Type 2 diabetes and influence of diabetes-specific distress on depression

Help-seeking during 1-year follow-up in Chinese patients diagnosed with type 2 diabetes mellitus comorbid major depressive disorder

Introduction

Previous research has revealed a bidirectional relationship between type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD). A very limited proportion of patients with T2DM comorbid MDD received adequate psychiatric intervention. This study investigated the help-seeking behaviors of patients with T2DM comorbid with MDD during one-year follow-up.

Methods

At a medical center in China, a cohort of outpatients with T2DM were assessed and diagnosed for comorbid depression at baseline and after one year. The Mini International Neuropsychiatric Interview was used to diagnose MDD, while The Patient Health Questionnaire-9 (PHQ-9) and The Hamilton Depression Scale 17-item (HAMD-17) were used for depression assessment. Mental health help-seeking behaviors of patients during follow-up period were also evaluated.

Results

Out of the 203 patients with T2DM at baseline, 114 (56.2%) completed the follow-up. The prevalence of MDD in participants with T2DM was 12.8% at baseline and 22.8% at follow-up. Patients who completed the follow-up had a lower baseline PHQ-9 score (test statistic -2.068, p=0.039), HAMD-17 score (test statistic -2.285, p=0.022) than those who did not complete the follow-up. A total of 26 patients had comorbid MDD during the follow-up period, among which 8 patients (30.8%) voluntarily visited psychiatric clinics, while others did not seek assistance. The level of HbA1c at follow-up was higher in patients who sought help than in those who did not (8.1 ± 1.8% vs. 7.0 ± 0.7%), although the difference was not statistically significant.

Conclusion

Voluntary psychiatric help-seeking for Chinese patients with comorbid T2DM and MDD is uncommon. It is crucial to increase awareness of depression among patients and healthcare professionals alike.

Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT

AIMS

Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friend Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons.

METHODS

PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9 months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons.

RESULTS

PWDs (N = 329) were 52% male and 39% reported minoritized race or ethnicity ; 50% enrolled with elevated diabetes distress. Support persons (N = 294) were 26% male and 33% reported minoritized race or ethnicity. FAMS improved PWDs' diabetes distress (d = -0.19) and global well-being (d = 0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention (9-month) and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement.

CONCLUSIONS

FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.

Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT

Aims

Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friends Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons.

Methods

PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9-months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons.

Results

PWDs (N=329) were 52% male and 39% from minoritized racial or ethnic groups; 50% enrolled with elevated diabetes distress. Support persons (N=294) were 26% male and 33% minoritized racial or ethnic groups. FAMS improved PWDs' diabetes distress ( d =-0.19) and global well-being ( d =0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement.

Conclusions

FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.

Impact of Type D Personality, Role Strain, and Diabetes Distress on Depression in Women With Type 2 Diabetes: A Cross-Sectional Study

BACKGROUND

Women with diabetes face a significantly elevated risk of developing depression. Clarifying the factors associated with depression is critical to designing more timely interventions for this vulnerable population.

PURPOSE

This study was developed to examine the impact of Type D personality, diabetes-care-related role strain, and diabetes-related distress on depression in women with Type 2 diabetes.

METHODS

A cross-sectional design was used. Convenience sampling was used to recruit 298 women aged 20-64 years who had been diagnosed with Type 2 diabetes for over 6 months from three outpatient endocrine clinics in Taiwan. Demographic and disease characteristics and Type D personality (negative affectivity and social inhibition), diabetes-care-related role strain, and diabetes-related distress and depression status information were collected using self-reported questionnaires and medical records. The important factors of influence on depression were examined using hierarchical multiple regression.

RESULTS

On the basis of the results of the hierarchical multiple regression analysis, age, negative affectivity, diabetes-care-related role strain, and diabetes-related distress were identified as significantly associated with depression, with negative affectivity explaining most (43.4%) of the variance in depression, followed by diabetes-care-related role strain and diabetes-related distress, which respectively explained 3% and 2.5% of the variance.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The negative affectivity associated with the Type D personality was shown to be more significantly associated with depression than diabetes-related psychosocial factors such as diabetes-related distress and diabetes-care-related role strain. Timely assessment of negative affectivity and the provision of brief mindfulness intervention to reduce negative affectivity may be useful in preventing depression in women with Type 2 diabetes, whereas addressing diabetes-related distress and diabetes-care-related role strain should not be neglected when providing comprehensive depression-preventing interventions to young women with diabetes.

The increased prevalence of depression and anxiety in T2DM patients associated with blood glucose fluctuation and sleep quality

BACKGROUND

Current evidence demonstrates that blood glucose fluctuation can be associated with depression and anxiety. The association among blood glucose fluctuation, traditional risk factors and emotional disorders in T2DM should be studied and clarified.

METHODS

A total of 182 diabetic patients including 81 patients with depression or anxiety and 101 patients without emotional disorder were enrolled into this study. Data were obtained through medical history and questionnaire survey. Data were analyzed using appropriate statistical methods.

RESULTS

The comparison results of basic information between the two groups showed that the differences of the proportion of female were statistically significant (p = 0.002). There was no statistical difference in laboratory examination indexes between the two groups, however, standard deviation of blood glucose (SDBG) and postprandial glucose excursion (PPGE) of the comorbidity group were significantly higher than that of control group (p = 0.032 and p = 0.037). The results of questionnaire survey showed that there were statistically significant differences in sleep quality, PSQI and dietary habit between the two groups (p < 0.001, p < 0.001 and p < 0.001). Stratified analysis results according to gender showed that the percentage of cognitive disorder, anxiety and depression in female group was significantly higher than that in male group (p = 0.001, p < 0.001 and p < 0.001). Mini-mental state examination (MMSE), self-rating anxiety scale (SAS) and patient health questionnaire (PHQ-9) score in female group were also higher than male group (p = 0.001, p < 0.001 and p < 0.001). Logistic regression analysis results showed that SDBG and sleep quality were associated with emotional disorders in T2DM (p = 0.040 and p < 0.001) and the OR values of these factors were 7.588 (1.097-52.069) and 4.428 (2.649-7.401).

CONCLUSIONS

Blood glucose fluctuation and sleep quality are associated with the increased prevalence of depression and anxiety disorders in T2DM.

Diabetes-related distress and its impact on self-care of diabetes among people with type 2 diabetes mellitus living in a resource-limited setting: A community-based cross-sectional study

AIM

To assess the a) prevalence, b) factors associated, and c) effect on self-care practices (SCP) of diabetes related distress (DRD) among patients with Type 2 Diabetes Mellitus (T2DM) in rural Punjab, India.

METHODS

Amongst the cohort of 700 patients, the Diabetes Distress Scale-17 (DDS-17) was used to assess DRD and the Summary of Diabetes Self Care Activities scale (SDSCA) for diabetes SCP. Multivariable logistic regression identified the factors associated with DRD.

RESULTS

DRD was universal [severe or moderate in 391 (56%) and 309 (44%) patients, respectively]. Hypertension increased the odds of severe DRD [aOR 3.47; 95% CI:2.48-4.87, p-<0.01] whereas living in a joint family reduced the odds of severe DRD [aOR 0.68; 95% CI: 0.47-0.97, p- 0.03]. Patients with severe DRD were less likely to perform DM SCPs [aOR 0.53; 95% CI:0.32-0.85, p-0.01].

CONCLUSIONS

The burden of DRD was alarmingly high. There is an urgent need to screen, prevent and treat DRD to improve selfcare in T2DM.

Prevalence of diabetes distress and its relationship with self-management in patients with type 2 diabetes mellitus

CONTEXT

Diabetes distress (DD) in India has been studied mainly in the context of depression. Little is known about DD, its determinants, distribution, and its impact.

AIMS

This study aims to estimate the prevalence of DD and identify its socio-demographic and clinical determinants in type 2 diabetes mellitus patients. To assess the relationship of DD with self-management in nondepressed type 2 diabetes mellitus.

SETTINGS AND DESIGN

A cross-sectional descriptive study in noncommunicable disease clinic of a tertiary care medical center.

SUBJECTS AND METHODS

DD Scale was used to assess DD in 200 patients with type 2 diabetes mellitus. Diabetes Self-Management Questionnaire was used to evaluate self-management behavior. Patient Health Questionnaire 9 was used to exclude depression.

STATISTICAL ANALYSIS USED

Sample size calculation was done as per prevailing prevalence estimates. SPSS 20.0 was used for statistical analysis. ANOVA and Independent t-tests were done to compare between groups means. Hierarchical multiple regression analysis was done, keeping self-management as a dependent variable and socio-demographic, clinical variables, and DD as independent variables.

RESULTS

The prevalence of DD was 42% in our sample. The duration of diabetes showed that a significant association with DD. DD was significantly and negatively associated with all four domains of self-management, while statistical significance was reached in three domains: dietary control (β = -0.378, P < 0.01); glucose management (β = -0.181, P < 0.01); and healthcare use (β = -0.244, P < 0.01).

CONCLUSIONS

DD is widespread in our patients and harms self-management. There is a need to address DD to improve disease-specific outcomes.

Distress and depression among patients with diabetes mellitus: prevalence and associated factors: a cross-sectional study

PURPOSE

This study aimed to validate the internal consistency of the Persian version of the diabetes distress scale-17 (DDS-17) and to investigate the prevalence of diabetes distress (DD), depression, and possible relevant factors.

METHODS

This was a cross-sectional study on 820 diabetes patients (62.4 % females) in Tehran, Iran between January and June 2017. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the protocol. Patients filled out a demographic and health survey, DDS-17, the Beck Depression Inventory Second Edition (BDI-II) and the Summary of Diabetes Self-Care Activities Measure (SDSCA). DDS-17 consist of emotional burden, and physician, regimen, and interpersonal related distress. The correlation between DDS subscales and association between DDS and BDI-II or SDSCA scores were assessed using SPSS.

RESULTS

The mean age was 58.91 ± 12.35 years. Majority of patients had high DD (37.2 %) and severe depression (38.7 %). The general and specific diets got the highest score in six SDSCA subscales. The Persian version of DDS-17 had excellent internal consistency with Cronbach's alpha coefficient of 0.924. The DDS score had significant relationship with socioeconomic level (p < .001), type of DM (p < .001), type of treatment (p < .001), glycemic control status (p < .001), complication (p < .001) and depression level (p < .001). The level of hemoglobin A1c was the most useful predictor of DDS score (p < .001).

CONCLUSIONS

High prevalence of depression and distress in patient with diabetes calls for greater emphasizes on the importance of enhanced physicians and patients' knowledge in these areas.

An Empirical Study on Diabetes Depression over Distress Evaluation Using Diagnosis Statistical Manual and Chi-Square Method

Diabetes distress is an alternative disorder that is often associated with depression syndromes. Psychosocial distress is an alternative disorder that acts as a resistance to diabetes self-care management and compromises diabetes control. Yet, in Nigeria, the focus of healthcare centers is largely inclined toward the medical aspect of diabetes that neglects psychosocial care. In this retrospective study, specific distress was measured by the Diabetes Distress Screening (DDS) scale, and depression was analyzed by the Beck Depression Inventory (BDI) and Diagnosis Statistics Manual (DSM) criteria in type 2 diabetes mellitus (T2DM) patients of Northwestern Nigeria. Additionally, we applied the Chi-square test and linear regression to measure the forecast prevalence ratio and evaluate the link between the respective factors that further determine the odd ratios and coefficient correlations in five nonintrusive variables, namely age, gender, physical exercise, diabetes history, and smoking. In total, 712 sample patients were taken, with 51.68% male and 47.31% female patients. The mean age and body mass index (BMI) was 48.6 years ± 12.8 and 45.6 years ± 8.3. Based on the BDI prediction, 90.15% of patients were found depressed according to the DSM parameters, and depression prevalence was recorded around 22.06%. Overall, 88.20% of patients had DDS-dependent diabetes-specific distress with a prevalence ratio of 24.08%, of whom 45.86% were moderate and 54.14% serious. In sharp contrast, emotion-related distress of 28.96% was found compared to interpersonal (23.61%), followed by physician (16.42%) and regimen (13.21%) distress. The BDI-based matching of depression signs was also statistically significant with p < 0.001 in severe distress patients. However, 10.11% of patients were considered not to be depressed by DSM guidelines. The statistical evidence indicates that depression and distress are closely correlated with age, sex, diabetes history, physical exercise, and smoking influences. The facts and findings in this work show that emotional distress was found more prevalent. This study is significant because it considered several sociocultural and religious differences between Nigeria and large, undeveloped, populated countries with low socioeconomic status and excessive epidemiological risk. Finally, it is important for the clinical implications of T2DM patients on their initial screenings.

The joint association of diabetes distress and depressive symptoms with all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 20])

AIMS/HYPOTHESIS

The independent association of depressive symptoms and diabetes distress with mortality risk in individuals with diabetes has not been evaluated. We examined the temporal joint association of diabetes distress and depressive symptoms at baseline and the subsequent risk of all-cause mortality.

METHODS

The longitudinal data of 3118 individuals with type 2 diabetes were obtained from a large Japanese diabetes registry. To assess the joint association of diabetes distress and depressive symptoms at baseline with the subsequent risk of all-cause mortality, the Cox proportional hazards model was used with adjustment for potential confounders.

RESULTS

The mean age, BMI and HbA_1c levels were 64.7 years, 24.6 kg/m² and 58.6 mmol/mol (7.5%), respectively, and 38.1% of the participants were women. In the multivariable-adjusted models evaluating the diabetes distress and depressive symptoms separately, the HRs for all-cause mortality were 1.67 (95% CI 1.14, 2.43; p = 0.008) and 1.40 (95% CI 1.05, 1.85; p = 0.020), respectively. In such models evaluating the joint association of diabetes distress and depressive symptoms, compared with individuals without diabetes distress or depressive symptoms (DD^-/DS^-), the HRs for all-cause mortality for the group without diabetes distress but with depressive symptoms (DD^-/DS⁺), with diabetes distress but without depressive symptoms (DD⁺/DS^-), and with diabetes distress and depressive symptoms (DD⁺/DS⁺) were 1.34 (95% CI 0.99, 1.86; p = 0.056), 1.96 (95% CI 1.10, 3.50; p = 0.023) and 1.71 (95% CI 1.06, 2.77; p = 0.029), respectively. We did not observe a significant interaction between diabetes distress and depressive symptoms with all-cause mortality risk (p = 0.2636). In the stratified analysis by sex, a significant joint association of diabetes distress and depressive symptoms with the risk of all-cause mortality was observed only in men.

CONCLUSIONS/INTERPRETATION

Diabetes distress and depressive symptoms were independently associated with all-cause mortality risk in male participants with type 2 diabetes, but we did not observe a significant interaction between diabetes distress and depressive symptoms in relation to all-cause mortality. Graphical abstract.

The Effects of a Stress Management Group Education Program on Symptoms of Depression, Anxiety, and Stress in People With Comorbid Diabetes and Chronic and/or Recurrent Foot and Ankle Complications

BACKGROUND

Individuals with diabetic foot and ankle complications are at heightened risk for depression, anxiety, and stress.

PURPOSE

This study evaluated the effect of a stress management group education (SMGE) program in this population.

METHODS

The 21-question Depression Anxiety Stress Scales and the Problem Areas in Diabetes scale were administered prior to, upon completion of, and at approximately 6 weeks after the program.

RESULTS

Twenty-five patients from an urban diabetic foot and ankle center completed the study.

CONCLUSION

The SMGE program demonstrated decreased levels of anxiety, depression, and diabetes problem areas for our study population.

Depression and Diabetes Distress in South Asian Adults Living in Low- and Middle-Income Countries: A Scoping Review

OBJECTIVES

In this study, we conducted a scoping review to identify the prevalence of both depression and diabetes distress in patients with type 2 diabetes in low- and middle-income countries in South Asia.

METHODS

This scoping review was grounded in the methodology of Arksey and O'Malley by searching for relevant studies using Ovid MEDLINE, PsycINFO and Cumulative Index of Nursing and Allied Health Literature databases, as well as grey literature sources and hand searches. Two reviewers independently screened and extracted data from articles that met the inclusion criteria.

RESULTS

A total of 46 studies were included, with only 1 addressing both depression and diabetes distress. We present 42 total articles on depression and 5 on diabetes distress. The prevalence of type 2 diabetes and elevated depressive symptoms ranged from 11.6% to 67.5%, whereas the prevalence of diabetes distress ranged from 18.0% to 76.2%.

CONCLUSIONS

The prevalence of elevated depressive symptoms was found to be much higher than that reported in data from high-income countries and in data on South Asians living in high-income countries. Diabetes distress was found to be lower compared with other studies; however, the scarcity of data makes this observation inconclusive. Variations in depression inventories, lack of culturally tailored inventories and the focus on urban clinic-based populations are identified as limitations and areas requiring further research. Our review provides evidence for the need of increased mental health screening and treatment in diabetes care in South Asian countries.

Levels of personality functioning and not depression predict decline of plasma glucose concentration in patients with type 2 diabetes mellitus

AIMS

Psychosocial variables influence chronic diseases, such as type 2 diabetes mellitus. While there is evidence for a negative impact of depression, much less is known about stable, personality oriented factors. Aim of the study was to assess the impact of depression and personality functioning on glucose regulation in patients with type 2 diabetes.

METHODS

Seventy-five adult individuals with a first diagnosis of type 2 diabetes were consecutively recruited in an outpatient medical practice. Plasma glucose (HbA1c) was measured at initial contact, and after three and six months of a standardized disease management program. Depression was assessed by self-report (Patient Health Questionnaire, PHQ-D), levels of personality functioning with the screening version of the Operationalized Psychodynamic Diagnosis structure questionnaire (OPD-SQS).

RESULTS

Using mixed regression models, OPD-SQS scores were associated with lower baseline levels of HbA1c, but a less steep decline over time. PHQ-D scores were neither associated with intercept nor with slopes of HbA1c.

CONCLUSIONS

In type 2 diabetes, levels of personality functioning but not depression predicted decline in plasma glucose during the first six months of a standardized disease management program. Personality functioning may be especially important in chronic diseases that demand a high level of compliance and lifestyle change.

The Importance of Addressing Depression and Diabetes Distress in Adults with Type 2 Diabetes

People with type 2 diabetes often experience two common mental health conditions: depression and diabetes distress. Both increase a patient's risk for mortality, poor disease management, diabetes-related complications, and poor quality of life. The American Diabetes Association and the U.S. Preventive Services Task Force recommend routine evaluations for these conditions in adults for optimal disease management and prevention of life-threatening complications. However, barriers exist within primary care and specialty settings that make screening for depression and diabetes distress challenging. Depression and diabetes distress influence diabetes self-care and diabetes control and barriers in clinical care practice that can hinder detection and management of psychosocial issues in diabetes care. This paper highlights opportunities to increase mental health screenings and provides strategies to help providers address depression and diabetes distress in patients with type 2 diabetes.

Prevalence of depression among type 2 diabetes mellitus patients in India: A meta-analysis

Depression as a co-morbid condition in type 2 diabetes mellitus (T2DM) patients is associated with significant morbidity, mortality, and rising health economic burden. Indian healthcare system is heavily burdened with T2DM, and it is important to understand the prevalence of depression associated with T2DM. This meta-analysis conducted as per the registered protocol (PROSPERO registration: CRD42016051552), searched for published studies in the databases including MEDLINE and Embase till 31st August 2018. The modified Newcastle-Ottawa Scale was used to assess the methodological quality. The pooled prevalence of depression among T2DM patients was estimated as primary outcomes, while prevalence based on demographic sub-group was estimated as the secondary outcome. In total, 43 studies including 10,270 patients fulfilled the eligibility criteria and were included in the analysis. The pooled prevalence of depression in T2DM patients was found to be 38% (95% CI: 31%-45%). Presence of depression in people with type 2 diabetes was more often associated with the presence of complications with an odds ratio of 2.33, 95% CI: 1.62-3.36, p < 0.00001. Overall, the study found a high prevalence of depression among T2DM patients in India. Diabetes management programs in India may consider early screening of depression in T2DM patients.