpek H. Tip 2 diyabet hastalarında anksiyete ve depresyon riski ve ilişkili faktörler. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.463589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Rosedale MT, Strauss SM, Kaur N, Danoff A, Malaspina D. Identification of diabetes risk in dental settings: Implications for physical and mental health. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2018; 47:64-73. [DOI: 10.1080/00207411.2017.1377803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mary T. Rosedale
- Rory Meyers College of Nursing, New York University, New York, NY, USA
- New York University Langone Medical Center, New York, NY, USA
| | - Shiela M. Strauss
- Rory Meyers College of Nursing, New York University, New York, NY, USA
- New York University Langone Medical Center, New York, NY, USA
| | - Navjot Kaur
- New York University Langone Medical Center, New York, NY, USA
| | - Ann Danoff
- New York University Langone Medical Center, New York, NY, USA
| | - Dolores Malaspina
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
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Parental History of Diabetes, Positive Affect, and Diabetes Risk in Adults: Findings from MIDUS. Ann Behav Med 2017; 50:836-843. [PMID: 27287937 DOI: 10.1007/s12160-016-9810-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Family history of diabetes is one of the major risk factors for diabetes, but significant variability in this association remains unexplained, suggesting the presence of important effect modifiers. PURPOSE To our knowledge, no previous work has examined whether psychological factors moderate the degree to which family history of diabetes increases diabetes risk. METHODS We investigated the relationships among parental history of diabetes, affective states (positive affect, negative affect, and depressed affect), and diabetes in 978 adults from the MIDUS 2 national sample. RESULTS As expected, parental history of diabetes was associated with an almost threefold increase in diabetes risk. We found a significant interaction between positive affect and parental history of diabetes on diabetes (p = .009): higher positive affect was associated with a statistically significant lower relative risk for diabetes in participants who reported having a parental history of diabetes (RR = .66 per unit increase in positive affect; 95 % CI = .47; .93), but it did not influence diabetes risk for participants who reported no parental history of diabetes (p = .34). This pattern persisted after adjusting for an extensive set of health and sociodemographic covariates and was independent of negative and depressed affect. CONCLUSIONS These results suggest that psychological well-being may protect individuals at increased risk from developing diabetes. Understanding such interactions between non-modifiable risk factors and modifiable psychological resources is important for delineating biopsychosocial pathways to diabetes and informing theory-based, patient-centered interventions to prevent the development of diabetes.
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Akbaş-Şimşek T, Onat A, Kaya A, Tusun E, Yüksel H, Can G. Sex-dependent independent prediction of incident diabetes by depressive symptoms. Int J Geriatr Psychiatry 2017; 32:1425-1432. [PMID: 27891676 DOI: 10.1002/gps.4630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/22/2016] [Accepted: 10/26/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To study the predictive value of depressive symptoms (DeprSs) in a general population of Turkey for type 2 diabetes. METHODS Responses to three questions served to assess the sense of depression. Cox regression analyses were used regarding risk estimates for incident diabetes, after exclusion of prevalent cases of diabetes. Mean follow-up consisted of 5.15 (±1.4) years. RESULTS Depressive symptoms were present at baseline in 16.2% of the whole study sample, threefold in women than men. Reduced physical activity grade was the only significant covariate at baseline in men, while younger age and lower blood pressure were significantly different in women compared with those without DeprS. In men, presence of DeprS predicted incident diabetes at a significant 2.58-fold relative risk (95% confidence interval 1.03; 6.44), after adjustment for age, systolic blood pressure, and antidepressant drug usage. When further covariates were added, waist circumference remained the only significant predictor, while DepS was attenuated to a relative risk of 2.12 (95% confidence interval 0.83; 5.40). DeprS was not associated with diabetes in women, whereas antidepressant drug usage only tended to be positively associated. CONCLUSION Gender difference existed in the relationship between DeprS and incident diabetes. DeprS predicted subsequent development of diabetes in men alone, not in women. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tuğba Akbaş-Şimşek
- Section of Internal Medicine, Bağcılar Educational Hospital, Istanbul, Turkey
| | - Altan Onat
- Department of Cardiology and Public Health, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Adnan Kaya
- Department of Cardiology and Public Health, Suruç State Hospital, Şanlıurfa, Turkey
| | - Eyyup Tusun
- Department of Cardiology, Şanlıurfa Educational Hospital, Şanlıurfa, Turkey
| | - Hüsniye Yüksel
- Department of Cardiology and Public Health, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Günay Can
- Department of Cardiology and Public Health, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Zhuang QS, Shen L, Ji HF. Quantitative assessment of the bidirectional relationships between diabetes and depression. Oncotarget 2017; 8:23389-23400. [PMID: 28177893 PMCID: PMC5410312 DOI: 10.18632/oncotarget.15051] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/09/2017] [Indexed: 01/07/2023] Open
Abstract
Diabetes and depression impose an enormous public health burden and the present study aimed to assess quantitatively the bidirectional relationships between the two disorders. We searched databases for eligible articles published until October 2016. A total of 51 studies were finally included in the present bidirectional meta-analysis, among which, 32 studies were about the direction of depression leading to diabetes, and 24 studies about the direction of diabetes leading to depression. Pooled results of the 32 eligible studies covering 1274337 subjects showed that depression patients were at higher risk for diabetes (odds ratio (OR) = 1.34, 95% confidence intervals (CI) = [1.23, 1.46]) than non-depressive subjects. Further gender-subgroup analysis found that the strength of this relationship was stronger in men (OR = 1.63, 95%CI = [1.48, 1.78]) than in women (OR = 1.29, 95%CI = [1.07, 1.51]). For the direction of diabetes leading to depression, pooled data of 24 articles containing 329658 subjects showed that patients with diabetes were at higher risk for diabetes (OR = 1.28, 95%CI = [1.15, 1.42]) than non-diabetic subjects. The available data supports that the relationships between diabetes and depression are bidirectional and the overall strengths are similar in both directions. More mechanistic studies are encouraged to explore the molecular mechanisms underlying the relationships between the two diseases.
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Affiliation(s)
- Qi-Shuai Zhuang
- Shandong Provincial Research Center for Bioinformatic Engineering and Technique, School of Life Sciences, Shandong University of Technology, Zibo, P. R. China
| | - Liang Shen
- Shandong Provincial Research Center for Bioinformatic Engineering and Technique, School of Life Sciences, Shandong University of Technology, Zibo, P. R. China
| | - Hong-Fang Ji
- Shandong Provincial Research Center for Bioinformatic Engineering and Technique, School of Life Sciences, Shandong University of Technology, Zibo, P. R. China
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Chan DKC, Zhang X, Fung HH, Hagger MS. Affect, Affective Variability, and Physical Health: Results from a Population-Based Investigation in China. Int J Behav Med 2017; 23:438-46. [PMID: 26416662 DOI: 10.1007/s12529-015-9510-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is good evidence linking positive affect with adaptive psychological and physical health outcomes and negative affect with maladaptive outcomes, in multiple contexts and samples. However, recent research has suggested that the fluctuation of emotions, known as affective variability, may also be an important correlate of individuals' health. PURPOSE The present study examined the relationship between affect, affective variability, and self-reported health status in a large representative sample of adults in China. METHOD We analyzed cross-sectional data retrieved from the World Health Organization's study on global ageing and adults' health. A total of 15,050 Chinese adults (aged between 18 and 99) from China reported their affective experiences during the previous day, perceived health, and their history of multiple chronic illnesses from their medical records (stroke, angina, diabetes, chronic lung disease, depression, and hypertension). Hierarchical multiple regression and logistic regression analyses were employed to analyze the data. RESULTS Independent of individuals' mean levels of affect, affective variability was negatively related to subjective health conditions and positively related to diagnosed illness status, after controlling for demographic variables. Results suggest that affective variability increases the likelihood of reported impaired health and diagnosis of affect-related illnesses such as angina and depression. CONCLUSION The present study highlighted the importance of studying the impact of affective variability, in addition to that of mean affect levels, on health.
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Affiliation(s)
- Derwin K C Chan
- Institute of Human Performance, University of Hong Kong, Hong Kong, Hong Kong
| | - Xin Zhang
- Department of Psychology and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China, 100871.
| | - Helene H Fung
- Department of Psychology, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Martin S Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Hasan SS, Thiruchelvam K, Ahmed SI, Clavarino AM, Mamun AA, Kairuz T. Psychological health and menopause-specific quality of life of Malaysian women with type 2 diabetes. Asian J Psychiatr 2016; 23:56-63. [PMID: 27969080 DOI: 10.1016/j.ajp.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/13/2016] [Accepted: 07/07/2016] [Indexed: 01/31/2023]
Abstract
Anxiety and depression are more common among females and those experiencing diabetes and menopause. Menopausal symptoms experienced by women can vary tremendously from population to population; therefore, there is a need to investigate these symptoms and associated risk factors in different communities. This study investigated the differences in psychological health and menopause-specific quality of life (MENQOL) between women with and without diabetes type 2 (T2DM) in Malaysia. Women with T2DM (n=320) were matched by age range to controls without T2DM (n=320). Data were collected from March 2012 to January 2013. Delusions Symptoms States Inventory (DSSI) instrument was used to identify symptoms of depression and anxiety. Women with diabetes had higher depressive (11.8% versus 8.4%) and anxiety (8.4% versus 6.6%) symptoms compared to women without diabetes. In both groups, the most common menopausal symptom was aches (muscles and joints). Women without diabetes had significantly higher scores for the sexual domain compared to women with diabetes (4.20 versus 3.21, p=0.001). The odds that a postmenopausal woman with diabetes was depressed or anxious on the DSSI scale increased significantly when the MENQOL score on the physical, vasomotor, and psychosocial domains increased by one unit. Both diabetes and psychological problems have negative impact on MENQOL. Our findings support the view of screening postmenopausal women with diabetes for depressive and anxiety, to improve overall quality of life.
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Affiliation(s)
- Syed Shahzad Hasan
- The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102 Queensland, Australia.
| | - Kaeshaelya Thiruchelvam
- International Medical University, Jalan Jalil Perkasa 19, 57000 Bukit Jalil, Kuala Lumpur, Malaysia.
| | - Syed Imran Ahmed
- International Medical University, Jalan Jalil Perkasa 19, 57000 Bukit Jalil, Kuala Lumpur, Malaysia.
| | - Alexandra M Clavarino
- The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102 Queensland, Australia.
| | - Abdullah A Mamun
- The University of Queensland, Herston Road, Herston, 4006 Queensland, Australia.
| | - Therese Kairuz
- James Cook University, Angus Smith Drive, Townsville, 4811 Queensland, Australia.
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Depression and Risk for Diabetes: A Meta-Analysis. Can J Diabetes 2015; 39:266-72. [DOI: 10.1016/j.jcjd.2014.11.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 11/28/2014] [Accepted: 11/28/2014] [Indexed: 12/20/2022]
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Köhler S, Buntinx F, Palmer K, van den Akker M. Depression, vascular factors, and risk of dementia in primary care: a retrospective cohort study. J Am Geriatr Soc 2015; 63:692-8. [PMID: 25900484 DOI: 10.1111/jgs.13357] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To study the interaction between and timing effects of depression and vascular disorders on dementia risk. DESIGN Retrospective cohort study. SETTING Primary care practices in the south of the Netherlands. PARTICIPANTS Individuals in primary care aged 50 to 100 followed for 13 years (N = 35,791). MEASUREMENTS Medical diagnoses of incident depression, hypertension, obesity, type 2 diabetes mellitus, stroke, and dementia were extracted from a research database. Cox proportional hazards regression was used to test whether incident depression predicted dementia and its putative interactions with vascular factors. RESULTS In total, 1,680 participants developed dementia. Individuals with depression (n = 978) had a higher risk of dementia (adjusted hazard ratio (HR) = 2.03, 95% confidence interval (CI) = 1.56-2.64). Depression exerted most effect in participants with incident stroke (HR = 5.29, 95% CI = 2.52-11.14) or newly diagnosed hypertension (HR = 3.09, 95% CI = 1.54-6.20). CONCLUSION Depression in later life increases the risk of dementia. The effect is particularly high in individuals with depression and vascular disorders. Targeting late-onset depression in individuals with vascular disorders might lower dementia risk by preventing cerebrovascular changes.
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Affiliation(s)
- Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Abstract
BACKGROUND Depression and anxiety have been inconsistently associated with diabetes. Sex differences in the biological and behavioral correlates of these forms of distress could partially explain these inconsistencies. We investigated sex-specific associations between depression/anxiety symptoms and diabetes in two separate samples. METHODS The First National Health and Nutrition Examination Survey enrolled 3233 participants aged 25 to 74 years from 1971 to 1974. Depression and anxiety symptoms were measured via General Well Being schedule subscales. Incident diabetes for 17 years was defined by the following: a) death certificate, b) participant self-report, or c) health care facility discharge. The Detroit Neighborhood Health Study enrolled 1054 participants 18 years or older from 2008 to 2010. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 assessed depression and anxiety. Participants' self-reported physician-diagnosed prevalent diabetes. RESULTS In the First National Health and Nutrition Examination Survey, the risk ratio (RR; 95% confidence interval) for incident diabetes among men with high versus low anxiety symptoms was 0.85 (0.56-1.29) and that among women was 2.19 (1.17-4.09; p for interaction = .005). RRs comparing high versus low depressive symptoms for men and women were 0.69 (0.43-1.100) and 2.11 (1.06-4.19); p for interaction = .007. In the Detroit Neighborhood Health Study, the RRs for prevalent diabetes comparing those with high versus low anxiety symptoms were 0.24 (0.02-2.42) for men and 1.62 (0.61-4.32) for women (p for interaction = < .001), whereas RRs for depression were 1.30 (0.46-3.68) for men and 2.32 (1.10-4.89) for women (p for interaction = .16). CONCLUSIONS In two separate samples, depressive symptoms were related to increased diabetes risk among women but not men. Although less robust, findings for anxiety were differentially associated with diabetes by sex.
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Rosedale M, Strauss SM, Knight C, Malaspina D. Awareness of Prediabetes and Diabetes among Persons with Clinical Depression. Int J Endocrinol 2015; 2015:839152. [PMID: 26060495 PMCID: PMC4427826 DOI: 10.1155/2015/839152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/03/2015] [Indexed: 01/30/2023] Open
Abstract
Background. Major depressive disorder (MDD) is highly comorbid with diabetes, a relationship underappreciated by clinicians. Purpose. Examine the proportion of nonpregnant individuals ≥20 years with MDD and elevated glucose and the demographic and clinical characteristics associated with unrecognized elevated glucose. Methods. 14,373 subjects who participated in the National Health and Nutrition Examination Survey (2007-2012) completed the PHQ-9 depression screen and had hemoglobin A1C (HbA1c) measured. PHQ-9 scores ≥10 and HbA1c scores ≥5.7% were defined as MDD and elevated HbA1c, respectively. Data were analyzed using complex survey sampling software. Results. 38.4% of the sample with MDD had elevated HbA1c readings. Compared with nondepressed subjects, they were significantly more likely to have elevated glucose readings (P = 0.003) and to be aware of their elevated glucose levels if they had a higher body mass index, family history of diabetes, more doctor visits in the past year, a usual care source, health insurance, or were taking hypertension or hypercholesterolemia medications. Conclusions. Many adults with MDD have elevated HbA1c levels, have never been advised of elevated HbA1c, have not received diabetes screening, and have minimal contact with a healthcare provider. Additional opportunities for diabetes risk screening in people with MDD are needed.
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Affiliation(s)
- Mary Rosedale
- New York University College of Nursing, New York, NY 10010, USA
- NYU Langone Medical Center, New York, NY 10016, USA
| | | | - Candice Knight
- New York University College of Nursing, New York, NY 10010, USA
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Kelly SJ, Ismail M. Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes. Annu Rev Public Health 2015; 36:441-62. [PMID: 25581145 DOI: 10.1146/annurev-publhealth-031914-122921] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.
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Affiliation(s)
- Shona J Kelly
- Center for Health and Social Care Research, Sheffield Hallam University, Sheffield S10 2BP, United Kingdom;
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Hasan SS, Clavarino AM, Mamun AA, Kairuz T. Incidence and risk of diabetes mellitus associated with depressive symptoms in adults: evidence from longitudinal studies. Diabetes Metab Syndr 2014; 8:82-87. [PMID: 24907171 DOI: 10.1016/j.dsx.2014.04.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We estimated the incidence and risk of diabetes associated with depressive symptoms using data from longitudinal studies. MATERIALS AND METHODS Databases were systematically searched for relevant studies. Incidence of diabetes is presented as cumulative incident proportion (CIP). Pooled effect sizes were calculated using random-effects model. The data were reconstructed to compute relative risk (RR). RESULTS The 16 studies selected for review generated 16 datasets of which 8 studies reporting binary estimates (RR) and 8 studies reporting time-to-event estimates (hazard ratio (HR)). Both RR and HR were significant at 1.67 (95% CI: 1.30-2.15) and 1.45 (95% CI: 1.12-1.87) for incident diabetes associated with depressive symptoms. CONCLUSION Our observations revealed greater cumulative incidence of diabetes in depressed than in non depressed groups. Depression should be included among risk factors that required regular screening for diabetes.
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Affiliation(s)
- Syed Shahzad Hasan
- The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia.
| | - Alexandra M Clavarino
- The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia.
| | - Abdullah A Mamun
- The University of Queensland, Herston Road, Herston 4006, Queensland, Australia.
| | - Therese Kairuz
- The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia.
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Population impact of depression either as a risk factor or consequence of type 2 diabetes in adults: a meta-analysis of longitudinal studies. Asian J Psychiatr 2013; 6:460-72. [PMID: 24309855 DOI: 10.1016/j.ajp.2013.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/09/2013] [Accepted: 09/15/2013] [Indexed: 11/21/2022]
Abstract
This meta-analysis examined the reciprocal relationship between depression and diabetes mellitus type 2 (T2DM) by conducting a bias adjusted meta-analysis of longitudinal studies using relative and absolute risk estimates. Specifically, the data were reconstructed to compute relative risk (RR), risk difference (RD), and the number needed to be exposed for one additional person to be harmed (NNEH) or benefited (NNEB). The 25 studies selected for review generated 29 datasets of which 15 examined endpoint A (depression as a risk factor for T2DM), and 14 examined endpoint B (T2DM as a risk factor for depression). For both endpoints, there was a small relative risk increase (for both the RR and hazard ratio (HR)) though with significant heterogeneity between studies. This however translated to a non-significant NNEH of 87 (NNEB 161 to ∞ to NNEH 35) and NNEH of 233 (NNEB 28 to ∞ to NNEH 23) for studies examining endpoint A and endpoint B respectively. This study suggests that the magnitude of the relative risk increase for depression as a risk factor or consequence of T2DM is small without significant impact on absolute risk indices. While these risks may be considered in terms of individual patient management, they are unlikely to have an impact on a population perspective.
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Hasan SS, Thiruchelvam K, Ahmed SI, Clavarino AM, Mamun AA, Kairuz T. Pregnancy complications, mental health-related problems and type 2 diabetes mellitus in Malaysian women. Diabetes Metab Syndr 2013; 7:191-197. [PMID: 24290082 DOI: 10.1016/j.dsx.2013.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS The aim of this study was to investigate the association between pregnancy complications, mental health-related problems, and type 2 diabetes mellitus (T2DM) in Malaysian women. MATERIALS AND METHODS A case-control study of women with T2DM (n=160) matched by age range to controls without T2DM (n=160). Data were collected in the Negeri Sembilan and PutraJaya regions in Malaysia, from two hospital outpatient clinics, PutraJaya Hospital and Tuanku Jaa'far Hospital Seremban, and one health clinic at Seremban. Validated, interviewer-administered questionnaires were used to obtain the data. The unadjusted and adjusted estimates were calculated using the Mantel-Haenszel method. RESULTS Neither depression (RR 0.74, 95% CI: 0.39-1.41) nor anxiety (RR 1.00, 95% CI: 0.53-1.88) symptoms increased the risk of T2DM significantly. However, gestational diabetes (RR 1.35, 95% CI: 1.02-1.79), and ≥3 pregnancies (RR 1.39, 95% CI: 1.08-1.79) were significant risk factors for the development of T2DM. T2DM was not a significant risk factor for either depression (RR 1.26, 95% CI: 0.91-1.74) or anxiety symptoms (RR 1.13, 95% CI: 0.59-2.19). CONCLUSION In this study, T2DM is not a significant risk factor for depression and anxiety; similarly, neither are depression and anxiety significant risk factors for T2DM. Although prevalence of depression and anxiety is not alarming, the findings reported here should alert clinicians to screen and treat anxiety and depression in people with diabetes and also note the importance of monitoring women with complications in pregnancy for risk of later T2DM.
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Affiliation(s)
- Syed Shahzad Hasan
- The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia.
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Valkanova V, Ebmeier KP. Vascular risk factors and depression in later life: a systematic review and meta-analysis. Biol Psychiatry 2013; 73:406-13. [PMID: 23237315 DOI: 10.1016/j.biopsych.2012.10.028] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/22/2012] [Accepted: 10/31/2012] [Indexed: 02/07/2023]
Abstract
Reports of the association between cardiovascular risk factors and depression in later life are inconsistent; to establish the nature of their association seems important for prevention and treatment of late-life depression. We searched MEDLINE, EMBASE, and PsycINFO for relevant cohort or case control studies over the last 22 years; 1097 were retrieved; 26 met inclusion criteria. Separate meta-analyses were performed for Risk Factor Composite Scores (RFCS) combining different subsets of risk factors, Framingham Stroke Risk Score, and single factors. We found a positive association (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.27-1.75) between RFCS and late-life depression. There was no association between Framingham Stroke Risk Score (OR: 1.25; 95% CI: .99-1.57), hypertension (OR: 1.14; 95% CI: .94-1.40), or dyslipidemia (OR: 1.08; 95% CI: .91-1.28) and late-life depression. The association with smoking was weak (OR: 1.35; 95% CI: 1.00-1.81), whereas positive associations were found with diabetes (OR: 1.51; 95% CI: 1.30-1.76), cardiovascular disease (OR: 1.76; 95% CI: 1.52-2.04), and stroke (OR: 2.11; 95% CI: 1.61-2.77). Moderate to high heterogeneity was found in the results for RFCS, smoking, hypertension, dyslipidemia, and stroke, whereas publication bias was detected for RFCS and diabetes. We therefore found convincing evidence of a strong relationship between key diseases and depression (cardiovascular disease, diabetes, and stroke) and between composite vascular risk and depression but not between some vascular risk factors (hypertension, smoking, dyslipidemia) and depression. More evidence is needed to be accumulated from large longitudinal epidemiological studies, particularly if complemented by neuroimaging.
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Affiliation(s)
- Vyara Valkanova
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Chen PC, Chan YT, Chen HF, Ko MC, Li CY. Population-based cohort analyses of the bidirectional relationship between type 2 diabetes and depression. Diabetes Care 2013; 36:376-82. [PMID: 23150281 PMCID: PMC3554286 DOI: 10.2337/dc12-0473] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study addresses the strength of association for the bidirectional relationship between type 2 diabetes and depression. RESEARCH DESIGN AND METHODS We used two cohort studies with the same source of database to determine the link between depression and type 2 diabetes. The data analyzed included a random sample of 1 million beneficiaries selected from the National Health Insurance claims in 2000. The analysis of diabetes predicting the depression onset consisted of 16,957 diabetic patients and the same number of sex- and age-matched nondiabetic control subjects. The analysis of depression predicting diabetes onset included 5,847 depressive patients and 5,847 sex- and age-matched nondepressive control subjects. The follow-up period was between 2000 and 2006, and onset of end points was identified from ambulatory care claims. The Cox proportional hazards regression model adjusted for potential confounders was used to estimate relative hazards. RESULTS The first cohort analysis noted an incidence density (ID) of 7.03 per 1,000 person-years (PY) and 5.04 per 1,000 PY for depression in diabetic and nondiabetic subjects, respectively, representing a covariate-adjusted hazard ratio (HR) of 1.43 (95% CI 1.16-1.77). The second cohort analysis noted an ID of 27.59 per 1,000 PY and 9.22 per 1,000 PY for diabetes in depressive and nondepressive subjects, respectively. The covariate-adjusted HR was stronger at 2.02 (1.80-2.27) for incident diabetes associated with baseline depression. CONCLUSIONS The two cohort studies provided evidence for the bidirectional relationship between diabetes and depression, with a stronger association noted for the depression predicting onset of diabetes.
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Affiliation(s)
- Pei-Chun Chen
- Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
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Icks A, Albers B, Haastert B, Pechlivanis S, Bokhof B, Slomiany U, Erbel R, Jöckel KH, Kruse J, Nowotny B, Herder C, Giani G, Moebus S. Diabetes incidence does not differ between subjects with and without high depressive symptoms--5-year follow-up results of the Heinz Nixdorf Recall Study. Diabet Med 2013; 30:65-9. [PMID: 22672118 DOI: 10.1111/j.1464-5491.2012.03724.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Cross-sectional studies have consistently reported evidence for an association between diabetes and depressive disorders. However, only limited prospective studies have examined this association, reporting conflicting results. In a population-based cohort study, we compared cumulative incidences of diabetes between participants with and without high depressive symptoms. METHOD We analysed the 5-year follow-up data from the German Heinz Nixdorf Recall study of 3547 participants without diabetes at baseline [mean age 58.8 (sd 7.6) years, 47.5% male]. Depressive symptoms were defined using the Centre for Epidemiologic Studies Depression scale (cut point ≥ 17). Diabetes (diagnosed or previously undetected) was identified by self-reported physician-diagnosed diabetes, medication and high blood glucose levels. We estimated 5-year cumulative incidences with 95% confidence intervals and fitted multiple logistic regression models to calculate the odds ratios, adjusted for age, sex, physical activity, smoking, living with or without partner, and educational level. RESULTS The cumulative incidence of diabetes was 9.2% (95% CI 6.3-12.8) in participants with high depressive symptoms at baseline and 9.0% (95% CI 8.0-10.0) in participants without these symptoms. The age- and sex-adjusted odds ratio of diabetes in participants with depressive symptoms compared with those without was 1.13 [95% CI 0.77-1.68; fully adjusted 1.11 (95% CI 0.74-1.65)]. These results did not substantially change in several additional sensitivity analyses. CONCLUSION Our study did not show a significantly increased risk of developing diabetes in individuals with high depressive symptoms compared with those without high depressive symptoms during a 5-year follow-up period.
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Affiliation(s)
- A Icks
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Khanam R, Najfi H, Akhtar M, Vohora D. Evaluation of venlafaxine on glucose homeostasis and oxidative stress in diabetic mice. Hum Exp Toxicol 2012; 31:1244-50. [DOI: 10.1177/0960327112446840] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Depression occurs frequently with diabetes affecting the quality of life. All major classes of antidepressants have been shown to have a direct pharmacologic effect on metabolic function, which further worsens glycemic control. There were no reports on the effects of venlafaxine on glucose levels and oxidative stress in diabetic animals. The present study evaluated the effects of venlafaxine (8 and 16 mg/kg per d) on glucose homeostasis along with oxidative stress in brain in diabetic mice (streptozotocin (STZ), 40 mg/kg per d for 5 days). We observed that 21 days of administration of venlafaxine (8 and 16 mg/kg per d) in diabetic mice significantly enhanced swimming in normal and STZ-treated mice with a corresponding reduction in immobility. No significant difference in blood glucose levels was observed in diabetic and normal mice following venlafaxine treatment. Venlafaxine (16 mg/kg) reversed STZ-induced elevated thiobarbituric acid reactive substance (TBARS) levels and also restored the glutathione (GSH) levels in diabetic mice. Venlafaxine (8 and 16 mg/kg) per se does not produce any significant effect in normal animals. The results indicate a dose-dependent antidepressant action of venlafaxine in diabetes-induced depressive mice. Furthermore, the blood glucose levels were not significantly altered in normal and diabetic mice. In addition, venlafaxine exhibited a decrease in TBARS and elevation in GSH levels in mice brain. Venlafaxine drug treatment appears to be safer for depression associated with diabetes.
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Affiliation(s)
- R Khanam
- Department of Pharmacology, Jamia Hamdard University, New Delhi, India
| | - H Najfi
- Department of Pharmacology, Jamia Hamdard University, New Delhi, India
| | - M Akhtar
- Department of Pharmacology, Jamia Hamdard University, New Delhi, India
| | - D Vohora
- Department of Pharmacology, Jamia Hamdard University, New Delhi, India
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The relationship between psychiatric symptoms and glycemic status in a Chinese population. J Psychiatr Res 2012; 46:927-32. [PMID: 22608774 DOI: 10.1016/j.jpsychires.2012.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/24/2012] [Accepted: 04/03/2012] [Indexed: 01/09/2023]
Abstract
With the exception of depression and anxiety, there has been no study designed to evaluate the association between other psychiatric symptoms and Type 2 diabetes. The aim of this study was to investigate the relationship between different psychiatric symptoms and diabetes as well as pre-diabetes (Pre-DM) in a Chinese population. Totally, 9561 participants without a history of diabetes, depression, psychosis, use of hypnotics, and abnormal thyroid function were enrolled. Psychiatric symptoms were measured by Brief Symptoms Rating Scale questionnaire, which consists of three global indices [General Severity Index (GSI), Total Number of Positive Symptoms (PST), and Positive Symptom Distress Index (PSDI)] and ten subscales, including somatization, obsession, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid ideation, psychoticism and additional symptoms. Different glycemic statuses included normal glucose tolerance (NGT), Pre-DM, and newly-diagnosed diabetes (NDD) group. GSI, somatization, hostility, phobia, psychoticism, and additional symptoms were the factors positively associated with NDD as well as pre-DM in an age-adjusted model. After adjustments for age, gender, body mass index, educational level, hypertension, plasma triglycerides and creatinine, smoking, alcohol use, regular exercise, marital status, and family history of diabetes mellitus, the following psychiatric symptoms were independently related to both NDD and pre-DM: GSI, PST, somatization, obsession, interpersonal sensitivity, depression, anxiety, hostility, phobia, psychoticism, and additional symptoms. In addition to depression and anxiety, global indices of psychiatric symptoms and other subscales, including somatization, obsession, interpersonal sensitivity, hostility, phobia, psychoticism and additional symptoms, may have an impact on both diabetes and Pre-DM.
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Depression and type 2 diabetes: Inflammatory mechanisms of a psychoneuroendocrine co-morbidity. Neurosci Biobehav Rev 2012; 36:658-76. [DOI: 10.1016/j.neubiorev.2011.10.001] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 10/01/2011] [Accepted: 10/05/2011] [Indexed: 01/28/2023]
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DE Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011; 10:52-77. [PMID: 21379357 PMCID: PMC3048500 DOI: 10.1002/j.2051-5545.2011.tb00014.x] [Citation(s) in RCA: 1436] [Impact Index Per Article: 110.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.
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Aarts S, van den Akker M, van Boxtel MPJ, Jolles J, Winkens B, Metsemakers JFM. Diabetes mellitus type II as a risk factor for depression: a lower than expected risk in a general practice setting. Eur J Epidemiol 2009; 24:641-8. [PMID: 19718502 PMCID: PMC2762524 DOI: 10.1007/s10654-009-9385-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 08/18/2009] [Indexed: 11/20/2022]
Abstract
The aim of the present study was to determine whether a diagnosis of diabetes mellitus (DM) in a primary setting is associated with an increased risk of subsequent depression. A retrospective cohort design was used based on the Registration Network Family Practice (RNH) database. Patients diagnosed with diabetes mellitus at or after the age of 40 and who were diagnosed between 01-01-1980 and 01-01-2007 (N = 6,140), were compared with age-matched controls from a reference group (N = 18,416) without a history of diabetes. Both groups were followed for an emerging first diagnosis of depression (and/or depressive feelings) until January 1, 2008. 2.0% of the people diagnosed with diabetes mellitus developed a depressive disorder, compared to 1.6% of the reference group. After statistical correction for confounding factors diabetes mellitus was associated with an increased risk of developing subsequent depression (HR 1.26; 95% CI: 1.12–1.42) and/or depressive feelings (HR 1.33; 95% CI: 1.18–1.46). After statistical adjustment practice identification code, age and depression preceding diabetes, were significantly related to a diagnosis of depression. Patients with diabetes mellitus are more likely to develop subsequent depression than persons without a history of diabetes. Results from this large longitudinal study based on a general practice population indicate that this association is weaker than previously found in cross-sectional research using self-report surveys. Several explanations for this dissimilarity are discussed.
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Affiliation(s)
- S Aarts
- Department of General Practice, School for Public Health and Primary Care: Caphri, Maastricht University, Maastricht, The Netherlands.
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Aujla N, Abrams KR, Davies MJ, Taub N, Skinner TC, Khunti K. The prevalence of depression in white-European and South-Asian people with impaired glucose regulation and screen-detected type 2 diabetes mellitus. PLoS One 2009; 4:e7755. [PMID: 19898618 PMCID: PMC2768906 DOI: 10.1371/journal.pone.0007755] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/14/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a clear relationship between depression and diabetes. However, the directionality of the relationship remains unclear and very little research has considered a multi-ethnic population. The aim of this study was to determine the prevalence of depression in a White-European (WE) and South-Asian (SA) population attending a community diabetes screening programme, and to explore the association of depression with screen-detected Type 2 diabetes mellitus (T2DM) and impaired glucose regulation (IGR). METHODOLOGY/PRINCIPAL FINDINGS Participants were recruited from general practices in Leicestershire (United Kingdom) between August 2004 and December 2007. 4682 WE (40-75 years) and 1327 SA participants (25-75 years) underwent an Oral Glucose Tolerance Test, detailed history, anthropometric measurements and completed the World Health Organisation-Five (WHO-5) Wellbeing Index. Depression was defined by a WHO-5 wellbeing score < or =13. Unadjusted prevalence of depression for people in the total sample with T2DM and IGR was 21.3% (21.6% in WE, 20.6% in SA, p = 0.75) and 26.0% (25.3% in WE, 28.9% in SA, p = 0.65) respectively. For people with normal glucose tolerance, the prevalence was 25.1% (24.9% in WE, 26.4% in SA, p = 0.86). Age-adjusted prevalences were higher for females than males. Odds ratios adjusted for age, gender, and ethnicity, showed no significant increase in prevalent depression for people with T2DM (OR = 0.95, 95%CI 0.62 to 1.45) or IGR (OR = 1.17, 95%CI 0.96 to 1.42). CONCLUSIONS Prior to the knowledge of diagnosis, depression was not significantly more prevalent in people with screen detected T2DM or IGR. Differences in prevalent depression between WE and SA people were also not identified. In this multi-ethnic population, female gender was significantly associated with depression.
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Affiliation(s)
- Navneet Aujla
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
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Riley AA, McEntee ML, Gerson L, Dennison CR. Depression as a Comorbidity to Diabetes: Implications for Management. J Nurse Pract 2009. [DOI: 10.1016/j.nurpra.2009.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Holt RIG, Phillips DIW, Jameson KA, Cooper C, Dennison EM, Peveler RC. The relationship between depression and diabetes mellitus: findings from the Hertfordshire Cohort Study. Diabet Med 2009; 26:641-8. [PMID: 19538241 DOI: 10.1111/j.1464-5491.2009.02742.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To assess the relationship between depression scores and diabetes, glucose and insulin in a cross-sectional population-based study. METHODS One thousand, five hundred and seventy-nine men and 1418 women from the Hertfordshire Cohort Study were assessed for diabetes. Plasma glucose and insulin concentrations were measured at 0, 30 and 120 min during a standard 75-g oral glucose tolerance test. Depressive and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). RESULTS Overall, 431 (14.6%) were diagnosed with diabetes [232 men (14.9%) and 199 women (14.3%)]. One hundred and eight (47%) men and 74 (37%) women had known diabetes. The remainder were previously undiagnosed. Fifty-nine (3.7%) men and 65 (4.6%) women had possible depression (HAD-D scores 8-10) and 17 (1.1%) men and 20 (1.4%) women had probable depression (HAD-D scores > or = 11). Probable depression was associated with an adjusted odds ratio for diabetes of 3.89 [95% confidence interval (CI) 1.28-11.88] in men and 1.51 (95% CI 0.47-4.84) in women. In men without previously diagnosed diabetes, fasting insulin (P = 0.035), 2-h glucose concentrations (P = 0.028) and insulin resistance (P = 0.032) were significantly associated with HAD-D scores. With the exception of 2-h glucose concentrations (P = 0.034), the associations were not significant in women. CONCLUSIONS These data support the hypothesis that depression may increase the risk for diabetes. The relationship between depression score and metabolic variables extends across the whole population and is not confined to those with either diagnosed depression or diabetes. This relationship should lead clinicians to consider screening for diabetes in those with depression and vice versa.
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Affiliation(s)
- R I G Holt
- The Institute of Developmental Sciences (IDS Building), MP887, Developmental Origins of Health and Disease Division, School of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK.
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Knol MJ, Geerlings MI, Grobbee DE, Egberts ACG, Heerdink ER. Antidepressant use before and after initiation of diabetes mellitus treatment. Diabetologia 2009; 52:425-32. [PMID: 19130036 DOI: 10.1007/s00125-008-1249-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 12/03/2008] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS Although current literature suggests an association between diabetes and depression, the direction of the association is unclear. We examined the temporal association between diabetes and depression by studying antidepressant and benzodiazepine use around the initiation of diabetes treatment. METHODS From a pharmacy registry database we selected 49,593 diabetic patients and a random sample of non-diabetic individuals (n = 154,441), all >40 years old. Antidepressant and benzodiazepine use was calculated for the 7 years before and 7 years after the index date. The index date in diabetes patients was defined as the date of initiation of diabetes medication. A random index date was assigned to non-diabetic individuals. Time-specific incidence rate ratios of antidepressant and benzodiazepine use were calculated for intervals of 1 year, 3 months and 1 month. RESULTS Antidepressant and benzodiazepine use was increased 2 months before and 3 months after the initiation of diabetes treatment compared with non-diabetic individuals. The strongest increase in incidence of antidepressant and benzodiazepine use was seen in the month after initiation of diabetes treatment with incidence rate ratios of 2.4 (95% CI 2.0-3.0) and 3.4 (95% CI 3.0-3.8) respectively, after adjustment for age, sex and Chronic Disease Score. CONCLUSIONS/INTERPRETATION The increased incidence of antidepressant and benzodiazepine use may be a consequence of the burden of disease, of starting with diabetes medication or of being diagnosed with diabetes. Our findings could also reflect earlier detection by their physician.
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Affiliation(s)
- M J Knol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.
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Abstract
The authors review the science linking depression with diabetes. Some recent heuristic research is identified that highlights progress in the field and is directing future research. Issues in the management of depression in diabetes are outlined, including interactions of depression and insulin resistance.
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Abstract
OBJECTIVE It has been argued that the relationship between depression and diabetes is bi-directional, but this hypothesis has not been explicitly tested. This systematic review examines the bi-directional prospective relationships between depression and type 2 diabetes. RESEARCH DESIGN AND METHODS A search was conducted using Medline for publications from 1950 through 2007. Reviewers assessed the eligibility of each report by exposure/outcome measurement and study design. Only comparative prospective studies of depression and type 2 diabetes that excluded prevalent cases of depression (for diabetes predicting depression) or diabetes (for depression predicting diabetes) were included. Two sets of pooled risk estimates were calculated using random effects: depression predicting type 2 diabetes and type 2 diabetes predicting depression. RESULTS Of 42 full-text publications reviewed, 13 met eligibility for depression predicting onset of diabetes, representing 6,916 incident cases. Seven met criteria for diabetes predicting onset of depression, representing 6,414 incident cases. The pooled relative risk (RR) for incident depression associated with baseline diabetes was 1.15 (95% CI 1.02-1.30). The RR for incident diabetes associated with baseline depression was 1.60 (1.37-1.88). CONCLUSIONS Depression is associated with a 60% increased risk of type 2 diabetes. Type 2 diabetes is associated with only modest increased risk of depression. Future research should focus on identifying mechanisms linking these conditions.
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Affiliation(s)
- Briana Mezuk
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
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Rhee MK, Musselman D, Ziemer DC, Vaccarino V, Kolm P, Weintraub WS, Caudle JM, Varughese RM, Irving JM, Phillips LS. Unrecognized glucose intolerance is not associated with depression. Screening for Impaired Glucose Tolerance study 3 (SIGT 3). Diabet Med 2008; 25:1361-5. [PMID: 19046230 PMCID: PMC2675874 DOI: 10.1111/j.1464-5491.2008.02543.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To understand the metabolic and temporal links in the relationship between diabetes and depression, we determined the association between depressive symptoms and unrecognized glucose intolerance. METHODS In a cross-sectional study, 1047 subjects without known diabetes were screened for diabetes or pre-diabetes using the oral glucose tolerance test and for depressive symptoms using the Patient Health Questionnaire (PHQ). RESULTS Mean age was 48 years, body mass index 30 kg/m(2); 63% were female, 54% black, 11% previously treated for depression and 10% currently treated; 5% had diabetes and 34% pre-diabetes. Median PHQ score was 2 (interquartile range 0-5). Depressive symptoms did not increase with worsening glucose tolerance, after adjusting for age, sex, ethnicity, body mass index, family history, exercise, education and depression treatment. CONCLUSIONS There is no association between depressive symptoms and unrecognized glucose intolerance. However, it remains possible that diagnosed diabetes, with its attendant health concerns, management issues, and/or biological changes, may be a risk for subsequent development of depression. Thus, patients with newly diagnosed diabetes should be counselled appropriately and monitored for the development of depression.
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Affiliation(s)
- M K Rhee
- Department of Medicine, Division of Endocrinology, Emory University, Atlanta, GA 30303, USA.
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Abstract
OBJECTIVE To examine the association between anxious temperament and disease progression at diagnosis for individuals with Type 2 diabetes mellitus (T2DM). METHODS A sample of 204 individuals, newly diagnosed with T2DM, completed the Behavioral Inhibition and Activation Scales (BIS/BAS) and provided an A1C reading. Regression analyses were used to predict A1C levels from individual differences in BIS and BAS. RESULTS Individual differences in BIS were inversely related to A1C at diagnosis in the sample as a whole, and this association remained strong after controlling for demographic variables and body mass index. Most importantly, temperamentally anxious individuals had low A1C levels at diagnosis in all age groups, in contrast to their nonanxious counterparts who showed increasing A1C at diagnosis as a function of decreasing age. BAS scores were unrelated to A1C. CONCLUSIONS Although older age is generally associated with lower disease progression at diagnosis, high BIS individuals show uniformly lower disease progression across all age groups. High levels of temperamental anxiety may facilitate early diagnosis of T2DM, particularly among younger individuals who are not subject to routine screening.
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Nuyen J, Spreeuwenberg PM, Van Dijk L, den Bos GAMV, Groenewegen PP, Schellevis FG. The influence of specific chronic somatic conditions on the care for co-morbid depression in general practice. Psychol Med 2008; 38:265-277. [PMID: 17825119 DOI: 10.1017/s0033291707001298] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited information exists on the relationship between specific chronic somatic conditions and care for co-morbid depression in primary care settings. Therefore, the present prospective, general practice-based study examined this relationship. METHOD Longitudinal data on morbidity, prescribing and referrals concerning 991 patients newly diagnosed with depression by their general practitioner (GP) were analysed. The influence of a broad range of 13 specific chronic somatic conditions on the initiation of any depression care, as well as the prescription of continuous antidepressant therapy for 180 days, was examined. Multilevel logistic regression analysis was used to control for history of depression, psychiatric co-morbidity, sociodemographics and interpractice variation. RESULTS Multilevel analysis showed that patients with pre-existing ischaemic heart disease (72.1%) or cardiac arrhythmia (59.3%) were significantly less likely to have any depression care being initiated by their GP than patients without chronic somatic morbidity (88.0%). No other specific condition had a significant influence on GP initiation of any care for depression. Among the patients being prescribed antidepressant treatment by their GP, none of the conditions was significantly associated with being prescribed continuous treatment for 180 days. CONCLUSIONS Our study indicates that patients with ischaemic heart disease or cardiac arrhythmia have a lower likelihood of GP initiation of any care for depression after being newly diagnosed with depression by their GP. This finding points to the importance of developing interventions aimed at supporting GPs in the adequate management of co-morbid depression in heart disease patients to reduce the negative effects of this co-morbidity.
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Affiliation(s)
- J Nuyen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
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Brown LC, Majumdar SR, Johnson JA. Type of antidepressant therapy and risk of type 2 diabetes in people with depression. Diabetes Res Clin Pract 2008; 79:61-7. [PMID: 17714823 DOI: 10.1016/j.diabres.2007.07.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 07/10/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the differential risk of diabetes among people with depression taking antidepressant therapy. METHODS A nested case control design was used to investigate the study objective. Data from the Canadian province of Saskatchewan was available from January 1, 1991 to December 31, 2001; the average length of follow-up was 4.07 years. Type 2 diabetes was identified based on ICD-9 diagnostic codes and antidiabetic medication prescriptions; prior depression was ascertained based on ICD-9 diagnostic codes and antidepressant prescriptions. RESULTS Multivariate logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence intervals (CI). We identified 2391 individuals with incident depression treated with antidepressant therapy. The mean age was 53.6 (S.D.: 16.4) and 68% were female. After multivariate adjustment, the concurrent use of selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressants (TCA) was associated with a significantly increased risk of type 2 diabetes (adjusted OR: 1.89; 95% CI: 1.35-2.65). CONCLUSIONS Concurrent use of TCA and SSRI was associated with an increased risk of developing type 2 diabetes compared to using TCA alone. Individuals taking combination TCA and SSRI therapy should be closely monitored for development of type 2 diabetes.
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Affiliation(s)
- Lauren C Brown
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Nuyen J, Spreeuwenberg PM, Groenewegen PP, van den Bos GA, Schellevis FG. Impact of Preexisting Depression on Length of Stay and Discharge Destination Among Patients Hospitalized for Acute Stroke. Stroke 2008; 39:132-8. [DOI: 10.1161/strokeaha.107.490565] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
There exists limited knowledge regarding the relation between depression and healthcare utilization in stroke patients. The objective of this register-based study was to examine the impact of having preexisting depression at the time of hospital admission for acute stroke on length of hospital stay and discharge destination.
Methods—
Data from a general-practice database were linked to those of a hospital database to identify patients hospitalized for stroke and were used to categorize these patients into 3 groups based on preexisting mental health (MH) status at admission, ie, those with preexisting depression, those with another preexisting MH condition, and those without any preexisting MH condition. Multilevel analyses controlling for several potentially important covariates were performed to estimate the associations under study.
Results—
Both patients with preexisting depression (n=41) and those with another preexisting MH condition (n=62) did not differ significantly from patients without any preexisting MH condition (n=211) regarding length of hospital stay for acute stroke. Among patients who survived hospitalization, those with preexisting depression had significantly higher odds of being discharged to an institution instead of their home than did patients without any preexisting MH condition. Having another preexisting MH condition had no significant effect on discharge destination.
Conclusions—
Having preexisting depression at admission seems to be a relevant factor in determining discharge to institutional care after acute stroke hospitalization. Further research is needed to determine the mechanism(s) through which preexisting depression decreases the chances of being discharged to home.
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Affiliation(s)
- Jasper Nuyen
- From the NIVEL (J.N., P.M.S., P.P.G., F.G.S.), Netherlands Institute for Health Services Research, Utrecht; the Trimbos Institute (J.N.), Netherlands Institute of Mental Health and Addiction, Utrecht; the Academic Medical Center (G.A.M.v.d.B.), University of Amsterdam, Amsterdam; and the Institute for Research in Extramural Medicine (EMGO) (F.G.S.), VU University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Peter M. Spreeuwenberg
- From the NIVEL (J.N., P.M.S., P.P.G., F.G.S.), Netherlands Institute for Health Services Research, Utrecht; the Trimbos Institute (J.N.), Netherlands Institute of Mental Health and Addiction, Utrecht; the Academic Medical Center (G.A.M.v.d.B.), University of Amsterdam, Amsterdam; and the Institute for Research in Extramural Medicine (EMGO) (F.G.S.), VU University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Peter P. Groenewegen
- From the NIVEL (J.N., P.M.S., P.P.G., F.G.S.), Netherlands Institute for Health Services Research, Utrecht; the Trimbos Institute (J.N.), Netherlands Institute of Mental Health and Addiction, Utrecht; the Academic Medical Center (G.A.M.v.d.B.), University of Amsterdam, Amsterdam; and the Institute for Research in Extramural Medicine (EMGO) (F.G.S.), VU University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Geertrudis A.M. van den Bos
- From the NIVEL (J.N., P.M.S., P.P.G., F.G.S.), Netherlands Institute for Health Services Research, Utrecht; the Trimbos Institute (J.N.), Netherlands Institute of Mental Health and Addiction, Utrecht; the Academic Medical Center (G.A.M.v.d.B.), University of Amsterdam, Amsterdam; and the Institute for Research in Extramural Medicine (EMGO) (F.G.S.), VU University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - François G. Schellevis
- From the NIVEL (J.N., P.M.S., P.P.G., F.G.S.), Netherlands Institute for Health Services Research, Utrecht; the Trimbos Institute (J.N.), Netherlands Institute of Mental Health and Addiction, Utrecht; the Academic Medical Center (G.A.M.v.d.B.), University of Amsterdam, Amsterdam; and the Institute for Research in Extramural Medicine (EMGO) (F.G.S.), VU University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
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Abstract
The authors review the science linking depression with diabetes. Some recent heuristic research is identified that highlights progress in the field and is directing future research. Issues in the management of depression in diabetes are outlined, including interactions of depression and insulin resistance.
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Affiliation(s)
- Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA.
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Nuyen J, Spreeuwenberg PM, Beekman ATF, Groenewegen PP, van den Bos GAM, Schellevis FG. Cerebrovascular risk factors and subsequent depression in older general practice patients. J Affect Disord 2007; 99:73-81. [PMID: 17005255 DOI: 10.1016/j.jad.2006.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 08/09/2006] [Accepted: 08/11/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND This general practice-based case-control study tested the association between cerebrovascular risk factors (CVRFs) and the development of later-life depression by focusing on the impact of exposure duration to CVRFs and the modifying influence of age at depression onset. METHODS Cases were 286 patients aged > or = 50 years with a first diagnosis of depression at age > or = 50 years. Nondepressed controls (N=832) were individually matched for age, gender and practice. CVRF diagnoses (hypertension, diabetes mellitus, cardiovascular conditions) prior to depression were determined. Analyses controlled for education, somatic and nondepressive psychiatric disease. RESULTS No CVRF variable examined was significantly associated with subsequent depression in the total sample. An unexpected impact of age at onset of depression was observed: the odds ratio associated with having any CVRF was smaller for patients with age at onset > or = 70 years than for patients with onset between ages 50-59 years (p=.002) and 60-69 years (p=.067). Subsequent analyses excluding patients with onset at age > or = 70 years revealed that CVRF variables, including long-term exposure to CVRFs, significantly increased the odds of subsequent depression with onset between ages 50 and 69 years. LIMITATIONS Reliance on GPs' records of morbidity may have resulted in bias towards underestimation in patients with depression onset at age > or = 70 years. CONCLUSIONS Our findings suggest that CVRFs play a relevant role in the development of depression with onset between ages 50 and 69 years, but no evidence was found that they contribute to the occurrence of depression with onset at age > or = 70 years. Replication is warranted to exclude the possibility of bias.
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Affiliation(s)
- Jasper Nuyen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
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Engum A. The role of depression and anxiety in onset of diabetes in a large population-based study. J Psychosom Res 2007; 62:31-8. [PMID: 17188118 DOI: 10.1016/j.jpsychores.2006.07.009] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 06/27/2006] [Accepted: 07/04/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Recent research has shown that depression may predict incident diabetes. The aims of the study are to investigate if symptoms of depression and anxiety precede the onset of diabetes or vice versa and to examine if mediating factors may explain such associations. METHODS A prospective population-based study (N=37,291) investigating the associations between symptoms of depression/anxiety and diabetes was conducted. RESULTS Individuals reporting symptoms of depression and anxiety at baseline had increased risk of onset of type 2 diabetes at 10-year follow-up. No gender differences were found. The analyses did not reveal underlying factors that mediated the association. Baseline diagnosis of diabetes was not associated with subsequent symptoms of anxiety or depression among males or females. CONCLUSION Diabetes did not predict symptoms of depression or anxiety. Symptoms of depression and anxiety emerged as significant risk factors for onset of type 2 diabetes independent of established risk factors for diabetes, such as socioeconomic factors, lifestyle factors, and markers of the metabolic syndrome. The comorbidity between depression and anxiety may be the most important factor.
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Affiliation(s)
- Anne Engum
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Kruse J, Petrak F, Herpertz S, Albus C, Lange K, Kulzer B. [Diabetes and depression--a life-endangering interaction]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2006; 52:289-309. [PMID: 17156601 DOI: 10.13109/zptm.2006.52.3.289] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the past decade, research has increasingly discovered the relevance of depressive symptoms for the development and course of diabetes, particularly in diabetes type 2. The present paper provides an update on the present state of empirical research concerning this question.One fourth of all patients with diabetes mellitus suffer from depressive symptoms up to and including states of depressive disorders. The studies reviewed advise that depression in patients with diabetes concur with an unfavourable attitude towards the illness as well as towards treatment, a reduction in quality of life, an increased risk for the development of follow-up diseases as well as an increase in mortality risk. As a cause for the increasing risk in morbidity and mortality in depressive patients with diabetes, both neuroendocrinologic changes as well as unfavourable therapy and illness attitudes are discussed. First studies document that psychotherapeutic interventions are helpful in increasing the quality of life of depressive patients with diabetes and improving therapy behaviour.
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Affiliation(s)
- Johannes Kruse
- Klinik für Psychotherapeutische Medizin der Heinrich-Heine-Universität Düsseldorf.
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Brown LC, Majumdar SR, Newman SC, Johnson JA. Type 2 diabetes does not increase risk of depression. CMAJ 2006; 175:42-6. [PMID: 16818907 DOI: 10.1503/cmaj.051429] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although diabetes mellitus has a strong association with the presence of depression, it is unclear whether diabetes itself increases the risk of developing depression. The objective of our study was to evaluate whether people with diabetes have a greater incidence of depression than those without diabetes. METHODS We conducted a population-based retrospective cohort study using the administrative databases of Saskatchewan Health from 1989 to 2001. People older than 20 years with newly identified type 2 diabetes were identified by means of diagnostic codes and prescription records and compared with a nondiabetic cohort. Depression was ascertained via diagnostic codes and prescriptions for antidepressants. Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for age, sex, frequency of visits to physicians and presence of comorbidities. RESULTS We identified 31 635 people with diabetes and 57 141 without. Those with diabetes were older (61.4 v. 46.8 yr; p < 0.001), were more likely to be male (55.4% v. 49.8%; p < 0.001) and had more physician visits during the year after their index date (mean 14.5 v. 5.9; p < 0.001). The incidence of new-onset depression was similar in both groups (6.5 v. 6.6 per 1000 person-years among people with and without diabetes, respectively). Similarity of risk persisted after controlling for age, sex, number of physician visits and presence of prespecified comorbidities (adjusted HR 1.04, 95% CI 0.94- 1.15). Other chronic conditions such as arthritis (HR 1.18) and stroke (HR 1.73) were associated with the onset of depression. INTERPRETATION Using a large, population-based administrative cohort, we found little evidence that type 2 diabetes increases the risk of depression once comorbid diseases and the burden of diabetes complications were accounted for.
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Affiliation(s)
- Lauren C Brown
- Department of Public Health Sciences, University of Alberta, Edmonton, Alta
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Abstract
This article reviewed the literature on the adverse health outcomes of the coexistence of diabetes and depression, the challenges of treating coexisting diabetes and depression in a fragmented health care system, and the need for integrated care as a strategy to improve the quality of care for patients who have complex medical illnesses (eg, patients who have coexisting diabetes and depression).
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Affiliation(s)
- Leonard E Egede
- Medical University of South Carolina, Center for Health Disparities Research, Charleston, SC 29425, USA.
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Millan MJ. Multi-target strategies for the improved treatment of depressive states: Conceptual foundations and neuronal substrates, drug discovery and therapeutic application. Pharmacol Ther 2006; 110:135-370. [PMID: 16522330 DOI: 10.1016/j.pharmthera.2005.11.006] [Citation(s) in RCA: 419] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 11/28/2005] [Indexed: 12/20/2022]
Abstract
Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost. Depressed patients generally display co-morbid symptoms, and depression frequently accompanies other serious disorders. Currently available drugs display limited efficacy and a pronounced delay to onset of action, and all provoke distressing side effects. Cloning of the human genome has fuelled expectations that symptomatic treatment may soon become more rapid and effective, and that depressive states may ultimately be "prevented" or "cured". In pursuing these objectives, in particular for genome-derived, non-monoaminergic targets, "specificity" of drug actions is often emphasized. That is, priority is afforded to agents that interact exclusively with a single site hypothesized as critically involved in the pathogenesis and/or control of depression. Certain highly selective drugs may prove effective, and they remain indispensable in the experimental (and clinical) evaluation of the significance of novel mechanisms. However, by analogy to other multifactorial disorders, "multi-target" agents may be better adapted to the improved treatment of depressive states. Support for this contention is garnered from a broad palette of observations, ranging from mechanisms of action of adjunctive drug combinations and electroconvulsive therapy to "network theory" analysis of the etiology and management of depressive states. The review also outlines opportunities to be exploited, and challenges to be addressed, in the discovery and characterization of drugs recognizing multiple targets. Finally, a diversity of multi-target strategies is proposed for the more efficacious and rapid control of core and co-morbid symptoms of depression, together with improved tolerance relative to currently available agents.
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Affiliation(s)
- Mark J Millan
- Institut de Recherches Servier, Centre de Recherches de Croissy, Psychopharmacology Department, 125, Chemin de Ronde, 78290-Croissy/Seine, France.
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43
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Knol MJ, Twisk JWR, Beekman ATF, Heine RJ, Snoek FJ, Pouwer F. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia 2006; 49:837-45. [PMID: 16520921 DOI: 10.1007/s00125-006-0159-x] [Citation(s) in RCA: 590] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Accepted: 11/14/2005] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Evidence strongly suggests that depression and type 2 diabetes are associated, but the direction of the association is still unclear. Depression may occur as a consequence of having diabetes, but may also be a risk factor for the onset of type 2 diabetes. This study examined the latter association by reviewing the literature and conducting a meta-analysis of longitudinal studies on this topic. METHODS Medline and PsycInfo were searched for articles published up to January 2005. All studies that examined the relationship between depression and the onset of type 2 diabetes were included. Pooled relative risks were calculated using fixed and random effects models. To explore sources of heterogeneity between studies, subgroup analyses and meta-regression analyses were performed. RESULTS Nine studies met our inclusion criteria for this meta-analysis. The pooled relative risk was 1.26 (1.13-1.39) using the fixed effects model and 1.37 (1.14-1.63) using the random effects model. Heterogeneity between studies could not be explained by (1) whether studies controlled for undetected diabetes at baseline; (2) the method of diabetes assessment at follow-up; (3) the baseline overall risk of diabetes in the study population; and (4) follow-up duration. CONCLUSIONS/INTERPRETATION Depressed adults have a 37% increased risk of developing type 2 diabetes mellitus. The pathophysiological mechanisms underlying this relationship are still unclear and warrant further research. A randomised controlled study is needed to test whether effective prevention or treatment of depression can reduce the incidence of type 2 diabetes and its health consequences.
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Affiliation(s)
- M J Knol
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
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Sundquist K, Li X. Alcohol abuse partly mediates the association between coronary heart disease and affective or psychotic disorders: a follow-up study in Sweden. Acta Psychiatr Scand 2006; 113:283-9. [PMID: 16638072 DOI: 10.1111/j.1600-0447.2006.00774.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyse whether hospitalization for affective or psychotic disorders predicts coronary heart disease (CHD) after accounting for occupation, region and alcohol-related disorders. METHOD National registers were used to identify all individuals in Sweden aged 25-64 years at first hospitalization for affective or psychotic disorders and aged 25-79 years at first hospitalization for CHD between 1987 and 2001. Standardized incidence ratios (SIRs) were calculated. RESULTS The association between CHD and affective or psychotic disorders was strongest in the youngest age groups. The overall SIRs varied between 1.39 and 1.68. They were strongly attenuated but remained significant after adjustment for hospitalization because of alcohol-related disorders, especially among women. CONCLUSION Hospitalization because of affective or psychotic disorders predicts CHD. These associations are partly mediated by alcohol abuse. Clinicians and decision makers should be aware of the increased risk of CHD in these patient groups.
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Affiliation(s)
- K Sundquist
- Center for Family and Community Medicine, Karolinska Institute, Huddinge, Sweden.
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Lin YH, Liu AH, Xu Y, Tie L, Yu HM, Li XJ. Effect of chronic unpredictable mild stress on brain–pancreas relative protein in rat brain and pancreas. Behav Brain Res 2005; 165:63-71. [PMID: 16154211 DOI: 10.1016/j.bbr.2005.06.034] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2005] [Revised: 06/17/2005] [Accepted: 06/21/2005] [Indexed: 10/25/2022]
Abstract
Brain-pancreas relative protein (BPRP) is a novel protein whose biological function remains unknown. Here, we report a possible role of BPRP in male rats exposed to chronic unpredictable mild stress (CUMS) to induce depression for 3 weeks. Compared to unstressed rats, those exposed to CUMS showed significantly less weight gain with age, decreased consumption of (and preference for) sucrose without a change in total fluid consumption. Exposure to CUMS significantly reduced open-field exploration, rearing and grooming indicative of lethargy, apathy and bodily neglect, respectively. Brain MAO-A and MAO-B activity were both significantly increased in the stressed rats. These results verified induction of depressive symptoms by CUMS. The stressed animals showed a significant reduction in pancreatic BPRP, which was accompanied by an increase in levels of blood sugar and a decrease of insulin. But they showed no apparent alteration in levels or distribution of BPRP in the hippocampal formation, which nevertheless displayed a thinner dentate granule cell layer perhaps related to elevated MAO-B activity. These findings suggest that stress-induced reduction of pancreatic BPRP may cause diabetic symptoms. Whether those symptoms in turn contribute to the onset of depression requires further study.
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Affiliation(s)
- Yan-Hua Lin
- Department of Pharmacology, School of Basic Medical Sciences and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100083, China
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Abstract
Depression and anxiety can adversely affect the course of chronic physical illnesses, increasing morbidity and mortality. The literature during the past year is reviewed for gastrointestinal disorders, cancer, pain, heart disease, diabetes, and pulmonary disease. Causes for this relationship are behavioral and biological. Behavioral factors in patients with depressive and anxiety disorders include unhealthy lifestyle choices, disrupted sleep, and poor adherence to medical regimens. Biological mechanisms include increased inflammatory response and disruption of the hypothalamic-pituitary-adrenal axis.
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Affiliation(s)
- Richard M Sobel
- Department of Psychiatry, Jefferson Medical College, 1518 Walnut Street, Suite 1110, Philadelphia, PA 19102, USA.
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Brown LC, Majumdar SR, Newman SC, Johnson JA. History of depression increases risk of type 2 diabetes in younger adults. Diabetes Care 2005; 28:1063-7. [PMID: 15855568 DOI: 10.2337/diacare.28.5.1063] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the history of previous depression in people with incident diabetes compared with people without diabetes. RESEARCH DESIGN AND METHODS We conducted a population-based nested case-control study using the administrative databases of Saskatchewan Health to assess the study objective. We identified cases of type 2 diabetes based on diagnostics codes and prescription records for individuals over the age of 20 years. For each case subject, two control subjects were randomly selected from the nondiabetic population during the same index year. History of depression, based on diagnostic codes and antidepressant prescription, was ascertained up to 3 years before index date. Simple and multivariate logistic regression analysis was used to estimate the odds ratio (OR) and 95% CIs, after adjusting for age, sex, and frequency of physician visits. RESULTS Individuals with newly diagnosed diabetes (1,622 of 33,257; 4.9%) were 30% more likely to have had a previous history of depression compared with people without diabetes (2,279 of 59,420; 3.8%). This increased risk remained after controlling for sex and number of physician visits but was limited to subjects 20-50 years of age (adjusted OR 1.23 [95% CI 1.10-1.37]) and not in those aged > or =51 years (0.92 [0.84-1.00]). CONCLUSIONS Depression appears to increase the risk of developing diabetes by approximately 23% in younger adults. This provides information regarding the temporality of the relationship between diabetes and depression.
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Affiliation(s)
- Lauren C Brown
- Department of Public Health Sciences, University of Alberta, 1200-10405 Jasper Avenue, Edmonton, Alberta, Canada T5J 3N4
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