The effect of depression on quality of life of patients with type II diabetes mellitus

Quality of life among residents of Gaza, Palestine: the predictive role of mental distress, fear of COVID-19, and social support

BACKGROUND

Living under siege and deteriorated health, social, educational, and economic conditions and isolation with scarce opportunities to fulfil basic needs and aspirations affect the civil population's mental health and perceived quality of life. In this cross-sectional investigation, we explored the consequences of mental distress, fear of COVID-19, and social support for QoL in the Gaza strip.

METHODS

Nine hundred seventy nine (32.9% males; 67.1% females; mean age was 35.2 years; s.d. = 11.4) adults were recruited in the Gaza strip. We used the Fear for COVID-19 scale (FCS-19), The WHOQOL-BREF Scale, Berlin Social Support Scale (BSSS), Depression Anxiety and Stress Scale (DASS). Pearson correlation coefficient was computed to assess relationships between quality of life, fear of COVID19, mental distress, and social support; a hierarchical regression analysis was used to assess the association between QoL as the dependent variable and demographic variables and fear of COVID19, mental health, and social support as the independent variables.

RESULTS

QoL was positively associated with perceived emotion, instrumental, and support seeking. Depression, anxiety, stress, and fear of COVID19 were negatively associated with quality of life. Gender was significantly associated with lower QoL. The study highlighted that the level of fear of COVID-19 was negatively influencing individuals' quality of life (QoL). This fear was negatively associated to psychological distress, gender, place of residence, and family type. Lower-educated and poorer participants had lower QoL scores. Conversely, female gender was notably linked to a lower QOL. The hierarchical regression confirmed that COVID-19 was an added burden for the Palestinian population. The fear of COVID-19 term added a 6.2% variance in QoL. In the final analysis, all predictors were statistically significant, with the fear of COVID-19 term recording a higher contribution of 22.5%, followed by depression term with 21.5%, perceived emotional 18.5%, income at 15.4%, and perceived instruments at 14.8% towards QoL.

CONCLUSIONS

Practitioners and policymakers must consider the severe violation of human rights when developing psychosocial programs to intervene in the COVID-19 crisis.

Neutrophil-to-lymphocyte ratio as a predictive biomarker for early diagnosis of depression: A narrative review

Depression is a mood disorder that causes persistent feelings of sadness, hopelessness, loss of interest, and decreased energy. Early diagnosis of depression can improve its negative impacts and be effective in its treatment. Previous studies have indicated that inflammation plays an important role in the initiation and development of depression, hence, various inflammatory biomarkers have been investigated for early diagnosis of depression, the most popular of which are blood biomarkers. The Neutrophil to lymphocyte ratio (NLR) may be more informative in the early diagnosis of depression than other widely used markers, such as other leukocyte characteristics or interleukins. Considering the importance of early diagnosis of depression and the role of NLR in early diagnosis of depression, our paper reviews the literature on NLR as a diagnostic biomarker of depression, which may be effective in its treatment. Various studies have shown that elevated NLR is associated with depression, suggesting that NLR may be a valuable, reproducible, easily accessible, and cost-effective method for the evaluation of depression and it may be used in outpatient clinic settings. Closer follow-up can be performed for these patients who have higher NLR levels. However, it seems that further studies on larger samples, taking into account important confounding factors, and assessing them together with other inflammatory markers are necessary to draw some conclusive statements.

Health-related quality of life of type 2 diabetes mellitus patients: A cross-sectional study in the cape coast metropolis

Background and Aim

Type 2 diabetes mellitus (DM) has in recent decades become a global pandemic, accounting for over 90% of DM cases. The study evaluated the health-related quality of life (HrQoL) and identified its determinants among type 2 DM patients at the University of Cape Coast Hospital.

Methods

We conducted our study at the University of Cape Coast Hospital from January to March 2022. The EQ-5D-5L questionnaire was administered to 68 type 2 DM patients. Data were then inputted into Microsoft Excel and analyzed accordingly using IBM SPSS statistical software version 26 and GraphPad Prism 8.

Results

The mean age of the participants was 60.71 ± 12.18 with 55.9% being females. The average systolic, diastolic blood pressure and fasting blood glucose (FBG) of participants were 140.99 ± 22.27, 85 ± 11.14 and 7.97 ± 2.66 respectively. With the EQ-5D-5L scale, participants reported severe to extreme problems mainly in pain/discomfort (19.1%) and mobility (8.8%) dimensions. Approximately 21% (14/68) of patients reported themselves as being in perfect health based on the EQ-5D index score with no significant difference between males and females (p ≥ 0.05). On a scale of 0 to 100, most (26.5%) of the participants rated their general health state at 80. Age was significantly associated with all five dimensions while patients with comorbidities had higher odds of experiencing pain/discomfort and anxiety/depression.

Conclusion

The study reveals that pain/discomfort and anxiety/depression are the most experienced problems among patients with type 2 DM. The HrQoL of type 2 DM patients was also found to be affected by age, comorbidities, systolic and diastolic blood pressure. Therefore, identifying these factors and developing appropriate interventions is crucial for improving patient outcomes and enhancing treatment outcomes.

The Role of Mass Media in Influencing the Lifestyle of the Elderly during the COVID-19 Pandemic

The elderly represent one of the categories that was most affected by the pandemic period. The purpose of this research was to analyze the ways in which mass media and very often contradictory information flows influenced the lives and personal communications of the Romanian elderly population during the COVID-19 pandemic. In order to conduct the research, we used a mixed-methods approach. For the quantitative research, we gave a questionnaire to the elderly population of Romania, and for the qualitative research, we conducted interviews. Our quantitative sample included 881 retired persons with an age between 55 and 94 years old; the mean age was 71.48 years old with 6.6 years standard deviation. The elderly described the pandemic period using negative words: fear, loneliness, anxiety, disaster; the channel they mostly watched and trusted was the TV; they were aware of the measures they had to take to protect themselves; they missed most of the meetings with the family and the main problems they had were represented by loneliness, the inability to be with their families or the lack of access to medical services. The elderly's mass media consumption during the pandemic was mostly represented by TV consumption; the information spread by mass media was sometimes contradictory; it influenced their behavior and may have generated feelings of anxiety among them.

Health-related quality of life, medical resource use and physical function in patients with diabetes mellitus and depression: A cross-sectional analysis from the National Health and Nutrition Examination Survey

BACKGROUND

Patients with either diabetes (DM) or depression (DP) are prone to developing other diseases and require more medical resources than do the general population. This study aimed to examine health-related quality of life, medical resource use, and physical function of patients with both diabetes mellitus and depression, and the magnitude of effects among patients with different combinations of comorbid diseases.

METHODS

A retrospective cross-sectional study was conducted using the National Health and Nutrition Examination Survey data from 2009 to 2014. Total 16,159 patients were studied and classified into one of 4 groups: both DM and DP(DM+/DP+), DM+/without DP(DP-), without DM (DM-)/DP+, and DM-/DP-, according to the perceived score in Patient Health Questionnaire and diabetes questionnaire in NHANES. Health-related quality of life (HRQoL), medical resource use, and physical function were measured as outcomes of interests. Multivariate logistic regression models were used.

RESULTS

Compared with DM-/DP- patients, the DM+/DP+ (adjusted odds ratio [AOR]: 2.59; 95 % CI: 1.77-3.80) and DM-/DP+ (AOR: 2.44; 95 % CI: 1.94-3.06) had greater likely to have worse health. In addition, the DM+/DP+ (AOR: 5.40; 95 % CI: 1.30-22.41) and DM+/DP- (AOR: 2.49; 95 % CI: 1.91-3.25) were more likely to have medical visits, and worse physical function.

CONCLUSIONS

This study found that both depression and diabetes mellitus worsen HRQoL, increase medical resource use, and decrease physical function. Depression status should be considered by clinicians treating diabetes mellitus patients in order to improve their HRQoL, reduce medical resource use, and improve physical function.

Relationships between Physical Activity Frequency and Self-Perceived Health, Self-Reported Depression, and Depressive Symptoms in Spanish Older Adults with Diabetes: A Cross-Sectional Study

Diabetes is one of the most prevalent noncommunicable diseases in the world. This disease can affect both physical and mental health in the population. This study analyzed the prevalence of Self-Perceived Health (SPH), self-reported depression, and depressive symptoms in comparison with the Physical Activity Frequency (PAF) reported by Spanish older adults with diabetes. A cross-sectional study was carried out with data from 2799 self-reported diabetic participants, all of whom were residents of Spain, aged 50-79 years, and included in the European Health Surveys carried out in Spain (EHIS) both in 2014 and 2020. The relationships between the variables were analysed with a chi-squared test. A z-test for independent proportions was performed to analyze differences in proportions between the sexes. A multiple binary logistic regression was carried out on the prevalence of depression. Linear regressions were performed on depressive symptoms and SPH. Dependent relationships were found between the SPH, self-reported depression, and depressive symptoms with PAF. Most of the very active participants reported a higher prevalence of self-reported depression. Physical inactivity increased the risk of depression, major depressive symptoms, and negative SPH.

Mapping post-traumatic stress disorder symptoms and quality of life among residents of Wuhan, China after the COVID-19 outbreak: A network perspective

OBJECTIVES

The Coronavirus Disease 2019 (COVID-19) outbreak may have a long-term impact on mental health in the general population. This study examined inter-relationships between post-traumatic stress disorder symptoms (PTSS) and quality of life (QOL) in Wuhan residents after the COVID-19 outbreak using network approach.

METHODS

A cross-sectional survey was conducted between May 25 and June 18, 2020. PTSS and QOL were measured using Chinese versions of the Post -Traumatic Stress Disorder Checklist - Civilian Version and the World Health Organization Quality of Life Questionnaire - brief version, respectively.

RESULTS

A total of 2598 participants were included. A network analysis revealed "Avoiding reminders", "Feeling emotionally numb", "Avoiding thoughts", "Hypervigilance", and "Reliving experiences" as the most central (influential) nodes in PTSS network models both before and after controlling for covariates. The connection between "Avoiding thoughts" and "Avoiding reminders" had the strongest edge. Three symptom communities were detected and can be summarized as "re-experiencing and avoidance", "negative changes in thinking and mood", and "hyperarousal". The bridge symptoms connecting PTSS and QOL were "Sleep disturbances", "Irritability", and "Loss of interest".

LIMITATIONS

Limitations included the cross-sectional study design, self-report measures in data collection, and lack of follow-ups beyond the initial phase of the pandemic.

CONCLUSIONS

PTSS were common among Wuhan residents even after the initial COVID-19 outbreak had passed. Attention should be paid to lingering symptoms of avoiding reminders, emotional numbness, avoiding thoughts, hypervigilance, and reliving experiences in treating PTSS related to the COVID-19 outbreak.

Prevalence of depressive symptoms and quality of life among patients with diabetes mellitus with and without HIV infection: A South African study

Background

Diabetes mellitus (DM) and human immunodeficiency virus (HIV) infection are both associated with increased risk of mood disorders and poorer quality of life (QOL). This association has not been explored in patients living with comorbid DM and HIV.

Aim

To describe the prevalence of depressive symptoms and impact on the QOL in patients with DM living with and without HIV attending a public sector hospital in South Africa.

Setting

A medical outpatient clinic at a state regional hospital.

Methods

A cross-sectional questionnaire pilot survey was conducted amongst 101 patients with DM attending a specialist medical outpatient service. The assessment was conducted using a structured socio-demographic and clinical questionnaire, the patient health questionnaire 9 (PHQ-9) for depressive symptoms and the World Health Organization QOL scale. The HIV status was confirmed from the clinical records. The correlates of depressive symptomatology in the participants with DM living with and without HIV were identified using t-tests.

Results

The prevalence of depressive symptoms in the participants with DM was 36%. Moderate to severe depression was associated with female gender (p = 0.03) and low educational level (p = 0.02) but not with HIV comorbidity or clinical characteristics of DM. The QOL was influenced by moderate to severe depressive symptoms (QOL in physical p < 0.218 and environmental p < 0.001 domains), but not HIV status (p = 0.218).

Conclusion

A substantial proportion of people with DM reported depressive symptoms, which is slightly higher than the average reported in other out-patient studies. The association of depression with poor QOL highlights the need for integrated mental health access in medical outpatient services. The lack of association between comorbid HIV status and DM with depression or QOL needs to be further explored.

Comparison of oxidative stress status and quality of life in participants with type 2 diabetes mellitus according to treatment modality

Background

Oxidative stress triggered by hyperglycemia in diabetic patients leads to macrovascular and microvascular complications, resulting in deterioration in the quality of life.

Aims

This study aimed to compare the oxidative stress status and quality of life in participants with type 2 diabetes mellitus according to treatment modality.

Patients and Methods

Ninety type 2 diabetes mellitus participants aged between 40 and 60 years were included in the study. Forty-five participants were receiving oral antidiabetic drugs and 45 participants were receiving insulin therapy. Total antioxidant status, total oxidant status, and paraoxonase-1 were measured and oxidative stress indices were calculated. The SF-36 quality of life questionnaire was applied to the participants.

Results

The total oxidant status and oxidative stress indices values were higher in the insulin-treated group than in the group treated with oral antidiabetic drugs. Paraoxonase-1 activities of the oral antidiabetic drugs-treated group were statistically significantly higher than the insulin-treated group. In the oral antidiabetic drugs-treated group, the physical function, social function, and pain subscale scores were higher than that of the insulin-treated group. In all participants, a negative correlation between total antioxidant status and fasting blood glucose and hemoglobin A1c, a positive correlation between total oxidant status and hemoglobin A1c and triglyceride, and a positive correlation was found between oxidative stress indices and fasting blood glucose and hemoglobin A1c.

Conclusions

It was found that oxidative stress parameters were higher and quality of life was worse in the insulin-treated participants than participants treated with oral antidiabetic drugs. These results may be closely related to more severe chronic complications in insulin-dependent diabetes.

The Association between Serum Neutrophil Gelatinase-Associated Lipocalin and Depression in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Patients wtih type 2 diabetes mellitus (DM) have an increased risk of depressive symptoms. Whether serum neutrophil gelatinase-associated lipocalin (NGAL) is associated with depressive symptoms in old patients with type 2 DM is still uncertain.

OBJECTIVE

We aim to investigate whether serum NGAL levels were associated with elevated risk of depressive symptoms in patients with type 2 DM in an old population.

METHODS

Blood samples from 1012 hospitalized patients were measured for serum NGAL within the first 24 hours after admission. The Center for Epidemiological Studies Depression (CES-D) scale was performed to calculate depressive score. Cox analyses were used to examine the prognostic value of serum NGAL on detecting depressive symptoms during a median period of 5 years (range = 0.3-6.2 years).

RESULTS

136 (36.6)% of all subjects have depressive symptoms during the follow-up period. Linear analysis showed that serum NGAL levels at baseline were associated with CES-D score after adjusting for clinically relevant variables in type 2 DM patients (Sβ = 0.118, 95% CI 0.106-0.171, P < .001) but not in non-DM patients (Sβ = 0.025, 95% CI, -0.047-0.083; P = .205). Cox analysis revealed that serum NGAL did have an independent prognostic value on predicting depressive symptoms (HR = 2.247, 95% CI 1.415-3.811, P-trend<0.001, Model 2) in type 2 DM patients but not in non-DM patients (HR = 1.811, 95% CI 1.209-3.292, P-trend = 0.189, Model 2) during follow-up period.

CONCLUSIONS

We found the first evidence that serum NGAL were strongly associated with depressive symptoms in patients with type 2 DM but not in non-DM patients. Further studies are needed to prove the underlying mechanism for the impact of type 2 DM on the association.

Prevalence of gastrointestinal complications in patients with type 2 diabetes mellitus in Iran: a systematic review and meta-analysis

Background

Type 2 diabetes is the most common diabetes in the world and constitutes a high percentage of diabetes cases. This study aims to determine the overall prevalence of gastrointestinal complaints in Iranian patients with type 2 diabetes.

Methods

The articles were extracted based on entry and exit criteria by searching the Cochrane (Embase), ScienceDirect databases. Scopus PubMed; And Web of Science (WoS), based on PRISMA 2009. To evaluate the studies, a 22-item STROBE checklist was selected and related items were used.

Results

The probability of publication bias in reporting the results was examined by the Egger test (P = 0.891). The prevalence rate of gastrointestinal complaints in patients with type 2 diabetes in Iran in 10 studies was 52.3% (95% CI: 33.4-70.7%). The results of metargression showed a significant difference between the sample size and the prevalence of gastrointestinal complaints in patients with type 2 diabetes (P < 0.05). and the prevalence of gastrointestinal complaints in patients with type 2 diabetes.

Conclusion

The results of this study report that, the prevalence of gastrointestinal complications in type 2 diabetes patients was high. As a result, appropriate measures should be taken to improve the condition of diabetic patients through appropriate policy-making and providing feedback to hospitals and patients.

Frequency of depression and quality of life in patients with diabetes mellitus in public health facilities in Metropolitan Lima

INTRODUCTION

Diabetes is one of the main pandemics in recent years. Its association with depression increases the risk of mortality and morbidity. The coexistence of both diseases leads to poor management of diabetes, which leads to a worse quality of life.

OBJECTIVE

To determine the frequency of depression in patients with diabetes mellitus and the effect of both pathologies on the quality of life in patients who attend outpatient appointments at public health facilities in Lima and Callao.

METHODOLOGY

Secondary analysis of the Epidemiological Study of Mental Health of depression in diabetic adults. The instrument used to determine the depressive episode was the MINI (Mini-International Neuropsychiatric Interview) while quality of life was measured using the Mezzich Quality of Life Index. Diagnosis information of type 1 or 2 diabetes was obtained from the daily medical record (HIS) of care.

RESULTS

The frequency of depression in the 471 patients with diabetes was 5.8% in the last two weeks. While the annual frequency was 8.6% and 31.8% at some point in life. Being a woman was associated with a greater frequency of depression. Quality of life was lower in patients with diabetes and depression (p < 0.005).

CONCLUSIONS

The frequency of depression in patients with diabetes who are treated on an outpatient basis in public health centres is higher than the general population and their quality of life is significantly reduced, which raises the need for considering depression as an additional factor to the burden of morbidity of this condition.

Prevalence of Mental Health Disorders among Elderly Diabetics and Associated Risk Factors in Indonesia

This cross-sectional study aimed to explore mental health disorders (MHD) prevalence among elderly diabetics in Indonesia. Data were extracted from the 2018 national basic health survey in Indonesia (abbreviated as RISKESDAS). The survey involved households randomly selected from 34 provinces, 416 districts, and 98 cities in Indonesia, with 1,017,290 respondents. The number of subjects selected in this study was 2818 elderly diabetic subjects. MHD was determined by self-reporting assessment. Secondary data acquired from RISKESDAS 2018 data involved age, sex, urban–rural residence status, marital status, educational level, employment status, obesity, hypertension, heart disease, stroke, family history of MHD, and DM duration. Binary logistic regression with a backward stepwise method was used to analyze the risk factors related to MHD. MHD prevalence among elderly diabetics in Indonesia was 19.3%. Factors associated with MHD among elderly diabetics were being female (prevalence odds ratio (POR) = 1.64; 95% CI: 1.126–2.394), married (POR = 0.05; 95% CI: 0.031–0.084), less education (POR = 3.37; 95% CI: 1.598–10.355), and stroke (POR = 1.61; 95% CI: 1.183–2.269). MHD prevalence among elderly diabetics in Indonesia was 19.3%, suggesting that screening for psychological problems and educating elderly diabetic patients is essential. Unmarried female elderly diabetics with less education and stroke were altogether more likely to experience MHD.

Health-related quality of life among people with type 2 diabetes mellitus - A multicentre study in Bangladesh

AIMS

This study aimed to explore the health-related quality of life and the various demographics and clinical characteristics associated with it among people with type 2 diabetes mellitus in Bangladesh.

METHODS

A total of 1253 participants with type 2 diabetes were recruited from a cross-sectional and retrospective study conducted in Bangladesh in 2017. Participants were recruited from six rural and urban diabetes hospitals. The health-related quality of life of the participants was assessed using the validated EuroQol-5D-5L scale and EuroQol-VAS score. Information was collected via face-to-face interviews and existing medical records. Data was analysed using univariate and multivariable regression analyses with bootstrap resampling.

RESULTS

The average health-related quality of life was 0.64 (±0.20) for EQ-5D-5L score and 61.69 (±34.98) for EQ-VAS score. Old age, low income, low education level, residing in an urban area, longer duration of diabetes, being physically inactive, the presence of macro- and/or micro-vascular complications, impaired cognitive function, being depressed and having anxiety were related to poor health-related quality of life.

CONCLUSION

The health-related quality of life among people with type 2 diabetes in Bangladesh is low, and various socio-demographic and psychological factors and diabetes-related complications are associated with it. This finding will help reform treatments and enforce lifestyle modifications to ensure that the burden of diabetes on people's quality of life is minimal.

Unemployment associated with major depression disorder and depressive symptoms: a systematic review and meta-analysis

Objectives. This study investigated the association between unemployment and depressive symptoms and major depression disorder worldwide using a systematic review and meta-analysis. Methods. Search time was limited to all articles published in English until December 2020. In the association between unemployment and depression, first, the results of qualified studies were extracted and, then, the results of each study were pooled with each other using the random effects method. Results. The prevalence of depression in the unemployed is 21%, 95% confidence interval (CI) [18, 24%]. This prevalence for depression symptoms is 24%, 95% CI [20, 28%] and for major depressive disorder is 16%, 95% CI [9-24%]. The association between unemployment and depressive symptoms was odds ratio (OR) 2.06, 95% CI [1.85, 2.30] and the association for major depressive disorder was OR 1.88, 95% CI [1.57, 2.25]. The association between unemployment and depression in men was OR 2.27, 95% CI [1.76, 2.93] and in women was OR 1.62, 95% CI [1.40, 1.87]. Conclusions. What is clear from the present study is that unemployment can lead to a higher prevalence of depressive symptoms and major depressive disorder, thereby undermining the mental health of the unemployed.

Adaptation of the COV19-QoL Scale to Turkish culture: Its psychometric properties in diagnosed and undiagnosed individuals

This study was conducted to adapt the COV19-QoL scale to Turkish culture and to examine its psychometric properties in individuals diagnosed with and without COVID-19. A total of 1069 people aged between 18 and 65 years participated in the study. The COV19-QoL_TR scale has six items, and it was confirmed to be one-dimensional in the Turkish sample (participants diagnosed with and without COVID-19 and the general population). Participants' perceived quality of life and levels of anxiety and depression were the most affected areas and their physical and mental health levels were the least affected by the pandemic.

The effects of wheat germ consumption on mental health and brain-derived neurotrophic factor in subjects with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial

Objectives: Herbals, as bioactive foods, have been one of the most popular alternatives and complementary treatments in preventing and controlling type 2 diabetes mellitus (T2DM). The aim of the present trial was to examine the effects of wheat germ consumption on mental health and brain-derived neurotrophic factor (BDNF) among patients with T2DM.Methods: Eighty participants with T2DM were randomly allocated to receive 20 g wheat germ (n = 40) or placebo (n = 40) in a randomized double-blind clinical trial for 12 weeks. Depression, anxiety, stress scale-21 (DASS-21) questionnaire was used to assess the mental health of study participants. Serum BDNF was assessed at the baseline and end of intervention. Anthropometric indices were measured at the baseline, 6 and 12 weeks during the intervention.Results: A total of 75 subjects completed the trial. Compared with the placebo, wheat germ consumption led to a significant reduction in depression (P = .03) and stress (P = .04) scores. Moreover, a significant increase in serum BDNF concentrations was observed in the wheat germ group (P = .004), while there was no significant difference between the groups. Wheat germ intake had no significant effects on anthropometric indices and anxiety scores between the groups.Conclusion: Our findings showed that wheat germ consumption for 12 weeks could significantly reduce the stress and depression scores but had no significant effects on anxiety scale and anthropometric outcomes in patients with T2DM.

Quality of Life and its Determinants in Patients with Diabetes Mellitus from Two Health Institutions of Sub-himalayan Region of India

BACKGROUND

Diabetes mellitus (DM) causes serious deterioration in general quality of life (QoL) mainly affecting the health-related quality of life (HRQOL). Routine assessment of QoL improves communication with the patient, helps to predict treatment response, and supports clinical decision-making. QoL can predict an individual's capacity to manage the disease and maintain long-term health and wellbeing.

AIMS

To find out the QoL and its socio-demographic, anthropometric, and clinical determinants among DM patients attending health institutions from sub-Himalayan region, catering rural population.

SETTINGS AND DESIGN

This cross-sectional study was conducted in two hospitals mostly catering rural population from 2014 to 2018. Purposive sampling technique was used.

MATERIALS AND METHODS

Socio-demographic, anthropometric, and clinical data of DM patients (N = 300) were collected. They were administeredHindi translation of QoL Instrument for Indian Diabetes Patients (QOLID) and Patient Health Questionnaire-9 (PHQ-9). All statistical analyses were carried out using Statistical Package for Social Sciences (SSPS) (Version 17.0, USA).

RESULTS

About 10% had very poor, 13% poor, 11% average, 16% good, and 50% very good QoL on QOLID. General health (GH) and treatment satisfaction (TS) were the most affected domains. Fatigue was the most common symptom (79%) reported in QOLID. Age more than 55 years, rural background, and PHQ-9 score of more than 7 were predictors of poorer QoL.

CONCLUSION

There is a need for a holistic and collaborative care of DM patients, to maintain a good HRQoL. Screening of depression, fatigue, and regular assessment of QoL should be emphasized.

Depression and Health-Related Quality of Life Among Elderly Patients during the COVID-19 Pandemic in Israel: A Cross-sectional Study

AIM

This study aims to assess how optimism, social support, and perceived susceptibility are associated with depressive symptoms and health-related quality of life among elderly patients during the COVID-19 pandemic in Israel.

METHODS

In a cross-sectional study, 256 participants age 60 through 95 completed the following self-administered questionnaires: Perceived Susceptibility, Life Orientation Test (LOT-R), Multidimensional Scale of Perceived Social Support (MSPSS), Symptoms of Depression (CES-D) and health-related quality of life (SF-12v2 Health Survey). Data were collected from June to July 2020, 3 months after the COVID-19 state of emergency was declared in Israel. Participants were interviewed by family medicine residents via telephone. Statistical analyses included Pearson correlations, t-tests between groups, regression analyses, and Hayes' PROCESS to analyze a moderated mediation model.

RESULTS

Of the elderly participants, 37.5% were classified as having depression. Optimism, social support and health-related quality of life were positively associated. Higher optimism and social support were related to lower perceived susceptibility and lower depression. Results of a multivariate regression explained 29% of the variance in depression and 19% of the variance in health-related quality of life. The relationships assessed by 4 Process models were significant, such that higher optimism and social support were related to lower perceived susceptibility, which in turn was related to higher depression and lower health-related quality of life.

CONCLUSIONS

Optimism and social support may be effective in coping with challenges and buffering depression. Perceived susceptibility may mediate the association of optimism and social support with higher depression and lower health-related quality of life. The conclusions of this study underscore the need to treat depression among older adults during this period. Hence, healthcare providers should also support elderly patients living at home. In giving this type of help, healthcare providers should strive to increase social support and optimism among older adults.

The Association between Neutrophil-to-Lymphocyte Ratio and Diabetic Depression in U.S. Adults with Diabetes: Findings from the 2009-2016 National Health and Nutrition Examination Survey (NHANES)

Objective

To determine the association between neutrophil-to-lymphocyte ratio (NLR) and clinically relevant depressive symptoms in people with diabetes.

Methods

This cross-sectional study was conducted among adults (age >18) with diabetes in the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2016. NLR was calculated from complete blood count. Nine-item Patient Health Questionnaire (PHQ-9) was used to measure depression, with scores ≥10 indicating the presence of clinically relevant symptoms. Multivariable logistic regression was used to calculate the odds ratio (OR) with 95% confidence interval (CI) of clinically relevant depressive symptoms in relation to the NLR. We performed the smooth curve fitting and established a weighted generalized additive model to identify the nonlinearity of NLR and depression in diabetes patients. To account for the nonlinear relationship between NLR and depression in diabetes patients, weighted two-piecewise linear model was applied.

Results

We included 2,820 eligible participants, of which 371 (12.4%) had clinically relevant depressive symptoms. In the unadjusted model, the OR (95% CI) of clinically relevant depressive symptoms for the second (NLR 1.75-2.57) and third (NLR >2.57) were 1.24 (0.90, 1.70) and 1.68 (1.23, 2.30), respectively, compared to the reference group (NLR < 1.75). After controlling for potential confounding factors, NLR was significantly associated with clinically relevant symptoms (odds ratio = 1.57, 95% confidence interval: 1.13–1.87; P for trend = .0078). Nonlinear relationships were observed, and a two-piecewise linear regression model was established. The inflection point of NLR was 2.87. To the left of the inflection point (NLR ≤ 2.87), the OR (95% CIs) was 1.33 (1.07–1.66) (P < .031).

Conclusions

Elevated levels of NLR are independently associated with increased odds of clinically relevant depressive symptoms in people with diabetes. Prospective study is needed to further analyze the role of NLR in depression in diabetic patients.

Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19

INTRODUCTION

High risk of mental health problems is associated with Coronavirus Disease 2019 (COVID-19). This study explored the prevalence of depressive symptoms (depression hereafter) and its relationship with quality of life (QOL) in clinically stable patients with COVID-19.

METHODS

This was an online survey conducted in COVID-19 patients across five designated isolation hospitals for COVID-19 in Hubei province, China. Depression and QOL were assessed with standardized instruments.

RESULTS

A total of 770 participants were included. The prevalence of depression was 43.1% (95%CI: 39.6%-46.6%). Binary logistic regression analysis found that having a family member infected with COVID-19 (OR=1.51, P = 0.01), suffering from severe COVID-19 infection (OR=1.67, P = 0.03), male gender (OR=0.53, P<0.01), and frequent social media use to obtain COVID-19 related information (OR=0.65, P<0.01) were independently associated with depression. Patients with depression had lower QOL than those without.

CONCLUSION

Depression is highly prevalent in clinically stable patients with COVID-19. Regular screening and appropriate treatment of depression are urgently warranted for this population.

Perceptions and experiences of living with coexisting type 2 diabetes and severe mental illness: a scoping review

AIMS

To map existing research-based knowledge of everyday life and illness management among people with coexisting type 2 diabetes and severe mental illness, and to identify study designs, aims, populations and themes.

METHODS

A systematic literature search was performed on 16 April 2019 using Medline, Embase, PsycINFO, Cinahl, the Cochrane Library, and the Web of Science to conduct a scoping review. Included studies were summarized with regard to the quantity of research, the study designs, aims, populations and themes RESULTS: From 3406 records, we included 23 studies about everyday life and illness management among people with coexisting type 2 diabetes and severe mental illness. Four studies were qualitative (observations, interviews and focus groups), and 19 were quantitative (observational and interventions) and used questionnaires. Five themes emerged in the findings: (1) diet and exercise, but not other diabetes self-care activities, are consistently compromised in the target group; (2) psychiatric exacerbation diminishes diabetes self-care; (3) social support and high self-efficacy improve diabetes self-care; (4) use of healthcare services is compromised; and (5) quality of life and well-being is poor.

CONCLUSIONS

The limited research into the studied population's experiences with coexisting type 2 diabetes and severe mental illness is characterized by its heterogeneity in aims and methods and a strong focus on diabetes management and treatment. Further research focusing on the management of both conditions in everyday life is needed to improve specialized and integrated care targeting the population.

The relationship between trust in primary healthcare providers among patients with diabetes and levels of depression and anxiety

Background

Trust in healthcare providers has been shown to improve several clinical and patient-reported outcomes. However, its relationship with depression and anxiety has not been investigated among patients with chronic health conditions, such as diabetes. Therefore, the aim of this study was to examine whether trust in primary care physicians among patients with diabetes is associated with their levels of depression and/or anxiety.

Method

Adult patients (≥18 years) with a diagnosis of diabetes, confirmed through their electronic health records, were recruited and interviewed from the primary care clinics of three public hospitals. Patient trust in primary care physicians was assessed using the Health Care Relationship (HCR) Trust scale. Depression and anxiety were assessed using the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7), respectively. Two multiple linear regression analyses were conducted to examine the association of HCR-Trust scores with PHQ-9 and GAD-7 scores controlling for age, sex, Charlson comorbidity index score, education, health literacy, annual income, nationality, duration of illness, and research site.

Results

The number of patients who agreed to be interviewed was 367. Most of the participants were female (61.54%) and Saudi (92.86%). High HCR-Trust scores were negatively associated with PHQ-9 scores (β = -0.18; 95% CI: -0.23 –-0.13; P = < .0001), and GAD-7 scores (β = -0.17; 95% CI: -0.22– -0.12; P = < .0001).

Conclusions

Trust in primary care physicians among patients with diabetes was associated with lower levels of depression and anxiety. Therefore, healthcare providers should adopt a patient-centered care approach that fosters trust in the relationship between their patients and themselves. Further research should explore whether interventions that foster shared decision-making and trust in healthcare providers might also improve the health outcomes of patients with diabetes.

Associations of diabetes severity and risk of depression: a population-based cohort study

OBJECTIVE

Previous literature investigating effects of diabetes complications on subsequent depression have been inconsistent. We aim to investigate associations of diabetes, complication severity, and depression.

DESIGN

This study used a nationwide database to establish an 11-year cohort comprised of people with new onset Type II diabetes mellitus (DM) aged 20 and above.

METHOD

Severity of DM was measured using the adapted Diabetes Complication Severity Index (aDCSI). Status of depression was determined by having one recorded depression diagnosis from the inpatient setting or three recorded depression diagnoses from the outpatient setting. The risk of depression was analyzed by multivariate Cox proportional models.

RESULTS

In 50,590 cases with new onset DM from years 2000 to 2011, the incidence of depression increased with severity and rates of progressions in diabetes complications regardless of demographic status, comorbidities, or medication compliance. Adjusted hazard ratios (aHR) of depression were 1.21, 1.25, 1.48 (p<0.001 for trend) in patients with a total aDCSI score of 1, 2, and > 3, respectively. Risks of depression were the highest in subgroup with the most serious progression (change of aDCSI score >2 per year) (aHR ranged between 11.6~26.0). Elevated risks of depression (aHR: 1.59~4.36) were also observed in the slower progression subgroups throughout the disease course.

CONCLUSIONS

Risks of depression were associated with multiple DM-related complications and rates of progression in severity.

Frequency of Depression and Quality of Life in Patients with Diabetes Mellitus in Public Health Facilities in Metropolitan Lima

INTRODUCTION

Diabetes is one of the main pandemics in recent years. Its association with depression increases the risk of mortality and morbidity. The coexistence of both diseases leads to poor management of diabetes, which leads to a worse quality of life.

OBJECTIVE

To determine the frequency of depression in patients with diabetes mellitus and the effect of both pathologies on the quality of life in patients who attend outpatient appointments at public health facilities in Lima and Callao.

METHODOLOGY

Secondary analysis of the Epidemiological Study of Mental Health of depression in diabetic adults. The instrument used to determine the depressive episode was the MINI (Mini-International Neuropsychiatric Interview) while quality of life was measured using the Mezzich Quality of Life Index. Diagnosis information of type 1 or 2 diabetes was obtained from the daily medical record (HIS) of care.

RESULTS

The frequency of depression in the 471 patients with diabetes was 5.8% in the last two weeks. While the annual frequency was 8.6% and 31.8% at some point in life. Being a woman was associated with a greater frequency of depression. Quality of life was lower in patients with diabetes and depression (p <0.005).

CONCLUSIONS

The frequency of depression in patients with diabetes who are treated on an outpatient basis in public health centres is higher than the general population and their quality of life is significantly reduced, which raises the need for considering depression as an additional factor to the burden of morbidity of this condition.

Effects of Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy in People With Diabetes: A Systematic Review and Meta-Analysis

PURPOSE

The purpose of this study was to determine the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on depression, quality of life (QoL), and glycosylated hemoglobin (HbA1c) in people with diabetes.

DESIGN

A systematic literature review and meta-analysis was conducted.

METHODS

Eight databases (PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], Cochrane, PsycINFO, and three Chinese databases) were searched for relevant studies from inception to December 2019. Only randomized controlled trials (RCTs) of MBSR and MBCT interventions for people with type 1 and type 2 diabetes were included.

FINDINGS

Nine studies described in 11 articles were included in the review. Meta-analysis showed a significant effect favoring MBSR and MBCT on depression (standardized mean difference -0.84; 95% confidence interval [CI] -1.16 to -0.51; p < .0001), the mental health composite score of QoL (mean difference [MD] 7.06; 95% CI 5.09 to 9.03; p < .00001), and HbA1c (MD -0.28; 95% CI -0.47 to -0.09; p = .004). However, effects on the physical health composite score of QoL have not been found.

CONCLUSIONS

MBSR and MBCT are beneficial in improving depression, the mental health composite score of QoL, and HbA1c in people with diabetes. More well-designed trials using longer follow-up measurements are needed.

CLINICAL RELEVANCE

MBSR and MBCT could be considered as effective complementary treatment alternatives for people with diabetes.

Depression among Peruvian adults with hypertension and diabetes: Analysis of a national survey

BACKGROUND AND AIMS

Hypertension and diabetes are global health problems with an incidence that is rapidly increasing worldwide. Depression is the most frequent mental health co-morbidity and is considered an important risk factor for the development of both diseases. This study aimed to determine the prevalence and factors associated with depression among Peruvian adults with hypertension and diabetes.

METHODS

We performed a secondary analysis of the 2017 Peru Demographic and Family Health Survey, using data from 10,566 adults aged 40 and older. The main outcome was depression assessed with the Patient Health Questionnaire-9 (PHQ-9). Other important variables were the diagnosis of hypertension or diabetes, sex, age, level of education, geographical region, wealth index, daily smoking, harmful alcohol consumption and physical disability.

RESULTS

The overall prevalence of depression was 23.15% (CI 95%: 21.42%-24.88%) and among adults with hypertension and diabetes it was 34.96% (CI 95%: 29.33%-40.59%) and 35.56% (CI 95%: 24.49%-46.63%), respectively. Whereas the prevalence of depression among adults with type 2 diabetes mellitus (T2DM) was higher in the physical disability group (PRa: 1.28; CI 95%: 1.12-1.45), the prevalence of depression among adults with hypertension was higher in the female group (PRa: 1.36; CI 95%: 1.20-1.54) and among those with harmful alcohol consumption (PRa: 1.50; CI 95%: 1.01-2.24).

CONCLUSION

Peru has a considerable burden of depression in the hypertensive and diabetic populations. While the variables positively associated with depression in hypertensive adults were female gender and harmful alcohol consumption, in adults with diabetes it was the presence of physical disability.

Prevalence of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in Iran: A Systematic Review and Meta-Analysis

BACKGROUND

Type 2 diabetes mellitus (DM) is the most common type of DM and accounts for 90% of the cases. One of the most important complications of type 2 DM is cardiovascular complications, which are the most common cause of mortality in patients with DM. Various studies have reported different incidence rates of cardiovascular disease in patients with type 2 DM. However, no comprehensive review of previous studies has been done. This study is aimed at determining the prevalence of cardiovascular disease in patients with type 2 diabetes mellitus in Iran with a systematic review and meta-analysis.

METHODS

In this review, studies were first extracted searching domestic and international databases including SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI), published between 2001 and September 2019. The random effects model was adopted for the analysis, and heterogeneity of the extracted studies was investigated with the I ² index. The data collected from the extracted studies were analyzed using a comprehensive meta-analysis (Version 2) software.

RESULTS

The prevalence of cardiovascular disease in patients with type 2 DM in Iran in 17 studies with a sample size of 9656 was 37.4% (95% CI: 31.4-43.8). Based on meta-regression, there was a significant difference on the effect of year of conducting the study and sample size with the prevalence of cardiovascular disease in patients with type 2 DM in Iran (p ≤ 0.001).

CONCLUSION

The results of this study indicated that there was a high prevalence rate of cardiovascular disease in patients with type 2 DM in Iran. Therefore, appropriate strategies should be taken to improve this situation and trace and supervise it at all levels, providing feedback to hospitals.

Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus

Diabetes complications, medication adherence, and psychosocial well-being have been associated with quality of life (QOL) among several Western and Asian populations with diabetes, however, there is little evidence substantiating these relationships among Malaysia’s unique and diverse population. Therefore, a cross-sectional study was conducted in a Malaysian public primary care clinic among 150 patients diagnosed with type 2 diabetes mellitus (T2DM). Structured and validated questionnaires were used to investigate the associations between demographic, clinical, and psychological factors with QOL of the study participants. Approximately three-quarters of patients had a good-excellent QOL. Diabetes-related variables that were significantly associated with poor QOL scores included insulin containing treatment regimens, poor glycemic control, inactive lifestyle, retinopathy, neuropathy, abnormal psychosocial well-being, higher diabetes complication severity, and nonadherence (p < 0.05). The main predictors of a good-excellent QOL were HbA1c ≤ 6.5% (aOR = 20.78, 95% CI = 2.5175.9, p = 0.005), normal anxiety levels (aOR = 5.73, 95% CI = 1.8–18.5, p = 0.004), medication adherence (aOR = 3.35, 95% CI = 1.3–8.7, p = 0.012), and an aDCSI score of one and two as compared to those greater than or equal to four (aOR = 7.78, 95% CI = 1.5–39.2, p = 0.013 and aOR = 8.23, 95% CI = 2.1–32.8, p = 0.003), respectively. Medication adherence has also been found to be an effect modifier of relationships between HbA1c, depression, anxiety, disease severity, and QOL. These predictors of QOL are important factors to consider when managing patients with T2DM.

Health-related quality of life among people living with type 2 diabetes: a community based cross-sectional study in rural Nepal

Background

Diabetes as being a chronic disease with a number of complications deteriorates the quality of life among the people with type 2 diabetes. Health related quality of life is widely used as an important health outcome measure worldwide. This study assessed the quality of life among the people living with type 2 diabetes in rural area of eastern Nepal.

Methods

A cross sectional study was conducted among type 2 diabetic patient of rural area of eastern Nepal. Pre-tested Nepali version of D-39 questionnaire was administered through face to face interview to assess the quality of life. Door to door visit was done to identify all the type 2 diabetic patients residing in Baniyani village. Data was entered in Micro-soft excel 2007 and further processed in SPSS v.11.5 for analysis.

Results

Highest quality of life mean (SD) score was in social burden domain (56.26 ± 12.07), followed by sexual functioning domain (54.35 ± 9.47), Anxiety and worry domain (54.33 ± 7.76), energy and mobility domain (51.46 ± 8.73) and diabetes control domain (50.08 ± 10.84). There was negative correlation between age and domains sexual functioning (p = 0.001) and energy and mobility (p = 0.002). In bivariate analysis, there was significance difference by sex in sexual functioning (p = 0.002), educational status in diabetes control (p = 0.021), smoking habit in energy and mobility (p = 0.038), duration of disease in diabetes control (p = 0.002) and sexual functioning (p = 0.001), presence of co-morbidity in social burden (p = 0.034) and family history of diabetes in anxiety and worry (p = 0.042).

Conclusion

Increasing age affects sexual life and mobility of the type 2 diabetic patient. The domain sexual functioning is difference by sex and presence of co-morbidity. Similarly, domain diabetic control is affected by duration of disease and educational status of the patient. And having family history of diabetes affects the mental state of the type 2 diabetic patient.

The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies

AIMS

Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies.

METHODS

MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11".

RESULTS

In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%).

CONCLUSION

Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.

Geriatric syndromes and quality of life in older adults with diabetes

AIM

To describe geriatric syndromes and their relationships with quality of life in older adults with diabetes.

METHODS

Community-dwelling older adults (aged >60 years) with diabetes (n = 316) participated in the present study. Eight geriatric syndromes, including polypharmacy (number of medications), pain (Brief Pain Inventory), urinary incontinence (International Consultation on Incontinence Questionnaire), sleep disturbance (hours of sleep), lower cognitive level (Mini-Mental State Examination), falls, depressive symptoms (Geriatric Depression Scale short form) and functional limitation (Barthel Index and Instrumental Activity of Daily Living), were assessed. The WHOQOL-BREF Taiwan version was used to measure physical, psychological, social and environmental domains of quality of life.

RESULTS

Polypharmacy was the most common geriatric syndrome (46.6%), followed by pain (41.5%). Participants with any of the geriatric syndromes, except for polypharmacy and sleep disturbance, had significantly poorer quality of life than those without. The Geriatric Depression Scale score was the only common and significant contributor to all four domains of quality of life, explaining 16~29% of the variance. Number of medications, pain level and cognitive level were also significant contributors, although they explained a small amount (<5%) of the variance. The number of geriatric syndromes (mode = 2) was significantly correlated with all four domains of quality of life (partial correlation r = -0.278~0.460, all P < 0.001).

CONCLUSIONS

Geriatric syndromes, especially polypharmacy and pain, were common among older adults with diabetes. A greater number of geriatric syndromes or a higher Geriatric Depression Scale score were associated with poorer quality of life. Further studies focusing on combinations of different geriatric syndromes or comorbidities are required. Geriatr Gerontol Int 2019; 19: 518-524.

Fatores associados à qualidade de vida de brasileiros e de diabéticos: evidências de um inquérito de base populacional

Resumo Buscou-se avaliar as associações entre condições de saúde e características sociodemográficas em relação à qualidade de vida (QV) na população brasileira; bem como estimar os principais fatores associados às chances de uma melhor QV entre diabéticos. Trata-se de um estudo com dados obtidos do inquérito de base populacional realizado no Brasil, em 2008. Foram analisados 12.423 brasileiros, com idade ≥ 20 anos, cujos 935 eram diabéticos. Os desfechos de QV foram mensurados por meio dos componentes sumários do instrumento SF-36. Tanto para a população geral quanto para diabéticos, a QV teve seus escores agrupados em “acima” e “abaixo da média” para configurar desfechos binários. Foram realizadas regressões logísticas para obtenção das razões de prevalências ajustadas às chances de QV acima da média, controlando por variáveis sociodemográficas e de saúde. Resultados apontaram que as mulheres diabéticas com ≥ 65 anos, sedentárias, pertencentes à classe D/E e com mais morbidades apresentam maiores chances de uma pior QV física e mental. Para a população geral além desses fatores, não ter um companheiro e ser analfabeto proporcionou uma pior QV. O sedentarismo e a classe D/E apresentaram maior influência para pior QV entre diabéticos quando comparado à população total.

The combined polymorphisms of interleukin-6-174GG genotype and interleukin-10 ATA haplotype are associated with a poor quality of life in patients with chronic hepatitis C

PURPOSE

Chronic hepatitis C (CHC) is associated with a decreased health-related quality of life (HRQOL). More recent studies have pointed toward a genetic basis of patient-reported quality of life outcomes. Taking into account that the influence of single-nucleotide polymorphisms (SNPs) on the HRQOL of CHC patients has not been studied, we investigated the combined IL10-1082G/A, - 819C/T, and - 592C/A SNPs, and IL6-174G/C SNP. We also evaluated the association between demographic, clinical, psychiatric, virological, and genetic variables with domains and summaries of HRQOL in CHC patients.

METHODS

132 consecutive CHC patients and 98 controls underwent psychiatric evaluation by using the Mini International Neuropsychiatric Interview. HRQOL was assessed by a generic questionnaire, the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and by the specific Liver Disease Quality of Life Questionnaire (LDQOL). IL6 and IL10 polymorphisms were evaluated by Taqman SNP genotyping assay. Multivariate analysis was used to evaluate the associations.

RESULTS

Major depressive disorder was associated with lower SF-36 and LDQOL scores in seven and ten domains, respectively. Diabetes and hypertension were also associated with reduced HRQOL. CHC patients carrying the combination of IL10 ATA haplotype/IL6-GG genotype had lower scores in the SF-36-physical functioning domain, and reduced scores in the LDQOL effects of liver disease on activities of daily living, quality of social interaction, and sexual function domains than the non-carriers of the combined haplotype/genotype.

CONCLUSION

This is the first study to demonstrate that combined IL6 high-producer GG genotype and IL10 low-producer ATA haplotype is associated with poorer HRQOL in CHC patients.

Web-Based Interventions for Depression in Individuals with Diabetes: Review and Discussion

Background

Depression is twice as common in people with diabetes, and this comorbidity worsens the course of both pathologies. In clinical practice guidelines, screening and treatment of depression in patients with diabetes are highly recommended. However, depression is still both underrecognized and undertreated. To find ways to enhance their reach, psychological treatments have taken advantage of benefits of internet and technological devices as delivery formats, providing interventions that require considerably less (or even no) interaction time with therapists. Web-based treatments hold promise for effective interventions at low cost with positive results.

Objective

The objectives of this review were to describe Web-based interventions for depression in individuals with diabetes and to discuss these studies’ procedures and findings in light of evidence from a wider range of interventions for depression and diabetes.

Methods

A comprehensive literature search was conducted in PsycINFO and MEDLINE electronic databases. Studies were included when they met the following selection criteria: the study was available in a peer-reviewed journal mainly publishing studies written in either English or Spanish; the studied sample comprised individuals with diabetes; the intervention targeted depression symptomatology; the intervention was accessible via the internet; and the intervention was accessible via the internet with little or no clinician support.

Results

Overall, 5 research studies were identified in the review. All studies were randomized controlled trials, and most used a wait list as a control; 4 studies reported treatment dropout, rates of which varied from 13% to 42%. Studies supported the notion that the Web-based format is a suitable psychology service delivery option for diabetic individuals with depression (effect size range for completers 0.7-0.89). Interventions varied in their characteristics but most were clinical-assisted, had a cognitive behavioral therapy approach, used diabetes-specific topics, had a weekly modular display, used homework assignments, and had some adherence management strategy. These characteristics are consistent with the intervention features associated with positive results in the literature.

Conclusions

The analyzed studies’ findings and procedures are discussed in light of evidence drawn from a wider range of reviews on Web-based interventions for depression and diabetes. Consistent with previous research on depression treatment, Web-based interventions for depression among individuals with diabetes have shown positive results. Future research should contribute new evidence as to why these interventions are effective, for whom, and which particular aspects can increase patients’ adherence.

Emotional and Psychological Needs of People with Diabetes

Diabetes is a chronic metabolic disorder that impacts physical, social and mental including psychological well-being of people living with it. Additionally, psychosocial problems that are most common in diabetes patients often result in serious negative impact on patient's well-being and social life, if left un-addressed. Addressing such psychosocial aspects including cognitive, emotional, behavioral and social factors in the treatment interventions would help overcome the psychological barriers, associated with adherence and self-care for diabetes; the latter being the ultimate goal of management of patients with diabetes. While ample literature on self-management and psychological interventions for diabetes is available, there is limited information on the impact of psychological response and unmanaged emotional distresses on overall health. The current review therefore examines the emotional, psychological needs of the patients with diabetes and emphasizes the role of diabetologist, mental health professionals including clinical psychologists to mitigate the problems faced by these patients. Search was performed using a combination of keywords that cover all relevant terminology for diabetes and associated emotional distress. The psychological reactions experienced by the patient upon diagnosis of diabetes have been reviewed in this article with a focus on typical emotional distress at different levels. Identifying and supporting patients with psychosocial problems early in the course of diabetes may promote psychosocial well-being and improve their ability to adjust or take adequate responsibility in diabetes self-management - the utopian state dreamt of by all diabetologists !.

Predictors of Depression Among Adult Women With Diabetes in the United States: An Analysis Using National Health and Nutrition Examination Survey Data From 2007 to 2012

PURPOSE

The purpose of the study was to identify the sex-specific characteristics that predict depression among adult women with diabetes.

METHODS

Data from the 2007-2012 National Health and Nutrition Examination Survey in the United States were used to identify the predictors of depression in a large sample of women ages 20 years and older with diabetes (n = 946).

RESULTS

When extrapolated to almost 9 million women in the United States ≥ 20 years of age with diabetes, 19.0% had depression. Female-specific significant predictors of depression included younger age (< 65 years old), less than high school graduation, self-rated fair or poor health, inactivity due to poor health, and pain that interferes with usual activities. Marital status and diabetes-related factors (years living with diabetes, use of insulin, parent or sibling with diabetes) were not significant predictors of depression in adult women with diabetes.

CONCLUSION

When educating and counseling women with diabetes, diabetes educators should be aware that some of the predictors of depression in women with diabetes differ from those of populations that include both sexes. Depression screening, although important for all women with diabetes, should especially be performed among women with female-specific depression predictors.

Independent socio-demographic and clinical correlates associated with the perception of quality of life of women with postpartum depressionin North-central, Nigeria

OBJECTIVE

Quality of life (QoL) is probably the most desired outcome of all health care policies and monitoring. This concept is seldom used on women in the postpartum, especially in the developing world.

AIM

This study aimed at determining the independent socio-clinical variables associated with the perception of QoL of women with postpartum depression.

METHODS

A two-stage cross-sectional procedure was used to recruit 550 participants, out of whom 531 participants completed the questionnaires with 116 participants found to have postpartum depression and were the studied population, in Nigeria. The Socio-demographic questionnaire, the Edinburgh Postnatal Depression Scale, the World Health Organization Quality of Life-Bref-26 and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis were used.

RESULTS

Participants with postpartum depression had significantly poor perception of QoL in all the four domains of the WHOQoL-BREF-26. The independent socio-demographic and clinical correlate associated with poor perception for both rating of QoL and satisfaction with health was education (β = 0.321, p < .001 and β = 0.0326, p = .002, respectively); for physical domain [(modes of delivery) (β = -0.28, p = .016)]; psychological domain [(age <35years) (β = 0.391, p = .010)] and for social relationships [(complications during delivery) (β = 0.257, p = .043)].

CONCLUSIONS

The determination of the predictors of QoL, which is an indicator of disease outcome will improve service delivery to women of childbearing age.

Perceived quality of life and acceptance of illness in people with type 2 diabetes mellitus

Objectives

Type 2 diabetes exerts a significant impact on the patient’s quality of life. Its chronic nature, incurability and complications weaken the motivation of patients to fight the disease and its acceptance. The aim of research was to determine whether and to what extent diabetes modulates the quality of life of patients and in particular which domain of the patient’s life is most limited. In addition, we looked at whether the quality of life perceived by patients is determined by gender and whether and to what extent they accept their illness.

Material and methods

A study on 100 patients with type 2 diabetes from the Wielkopolska region in Poland was carried out at the end of 2013/beginning of 2014 using a diagnostic survey, and the research techniques were a standardized questionnaire – ADDQoL19 (Audit of Diabetes-Dependent Quality of Life 19) and the AIS questionnaire (Acceptance of Illness Scale) developed by Felton and modified by Juczyński.

Results

The results suggest that the quality of life of the patients was “neither good nor bad”, whereby women perceive it as being lower than men. While analysing the impact of diabetes on the different domains of the lives of men and women, it should be stressed that most affected were diet, satisfying appetite, independence, financial position, feelings about the future, sex life, and freedom in the consumption of drinks. More than half of men and women did not accept their illness; however, younger persons unlike older accepted diabetes to a much greater degree.

Conclusions

Type 2 diabetes negatively affects the quality of life of patients and its impact is felt more by women. In both sexes, the most affected domain of quality of life is the lack of nutritional freedom. The acceptance of illness is dependent upon age.

Quality of life of diabetic patients with smear positive PTB in southeastern Iran: A cross-sectional study in a poor region of Iran

BACKGROUND

The quality of life is an important indicator of quality of care in chronic diseases such as diabetes and TB. The present research is conducted with an aim to assess the Quality of Life of Diabetic Patients with Smear Positive PTB.

METHODS

This cross-sectional study was conducted on 62 diabetic patients with smear positive PTB from January to May 2016 in a diabetes clinic in Zahedan city (southeast of Iran). A simple random sampling method was used in this study. Instrument for data collection was quality of life (SF-36) questioner.

RESULTS

Total quality of life score was 48 that showed an average level of quality of life. Sixty-five patients with diabetes and affected by smear positive pulmonary tuberculosis (PTB) with the average age of 51.30±10.84 years participated in this research. Four patients (0.06%) suffered from type 1 diabetes and 58 (94%) from type 2 diabetes, and all of them were smear positive PTB patients. Study of their quality of life revealed that, in general, the average scores for quality of life in the two main subgroups of physical health and mental health were lower than the average and, among the eight studied dimensions, the highest scores were those for physical activity (60±14.23) and the lowest (31.42±12.14) for general health in the subgroup of physical health.

CONCLUSION

Results indicated that the patients had a low quality of life although they received the care and treatments that are effective in patients with diabetes and suffering from smear-positive PTB.

Effect of 12 Weeks of Yoga Therapy on Quality of Life and Indian Diabetes Risk Score in Normotensive Indian Young Adult Prediabetics and Diabetics: Randomized Control Trial

Introduction

India has become the epicentre for diabetes, a stress-related disorder affecting the working skills and day-to-day lifestyle management of younger population. Most of the studies have reported the effect of yoga on improving Quality of Life (QoL) in diabetic patients with other comorbidities. Till date, no randomized control trial reports are available to show the effect of yoga therapy on QoL and Indian Diabetes Risk Score (IDRS) in normotensive prediabetic and diabetic young individuals.

Aim

To determine the effect of 12 weeks of yoga therapy on QoL and IDRS among normotensive prediabetic and diabetic young Indian adults.

Materials and Methods

A randomized control trial was conducted in Endocrinology Outpatient Department (OPD). Normotensive participants (n=310) aged 18-45 years were divided into healthy controls (n=62), prediabetics (n=124) and diabetics (n=124). Study group subjects were randomly assigned to Group II (n=62, prediabetes-standard treatment), Group III (n=62, prediabetes-standard treatment + yoga therapy), Group IV (n=62, diabetes-standard treatment) and Group V (n=62, diabetes-standard treatment + yoga therapy). Flanagan QoL scale, IDRS questionnaire, Fasting Plasma Glucose (FPG) and insulin were assessed pre and post 12 weeks of intervention. Statistical analysis was done using Student's paired t-test and one-way ANOVA.

Results

Pre-post intervention analysis showed significant improvement in QoL scale with p<0.01 in Group II and Group IV; p<0.001 in Group III and Group V respectively. There was significant reduction in IDRS in Group II (p<0.05); p<0.001 in Group III, Group IV and Group V respectively. Significant difference (p<0.001) in QoL scale and IDRS were found when study groups with standard treatment along with yoga therapy were compared to standard treatment alone.

Conclusion

Yoga therapy along with standard treatment for 12 weeks improved QoL and attenuated the diabetes risk among Indian prediabetics and diabetics compared to standard treatment alone.

The effectiveness of cognitive behavioural therapy for depressed patients with diabetes: A systematic review

Depression is common among patients with diabetes, who have a higher risk of diabetes-related complications such as diabetic retinopathy, nephropathy, neuropathy and macrovascular complications. The aim of the systematic review is to determine whether cognitive behavioural therapy is effective in reducing depressive symptoms and improving glycaemic control among depressed diabetic patients. The results reveal diversified application of cognitive behavioural therapy. All studies reported that cognitive behavioural therapy had a positive impact on depressive symptoms; three found an improvement in glycated haemoglobin, and one demonstrated improved self-efficacy and self-concept related to successful diabetes management. There is a need for controlled studies with larger sample sizes and long-term follow-up.

Occurrence and Predictors of Depression and Poor Quality of Life among Patients with Type-2 Diabetes: A Northern India Perspective

BACKGROUND AND AIMS

Globally, depression has been linked to Type-2 diabetes mellitus (T2DM). However, similar data from India are scant. This study evaluated the occurrence and predictors of depression and health-related quality of life (QOL) in patients with T2DM as compared to healthy controls.

MATERIALS AND METHODS

One hundred adults with T2DM without prior diagnosis of depression and 100 matched controls were evaluated. Depression was assessed using Patient Health Questionnaire-9. World Health Organization QOL Brief (WHO-QOL-BREF) was used to assess QOL. Demography, anthropometry, biochemical parameters of diabetes control, and microvascular and macrovascular complications in patients were recorded.

RESULTS

Depression was significantly more common in T2DM (63%) as compared to controls (48%) (odds ratio [OR] - 1.84 [1.04, 3.24]; P = 0.03). In T2DM, depression was higher in patients with disease duration >5 years (OR = 2.66; P = 0.02), glycated hemoglobin >7% (OR = 3.45; P = 0.004), retinopathy (OR - 3.56; P = 0.03), and nephropathy (OR - 4.11; P = 0.07). Occurrence of depression was significantly higher among the patients with macrovascular complications, namely, coronary artery disease (17.4%; P = 0.000006), cerebrovascular disease (14.2%; P = 0.0006), and peripheral vascular disease (7.9%; P = 0.05). Insulin users had higher depression as compared to patients using only oral antihyperglycemic medications (P = 0.034). Patient with depression had significantly low QOL. The WHO-QOL for all the domains was significantly lower in T2DM with microvascular and macrovascular complications, as compared to those without.

CONCLUSION

Indian T2DM had higher prevalence of depression and lower QOL as compared to controls, which was associated with poor glycemic control and higher end-organ damage. Public health measures are required to create more awareness for managing depression in diabetes.

Type D personality as a predictor of self-efficacy and social support in patients with type 2 diabetes mellitus

OBJECTIVE

The aim of this study was to estimate the prevalence of Type D personality and assess the relationship between this personality type and self-efficacy/social support in Chinese patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

From January 1, 2014, to July 31, 2014, 532 consecutive patients with T2DM were recruited from two hospitals in Guangzhou, China. The participants completed questionnaires containing questions about sociodemographic characteristics, Type D personality, self-efficacy, and social support scales, and their medical records were reviewed for additional data.

RESULTS

Of the 532 patients, 18.2% had Type D personality. Patients with this personality type reported significantly lower levels of self-efficacy (P<0.001), total social support (P<0.001), subjective support (P<0.001), and support utilization (P=0.003), but similar level of objective support (P=0.314), compared to those of patients without Type D personality. Negative affectivity and social inhibition, two intrinsic traits of Type D personality, negatively correlated with self-efficacy and social support scores. Type D personality was significantly associated with less self-efficacy and social support (P<0.001), controlling for other sociodemographic factors. Glycosylated hemoglobin (HbA1c) levels were significantly higher in T2DM patients with Type D personality than in patients with non-Type D personality.

CONCLUSION

This study provides new evidence linking Type D personality with self-efficacy, social support, and poor glycemic control, highlighting the special need for care among T2DM patients with Type D personality.

Health-Related Quality of Life and its Determinants Among Women With Diabetes Mellitus: A Cross-Sectional Analysis

BACKGROUND

Diabetes is a chronic and threatening condition. However, there are controversies on the factors affecting the health related quality of life (HRQOL) in patients with diabetes.

OBJECTIVES

The current study aimed to evaluate HRQOL and its determinants among females with type II diabetes referred to Diabetes Clinic of Khoy city, Northwest of Iran.

PATIENTS AND METHODS

This cross-sectional study was performed on 352 eligible females with diabetes referring to Diabetes Clinic of Khoy. The study data were collected using a three-part instrument including a socio-demographic questionnaire, a questionnaire to assess patients' knowledge on diabetes and the world health organization's quality of life (WHOQOL-BREF) questionnaire. Based on descriptive and inferential statistics, analyses were conducted using frequency, independent samples t-test, correlation coefficient and regression analysis.

RESULTS

The total mean score of QOL was 58.02 ± 17.63. The lowest and the highest mean scores were observed in physical health and social relationship domains (53.84 ± 17.09) and (65.08 ± 14.87), respectively. The regression models revealed that age, education, duration of disease, and family income were significantly associated with all areas of quality of life (P < 0.05). The results also revealed that co-morbidity was significantly correlated with the overall quality of life and the physical health domain (P < 0.01).

CONCLUSIONS

The mean score of quality of life (QOL) in females with diabetes was far from desirable condition. These findings can help physicians and healthcare providers to design suitable interventions to improve the patients QOL.

Depression and Health-Related Quality of Life among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Nepal

Background

Diabetes is accompanied by a marked reduction in patient’s quality of life (QOL) and leads to higher disability-adjusted life years than most diseases. Depression further deteriorates QOL and is associated with poor treatment outcomes and lowered glycemic control in diabetes. We analysed the QOL and depression among the people living with diabetes in Nepal.

Methods

We conducted a cross-sectional survey among a random sample of 157 diabetic patients visiting diabetes clinic at a major teaching hospital in Kathmandu, Nepal. We administered the Nepali version of WHO-BREF for face to face interviews to obtain data on QOL scores. The Nepali version of Patient Health Questionnaire-9was also used to record responses on depression items.

Results

More than half of the respondents (54.1%) experienced depression with mean PHQ-9 score of 6.15 ± 5.01 on a scale of 0–27. On a scale of 0 to 100, highest QOL mean score was reported in social relationship domain (57.32 ± 11.83), followed by environment domain (54.71 ± 7.74), psychological health (53.25 ± 10.32) and physical health (50.74 ± 11.83). After adjusting for other covariates, urban residence decreased the physical health score by 4.74 (β = -4.74, 95% CI: -8.664,-0.821), social relationship domain score by 3.420 (β = -3.420, 95% CI: -6.433,-0.406) and the overall QOL by 2.773 (β = -2.773, 95% CI: -5.295,-0.252). Having diagnosed with diabetes since more than 10 years increased physical health by 5.184 score points (β = 5.184; 95% CI: 0.753, 9.615).Similarly, having severe depression decreased social relation domain score by 6.053 (β = -6.053, 95% CI:-11.169,-.936).

Conclusion

Having urban residence significantly decreased the physical health and social relation domain scores as well as the overall QOL scores. Similarly, having diagnosed since more than 10 years increased physical health domain score. Severe depression decreased social relationship domain score. Since depression affects QOL, we suggest early diagnosis and prompt treatment of depression in T2DM people as part of their routine primary care in Nepal.

Depression treatment and health-related quality of life among adults with diabetes and depression

BACKGROUND

Previous findings regarding depression treatment and its consequences on health-related quality of life (HRQoL) of adults with diabetes were inconsistent and targeted certain groups of population. Therefore, there is a critical need to conduct a population-based study that focuses on a general population with diabetes and depression.

OBJECTIVE

The primary aim of this study was to examine the physical and mental HRQoL associated with depression treatment during the follow-up year.

METHODS

We adopted a longitudinal design using multiple panels (2005-2011) of the Medical Expenditure Panel Survey to create a baseline year and follow-up year. We included adults with diabetes and depression. We categorized the baseline depression treatment into: (1) antidepressant use only; (2) psychotherapy with or without antidepressants; and (3) no treatment. HRQOL was measured using SF-12 version 2 physical component summary (PCS) and SF-12 mental component summary (MCS) scores during both baseline year and follow-up year. Ordinary least squares (OLS) were used to estimate the association between depression treatment and the HRQoL measures. The OLS regression controlled for predisposing, enabling, need, external environment factors, personal health practices, and baseline HRQoL measures.

RESULTS

After controlling for all the independent variables and the baseline PCS, individuals who received psychotherapy with or without antidepressants had higher PCS scores as compared to those without any treatment for depression (beta = 1.28, p < 0.001). Individuals who reported using only antidepressants had lower PCS scores (beta = -0.54, p < 0.001) as compared to those without depression treatment. On the contrary, individuals who reported receiving psychotherapy with or without antidepressants had lower MCS scores as compared to those without depression treatment (beta = -1.43, p < 0.001). Those using only antidepressants had higher MCS scores as compared to those without depression treatment (beta = 0.56, p < 0.001).

CONCLUSION

The associations between depression treatment and the HRQoL varied by the type of depression treatment and the component of the HRQoL measures.

Use of the 9-Item Patient Health Questionnaire for Depression Assessment in Primary Care Patients With Type 2 Diabetes

The purpose of the current study was to assess the frequency and distribution of the 9-Item Patient Health Questionnaire (PHQ-9) among individuals with type 2 diabetes with and without depression. The current case-control study used electronic medical record data from two primary care institutions. The sample was divided into cases with coexisting depression and type 2 diabetes and controls without depression. Data included demographics, biomarkers, number of services delivered, and clinic visits in 2013. Similar PHQ-9 use was seen between unique primary care practices. However, less than one third of patients at either site received depression screening with the PHQ-9 in 2013. Male and older adult patients were less likely to receive assessment. Guideline ambiguity and lack of accountability in primary care practice has made the use of depression metrics arbitrary in diabetic populations at risk for depression. To assure adequate care provision, it is imperative that proven tools for assessing depressive symptoms are used.

TYPE 2 DIABETES IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER: A META-ANALYSIS OF PREVALENCE ESTIMATES AND PREDICTORS

BACKGROUND

Patients with depression may be at increased risk of type 2 diabetes mellitus (T2DM), which is a risk factor for cardiovascular diseases and premature mortality. We aimed to clarify the prevalence and predictors of T2DM in patients with major depressive disorder (MDD) and where possible compare the prevalence of T2DM in those with MDD versus general population controls.

METHODS

We searched major electronic databases until December 2014 for studies reporting T2DM prevalence in patients with MDD. Two independent authors extracted data and completed methodological quality appraisal in accordance with the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. A random effects meta-analysis was utilized.

RESULTS

The initial electronic database search resulted in 145 valid hits and 16 publications with clearly defined MDD (n = 15,8834; 31% male; mean age = 39-78 years) met the eligibility criteria. The overall prevalence of T2DM was 8.7% (95% confidence interval [CI] = 7.3-10.2%). Mean age of the MDD sample predicted a higher prevalence of T2DM (β = 0.0411; 95% CI = 0.0032-0.079, P = .03; R² = .22). A comparative meta-analysis revealed people with MDD (n = 154,366) had a higher risk of T2DM versus general controls (n = 2,098,063; relative risk [RR] = 1.49; 95% CI = 1.29-1.72; P < 0.001, N = 10). The RR (N = 3) focusing on age- and gender-matched general population controls (n = 103,555) was 1.36 (95% CI = 1.28-1.44; P < 0.001, n [MDD] = 10,895).

CONCLUSIONS

T2DM is significantly more common in people with MDD compared with the general population. The current meta-analysis indicates that action is needed in order to curb the diabetes epidemic in this high-risk population.

Validation of WHOQOL-BREF in Malayalam and Determinants of Quality of Life Among People With Type 2 Diabetes in Kerala, India

Quality of life (QOL) is an important health outcome in people with chronic conditions like diabetes and WHOQOL-BREF is a popular instrument used worldwide to assess QOL. However, QOL varies considerably from society to society depending on the culture of the person. Hence, the WHOQOL-BREF was translated to the local language, Malayalam. This article attempts to establish reliability, construct and discriminant validity of the translated WHOQOL-BREF, and determinants of QOL among people with type 2 diabetes. A cross-sectional study was undertaken among 200 patients with diabetes attending a primary care center in a rural area of Kerala, India. The translated version of WHOQOL-BREF was found to be internally consistent (Cronbach's α = .86) and demonstrated discriminant and construct validity. Education was found to be an independent determinant of QOL in the physical, psychological, and environmental domains. Thus, the translated version had good psychometric properties and education was an independent determinant of QOL in 3 of 4 domains.