Diabetes and depression

Evaluation of Quality of Life and Psychosocial Problems in Children with Type 1 Diabetes Mellitus

Objectives

To evaluate the frequency of psychosocial problems and the factors affecting the quality of life in children and adolescents aged between 8 and 18 years with type 1 diabetes mellitus (T1DM).

Methods

In the study, children and adolescents aged between 8 and 18 years who had been followed for at least 6 months for T1DM were evaluated (T1DM group), and compared with healthy children and adolescents who applied to the general pediatric outpatient clinic and did not have any chronic disease (control group). Data on disease follow-up of children and adolescents with T1DM were obtained from medical records. Sociodemographic characteristics of both groups were recorded in the study form. In addition, the Children's Depression Inventory (CDI), Screen for Child Anxiety Related Disorders (SCARED) and Children Quality of Life Questionnaire (KINDL: KINDerLebensqualitätsfragebogen) were applied to both groups. The scale scores of the T1DM group and the control group were compared. Factors affecting the scale scores of the T1DM group were evaluated.

Results

A total of 181 children or adolescents, 81 of whom were in the T1DM group and 100 in the control group, were evaluated for this study. The mean age was 13.1±2.4 years in the T1DM group and 12.4±2.1 years in the control group. The mean CDI, SCARED, and KINDL scores, respectively; it was 15.3±7.2, 23.6±11.9, and 53.5±13.7 in the T1DM group and 7.9±6.8, 14.7±13, 60±11.6 in the control group. There was a statistically significant difference between the two groups in terms of mean CDI, SCARED, and KINDL scores (all p values <0.001). As compliance with the diabetic diet decreased at home, there was a significant increase in the mean CDI score (p=0.005) and a significant decrease in the KINDL score (p=0.002). It was observed that KINDL score decreased significantly as compliance with the diabetic diet decreased outside the home (p=0.001).

Conclusion

Quality of life is lower, and levels of depression and anxiety are higher in children with T1DM compared to healthy children. Psychosocial support should be provided from the moment of diagnosis in order to improve the psychosocial problems and quality of life of children with T1DM.

A Hypothesis of Gender Differences in Self-Reporting Symptom of Depression: Implications to Solve Under-Diagnosis and Under-Treatment of Depression in Males

The phenomenon of female preponderance in depression has been well-reported, which has been challenged by higher rates of suicide and addictive behaviors in males, and a longer life-span in females. We thus propose an alternative hypothesis "Gender differences in self-reporting symptom of depression," suggesting mild-moderate depression tends to be reported more often by females, and severe depression and suicide tend to be reported more often by males. Potential mechanisms that account for this difference may include three aspects: covariation between estrogen levels and the incidence peak of female depression, gender differences in coping style (e.g., comparative emotional inexpressiveness and non-help-seeking in males), and gender differences in symptom phenotypes (e.g., atypical symptoms in male depression). Our newly presented hypothesis implied the overlooked under-diagnosis and under-treatment of depression in males. For effective diagnoses and timely treatment of male depression, it is critical to incorporate symptoms of depression in males into the relevant diagnostic criteria, encourage males to express negative emotions, and increase awareness of suicidal behavior in males.

Satisfaction about Patient-centeredness and Healthcare System among Patients with Chronic Multimorbidity

The aim of the present study was to measure the prevalence of multimorbidity in Bangladesh, India and China, and to assess the relationship between multimorbidity and patient's opinion regarding their involvement in healthcare decision-making and overall satisfaction of healthcare system. Cross-sectional data on 18 696 men and women aged 18 and above were collected from the World Health Survey of World Health Organization (WHO). Outcome variables were subjective rating of (1) healthcare system's ability to involve patients in decision-making, and (2) satisfaction with the way healthcare system runs in the country. Self-reported chronic conditions were used to measure the prevalence of multimorbidity. Out of 9 chronic conditions, back pain, arthritis, and chronic cough appeared to be the most prevalent ones among majority of the participants. About one-third of the participants in China (30.7%) and two-thirds in Bangladesh (66.1%) and India (66.6%) reported having at least one chronic illness. Prevalence of multimorbidity was highest in India (34.3%) followed by Bangladesh (28.8%) and China (14.3%). In Bangladesh, India and China, respectively 70.5%, 41.7%, 61.3% women and 54.5%, 42.8% and 58.8 % men expressed dissatisfaction regarding the way healthcare system runs in their country. In Bangladesh and India, men who were living with multimorbidity were more likely to rate the patient-centeredness as "bad" than those who had no disease illness. This study suggests that the prevalence of multimorbidity was remarkably high especially in Bangladesh and India. Higher likelihood of dissatisfaction about healthcare system among multimorbid patients might be indicative of inadequacy in the provision of care in qualitative and quantitative terms.

Neighborhood Social Environment and Patterns of Depressive Symptoms Among Patients with Type 2 Diabetes Mellitus

This study sought to examine whether neighborhood social environment was related to patterns of depressive symptoms among primary care patients with type 2 diabetes mellitus (DM). Neighborhood social environment was assessed in 179 patients with type 2 DM. Individual patient residential data at baseline was geo-coded at the tract level and was merged with measures of neighborhood social environment. Depressive symptoms at baseline and at 12-week follow up were assessed using the nine-item Patient Health Questionnaire (PHQ-9). Patients in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage were much less likely to have a persistent pattern of depressive symptoms compared to a pattern of few or no depressive symptoms (adjusted odds ratio (OR) = 0.06, 95 % confidence interval (CI) [0.01, 0.36]). Detrimental neighborhood influences may amplify risk for persistent depressive symptoms.

The comorbidity of diabetes mellitus and depression

Several factors, including sedentary lifestyle, obesity, and an aging population, contribute to epidemic rates of type 2 diabetes mellitus. Depression frequently occurs comorbidly with diabetes although it is unrecognized and untreated in approximately two thirds of patients with both conditions. The course of depression in patients with both diabetes and depression is chronic and severe. Up to 80% of patients with diabetes and depression will experience a relapse of depressive symptoms over a 5-year period. Depression is associated with nonadherence to diabetes self-care--including following dietary restrictions, medication compliance, and blood glucose monitoring--resulting in worse overall clinical outcomes. Due to potential negative health consequences associated with comorbid diabetes and depression, both conditions should be optimally treated to maximize patient outcomes.

Depressive und Angststörungen bei somatischen Krankheiten

Depressiv-ängstliche Störungen sind bei den unterschiedlichen somatischen Erkrankungen häufig. Sie sind nicht nur als Reaktion auf die Situation der Erkrankung zu verstehen, sondern in ein komplexes Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen, die das Zentralnervensystem oder endokrine Regulationssysteme direkt betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich.