Network analysis of depression, cognitive functions, and suicidal ideation in patients with diabetes: an epidemiological study in Iran

AIMS

The main aim of this study was to assess the prevalence of suicidal ideation and previous suicide attempts among Iranian patients diagnosed with Type-1 diabetes (T1D) and Type-2 diabetes (T2D). Additionally, the study sought to estimate the network structure of depressive symptoms and cognitive functions.

METHODS

1073 patients participated in the current study. We used Patient Health Questionnaire-9 (PHQ-9), Ask Suicide-Screening Questionnaire, diabetes-related factors, and a battery of cognitive functions tasks to estimate network structures. Also, suicidal ideations and suicide attempts prevalence have been estimated. Statistical analyses were performed using R-studio software, including mixed-graphical models (MGMs) for undirected effects and Directed Acyclic Graphs (DAGs) for directed effects.

RESULTS

The prevalence of suicidal ideation was 29.97% in T1D and 26.81% in T2D (p < 0.05). The history of suicide attempts was higher in T1D (10.78%) compared to T2D (8.36%) (p < 0.01). In the MRF networks for T1D, suicidal ideation was directly linked to 'feeling guilt (PHQ.6)', 'Suicide (PHQ.9)', HbA1c, and FBS, while the Inhibition node was directly related to suicidal ideation. The DAGs suggested connections between 'depression', HbA1c, and 'inhibition' with suicidal ideation, along with a link between the current family history of suicide attempts and the patient's history of suicide attempts. For T2D, the MRF networks indicated direct links between suicidal ideation and 'anhedonia (PHQ.1)', 'suicide (PHQ.9)', age, being female, and BMI, with inhibition also being directly related to suicidal ideation. The DAGs revealed connections between 'depression', age, and 'inhibition' with suicidal ideation, as well as links between being female or single/divorced and the patient's history of suicide attempts.

CONCLUSION

The findings suggest that suicide ideation is highly prevalent in patients with diabetes, and these symptoms should be carefully monitored in these patients.

Evaluation of the psychometric indicators of the Comprehensive Autistic Trait Inventory in Iranian adults

BACKGROUND

The DSM-5's Comprehensive Autism Traits Inventory (CATI) was a useful diagnostic tool for the general population because it covered all the critical aspects of autism. However, its reliability and validity in the overall Iranian population still need to be investigated.

PURPOSE

We reviewed the inventory and estimated the validity and reliability of the Iranian version of CATI among 1800 adults.

METHODS

The Persian version of CATI (CATI-I) was administered to 1800 Iranian adults using the online Star Questionnaire system. Internal consistency, convergent validity, discriminant validity, test-retest reliability, and measurement invariance across genders were calculated.

RESULTS

The Correlated social & non-social bifactor model showed the best fit in the Iranian community (CFI=.966; TLI=.947; RMSEA=.045; SRMR=.028). Ultimately, the CATI-I scale in the Iranian community consisted of 39 items across six factors and two higher-order constructs. Additionally, the CATI-I scale's convergent validity and reliability values were acceptable.

CONCLUSION

The CATI-I demonstrates satisfactory reliability and validity in measuring autism traits. It is an appropriate model for the second-order social and non-social factors, and it also shows measurement invariance across genders.

Treatment Options for Urogenital Dysfunction in Parkinson's Disease

Urogenital dysfunction is commonly reported in Parkinson’s disease (PD), and history taking and a bladder diary form the cornerstone of evaluation. The assessment of lower urinary tract (LUT) symptoms include urinalysis, ultrasonography, and urodynamic studies and help to evaluate concomitant urological pathologies such as benign prostate enlargement. Antimuscarinic medications are the first line treatment for overactive bladder (OAB) symptoms and solifenacin has been specifically studied in PD. Antimuscarininc drugs may exacerbate PD-related constipation and xerostomia, and caution is advised when using these medications in individuals where cognitive impairment is suspected. Desmopressin is effective for the management of nocturnal polyuria which has been reported to be common in PD. Intradetrusor injections of botulinum toxin have been shown to be effective for detrusor overactivity, however, are associated with the risk of urinary retention. Neuromodulation is a promising, minimally invasive treatment for PD-related OAB symptoms. Erectile dysfunction is commonly reported and first line treatments include phosphodiesterase-5 inhibitors. A patient-tailored approach is required for the optimal management of urogenital dysfunction in PD.