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Saha CK, Shubrook JH, Guyton Hornsby W, Yang Z, Pillay Y, Mather KJ, de Groot M. Program ACTIVE II: 6- and 12-month outcomes of a treatment approach for major depressive disorder in adults with type 2 diabetes. J Diabetes Complications 2024; 38:108666. [PMID: 38266570 PMCID: PMC10922820 DOI: 10.1016/j.jdiacomp.2023.108666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024]
Abstract
AIMS To evaluate the long-term effects of behavioral treatments on glycemic and psychological outcomes for patients with major depressive disorder (MDD) and type 2 diabetes (T2D). METHODS Program ACTIVE II was a multicenter randomized controlled comparative effectiveness trial of cognitive behavioral therapy (CBT), exercise (EXER), combination treatment (CBT + EXER) and usual care (UC) for adults with MDD and T2D. RESULTS Primary outcomes: change in A1c and depressive symptoms at 6- (N = 87) and 12-months (N = 75) from baseline. In those with a baseline A1c ≥7.0 %, CBT + EXER showed lasting A1c benefit at 6- (-1.2 %; SE: 0.6; p = 0.032) and 12-months (-1.4 %; SE: 0.6; p = 0.025) compared to UC. All groups had clinically significant improvements in depressive symptoms. At 6 months, CBT + EXER had significant improvements in diabetes-related distress regimen burden (p = 0.005); and social support (CIRS, p = 0.043) compared to UC. CONCLUSIONS The Program ACTIVE II CBT + EXER intervention demonstrated a sustained improvement in A1c for a subgroup of study participants with a baseline A1c ≥7.0 %. However, this finding should be considered preliminary because of small sample size. All 3 behavioral intervention groups demonstrated improvements in psychosocial outcomes one-year post-intervention. These findings point to the enduring benefits of community-based interventions to extend the availability of depression treatment for T2D patients.
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Affiliation(s)
- Chandan K Saha
- Indiana University School of Medicine, United States of America
| | | | - W Guyton Hornsby
- West Virginia University School of Medicine, United States of America
| | - Ziyi Yang
- Indiana University School of Medicine, United States of America
| | | | - Kieren J Mather
- Indiana University School of Medicine, United States of America
| | - Mary de Groot
- Indiana University School of Medicine, United States of America.
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Mendorf S, Heimrich KG, Mühlhammer HM, Prell T, Schönenberg A. Trajectories of quality of life in people with diabetes mellitus: results from the survey of health, ageing and retirement in Europe. Front Psychol 2024; 14:1301530. [PMID: 38274698 PMCID: PMC10808439 DOI: 10.3389/fpsyg.2023.1301530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Previous longitudinal studies identified various factors predicting changes in Quality of Life (QoL) in people with diabetes mellitus (PwDM). However, in these studies, the stability of QoL has not been assessed with respect to individual differences. Methods We studied the predictive influence of variables on the development of QoL in PwDM across three waves (2013-2017) from the cross-national panel dataset Survey of Health, Ageing, and Retirement in Europe (SHARE). To determine clinically meaningful changes in QoL, we identified minimal clinically important difference (MCID). Linear regressions and Linear Mixed Models (LMM) were conducted to determine factors associated with changes in QoL. Results On average, QoL remained stable across three waves in 2989 PwDM, with a marginal difference only present between the first and last wave. However, when looking at individual trajectories, 19 different longitudinal patterns of QoL were identified across the three time-points, with 38.8% of participants showing stable QoL. Linear regression linked lower QoL to female gender, less education, loneliness, reduced memory function, physical inactivity, reduced health, depression, and mobility limitations. LMM showed that the random effect of ID had the strongest impact on QoL across the three waves, suggesting highly individual QoL patterns. Conclusion This study enhances the understanding of the stability of QoL measures, which are often used as primary endpoints in clinical research. We demonstrated that using traditional averaging methods, QoL appears stable on group level. However, our analysis indicated that QoL should be measured on an individual level.
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Affiliation(s)
- Sarah Mendorf
- Department of Neurology, University Hospital Jena, Jena, Germany
| | - Konstantin G. Heimrich
- Department of Neurology, University Hospital Jena, Jena, Germany
- Department of Geriatrics, University Hospital Jena, Jena, Germany
| | - Hannah M. Mühlhammer
- Department of Neurology, University Hospital Jena, Jena, Germany
- Department of Geriatrics, University Hospital Halle, Halle, Germany
| | - Tino Prell
- Department of Neurology, University Hospital Jena, Jena, Germany
- Department of Geriatrics, University Hospital Halle, Halle, Germany
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Ding H, Xie M, Wang J, Ouyang M, Huang Y, Yuan F, Jia Y, Zhang X, Liu N, Zhang N. Shared genetics of psychiatric disorders and type 2 diabetes:a large-scale genome-wide cross-trait analysis. J Psychiatr Res 2023; 159:185-195. [PMID: 36738649 DOI: 10.1016/j.jpsychires.2023.01.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/31/2022] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Individuals with psychiatric disorders have elevated rates of type 2 diabetes comorbidity. Although little is known about the shared genetics and causality of this association. Thus, we aimed to investigate shared genetics and causal link between different type 2 diabetes and psychiatric disorders. METHODS We conducted a large-scale genome-wide cross-trait association study(GWAS) to investigate genetic overlap between type 2 diabetes and anorexia nervosa, attention deficit/hyperactivity disorder, autism spectrum disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, schizophrenia, anxiety disorders and Tourette syndrome. By post-GWAS functional analysis, we identify variants genes expression in various tissues. Enrichment pathways, potential protein interaction and mendelian randomization also provided to research the relationship between type 2 diabetes and psychiatric disorders. RESULTS We discovered that type 2 diabetes and psychiatric disorders had a significant correlation. We identified 138 related loci, 32 were novel loci. Post-GWAS analysis revealed that 86 differentially expressed genes were located in different brain regions and peripheral blood in type 2 diabetes and related psychiatric disorders. MAPK signaling pathway plays an important role in neural development and insulin signaling. In addition, there is a causal relationship between T2D and mental disorders. In PPI analysis, the central genes of the DEG PPI network were FTO and TCF7L2. CONCLUSION This large-scale genome-wide cross-trait analysis identified shared genetics andpotential causal links between type 2 diabetes and related psychiatric disorders, suggesting potential new biological functions in common among them.
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Affiliation(s)
- Hui Ding
- The Affiliated Nanjing Brain Hospital of Nanjing Medical Univesity, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China
| | - Minyao Xie
- The Affiliated Nanjing Brain Hospital of Nanjing Medical Univesity, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China
| | - Jinyi Wang
- The Affiliated Nanjing Brain Hospital of Nanjing Medical Univesity, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China
| | - Mengyuan Ouyang
- The Affiliated Nanjing Brain Hospital of Nanjing Medical Univesity, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China
| | - Yanyuan Huang
- The Affiliated Nanjing Brain Hospital of Nanjing Medical Univesity, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China
| | - Fangzheng Yuan
- School of Psychology, Nanjing Normal University, Nanjing, 210023, PR China
| | - Yunhan Jia
- School of Psychology, Nanjing Normal University, Nanjing, 210023, PR China
| | - Xuedi Zhang
- The Affiliated Nanjing Brain Hospital of Nanjing Medical Univesity, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China
| | - Na Liu
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, PR China.
| | - Ning Zhang
- The Affiliated Nanjing Brain Hospital of Nanjing Medical Univesity, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China.
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de Groot M. 50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future. Diabetes Care 2021; 44:633-640. [PMID: 33608324 DOI: 10.2337/dci20-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article is adapted from a speech Dr. de Groot delivered in June 2020 as President, Health Care & Education, of the American Diabetes Association at the Association's 80th Scientific Sessions, which was held online as a result of coronavirus disease 2019. Dr. de Groot is an Associate Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism at Indiana University (IU) School of Medicine. She serves as the Acting Director of the IU Diabetes Translational Research Center. Dr. de Groot is the 2020 recipient of the Rachmiel Levine Medal for Leadership from the American Diabetes Association.In the year 2020, we marked the 50th anniversary of the field of behavioral science in diabetes in the modern era. Over this relatively short period of time, this field has charted the psychosocial landscape of prediabetes and diabetes by establishing the prevalence and impact of emotional and behavioral aspects of diabetes. Interventions to address these conditions have been developed that span the T2 to T4 translational research spectrum ranging from the intrapsychic to population-based interventions. Policies ranging from standards of care to Medicare benefits have been implemented. A review of research in the area of diabetes and depression is provided as an example of innovations in this field. Behavior is the foundation of all interventions we make in diabetes and prediabetes. As a mature science, it is critical to stemming the tide of diabetes and its outcomes. To make additional strides, we must rebalance our focus and augment funding for behavioral interventions for individuals, communities, and health care systems in conjunction with other forms of treatment.
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Affiliation(s)
- Mary de Groot
- Division of Endocrinology and Metabolism, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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de Groot M. 50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future. Diabetes Spectr 2021; 34:76-84. [PMID: 33627998 PMCID: PMC7887533 DOI: 10.2337/ds20-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Editor's Note: This article is adapted from a speech Dr. de Groot delivered in June 2020 as President, Health Care & Education, of the American Diabetes Association. She delivered her address at the Association's 80th Scientific Sessions, which was held online as a result of the coronavirus disease 2019.
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Healy SA, Fantaneanu TA, Whiting S. The importance of mental health in improving quality of life in transition-aged patients with epilepsy. Epilepsy Behav 2020; 112:107324. [PMID: 32721873 DOI: 10.1016/j.yebeh.2020.107324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Adolescents with epilepsy are known to have a lower quality of life (QoL) than the typically developing adolescent population. In order to address this, treating physicians have primarily focused on obtaining seizure control. However, growing evidence suggests a strong relation between QoL and mental health in adults with epilepsy and other chronic conditions. Given the high rate of mental health issues in transition-aged adolescents with epilepsy, this study aimed to examine the relation between QoL and mental health. METHODS Baseline data from 107 transition-aged adolescents (M = 16.08 years; 52 males, 55 females) enrolled in an epilepsy transition clinic were analyzed for this study. RESULTS Analysis found that over 56% of participants showed some signs of mental illness, and that these participants had significantly lower QoL scores than those without mental health issues. Furthermore, regression analysis found that both depression and anxiety remained significant, independent predictors of QoL, even when significant epilepsy and demographic variables were accounted for (t(99) = -1.28, p < .001 and t(99) = -1.10, p = .002, respectively). SIGNIFICANCE Results suggest that in order to ensure best outcomes for these adolescents, it may be important for clinicians to take a holistic approach to treatment, managing and treating both seizures and mental health concerns.
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Affiliation(s)
| | | | - Sharon Whiting
- The Children's Hospital of Eastern Ontario, Canada; The University of Ottawa, Canada.
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Zhou AS, Prince AA, Maxfield AZ, Shin JJ. Psychological Status as an Effect Modifier of the Association Between Sinonasal Instrument and Imaging Results. Otolaryngol Head Neck Surg 2020; 163:1044-1054. [PMID: 32450735 DOI: 10.1177/0194599820926129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether psychological status is an effect modifier of the previously observed low discriminatory capacity of Sinonasal Outcome Test-22 (SNOT-22) scores for Lund-Mackay computed tomography (CT) results. STUDY DESIGN Observational outcomes study. SETTING Tertiary care center. SUBJECTS AND METHODS We assessed patients presenting with chronic sinonasal complaints who underwent CT of the sinuses within 1 month of completing the SNOT-22 instrument. SNOT-22 overall and domain scores were calculated, as were Lund-Mackay CT scores. The discriminatory capacity of SNOT-22 scores for CT results was determined using the receiver-operator characteristic area under the curve (ROC-AUC). Patient-Reported Outcome Measurement Information System (PROMIS) mental health T-scores were assessed, and stratified analyses were used to test for effect modification by psychological status. RESULTS In stratified analyses, patients with better PROMIS mental health scores had SNOT-22 overall (ROC-AUC 0.96) and nasal domain scores (ROC-AUC 0.97-0.98) that were highly discriminatory for Lund-Mackay scores, while those with worse mental health scores did not (ROC-AUC 0.42-0.55, P < .007). Patients with better SNOT-22 psychological domain scores also had nasal scores that discriminated among CT results significantly better than those with worse psychological domain scores (ROC-AUC 0.65-0.69 and 0.34-0.35, respectively, P < .013). CONCLUSIONS Psychological status is an effect modifier of the relationship between SNOT-22 and Lund-Mackay scores. SNOT-22 scores were discriminatory for Lund-Mackay CT results in patients with better psychological status, while they were nondiscriminatory in those with worse psychological status. When assessing the relationship between subjective and objective measures of chronic rhinosinusitis, accounting for effect modification may have practical utility.
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Affiliation(s)
- Allen S Zhou
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony A Prince
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Z Maxfield
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Abu Ameerh MA, Hamad GI. The prevalence of depressive symptoms and related risk factors among diabetic patients with retinopathy attending the Jordan University Hospital. Eur J Ophthalmol 2020; 31:529-535. [PMID: 32202144 DOI: 10.1177/1120672120912691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the prevalence of depressive symptoms among diabetic patients suffering from retinopathy, and to identify crucial risk factors that affect patients' quality of life and whether social support mediates the relationship between retinopathy and depression. METHODS The sample comprises 155 participants with diabetic retinopathy recruited from the Jordan University Hospital during the year 2017. Arabic versions of all study tools were employed as follows: the Beck Depression Inventory; the short form of the health survey; the Berlin social support scale; ophthalmic examinations; patients' records; and a demographic questionnaire. ANALYSES Descriptive statistics, the Pearson correlation, linear regression using SPSS, and mediation analysis using the Sobel test were applied. In addition, the odds ratio analysis and qualitative analyses for the open-ended questions were included. RESULTS In general, 13 (8.9%) of our patients did not manifest any symptoms of depression while 42 (27.1%) had a mild mood disturbance, 26 (16.8%) were on the borderline of clinical depression, 47 (30.3%) had moderate depression, 22 (14.2%) with severe depression, and 5 (3.2%) had extreme depression. The results indicate a nonsignificant positive correlation between social support and health-related quality of life and a nonsignificant positive relationship between retinopathy severity and depression. Meanwhile, our results revealed a significant negative relationship between depression and social support and a nonsignificant negative relationship between retinopathy severity and social support. CONCLUSION Our findings suggest that diabetic patients with retinopathy have a higher risk of developing depression. Hence, psychological interventions are highly needed to meet the mental health needs of these patients.
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Affiliation(s)
- Mohammed Ali Abu Ameerh
- Department of Ophthalmology, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Ghada Ismail Hamad
- Department of Students Counseling, The University of Jordan, Amman, Jordan
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Pan S, Liu ZW, Shi S, Ma X, Song WQ, Guan GC, Zhang Y, Zhu SM, Liu FQ, Liu B, Tang ZG, Wang JK, Lv Y. Hamilton rating scale for depression-24 (HAM-D 24) as a novel predictor for diabetic microvascular complications in type 2 diabetes mellitus patients. Psychiatry Res 2017; 258:177-183. [PMID: 28774662 DOI: 10.1016/j.psychres.2017.07.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022]
Abstract
The study was designed to investigate whether the hamilton rating scale for depression (24-items) (HAM-D24) can be used to predict the diabetic microvascular complications in type 2 diabetes mellitus (T2DM) patients. 288 hospitalized patients with T2DM were enrolled. Their diabetic microvascular complications including diabetic nephropathy, diabetic retinopathy, diabetic peripheral neuropathy and diabetic foot as well as demographic, clinical data, blood samples and echocardiography were documented. All the enrolled patients received HAM-D24 evaluation. The HAM-D24 score and incidence of depression in T2DM patients with each diabetic microvascular complication were significantly higher than those in T2DM patients without each diabetic microvascular complication. After the adjustment of use of insulin and hypoglycemic drug, duration of T2DM, mean platelet volume, creatinine, albumin, fasting glucose, glycosylated hemoglobin type A1C, left ventricular ejection fraction, respectively, HAM-D24 score was still significantly associated with diabetic microvascular complications (OR = 1.188-1.281, all P < 0.001). The AUC of HAM-D24 score for the prediction of diabetic microvascular complication was 0.832 (0.761-0.902). 15 points of HAM-D24 score was considered as the optimal cutoff with the sensitivity of 0.778 and specificity of 0.785. In summary, HAM-D24 score may be used as a novel predictor of diabetic microvascular complications in T2DM patients.
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Affiliation(s)
- Shuo Pan
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Zhong-Wei Liu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Shuang Shi
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Xun Ma
- Department of Emergency Medicine, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Wen-Qian Song
- Department of Internal Medicine, University Hospital of Northwest University, Xi'an, Shaanxi, People's Republic of China
| | - Gong-Chang Guan
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Yong Zhang
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Shun-Ming Zhu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Fu-Qiang Liu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Bo Liu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Zhi-Guo Tang
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Jun-Kui Wang
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China.
| | - Ying Lv
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China.
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Akdemir V, Sut N, Guldiken B. Factors affecting the quality of life in drug-resistant epilepsy patients. Acta Neurol Belg 2016; 116:513-8. [PMID: 26943462 DOI: 10.1007/s13760-016-0622-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/21/2016] [Indexed: 10/22/2022]
Abstract
Epilepsy patients whose seizures cannot be controlled by treatment have a lower quality of life (QoL). The aim of the present study was to compare the potential factors affecting the QoL in patients who were seizure-free with medication or who had drug-resistant epilepsy. The study included 46 drug-resistant and 42 seizure-free epilepsy patients. The demographic and clinical features of the patients were investigated for their effects on patient QoL. The QoL was assessed by the QoL in Epilepsy Inventory-89 and depression was detected by the Beck Depression Inventory. The QoL was significantly lower in the drug-resistant patients than in the seizure-free epilepsy patients (p < 0.001). Depression, lower education level, and unemployment were associated with lower QoL scores (p < 0.001, p < 0.01, p < 0.001, respectively). After adjusting for lower education level and unemployment, depression remained as an independent factor affecting QoL (p < 0.05). In addition to their efforts to control and stop seizures, clinicians should remain aware of depression and treat it effectively to improve the QoL of drug-resistant epilepsy patients.
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de Groot M, Crick KA, Long M, Saha C, Shubrook JH. Lifetime Duration of Depressive Disorders in Patients With Type 2 Diabetes. Diabetes Care 2016; 39:2174-2181. [PMID: 27729427 PMCID: PMC5127229 DOI: 10.2337/dc16-1145] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/25/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Depression in patients with type 2 diabetes (T2D) is associated with long-term complications, disability, and early mortality. No studies have systematically examined the length of episodes and remission in adults with major depressive disorder (MDD) and T2D. This study examined the course of depressive disorders in patients with T2D and MDD. RESEARCH DESIGN AND METHODS Participants (N = 50) enrolled in a behavioral intervention for adults with T2D and MDD were interviewed using the Structured Clinical Interview for DSM-IV-TR to assess history of depressive disorders at baseline (lifetime history), postintervention, and 3-month follow-up. Onset and remission dates were recorded for all Axis I depressive disorders from birth to final interview. RESULTS Average number of MDD episodes was 1.8 with a mean duration of 23.4 months (SD 31.9; range 0.5-231.3). Over the life course, mean exposure to MDD was 43.1 months (SD 46.5; range 0.5-231.3). Kaplan-Meier survival curve analysis indicated median episode duration decreased with subsequent episodes (14 months, first episode; 9 months, second episode; P < 0.002). In patients with multiple depressive episodes, recovery time was shorter with each subsequent episode (P = 0.002). No differences in length of episode or remission were observed based on chronology of T2D diagnosis. CONCLUSIONS The overall exposure to depression in this sample of adults with T2D represents a substantial period of time that can contribute to negative medical and psychiatric outcomes. Recurrent episodes decrease in duration as do recovery periods, resulting in a waxing and waning pattern. Findings from this study underscore the need to effectively diagnose and treat depression in patients with T2D to minimize risk of future depressive episodes.
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Affiliation(s)
- Mary de Groot
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Kent A Crick
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Molly Long
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Chandan Saha
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Jay H Shubrook
- Touro University California College of Osteopathic Medicine, Vallejo, CA
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Mocan AS, Iancu SS, Duma L, Mureseanu C, Baban AS. Depression in romanian patients with type 2 diabetes: prevalence and risk factors. ACTA ACUST UNITED AC 2016; 89:371-7. [PMID: 27547056 PMCID: PMC4990432 DOI: 10.15386/cjmed-641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/29/2016] [Indexed: 01/21/2023]
Abstract
Background and aims Co-existing major depression was found to have a negative impact on the diabetes outcome and the quality of life. The aim of the present study was to assess the prevalence of depressive symptoms in Romanian diabetes patients and to identify the risk factors associated with depression. Methods A total of 144 type 2 diabetes patients were included in the study. Five models of presumed predictors were used to assess the risk factors for depressive symptoms, using hierarchical regression analysis. Together with demographics, disease, lifestyle predictors, previous depressive symptoms and diabetes distress were taken into account. Results In our sample the prevalence of depression was 12.6%. Main risk factors for depressive symptoms were previous depressive symptoms which were associated with depression in both Model 4 (β=0.297, p=0.013) and Model 5 (β=0.239, p=0.017) and diabetes distress in Model 5 (β=0.540, p≤0.001). Employment (β =−0.276, p=0.029) and increased number of diabetes complications (β=0.236, p=0.017) became significant when diabetes distress was added to the analysis. Conclusions The overall prevalence of depressive symptoms was found to be in range with the prevalence identified in the literature. Previous depression and diabetes distress were both independently associated with depression, confirming the bidirectional relationship between depression and diabetes distress. Due to the consequences for daily living, screening for diabetes distress and depression should be done in primary care units both by physicians and trained nurses.
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Affiliation(s)
- Andreia S Mocan
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital Cluj, Romania; Department of Psychology and Educational Sciences, Babes-Bolyai University, Cluj, Romania
| | - Silvia S Iancu
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital Cluj, Romania
| | - Livia Duma
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital Cluj, Romania
| | - Camelia Mureseanu
- Department of Psychology and Educational Sciences, Babes-Bolyai University, Cluj, Romania
| | - Adriana S Baban
- Department of Psychology and Educational Sciences, Babes-Bolyai University, Cluj, Romania
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Czech SJ, Orsillo SM, Pirraglia PA, English TM, Connell AJ. Association Between Specific Depression Symptoms and Glycemic Control Among Patients With Comorbid Type 2 Diabetes and Provisional Depression. Prim Care Companion CNS Disord 2015; 17:14m01754. [PMID: 26835160 DOI: 10.4088/pcc.14m01754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 05/28/2015] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To determine whether specific depression symptoms are associated with glycemic control independent of potential demographic and clinical covariates among primary care patients with comorbid type 2 diabetes and provisional threshold or subthreshold depression. METHOD We examined a convenience sample of patients diagnosed with type 2 diabetes and provisional threshold or subthreshold depression (N = 82) at 2 family health centers. Cases were identified using a population-based registry of patients diagnosed with type 2 diabetes (ICD-9 codes 250.00 for controlled type 2 diabetes and 250.02 for uncontrolled type 2 diabetes). Data from patients with a primary care provider appointment from the beginning of April 2011 through the end of June 2012 and with at least one 9-item Patient Health Questionnaire (PHQ-9) depression screener and a glycated hemoglobin A1c (HbA1c) laboratory test between 2 weeks before and 10 weeks after PHQ-9 screening were eligible for inclusion. We defined provisional threshold or subthreshold depression using PHQ-9 scoring criteria, which were designed to yield provisional diagnostic information about major depressive disorder based on DSM-5 diagnostic criteria. RESULTS Patients reporting higher severity of sleep problems on the PHQ-9 had significantly higher HbA1c levels (mean = 8.48, SD = 2.17) compared to patients reporting lower severity or absence of this symptom (mean = 7.19, SD = 1.34, t 48.88 = -3.13, P = .003). Problems with sleep contributed unique variance on glycemic control (β = 0.27, P = .02) when controlling for potential clinical and demographic covariates, with those reporting more sleep difficulties having higher HbA1c levels. CONCLUSIONS For patients with type 2 diabetes and provisional threshold or subthreshold depression, it may be prudent to aggressively address sleep problems as a potential mechanism toward improving diabetes control.
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Affiliation(s)
| | - Susan M Orsillo
- Department of Psychology, Suffolk University, Boston, Massachusetts
| | - Paul A Pirraglia
- Primary Care, Providence VA Medical Center and Alpert Medical School, Brown University, Providence, Rhode Island
| | - Thomas M English
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Alexa J Connell
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester
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de Groot M, Shubrook J, Schwartz F, Hornsby WG, Pillay Y, Saha C. Program ACTIVE II: Design and Methods for a Multi-Center Community-Based Depression Treatment for Rural and Urban Adults with Type 2 Diabetes. ACTA ACUST UNITED AC 2015; 1. [PMID: 27500279 PMCID: PMC4974010 DOI: 10.16966/2380-5544.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to conduct a cost-effectiveness analysis of predicted incidence of cardiovascular complications across groups. Methods The study is a 2-by-2 factorial randomized controlled trial consisting of 4 treatment groups: CBT alone, EXER alone, combination of CBT and EXER, and UC. Adults with T2DM for > 1 year and who meet DSM-IVTR criteria for Major Depressive Disorder (MDD) are eligible to participate at two rural Appalachian sites (southeastern Ohio and West Virginia) and one urban site (Indianapolis). This type II behavioral translation study uses a community-engaged research (CEnR) approach by incorporating community fitness centers and mental health practices as interventionists. Conclusions This is the first study to evaluate the comparative effectiveness of combined CBT and exercise in the treatment of depression using community-based intervention delivery. This approach may serve as a national model for expanding depression treatment for patients with T2DM.
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Affiliation(s)
| | | | - Frank Schwartz
- Ohio University Heritage College of Osteopathic Medicine, USA
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15
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Abstract
Type 2 diabetes (T2D) patients are twice as likely to experience depressive symptoms than people without T2D, resulting in greater economic burden, worse clinical outcomes, and reduced quality of life. Several overlapping pathophysiological processes including hypothalamic-pituitary-adrenal axis hyperactivity, sympathetic nervous system activation, and elevated pro-inflammatory biomarkers are recognized as playing a role between T2D and depressive symptoms. However, other neurobiological mechanisms that may help to further link these comorbidities have not been extensively reviewed. Reduced neuroplasticity in brain regions sensitive to stress (e.g., hippocampus) may be associated with T2D and depressive symptoms. T2D patients demonstrate reduced neuroplasticity including morphological/volumetric abnormalities and subsequent neurocognitive deficits, similar to those reported by patients with depressive symptoms. This review aims to summarize recent studies on morphological/volumetric abnormalities in T2D and correlated neurocognitive deficits. Modifying factors that contribute to reduced neuroplasticity will also be discussed. Integrating reduced neuroplasticity with other biological correlates of T2D and depressive symptoms could enhance future therapeutic interventions and further disentangle the bidirectional associations between these comorbidities.
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Affiliation(s)
- Todd Doyle
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, Fahey Building, Maywood, IL, 60153, USA,
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Salum GA, DeSousa DA, Bosa VL, Schuch I, Goldani M, Isolan LR, Teche SP, Fleck MP, Rohde LA, Manfro GG. Internalizing disorders and quality of life in adolescence: evidence for independent associations. Rev Bras Psiquiatr 2014; 36:305-12. [DOI: 10.1590/1516-4446-2014-1362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 02/17/2014] [Indexed: 11/22/2022]
Affiliation(s)
- Giovanni A. Salum
- Hospital de Clínicas de Porto Alegre (HCPA), Brazil; HCPA, Brazil; HCPA, Brazil
| | | | | | | | | | | | | | | | - Luis A. Rohde
- Hospital de Clínicas de Porto Alegre (HCPA), Brazil; HCPA, Brazil
| | - Gisele G. Manfro
- Hospital de Clínicas de Porto Alegre (HCPA), Brazil; HCPA, Brazil; HCPA, Brazil
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17
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Abstract
Diabetes and depression occur together approximately twice as frequently as would be predicted by chance alone. Comorbid diabetes and depression are a major clinical challenge as the outcomes of both conditions are worsened by the other. Although the psychological burden of diabetes may contribute to depression, this explanation does not fully explain the relationship between these 2 conditions. Both conditions may be driven by shared underlying biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors. Depression is frequently missed in people with diabetes despite effective screening tools being available. Both psychological interventions and antidepressants are effective in treating depressive symptoms in people with diabetes but have mixed effects on glycemic control. Clear care pathways involving a multidisciplinary team are needed to obtain optimal medical and psychiatric outcomes for people with comorbid diabetes and depression.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences (IDS Building), MP887, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK,
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18
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Abstract
Aims/Introduction: The objective of this study was to translate and validate an Iranian version of the Diabetes Quality of Life (DQOL) questionnaire in an Iranian population of males and females with a diagnosis of type 2 diabetes. Materials and Methods: A total of 503 patients with type 2 diabetes were recruited from nine diabetes clinics across several Iranian cities. A standard backward and forward translation procedure was used to convert the English version of the DQOL into the Iranian language (Persian). Internal consistency, convergent validity, known group comparison, confirmatory factor analysis (CFA) and factorial invariance were applied for the assessment of psychometric properties of the translated version. Results: The translated version of the DQOL showed adequate internal consistency reliabilities for all subscales (Cronbach’s α >0.70). CFA confirmed the underlying domain structure to be the same as for the original English version, therefore supporting the factorial validity of the translated questionnaire. In addition, questionnaire responsiveness showed good sensitivity to interventions. Conclusions: In conclusion, the translated Iranian version of DQOL has shown high internal reliability and good construct validity, and can potentially be applied as an assessment tool for health‐related quality of life in patients with diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00217.x, 2012)
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Affiliation(s)
- Amir H Pakpour
- Qazvin Research Center for Social Determinants of Health ; Department of Public Health, Qazvin University of Medical Sciences, Qazvin
| | - Mohsen Saffari
- Department of Health Education, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Andrea Burri
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
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Lin CH, Yen YC, Chen MC, Chen CC. Relief of depression and pain improves daily functioning and quality of life in patients with major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:93-8. [PMID: 23989033 DOI: 10.1016/j.pnpbp.2013.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/04/2013] [Accepted: 08/10/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effects of depression relief and pain relief on the improvement in daily functioning and quality of life (QOL) for depressed patients receiving a 6-week treatment of fluoxetine. METHOD A total of 131 acutely ill inpatients with major depressive disorder (MDD) were enrolled to receive 20mg of fluoxetine daily for 6 weeks. Depression severity, pain severity, daily functioning, and health-related QOL were assessed at baseline and again at week 6. Depression severity, pain severity, and daily functioning were assessed using the 17-item Hamilton Depression Rating Scale, the Short-Form 36 (SF-36) Body Pain Index, and the Work and Social Adjustment Scale. Health-related QOL was assessed by three primary domains of the SF-36, including social functioning, vitality, and general health perceptions. Pearson's correlation and structural equation modeling were used to examine relationships among the study variables. Five models were proposed. In model 1, depression relief alone improved daily functioning and QOL. In model 2, pain relief alone improved daily functioning and QOL. In model 3, depression relief, mediated by pain relief, improved daily functioning and QOL. In model 4, pain relief, mediated by depression relief, improved daily functioning and QOL. In model 5, both depression relief and pain relief improved daily functioning and QOL. RESULTS One hundred and six patients completed all the measures at baseline and at week 6. Model 5 was the most fitted structural equation model (χ(2) = 8.62, df = 8, p = 0.376, GFI = 0.975, AGFI = 0.935, TLI = 0.992, CFI = 0.996, RMSEA = 0.027). CONCLUSION Interventions which relieve depression and pain improve daily functioning and QOL among patients with MDD. The proposed model can provide quantitative estimates of improvement in treating patients with MDD.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Nursing, Fooyin University, Kaohsiung, Taiwan.
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Sun CL, Kersey JH, Francisco L, Armenian SH, Baker KS, Weisdorf DJ, Forman SJ, Bhatia S. Burden of morbidity in 10+ year survivors of hematopoietic cell transplantation: report from the bone marrow transplantation survivor study. Biol Blood Marrow Transplant 2013; 19:1073-80. [PMID: 23583827 DOI: 10.1016/j.bbmt.2013.04.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/04/2013] [Indexed: 01/29/2023]
Abstract
Long-term morbidity after hematopoietic cell transplantation (HCT) is unknown. The risk of physical and psychological health in 324 patients who had survived 10 or more years after HCT and a sibling comparison group (n = 309) was evaluated. Using the Common Terminology Criteria for Adverse Events, the 15-year cumulative incidence of severe/life-threatening/fatal conditions was 41% (95% confidence interval, 34% to 48%). HCT survivors were 5.7 times as likely to develop a severe/life-threatening condition (P < .001) and 2.7 times as likely to report somatic distress (P < .001) compared with siblings. Compared with allogeneic HCT recipients with no chronic graft-versus-host disease (GVHD), those with active chronic GVHD were at a 1.8-fold higher risk of severe/life-threatening health conditions (P = .006) and a 4.5-fold higher risk of somatic distress (P = .04); allogeneic HCT recipients with resolved chronic GVHD were not at increased risk of morbidity compared with those with no chronic GVHD. Only 27% of the HCT survivors returned to the transplantation center for their cancer-related care. The burden of long-term physical and emotional morbidity borne by survivors remains substantial, even beyond 10 years after HCT; however, specialized health care is underused. Patients, families, and healthcare providers need to be made aware of the high burden, so they can plan for post-HCT care, even many years after HCT.
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Pauli C, Thais ME, Claudino LS, Bicalho MA, Bastos AC, Guarnieri R, Nunes JC, Lin K, Linhares MN, Walz R. Predictors of quality of life in patients with refractory mesial temporal lobe epilepsy. Epilepsy Behav 2012; 25:208-13. [PMID: 23032134 DOI: 10.1016/j.yebeh.2012.06.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/05/2012] [Accepted: 06/23/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE The identification of variables associated with health-related quality of life (HRQoL) in patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) would improve surgical decision-making and post-operatory follow-up in this group of patients. METHODS We analyzed the independent association between the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) of 81 consecutive patients with refractory MTLE-HS. The clinical, demographic, radiological and electrophysiological variables were analyzed by multiple linear regression analysis. KEY FINDINGS Approximately 36% (adjusted R(2)=0.36; R coefficient=0.66) of the QOLIE-31 overall score variance was explained by the history of initial precipitant injury, family history of epilepsy, disease duration, age of epilepsy onset, seizure frequency and presence of psychiatric axis-II diagnosis. The variance of QOLIE-31 sub-scales was: seizure worry=7%; overall QOL=11%; emotional well-being=32%; energy/fatigue=38%; cognitive function=13%; medication effects=7%; social function=13% (R coefficient between 0.30 and 0.65). SIGNIFICANCE The pre-surgical variables studied had relatively low prediction capacity for the overall QOLIE-31 score and its sub-scales in this set of Brazilian patients with refractory MTLE-HS.
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Chong J, Reinschmidt KM, Moreno FA. Symptoms of depression in a Hispanic primary care population with and without chronic medical illnesses. Prim Care Companion J Clin Psychiatry 2012; 12. [PMID: 20944771 DOI: 10.4088/pcc.09m00846blu] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 08/14/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe somatic and psychiatric symptoms reported by Hispanic primary care patients with and without depression and/or chronic medical illnesses. METHOD Adult Hispanic patients (n = 104) in a Mobile Health Program in underserved southern Arizona participated in a survey conducted between September 2006 and February 2007 to obtain information about the somatic and psychiatric symptoms that they were experiencing. They were asked to rate the severity of their symptoms listed in the depression screen Personal Health Questionnaire-9 (PHQ-9), the Symptom Checklist-90-Revised (SCL-90-R), and 5 new symptoms described by patients in focus groups conducted in the first phase of the project. Patients were categorized as depressed if their PHQ-9 scores were 10 or above, and they were further categorized as having or not having chronic illnesses based on self-report. Analyses of variance were conducted for each SCL-90-R symptom dimension to compare across the 4 groups (group 1: not depressed and not medically ill; group 2: medically ill but not depressed; group 3: depressed but not medically ill; and group 4: depressed and medically ill). RESULTS Patients with chronic medical illnesses comorbid with depression were found to report significantly more somatic symptoms than those with only chronic medical illnesses or depression alone (P ≤ .001). They also reported significantly more psychopathology than patients with depression alone (P ≤ .05 or better). CONCLUSIONS Patients with medical illnesses comorbid with depression are more likely to exhibit psychopathology than patients with medical illnesses or depression alone.
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Affiliation(s)
- Jenny Chong
- Native American Research and Training Center, Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA.
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de Groot M, Doyle T, Kushnick M, Shubrook J, Merrill J, Rabideau E, Schwartz F. Can lifestyle interventions do more than reduce diabetes risk? Treating depression in adults with type 2 diabetes with exercise and cognitive behavioral therapy. Curr Diab Rep 2012; 12:157-66. [PMID: 22350739 PMCID: PMC3314326 DOI: 10.1007/s11892-012-0261-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The epidemic of metabolic syndrome, prediabetes, and type 2 diabetes is global in scope and comprehensive in its impact on individuals, health care systems, and societies. One in four patients with diabetes will experience depression in their lifetime. Comorbid depression is associated with poorer outcomes, greater functional disability, and early mortality. Prior studies have demonstrated beneficial effects of exercise as an efficacious form of treatment for depression in the general population. Few studies have evaluated this strategy in patients with prediabetes or type 2 diabetes. Program ACTIVE (Appalachians Coming Together to Increase Vital Exercise) was designed to treat depression among adults with type 2 diabetes by pairing aerobic activity with individual cognitive behavioral therapy. This combination treatment approach has been shown to be feasible to implement in a rural environment and promising in terms of depression, diabetes, and cardiovascular outcomes. Data from this study suggest that exercise can be used to achieve multiple benefits for adults with type 2 diabetes. Future work to compare this approach to singular treatment strategies for adults at risk for type 2 diabetes is needed.
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Affiliation(s)
- Mary de Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Abstract
BACKGROUND Depression is common in patients with Type 1 or Type 2 diabetes, has a strong negative impact on the quality of life of patients and is associated with poor outcomes and higher mortality rates. Several guidelines encourage screening of patients with diabetes for depression. It is unclear which depression screening tools are currently being used in people with diabetes and which are most appropriate. METHODS A systematic review was conducted to examine which depression screening instruments are currently being used in diabetes research, and the operating characteristics of these tools in diabetes populations. Literature searches for the period January 1970 to October 2010 were conducted using MEDLINE, PSYCH-INFO, ASSIA, SCOPUS, ACADEMIC SEARCH COMPLETE, CINAHL and SCIENCE DIRECT. RESULTS Data are presented for the 234 published studies that were examined. The Beck Depression Inventory and the Centre for Epidemiologic Studies Depression Scale were the most popular screening tools (used in 24% and 21% of studies). Information on the cultural applicability of screening tools was mostly unavailable and, where reported, included only details of the language translation process. A small number of studies reported reliability data, most of which showed moderate-good sensitivity and specificity but a high rate of false positives. CONCLUSIONS Although a range of depression screening tools have been used in research, there remains few data on their reliability and validity. Information on the cultural applicability of these instruments is even scantier. Further research is required in order to determine the suitability of screening tools for use in clinical practice and to address the increasing problem of co-morbid diabetes and depression.
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Affiliation(s)
- T Roy
- Division of Social Research in Medicines and Health, University of Nottingham, Nottingham Faculty of Health and Social Care, The Open University, Milton Keynes, UK
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Baumeister H, Hutter N, Bengel J, Härter M. Quality of life in medically ill persons with comorbid mental disorders: a systematic review and meta-analysis. Psychother Psychosom 2011; 80:275-86. [PMID: 21646822 DOI: 10.1159/000323404] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 12/02/2010] [Indexed: 01/20/2023]
Abstract
BACKGROUND This systematic review aims to investigate the association between comorbid mental disorders and quality of life (QoL) in patients with chronic medical diseases. METHODS Studies investigating adults with diabetes mellitus, coronary artery disease, asthma, chronic back pain and colorectal cancer were included. Two reviewers independently extracted data and assessed methodological criteria. Effect sizes for QoL scores were analyzed in random-effects meta-analyses. Subgroup and sensitivity analyses were conducted. RESULTS The database search identified 7,291 references and 65 primary studies were included. Medically ill persons with comorbid mental disorders showed a significantly decreased overall (d = -1.10; 95% CI = -1.34 to -0.86), physical (d = -0.64; 95% CI = -0.74 to -0.53) and psychosocial (d = -1.18; 95% CI = -1.42 to -0.95) QoL compared to persons without mental disorders. Subgroup analyses did not reveal significant differences between the examined medical diseases or mental disorders. CONCLUSION The review provides evidence of a substantially reduced psychosocial and physical QoL in medically ill patients with comorbid mental disorders. This patient-reported outcome highlights the importance of recognizing and treating comorbid mental disorders in the medically ill.
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Affiliation(s)
- Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
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Sun CL, Francisco L, Baker KS, Weisdorf DJ, Forman SJ, Bhatia S. Adverse psychological outcomes in long-term survivors of hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study (BMTSS). Blood. 2011;118:4723-4731. [PMID: 21821714 DOI: 10.1182/blood-2011-04-348730] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Little information exists regarding long-term psychological health of hematopoietic cell transplantation (HCT) survivors. Using resources offered by the Bone Marrow Transplant Survivor Study (BMTSS), we evaluated adverse psychological outcomes in 1065 long-term HCT survivors and a healthy comparison group composed of siblings. Psychological health status was evaluated using the Brief Symptom Inventory-18. Twenty-two percent of the HCT survivors reported adverse psychological outcomes, compared with 8% of the siblings. Exposure to prednisone was associated with psychological distress across all domains (anxiety, depression, and somatic distress). Fifteen percent of the HCT survivors reported somatic distress, representing an almost 3-fold higher risk comparing to siblings. Among survivors, in addition to low annual household income and self-reported poor health, having severe/life-threatening conditions and presence of active chronic GVHD were associated with a 2-fold increased risk for somatic distress. Seven percent of the HCT survivors expressed suicidal ideation; patients with higher scores on depression subscale were most vulnerable. This study demonstrates that somatic distress is the biggest challenge faced by survivors long after HCT. These results identify vulnerable subpopulations and provide patients, families, and healthcare providers with necessary information to plan for post-HCT needs many years after HCT.
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Markowitz SM, Gonzalez JS, Wilkinson JL, Safren SA. A review of treating depression in diabetes: emerging findings. Psychosomatics 2011; 52:1-18. [PMID: 21300190 DOI: 10.1016/j.psym.2010.11.007] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 07/07/2009] [Accepted: 07/08/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Depression in patients with diabetes is associated with poorer adherence and worse health outcomes, however treating depression may help improve these outcomes. OBJECTIVE The present systematic review identified published papers to evaluate treatments for depression in patients with diabetes. RESULTS Seventeen studies that met criteria were identified, indicating that psychosocial interventions, particularly cognitive-behavior therapy, anti-depressant medications, and collaborative care are effective in the treatment of depression in patients with diabetes. CONCLUSION Evidence for the efficacy of these interventions in improving glycemic control was mixed. No study targeted adherence to treatment or health behaviors in addition to depression, which may be necessary to maximize improvement in diabetes outcomes such as glycemic control.
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Affiliation(s)
- Sarah M Markowitz
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Cruz LN, Fleck MPDA, Polanczyk CA. Depression as a determinant of quality of life in patients with chronic disease: data from Brazil. Soc Psychiatry Psychiatr Epidemiol 2010; 45:953-61. [PMID: 19771379 DOI: 10.1007/s00127-009-0141-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 09/11/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depressive symptoms are associated with impaired quality of life (QOL). However, there are scarce data comparing the magnitude of depression on QOL among persons with different chronic diseases in developing countries. This study aimed to evaluate the impact of depression on QOL in patients with ischemic heart disease (IHD) and end-stage renal disease (ESRD) in hemodialysis. METHODS Cross-sectional survey conducted in 173 patients: 103 with IHD and 70 in hemodialysis. Depression was diagnosed by the Mini International Neuropsychiatric Interview-5.0 and depressive symptoms measured by Beck Depression Inventory. QOL was assessed through the Short-Form-36 (SF-36) and World Health Organization Quality of Life Instrument-brief (WHOQOL-brief). Multivariate analyses were performed to assess the association between variables and QOL. RESULTS Depression prevalence was 14.3% among IHD patients and 9.9% in the hemodialysis group, and depressive symptoms were present in 39 and 36%, respectively. Regardless of the chronic condition, depressed patients presented lower QOL scores than non-depressed ones in all domains, and the most affected were role emotional, mental health and social functioning of SF-36, and psychological domain of WHOQOL-brief. In linear regression analysis, depressive symptoms were predictive for lower QOL in all domains, with the highest standardized beta coefficients (ranging from -0.26 to -0.64). CONCLUSION Depression is an independent factor associated with worse QOL in IHD and ESRD patients. Among the priorities aiming at improving QOL must be evaluation and management of depressive symptoms.
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Affiliation(s)
- Luciane Nascimento Cruz
- Post-graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Fuller-Thomson E, Milinovich JL, Merighi JR. Lifetime prevalence of comorbid mood disorders in a representative sample of Canadians with type 1 diabetes. J Diabetes Complications 2010; 24:297-300. [PMID: 19481958 DOI: 10.1016/j.jdiacomp.2009.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 03/23/2009] [Accepted: 04/22/2009] [Indexed: 01/03/2023]
Abstract
AIMS To compare the lifetime prevalence of mood disorders among those with and without type 1 diabetes. METHODS Data from a nationally representative sample were obtained. Individuals were classified as having type 1 diabetes if a health professional diagnosed them with diabetes before age 30 and they began insulin within 1 month of their diagnosis (N=314). RESULTS The prevalence of mood disorders in persons with type 1 diabetes was 7.9% (95% CI 3.1-12.7) compared to 5.6% (95% CI 5.4-5.8) for those without type 1 diabetes (age- and sex-adjusted OR=1.56, 95% CI 1.04-2.34). CONCLUSIONS Future research would benefit from the use of community-based representative samples.
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Affiliation(s)
- Esme Fuller-Thomson
- Faculty of Social Work, The University of Toronto, Toronto, Ontario, Canada.
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Sikdar KC, Wang PP, MacDonald D, Gadag VG. Diabetes and its impact on health-related quality of life: a life table analysis. Qual Life Res 2010; 19:781-7. [PMID: 20349211 DOI: 10.1007/s11136-010-9641-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2010] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the health burden of diabetes and determine its impact on health-related quality of life (HRQOL) in a population with a high prevalence of chronic conditions. METHODS A representative sample of the Canadian province of Newfoundland and Labrador (NL) was used to estimate prevalence of diabetes and mean health utility index (HUI), a utility-based measure of HRQOL. Diabetes-deleted life expectancy (LE) and health-adjusted life expectancy (HALE) were derived to measure HRQOL. RESULTS Diabetic individuals comprised 6.8% of the sample and accounted for 14% of total deaths from 2001 to 2005. Life Expectancy at age 15 was 61.3 years for men and 66.7 years for women, of which 53.0 and 57.0 years, respectively, were spent with perfect health (86.4 and 85.5%). Eliminating diabetes would extend both the overall LE and HALE for men by 1.3 and 1.4 years, and women by 2.0 and 1.7 years, respectively. People with diabetes had a significantly lower HRQOL than people without diabetes (mean HUI: 0.78 vs. 0.88, P < 0.01). CONCLUSION The burden of illness from diabetes in NL is considerable. Using cause-eliminated LE and HALE provides a robust approach for assessing HRQOL that may have important implications for diabetes surveillance, prevention, and management strategies.
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Skevington S, Norweg S, Standage M, The WHOQOL HIV Group. Predicting quality of life for people living with HIV: international evidence from seven cultures. AIDS Care 2010; 22:614-22. [DOI: 10.1080/09540120903311466] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S.M. Skevington
- a WHO Centre for the Study of Quality of Life , University of Bath , Bath , BA2 7AY , UK
- b Department of Psychology , University of Bath , Bath , BA2 7AY , UK
| | - S. Norweg
- a WHO Centre for the Study of Quality of Life , University of Bath , Bath , BA2 7AY , UK
- b Department of Psychology , University of Bath , Bath , BA2 7AY , UK
- c Department of Clinical Psychology , University of Konstanz , Konstanz , Germany
| | - M. Standage
- a WHO Centre for the Study of Quality of Life , University of Bath , Bath , BA2 7AY , UK
- d School for Health , University of Bath , Bath , BA2 7AY , UK
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Swinnen SGHA, Snoek FJ, Dain MP, DeVries JH, Hoekstra JBL, Holleman F. Rationale, design, and baseline data of the insulin glargine (Lantus) versus insulin detemir (Levemir) Treat-To-Target (L2T3) study: A multinational, randomized noninferiority trial of basal insulin initiation in type 2 diabetes. Diabetes Technol Ther 2009; 11:739-43. [PMID: 19905891 DOI: 10.1089/dia.2009.0044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To discuss the design and baseline data of the Lantus (sanofi-aventis, Paris, France) versus Levemir (Novo Nordisk A/S, Bagsvaerd, Denmark) Treat-To-Target (L2T3) study, a multinational, randomized comparison between the basal insulin analogs insulin glargine and insulin detemir. METHODS Insulin-naive subjects with type 2 diabetes suboptimally controlled on oral glucose-lowering drugs (OGLDs) (including at least metformin) were randomized to 24-week treatment with either insulin glargine once-daily or insulin detemir twice-daily, titrated to obtain fasting plasma glucose <100 mg/dL. The primary outcome was the percentage of subjects reaching hemoglobin A1c (HbA1c) <7% without symptomatic confirmed hypoglycemia. Important secondary outcomes were quality of life and treatment satisfaction, which were repeatedly assessed using validated questionnaires. Also, biomedical and psychological determinants of failure to reach HbA1c <7% were explored. RESULTS Recruitment was completed in November 2007. The majority of the randomized population (n = 973) was white (77.8%) and used one other OGLD beside metformin (70.7%). Concerning patient-reported outcomes, approximately 20% of subjects reported no physical symptoms of fatigue or hyperglycemia before insulin initiation, and approximately 10% were maximally satisfied with their previous treatment. One-third of patients (29.9%) reported suboptimal well-being, and 9.3% had a score indicating depression. Better emotional well-being was significantly associated with lower diabetes symptom distress and higher treatment satisfaction (respectively, r = -0.56 and 0.41; P < 0.001). CONCLUSIONS The L2T3 study will extend the evidence on both the efficacy and the effects on quality of life and treatment satisfaction of the long-acting insulin analogs glargine and detemir. Additionally, it will increase our understanding of the factors important to the (self-)management of type 2 diabetes patients starting insulin.
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Affiliation(s)
- Sanne G H A Swinnen
- Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands.
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Passamonti M, Pigni M, Colombo L, Sacchi E. The quality of life of patients with type 2 diabetes mellitus in general practice. Eur J Gen Pract 2009. [DOI: 10.3109/13814780009069955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kokoszka A, Pouwer F, Jodko A, Radzio R, Mućko P, Bieńkowska J, Kuligowska E, Smoczyńska O, Skłodowska Z. Serious diabetes-specific emotional problems in patients with type 2 diabetes who have different levels of comorbid depression: a Polish study from the European Depression in Diabetes (EDID) Research Consortium. Eur Psychiatry 2009; 24:425-30. [PMID: 19541457 DOI: 10.1016/j.eurpsy.2009.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 04/22/2009] [Accepted: 04/23/2009] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Depression is a common psychiatric problem in patients with type 2 diabetes (DM2). A common view is that the burden of having DM2 contributes to the development of depression in DM2. Aim of the present study was to compare the levels of diabetes-specific emotional problems of DM2 patients with diagnosed depression with those with a subclinical form of depression and those without depression. METHODS A cross-sectional study was conducted in 101 DM2 patients (51 men and 50 women, mean age = 63,17; SD = 10,74) who completed a standardized, structured psychiatric diagnostic interview (MINI), the Beck Depression Inventory, the Hamilton Depression Rating Scale as well as the Problem Areas in Diabetes (PAID) scale (a 20-item measure, with an overall scale measuring diabetes-related emotional distress and four subscales [negative emotions, treatment-related problems, food-related problems, lack of social support]). RESULTS A depression diagnosis was made in 35% (n = 35) of the participants, 24% (n = 24) had a subclinical form of depression, 42% (n = 42) were not diagnosed with any kind of depressive disorder. Diabetes-specific emotional problems were most common in DM2 patients with a depressive disorder (significantly highest PAID score: 39) compared to patients with subclinical depression or no depression. In the group of non-depressed patients, only 14% agreed to have four or more (somewhat) serious diabetes-specific problems. In those with subclinical depression, this percentage was 42% and in those with a depressive disorder 49% (P < 0.001). CONCLUSIONS Diabetes-related emotional problems are particularly common among DM2 patients with comorbid clinical depression and to a lesser extent in patients with subclinical depression, compared to non-depressed DM2 patients. Male diabetes patients with a depressive disorder are particularly vulnerable to develop high levels of diabetes-specific emotional distress. Major differences between the three groups mainly concern the diabetes-specific problems connected with the illness.
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Affiliation(s)
- A Kokoszka
- Department of Psychiatry II, Medical University of Warsaw, ul. Kondratowicza 8, 03-242 Warsaw, Poland.
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Abstract
Diabetes patients are known to have a worse quality of life than individuals without diabetes. They also have an increased risk for depressive symptoms, which may have an additional negative effect on their quality of life. This systematic review summarizes the current knowledge on the association between depressive symptoms and quality of life in individuals with diabetes. A systematic literature search using MEDLINE, Psychinfo, Social SciSearch, SciSearch and EMBASE was conducted from January 1990 until September 2007. We identified studies that compared quality of life between diabetic individuals with and without depressive symptoms. Twenty studies were identified, including eighteen cross-sectional and two longitudinal studies. Quality of life was measured as generic, diabetes specific and domain specific quality of life. All studies reported a negative association between depressive symptoms and at least one aspect of quality of life in people with diabetes. Diabetic individuals with depressive symptoms also had a severely lower diabetes specific quality of life. Generic and domain specific quality of life were found to be mild to moderately lower in the presence of depressive symptoms. Therefore, increased awareness and monitoring for depression is needed within different diabetes care settings.
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Affiliation(s)
- Miranda T Schram
- National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, The Netherlands.
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Yoshida S, Hirai M, Suzuki S, Awata S, Oka Y. Neuropathy is associated with depression independently of health-related quality of life in Japanese patients with diabetes. Psychiatry Clin Neurosci 2009; 63:65-72. [PMID: 19067994 DOI: 10.1111/j.1440-1819.2008.01889.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify factors independently associated with depression in Japanese patients with diabetes, after controlling for potential confounding factors. METHODS Among 197 outpatients with diabetes, 129 (type 1: 24, type 2: 105) completed a questionnaire concerning socio-demographic and health-related variables. Depression screening was done using Zung's Self-Rating Depression Scale test, followed by diagnostic interviews by experienced psychiatrists employing the Diagnostic Statistical Manual of Mental Disorders, 4th edition (DSM-IV). RESULTS Forty-seven patients (36.4%) had symptomatological depression. A Self-Rating Depression Scale cut-off score of 40 had good sensitivity (100%) and modest specificity (59%) for detecting major depressive episode, in accordance with the DSM-IV. Diabetic patients suffering from depression were more likely to have neuropathy, retinopathy, body pain, a feeling of poor general health, and lack of social support, than the non-depressed patients. However, age, gender, marital status, diabetes type, insulin requirement, duration of diabetes, hemoglobin A1c (HbA1c) and the presence of nephropathy did not differ between the two groups. In multivariate logistic regression analysis, body pain (OR 3.26, 95% CI 1.31-8.08) and the presence of microvascular complications (OR 2.81, 95% CI 1.13-6.98) were independent factors associated with depression. Specifically, diabetic neuropathy (OR 3.10, 95% CI 1.17-8.22) was associated with depression independently of age, gender, marital status, social supports, quality of life, diabetes type, duration of diabetes, HbA1c, and insulin requirement. CONCLUSIONS A diabetic complication, specifically neuropathy, was independently associated with depression in patients with diabetes. The present findings indicate the need to find a biological base common to both depression in diabetes and diabetic neuropathy.
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Affiliation(s)
- Sumiko Yoshida
- Department Psychiatry, Faculty of Medicine, Saitama Medical University, Saitama, Japan.
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Akinci F, Yildirim A, Gözü H, Sargin H, Orbay E, Sargin M. Assessment of health-related quality of life (HRQoL) of patients with type 2 diabetes in Turkey. Diabetes Res Clin Pract 2008; 79:117-23. [PMID: 17707943 DOI: 10.1016/j.diabres.2007.07.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 07/04/2007] [Indexed: 11/20/2022]
Abstract
We measured the health-related quality of life (HRQoL) in a sample of 376 type 2 diabetes patients in Turkey using the Diabetes Quality of Life (DQOL) instrument and examined which patient socio-demographic and diabetes-related clinical characteristics are associated with better quality of life (QoL). The influence of patient socio-demographic and clinical characteristics on QoL was examined using independent sample t-tests and one-way analysis of variance. Diabetes significantly affected the HRQoL of patients included in this study. The mean score of the total DQOL measure was higher among patients who were less than 40 years of age, male, married, had less than 8 years of education, lived with their family and had no family history of diabetes (p<0.05). Similarly, patients with less than 5 years of disease duration, no complications or prior hospitalization, receive insulin, and with HbA(1)c<7 reported significantly better overall HRQoL (p<0.05). Patients with BMI<24 had higher levels of satisfaction with diabetes than those with BMI>or=24 (p<0.05). Diabetes-related HRQoL information is clearly of supreme importance to family physicians and policy makers to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the QoL of diabetes patients.
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Affiliation(s)
- Fevzi Akinci
- Department of Health Policy and Administration, Washington State University, P.O. Box 1495, Spokane, WA 99210-1495, USA.
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Ozkan M, Corapçioglu A, Balcioglu I, Ertekin E, Khan S, Ozdemir S, Karayün D, Unsalver BO, Kocaman N, Kaymakglu S, Köroglu G. Psychiatric morbidity and its effect on the quality of life of patients with chronic hepatitis B and hepatitis C. Int J Psychiatry Med 2007; 36:283-97. [PMID: 17236696 DOI: 10.2190/d37y-x0jy-39mj-pvxq] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE The primary aim of our study was to determine the prevalence of psychiatric morbidity in a cohort of consecutive chronic hepatitis patients not receiving antiviral therapy. The secondary aim of our study was to determine if psychiatric morbidity, type of hepatitis, and the level of depression correlated with health-related quality of life (HRQL). METHODS The study was conducted in collaboration with Hepatology and Infectious Disease Clinics at three-major university hospitals. One hundred seven patients who met the criteria for being diagnosed with either chronic hepatitis B or C, had non-cirrhotic compensated liver disease, had not received antiviral treatment in the preceding 6 months, and had no accompanying physical illness were included in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders, the Short Form--36 for measuring HRQL, and semi-structured interviews for assessing psychosocial variables were used. Sixty-seven healthy adults formed the control group. RESULTS 43.9% of the patients had hepatitis B, 56.1% hepatitis C. A psychiatric diagnosis was made in 48.6%, of which 15% was depression. No significant difference was found in the rate of psychiatric diagnosis between hepatitis B and hepatitis C patients. Hepatitis B and C patients were found to vary significantly (p < 0.001) from the control group on all subcategories of quality of life criteria. Psychiatric morbidity (mainly depression) was the major variable on lowering HRQL (p = 0.000). CONCLUSIONS Chronic hepatitis B and C patients presented a high rate of psychiatric disorder. HRQL was significantly decreased in patients with psychiatric morbidity.
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Affiliation(s)
- Mine Ozkan
- Istanbul Faculty of Medicine, Istanbul Universitesi, Turkey.
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Abstract
The purpose of this paper is to report Health Utility Index Mark 3 (HUI3) scores, at baseline and at one year, for patients with psychotic disorders. Eighty two randomly selected outpatients from a Montreal teaching hospital completed the HUI3 and other measures of symptoms and side-effects. At baseline, the average Global Utility score was 0.64, which is rated in the "dysfunctional" health status range. Improvements were seen at one year follow-up in the Global, Dexterity, Cognition, and Pain Utility scores. The proportion of individuals rated in the "healthy" health status range improved by 32% from baseline to one year. HUI3 scores were negatively related to measures of psychotic symptoms and side-effects. We propose that the HUI3 should be used to assess health-related quality of life (HRQOL) in patients with psychotic disorders. Scores could be compared with other populations affected with chronic conditions (e.g., Alzheimer dementia, cancer, arthritis, etc.).
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Affiliation(s)
- Raymond Tempier
- Department of Psychiatry, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, Canada, S7N 0W8.
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Yildirim A, Akinci F, Gozu H, Sargin H, Orbay E, Sargin M. Translation, cultural adaptation, cross-validation of the Turkish diabetes quality-of-life (DQOL) measure. Qual Life Res 2007; 16:873-9. [PMID: 17286193 DOI: 10.1007/s11136-007-9172-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 12/29/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to test the validity and reliability of the Turkish version of the diabetes quality of life (DQOL) questionnaire for use with patients with diabetes. METHODS Turkish version of the generic quality of life (QoL) scale 15D and DQOL, socio-demographics and clinical parameter characteristics were administered to 150 patients with type 2 diabetes. Study participants were randomly sampled from the Endocrinology and Diabetes Outpatient Department of Dr. Lutfi Kirdar Kartal Education and Research Hospital in Istanbul, Turkey. RESULTS The Cronbach alpha coefficient of the overall DQOL scale was 0.89; the Cronbach alpha coefficient ranged from 0.80 to 0.94 for subscales. Distress, discomfort and its symptoms, depression, mobility, usual activities, and vitality on the 15 D scale had statistically significant correlations with social/vocational worry and diabetes-related worry on the DQOL scale indicating good convergent validity. Factor analysis identified four subscales: satisfaction", impact", "diabetes-related worry", and "social/vocational worry". CONCLUSION Statistical analyses showed that the Turkish version of the DQOL is a valid and reliable instrument to measure disease related QoL in patients with diabetes. It is a simple and quick screening tool with about 15 +/- 5.8 min administration time for measuring QoL in this population.
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Affiliation(s)
- Aysegul Yildirim
- Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
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Abstract
BACKGROUND Many patients with diabetes experience depression, yet it is unclear if the treatment of depression in diabetic patients is concordant with national guidelines, and whether appropriate antidepressant use is associated with better diabetes self-care behaviors. OBJECTIVES The purpose of this study was to (1) determine whether antidepressant medication use for managed care enrollees with type 2 diabetes was concordant with The Agency for Healthcare Research and Quality depression treatment guidelines; and (2) examine the relationship between guideline concordance and oral diabetes medication adherence. METHODS Retrospective analyses were conducted using medical/pharmacy claims for 2001 from a managed care organization in the midwestern United States. Subjects were adults with type 2 diabetes treated with oral medications only. The subjects were divided into 3 groups: (1) guideline-concordant users of antidepressants; (2) those who received antidepressants not in concordance with the guidelines; and (3) nonusers of antidepressants. Antidepressant users were determined to be in concordance with the acute phase treatment guidelines if they filled at least 90 days supply of antidepressant drugs within 118 days of the first fill. Adherence to diabetes medications was measured by the medication possession ratio. A 1-way analysis of variance with Scheffe's test was used to compare the antihyperglycemic medication possession ratio across the three groups. RESULTS One hundred eighty-two (12.5%) of the 1454 subjects initiated treatment with antidepressants. Eighty-nine (48.9%) of the 182 antidepressant users were in concordance with the acute phase treatment guidelines. Subjects with subconcordant antidepressant use had a lower mean diabetes medication possession ratio than those with either guideline-concordant use or no use (F=14.3, P<.01). CONCLUSION Over half of the diabetic patients initiating treatment for depression did not receive therapy in concordance with the Agency for Healthcare Research and Quality guidelines. Patients whose antidepressant use was not concordant with the guidelines were also less adherent to diabetes medications.
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Affiliation(s)
- David P Nau
- Department of Social and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-1065, USA.
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Ludman E, Katon W, Russo J, Simon G, Von Korff M, Lin E, Ciechanowski P, Kinder L. Panic episodes among patients with diabetes. Gen Hosp Psychiatry 2006; 28:475-81. [PMID: 17088162 DOI: 10.1016/j.genhosppsych.2006.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 08/05/2006] [Accepted: 08/07/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to examine the prevalence of panic episodes in persons with diabetes and the demographic, behavioral and clinical characteristics associated with panic symptoms in persons with diabetes. METHOD A survey mailed to 4385 patients with diabetes assessed recent experiences of panic episodes, depression, diabetes symptoms, quality of life, disability, smoking status and body mass index. Automated medical record data were used to measure diabetes treatment, hemoglobin A1c (Hb(A1c)) levels, diabetes complications and medical comorbidity. RESULTS One hundred ninety-three (4.4%) participants reported recent panic episodes, among whom 54.5% also met criteria for major depression. After accounting for the effects of depression, panic episodes were associated with higher Hb(A1c) values, increased diabetic complications and symptoms, greater disability and lower self-rated health and functioning. CONCLUSION Panic is strongly associated with decrements in disease status and functioning. Since panic is often comorbid with depression, efforts to address psychological disorders among persons with diabetes may need to pay increased attention to anxiety and mood disorders.
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Affiliation(s)
- Evette Ludman
- Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA.
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Abstract
The article reviews research on the problem of interrelationship between different physical and psychosocial factors in type 1 diabetes mellitus (DM1). The authors consider methodological principles of health-related quality of life (HRQoL) assessment in DM1 patients and stress the need for an integrated biopsychosocial approach to the management of the disease. DM1 is a chronic metabolic disease with an absolute requirement for insulin replacement therapy. The stress-inducing nature of DM1 is associated with its unexpected and dramatic manifestation in juvenile years, life-threatening nature of severe hypo-/hyperglycaemias and long-term complications, with the burden of diabetes self-management, threat of work disability, employment and career problems etc. These features of DM1 increase the likelihood of the development of anxiety and depressive disorders, which, in turn, may negatively influence the course of diabetes and in particular, diabetes self-care. This necessitates early diagnosis of emotional and behavioral disturbances in DM1 using self-report instruments as well as clinical assessment. Evidence suggests that active problem-focused coping behavior and adequate social support promote adherence to diabetes regimes and may act as a buffer against negative effects of the disease on HRQoL in DM1 patients. The core element in the HRQoL structure is personal disease picture (as opposed by objective clinical picture)--the cognitive-affective-behavioral complex reflecting the patient's personal perception of the disease. Examination of the personal disease picture and attitude towards the ailment in DM1 patients may help to improve understanding of the mechanisms of poor adjustment. Problems in disease adjustment can be detected also by diabetes-specific HRQoL assessment. The measures of HRQoL can be applied as screening instruments useful in increasing the effectiveness of patient-provider interactions and diabetes care.
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Affiliation(s)
- Ludvig I Wasserman
- Laboratory of Clinical Psychology of V.M. Bekhterev Psychoneurological Research Institute, 193019, St. Petersburg, ul. Bekhtereva 3, Russia.
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Chittleborough CR, Baldock KL, Taylor AW, Phillips PJ. Health status assessed by the SF-36 along the diabetes continuum in an Australian population. Qual Life Res 2006; 15:687-94. [PMID: 16688501 DOI: 10.1007/s11136-005-3570-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the association of health status with stage along the diabetes continuum. DESIGN, SETTING AND PARTICIPANTS Self-reported health status (SF-36) was assessed in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Impaired fasting glucose (IFG), undiagnosed diabetes, diagnosed diabetes, glycaemic control and cardiovascular disease were determined from fasting blood and self-reported data. RESULTS The prevalence of diagnosed diabetes was 5.6% (95% CI: 4.9-6.3), with an additional 1.0% (95% CI: 0.7-1.4) previously undiagnosed. When compared to those with normal glucose, those with diabetes were significantly impaired on all SF-36 dimensions except Mental Health, and those with IFG (4.3%) were significantly impaired in terms of Physical Functioning and Bodily Pain when controlling for the effects of age, sex and cardiovascular disease. Poor glycaemic control (HbA1c >or= 7.0%) was also associated with impaired health status. CONCLUSIONS Health status is impaired not only among those with diagnosed diabetes but also those with IFG and undiagnosed diabetes.
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Affiliation(s)
- Catherine R Chittleborough
- South Australian Department of Health, Diabetes Clearing House, Population Research and Outcome Studies Unit, PO Box 287, Rundle Mall, Adelaide, 5000, South Australia, Australia.
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Wexler DJ, Grant RW, Wittenberg E, Bosch JL, Cagliero E, Delahanty L, Blais MA, Meigs JB. Correlates of health-related quality of life in type 2 diabetes. Diabetologia 2006; 49:1489-97. [PMID: 16752167 DOI: 10.1007/s00125-006-0249-9] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 03/06/2006] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS We assessed the impact of medical comorbidities, depression, and treatment intensity on quality of life in a large primary care cohort of patients with type 2 diabetes. METHODS We used the Health Utilities Index-III, an instrument that measures health-related quality of life based on community preferences in units of health utility (scaled from 0=death to 1.0=perfect health), in 909 primary care patients with type 2 diabetes. Demographic and clinical correlates of health-related quality of life were assessed. RESULTS The median health utility score for this population was 0.70 (interquartile range 0.39-0.88). In univariate analyses, older age, female sex, low socioeconomic status, cardiovascular disease, microvascular complications, congestive heart failure, peripheral vascular disease, chronic lung disease, depression, insulin use and number of medications correlated with decreased quality of life, while obesity, hypertension and hypercholesterolaemia did not. In multiple regression analyses, microvascular complications, heart failure and depression were most strongly related to decreased health-related quality of life, independently of duration of diabetes; in these models, diabetes patients with depression had a utility of 0.59, while patients without symptomatic comorbidities did not have a significantly reduced quality of life. Treatment intensity remained a significant negative correlate of quality of life in multivariable models. CONCLUSIONS/INTERPRETATION Patients with type 2 diabetes have a substantially decreased quality of life in association with symptomatic complications. The data suggest that treatment of depression and prevention of complications have the greatest potential to improve health-related quality of life in type 2 diabetes.
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Affiliation(s)
- D J Wexler
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
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Recklitis CJ, Parsons SK, Shih MC, Mertens A, Robison LL, Zeltzer L. Factor structure of the brief symptom inventory--18 in adult survivors of childhood cancer: results from the childhood cancer survivor study. Psychol Assess 2006; 18:22-32. [PMID: 16594809 DOI: 10.1037/1040-3590.18.1.22] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The factor structure of the Brief Symptom Inventory--18 (BSI-18; L. R. Derogatis, 2000) was investigated in a sample of adult survivors of childhood cancer enrolled in the Childhood Cancer Survivor Study (CCSS; N = 8,945). An exploratory factor analysis with a randomly chosen subsample supported a 3-factor structure closely corresponding to the 3 BSI-18 subscales: Depression, Anxiety, and Somatization. Confirmatory factor analysis with structural equation modeling validated this 3-dimensional structure in a separate subsample, though an alternative 4-factor model also fit the data. Analysis of the 3-factor model showed consistent fit in male and female participants. Compared with available community-based norms, survivors reported fewer symptoms of psychological distress. Together, results support the hypothesized 3-dimensional structure of the BSI-18 and indicate the measure may be useful in assessing psychological distress in this growing population of cancer survivors.
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Affiliation(s)
- Christopher J Recklitis
- Department of Pediatric Oncology, Perini Family Survivor's Center, The Dana- Farber Cancer Institute, Boston, MA 02115-6084, USA.
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Elsenbruch S, Benson S, Hahn S, Tan S, Mann K, Pleger K, Kimmig R, Janssen OE. Determinants of emotional distress in women with polycystic ovary syndrome. Hum Reprod 2006; 21:1092-9. [PMID: 16459352 DOI: 10.1093/humrep/dei409] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The goals were to analyse the incidence of mental distress in women with untreated polycystic ovary syndrome (PCOS) using self-report measures, to characterize PCOS patients at risk for psychiatric disease with regard to sociodemographic and clinical characteristics, and to assess the impact of emotional distress on quality of life. METHODS AND RESULTS Complete metabolic, hormonal, clinical and self-report psychological data [emotional distress, Symptom Check List 90 (SCL-90-R); quality of life, Short-Form Health Survey 36 (SF-36); sexual satisfaction, visual analogue scales; sociodemographic data] were obtained from n = 143 untreated women with PCOS. Prior psychiatric diagnoses were exclusionary. Twenty-two patients (15.4%) had a possible psychological disorder, based on SCL-90-R global severity index (GSI) scores > or =63 (SCL cases). SCL cases had significantly elevated body mass index (BMI), but did not differ from SCL non-cases in other clinical, endocrine, metabolic or sociodemographic variables. Stepwise multiple regression analyses identified GSI as a significant predictor of SF-36 Psychological Sum score, along with age and current wish to conceive (R2 = 0.47); the SF-36 Physical Sum score was predicted by BMI and education (R2 = 0.27), but not GSI. CONCLUSIONS Psychiatric illness may go undetected in a proportion of PCOS patients. Although the majority of patients exhibit subclinical levels of psychological disturbances, emotional distress together with obesity lead to large decrements in quality of life in PCOS.
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Affiliation(s)
- Sigrid Elsenbruch
- Department of Medical Psychology, Endokrinologikum Ruhr, Center for Endocrine and Metabolic Diseases, Bochum, Germany.
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Pouwer F, Beekman ATF, Lubach C, Snoek FJ. Nurses' recognition and registration of depression, anxiety and diabetes-specific emotional problems in outpatients with diabetes mellitus. Patient Educ Couns 2006; 60:235-40. [PMID: 16442465 DOI: 10.1016/j.pec.2005.01.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Revised: 01/19/2005] [Accepted: 01/21/2005] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate how often emotional problems were recognized and registered by diabetes nurses. METHODS We studied medical charts and questionnaire data of 112 diabetes patients. The hospital anxiety, depression scale and the problem areas in diabetes survey were used to measure anxiety, depression and diabetes-specific emotional distress. RESULTS In patients with moderate to severe levels of anxiety or depression, the presence of an emotional problem was recorded in the medical chart in 20-25% of the cases. The registration-rate of diabetes-specific emotional distress was also found to be low, ranging from 0% (treatment-related problems) to 29% (diabetes-related emotional problems). CONCLUSION Registration-rates of emotional problems by diabetes nurses were found to be low, but quite similar to detection rates of physicians and nurses in studies with non-diabetic samples. PRACTICE IMPLICATIONS These findings suggest that recognition-rates of emotional problems in diabetes patients need to be increased. Future studies should investigate whether recognition and subsequent treatment of emotional problems in diabetes patients can be facilitated by utilizing validated, standardized self-report questionnaires.
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Affiliation(s)
- François Pouwer
- Department of Medical Psychology, Institute for Research in Extramural Medicine (EMGO), Vrije Universiteit Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Hahl J, Hämäläinen H, Simell T, Simell O. The effects of type 1 diabetes and its long-term complications on physical and mental health status. Pharmacoeconomics 2006; 24:559-69. [PMID: 16761904 DOI: 10.2165/00019053-200624060-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To analyse how type 1 diabetes mellitus (DM) and the symptoms of its chronic long-term complications correlate with health status domains in the adult population in Finland. METHODS A representative sample of patients with type 1 DM was selected randomly from the Finnish drug reimbursement registry. Participants reported symptoms, diagnoses and treatments indicating the presence and time of appearance of long-term complications, and completed the RAND 36 questionnaire. A principal component analysis was performed to compress the eight RAND 36 dimensions into composite domains of health status. The results were validated with split-sample analysis. Regression analyses were used to estimate the effects of age, sex, symptoms of long-term complications and comorbidities on the component T-scores. RESULTS Of the 752 (70.8%) responders, 592 fulfilled the criteria of type 1 DM. Of these, 82.6% fully completed the RAND 36 questionnaire. Principal component analysis of our data supports the theory of the 2-factor model of health, as physical and mental health domains were reflected unambiguously by different RAND 36 dimensions. The regression results show that the symptoms of long-term complications correlate more strongly with the physical than the mental domain of health status. CONCLUSION Type 1 DM, and especially the symptoms of its long-term complications, correlate mainly with the physical domain of health, although the mental domain is also affected. The prevalence of long-term complications with type 1 DM is sufficiently high within the Finnish population to substantially influence the health status of people with type 1 DM.
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Affiliation(s)
- Jarmo Hahl
- Department of Economics, Turku School of Economics and Business Administration, Turku, Finland.
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