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Snoek FJ. Mental health in diabetes care. Time to step up. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:1039192. [PMID: 36992782 PMCID: PMC10012141 DOI: 10.3389/fcdhc.2022.1039192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
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IŞIK G, EGELİOĞLU CETİŞLİ N. The Effect of Gestational Diabetes on Depression and Breastfeeding Self-Efficacy in Pregnancy and Postpartum Period. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.770882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The purpose of this study was to explore the effect of gestational diabetes mellitus (GDM) on depression and breastfeeding self-efficacy during pregnancy and the postpartum period.
Methods: This descriptive study was conducted in Obstetrics and Perinatology clinics of two university hospitals in Turkey between July 2016 and June 2017. Women were followed up two times. The first follow-up was performed face-to-face in the gestational week 34th to 38th and the second one was performed by telephone in the 8th week of the postpartum period. In the first follow-up, 104 pregnant women with GDM and 133 pregnant with non-GDM women were interviewed. In the second follow up, 30 women could not be reached in both groups. Data were collected by the Individual Description Form, Edinburgh Postpartum Depression Scale, and Breastfeeding Self-Efficacy Scale-Short Form. Descriptive statistics, repeated measures analysis of variance and correlation analysis were used in the data analysis.
Results: The depression risk of mothers with GDM was found higher compared to non- GDM mothers. No significant difference was found between the depression and breastfeeding self-efficacy mean scores in the antenatal and postpartum period of women by the presence of GDM. There was no significant difference between the depression and breastfeeding self-efficacy mean scores in the antenatal and postpartum period by the presence of GDM and some confounding variables. As the breastfeeding self-efficacy level of mothers with GDM both in the antenatal and postpartum period increased, the depression risk decreased.
Conclusion: In the study, it has been concluded that GDM does not have an impact on depression and breastfeeding self-efficacy during pregnancy and in the postpartum period.
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Affiliation(s)
- Gülşen IŞIK
- İZMİR KATİP ÇELEBİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, HEMŞİRELİK BÖLÜMÜ, KADIN HASTALIKLARI VE DOĞUM HEMŞİRELİĞİ ANABİLİM DALI
| | - Nuray EGELİOĞLU CETİŞLİ
- İZMİR KATİP ÇELEBİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, HEMŞİRELİK BÖLÜMÜ, KADIN HASTALIKLARI VE DOĞUM HEMŞİRELİĞİ ANABİLİM DALI
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Elgendy R, Deschênes SS, Burns RJ, Levy M, Schmitz N. Alcohol consumption, depressive symptoms, and the incidence of diabetes-related complications. J Diabetes 2019; 11:14-22. [PMID: 29989328 DOI: 10.1111/1753-0407.12822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Heavy alcohol consumption in individuals with type 2 diabetes mellitus (T2DM) is related to increased risks of diabetes-related micro- and macrovascular complications. Depressive symptoms may be relevant to this relationship, because high depressive symptoms are associated with an increased risk of complications. This study investigated whether the interaction between depressive symptoms and alcohol frequency was positively related to the development of neuropathy, retinopathy, nephropathy, and coronary artery disease (CAD), such that those with high depressive symptoms and high alcohol frequency will be at increased risk of complications. METHODS Data were from five waves of the Evaluation of Diabetes Treatment annual survey including 1413 adults with T2DM in Quebec. Data on alcohol frequency (number of drinking occasions), depressive symptoms, and complications were collected annually. The development of each complication was investigated using multiple logistic regression analysis with generalized estimating equations. RESULTS After adjusting for sociodemographic, lifestyle, and diabetes-related covariates, the interaction between alcohol frequency and depressive symptoms was positively related to the incidence of neuropathy and CAD, such that those with high depressive symptoms who drank the most frequently had the highest risk of neuropathy (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00-1.04; P = 0.04) and CAD (OR 1.02, 95% CI 1.00-1.04; P = 0.04). This interaction was not significantly related to retinopathy or nephropathy. CONCLUSION Individuals with high depressive symptoms and high alcohol frequency may have a particularly high risk of neuropathy and CAD. Future prevention efforts should examine both alcohol frequency and depressive symptoms when evaluating the risk of complications.
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Affiliation(s)
- Randa Elgendy
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
- Douglas Mental Health University Institute, Montreal, Canada
| | - Sonya S Deschênes
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
- Douglas Mental Health University Institute, Montreal, Canada
| | - Rachel J Burns
- Department of Psychology, Carleton University, Ottawa, Canada
| | - Melanie Levy
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
- Douglas Mental Health University Institute, Montreal, Canada
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Canada
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Is There a Relationship Between Gestational Diabetes and Perinatal Depression? MCN Am J Matern Child Nurs 2018; 43:206-212. [PMID: 29958203 DOI: 10.1097/nmc.0000000000000439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perinatal depression (PND) is one of the leading complications associated with childbirth. Early detection and treatment of depression, particularly during the perinatal period, is essential for the promotion of positive maternal-child outcomes. Gestational diabetes mellitus (GDM) has been suggested as a confounding factor associated with PND. Concerns associated with PND include interference with maternal-newborn bonding and long-term effects of neurobehavioral consequences. An exemplar case describing one woman's experience with GDM and her subsequent complications associated with PND is presented to discuss maternal depression and its plausible association with GDM. Recommendations include universal screening with the validated Edinburgh Postnatal Depression Scale screening tool during the early perinatal period to reduce incidence of maternal-newborn complications associated with PND and promote underpinnings for best practice.
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Molife C. Is Depression a Modifiable Risk Factor for Diabetes Burden? J Prim Care Community Health 2018; 1:55-61. [DOI: 10.1177/2150131909359633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this review article was to examine the empirical evidence supporting depression as a risk factor for diabetes complications and associated burden. A database search using keywords located recent clinical and population studies addressing the association between depression and type 2 diabetes. Both cross-sectional and cohort studies were reviewed. Depression appears to exacerbate the progression of type 2 diabetes. The evidence is strong supporting the hypothesis that depression in persons with diabetes increases the risk of diabetes-related burden, including suboptimal glycemic control, complications, functionality, mortality, and health care utilization. Screening for depression among patients with diabetes should be increased in primary care. Newer approaches to diabetes care management may help to slow the progression of diabetes.
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Affiliation(s)
- Cliff Molife
- Walden University, College of Health Sciences, Baltimore, MD, USA
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Pan S, Liu ZW, Shi S, Ma X, Song WQ, Guan GC, Zhang Y, Zhu SM, Liu FQ, Liu B, Tang ZG, Wang JK, Lv Y. Hamilton rating scale for depression-24 (HAM-D 24) as a novel predictor for diabetic microvascular complications in type 2 diabetes mellitus patients. Psychiatry Res 2017; 258:177-183. [PMID: 28774662 DOI: 10.1016/j.psychres.2017.07.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022]
Abstract
The study was designed to investigate whether the hamilton rating scale for depression (24-items) (HAM-D24) can be used to predict the diabetic microvascular complications in type 2 diabetes mellitus (T2DM) patients. 288 hospitalized patients with T2DM were enrolled. Their diabetic microvascular complications including diabetic nephropathy, diabetic retinopathy, diabetic peripheral neuropathy and diabetic foot as well as demographic, clinical data, blood samples and echocardiography were documented. All the enrolled patients received HAM-D24 evaluation. The HAM-D24 score and incidence of depression in T2DM patients with each diabetic microvascular complication were significantly higher than those in T2DM patients without each diabetic microvascular complication. After the adjustment of use of insulin and hypoglycemic drug, duration of T2DM, mean platelet volume, creatinine, albumin, fasting glucose, glycosylated hemoglobin type A1C, left ventricular ejection fraction, respectively, HAM-D24 score was still significantly associated with diabetic microvascular complications (OR = 1.188-1.281, all P < 0.001). The AUC of HAM-D24 score for the prediction of diabetic microvascular complication was 0.832 (0.761-0.902). 15 points of HAM-D24 score was considered as the optimal cutoff with the sensitivity of 0.778 and specificity of 0.785. In summary, HAM-D24 score may be used as a novel predictor of diabetic microvascular complications in T2DM patients.
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Affiliation(s)
- Shuo Pan
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Zhong-Wei Liu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Shuang Shi
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Xun Ma
- Department of Emergency Medicine, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Wen-Qian Song
- Department of Internal Medicine, University Hospital of Northwest University, Xi'an, Shaanxi, People's Republic of China
| | - Gong-Chang Guan
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Yong Zhang
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Shun-Ming Zhu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Fu-Qiang Liu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Bo Liu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Zhi-Guo Tang
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Jun-Kui Wang
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China.
| | - Ying Lv
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China.
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Thomas A, Ashcraft AS, Owen DC, Conway-Phillips R. Making It All Work: Qualitative Descriptions of Hispanic Adults Managing Type 2 Diabetes With Limited Resources. Glob Qual Nurs Res 2017; 4:2333393617691860. [PMID: 28462356 PMCID: PMC5302170 DOI: 10.1177/2333393617691860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 01/23/2023] Open
Abstract
The greater prevalence of type 2 diabetes is a critical issue among the U.S. Hispanic population. This study examined the struggles of Hispanic adults managing type 2 diabetes with limited resources. Ten Hispanic adults (enrolled in a larger study to determine the effects of diabetes self-management intervention), 25 to 80 years of age and living in a rural West Texas county in the United States, were selected. Three categories of challenges emerged: (a) diabetes self-care behaviors and challenges, (b) challenges with limited resources, and (c) challenges with support mechanisms. "Making it all work" was the overarching theme that tied all the categories together. This study offers lessons for health care providers and policymakers on how to maximize the availability of resources for Hispanic individuals with type 2 diabetes living within the constraints of limited resources.
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Affiliation(s)
- Annie Thomas
- Loyola University Chicago, Chicago, Illinois, USA
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Morrison C, McCook JG, Bailey BA. First trimester depression scores predict development of gestational diabetes mellitus in pregnant rural Appalachian women. J Psychosom Obstet Gynaecol 2016; 37:21-5. [PMID: 26594894 DOI: 10.3109/0167482x.2015.1106473] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Gestational diabetes (GDM) occurs in up to 9% of pregnancies. Perinatal depression affects up to 20% of women during pregnancy, and can extend into the postpartum period. A number of studies have linked depression and diabetes, however, whether this applies to GDM or which might come first is less understood. The purpose of this study was to examine the potential relationship between depression identified in the first trimester of pregnancy and the subsequent development of GDM. Women without pre-existing Type I/II diabetes (n = 1021) were evaluated for depression during the first trimester of pregnancy, and medical records were reviewed to identify a positive history of diabetes. Women identified as depressed during the first trimester were more likely to have GDM compared to those not depressed. After controlling for demographic factors and weight-related variables level of depression in the first trimester still predicted later GDM development. Depression identified in early pregnancy may predict increased risk of subsequent GDM development. Due to the numerous maternal, fetal and neonatal complications associated with GDM, early recognition is essential to promote the best possible outcomes for mother and infant. Recognizing depression as a possible risk factor for GDM development could lead to earlier screening and preventative measures.
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Affiliation(s)
- Chelsea Morrison
- a College of Nursing, East Tennessee State University , Johnson City, TN , USA and
| | - Judy G McCook
- a College of Nursing, East Tennessee State University , Johnson City, TN , USA and
| | - Beth A Bailey
- b Department of Family Medicine , College of Medicine, East Tennessee State University , Johnson City, TN , USA
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Byrn M, Penckofer S. The Relationship Between Gestational Diabetes and Antenatal Depression. J Obstet Gynecol Neonatal Nurs 2015; 44:246-55. [DOI: 10.1111/1552-6909.12554] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Hazel-Fernandez L, Xu Y, Moretz C, Meah Y, Baltz J, Lian J, Kimball E, Bouchard J. Historical cohort analysis of treatment patterns for patients with type 2 diabetes initiating metformin monotherapy. Curr Med Res Opin 2015; 31:1703-16. [PMID: 26154837 DOI: 10.1185/03007995.2015.1067194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe treatment regimen changes of patients with type 2 diabetes mellitus (T2DM) initiating metformin monotherapy, and assess factors associated with those changes 12 months post-initiation. METHODS Retrospective cohort analysis of medical, pharmacy and laboratory claims of 17,527 Medicare Advantage (MAPD) Humana members aged 18-89, who had ≥1 medical claim with primary diagnosis or ≥2 medical claims with secondary diagnosis of T2DM (ICD-9-CM code 250.x0 or 250.x2) who filled an initial prescription for metformin (GPI code 2725) between 1 January 2008 and 30 September 2011. The main outcome measure was change in metformin monotherapy during the 12 months following initiation. Factors associated with treatment changes during follow-up were examined using Cox proportional hazards regression models. RESULTS Fifty-nine percent of patients (mean age 69.6 years) remained on metformin monotherapy with no changes. Discontinuation was the most common treatment change (33%), followed by addition (5%), and switching (2%) to other antidiabetics. Of patients who discontinued treatment (median time to discontinuation = 90 days), 61% did not reinitiate any diabetic treatment during the follow-up period. Among patients who added or switched to other antidiabetics, sulfonylureas were the most common addition or replacement agent. Predictors of discontinuation were being female, Black or Hispanic, low-income subsidy eligible, having higher initial out-of-pocket metformin costs, or a diagnosis of depression. Discontinuation was less likely during follow-up if patients had higher pre-index pill burdens or records of a pre-index A1C screening test. A higher risk of discontinuation was observed for patients with low baseline A1C. One study limitation was that exact discontinuation dates could not be determined using claims. CONCLUSIONS The findings suggest that gender, race, ethnicity, depression, and low income status were contributory factors to metformin discontinuation. More intensive monitoring and treatment adjustments may be warranted for patients newly initiated on metformin. This could ultimately improve morbidity, mortality, and costs associated with poor glycemic control.
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Affiliation(s)
| | - Yihua Xu
- a a Comprehensive Health Insights Inc. , Louisville , KY , USA
| | - Chad Moretz
- a a Comprehensive Health Insights Inc. , Louisville , KY , USA
| | | | | | - Jean Lian
- c c Novo Nordisk Inc. , Plainsboro , NJ , USA
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Gowda U, Mutowo MP, Smith BJ, Wluka AE, Renzaho AMN. Vitamin D supplementation to reduce depression in adults: meta-analysis of randomized controlled trials. Nutrition 2014; 31:421-9. [PMID: 25701329 DOI: 10.1016/j.nut.2014.06.017] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/28/2014] [Accepted: 06/11/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The aim of this study was to estimate the weighted mean effect of vitamin D supplementation in reducing depressive symptoms among individuals aged ≥18 y diagnosed with depression or depressive symptoms. METHODS A meta-analysis of randomized controlled trials (RCTs) in which vitamin D supplementation was used to reduce depression or depressive symptoms was conducted. Databases MEDLINE, EMBASE, psych INFO, CINAHL plus, and the Cochrane library were searched from inception to August 2013 for all publications on vitamin D and depression regardless of language. The search was further updated to May 2014 to include newer studies being published. Studies involving individuals aged ≥18 y who were diagnosed with depressive disorder based on both the Diagnostic and Statistical Manual of Mental Disorders or other symptom checklist for depression were included. Meta-analysis was performed using random effects model due to differences between the individual RCTs. RESULTS The analysis included nine trials with a total of 4923 participants. No significant reduction in depression was seen after vitamin D supplementation (standardized mean difference = 0.28; 95% confidence interval, -0.14 to 0.69; P = 0.19); however, most of the studies focused on individuals with low levels of depression and sufficient serum vitamin D at baseline. The studies included used different vitamin D doses with a varying degree of intervention duration. CONCLUSIONS Future RCTs examining the effect of vitamin D supplementation among individuals who are both depressed and vitamin D deficient are needed.
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Affiliation(s)
- Usha Gowda
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mutsa P Mutowo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ben J Smith
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Andre M N Renzaho
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for International Health, Burnet Institute, Melbourne, Victoria, Australia; School of Social Sciences and Psychology, University of Western Sydney, Sydney, New South Wales, Australia.
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Caughey GE, Preiss AK, Vitry AI, Gilbert AL, Ryan P, Shakib S, Esterman A, McDermott RA, Roughead EE. Does antidepressant medication use affect persistence with diabetes medicines? Pharmacoepidemiol Drug Saf 2014; 22:615-22. [PMID: 23447430 DOI: 10.1002/pds.3424] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 11/29/2012] [Accepted: 01/25/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aimed to examine the effect of antidepressant use on persistence with newly initiated oral antidiabetic medicines in older people. METHODS A retrospective study of administrative claims data from the Australian Government Department of Veterans' Affairs, from 1 July 2000 to 30 June 2008 of new users of oral antidiabetic medicines (metformin or sulfonylurea). Antidepressant medicine use was determined in the 6 months preceding the index date of the first dispensing of an oral antidiabetic medicine. The outcome was time to discontinuation of diabetes therapy in those with antidepressant use compared with those without. Competing risks regression analyses were conducted with adjustment for covariates. RESULTS A total of 29,710 new users of metformin or sulfonylurea were identified, with 7171 (24.2%) dispensed an antidepressant. Median duration of oral antidiabetic medicines was 1.81 years (95% CI 1.72–1.94) for those who received an antidepressant at the time of diabetes medicine initiation, by comparison to 3.23 years (95% CI 3.10–3.40) for those who did not receive an antidepressant. Competing risk analyses showed a 42% increased likelihood of discontinuation of diabetes medications in persons who received an antidepressant (subdistribution hazard ratio 1.42, 95% CI 1.37–1.47, p < 0.001). CONCLUSIONS The results of this large population-based study demonstrate that depression may be contributing to non-compliance with medicines for diabetes and highlight the need to provide additional services to support appropriate medicine use in those initiating diabetes medicines with co-morbid depression.
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Byrn MA, Penckofer S. Antenatal depression and gestational diabetes: a review of maternal and fetal outcomes. Nurs Womens Health 2013; 17:22-33. [PMID: 23399010 DOI: 10.1111/1751-486x.12003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Depression and gestational diabetes are common and serious problems during pregnancy. While information exists regarding maternal and fetal outcomes in women who have either depression or gestational diabetes, there is a paucity of data regarding outcomes in women who have both. This article reviews and summarizes studies examining depression during pregnancy as well as an analysis of six studies examining depression in women with gestational diabetes, and discusses implications for clinicians and future research needs.
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Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression. Cochrane Database Syst Rev 2012; 12:CD008381. [PMID: 23235661 DOI: 10.1002/14651858.cd008381.pub2] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depression occurs frequently in patients with diabetes mellitus and is associated with a poor prognosis. OBJECTIVES To determine the effects of psychological and pharmacological interventions for depression in patients with diabetes and depression. SEARCH METHODS Electronic databases were searched for records to December 2011. We searched CENTRAL in The Cochrane Library, MEDLINE, EMBASE, PsycINFO, ISRCTN Register and clinicaltrials.gov. We examined reference lists of included RCTs and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) investigating psychological and pharmacological interventions for depression in adults with diabetes and depression. Primary outcomes were depression and glycaemic control. Secondary outcomes were adherence to diabetic treatment regimens, diabetes complications, death from any cause, healthcare costs and health-related quality of life (HRQoL). DATA COLLECTION AND ANALYSIS Two review authors independently examined the identified publications for inclusion and extracted data from included studies. Random-effects model meta-analyses were performed to compute overall estimates of treatment outcomes. MAIN RESULTS The database search identified 3963 references. Nineteen trials with 1592 participants were included. Psychological intervention studies (eight trials, 1122 participants, duration of therapy three weeks to 12 months, follow-up after treatment zero to six months) showed beneficial effects on short (i.e. end of treatment), medium (i.e. one to six months after treatment) and long-term (i.e. more than six months after treatment) depression severity (range of standardised mean differences (SMD) -1.47 to -0.14; eight trials). However, between-study heterogeneity was substantial and meta-analyses were not conducted. Short-term depression remission rates (OR 2.88; 95% confidence intervals (CI) 1.58 to 5.25; P = 0.0006; 647 participants; four trials) and medium-term depression remission rates (OR 2.49; 95% CI 1.44 to 4.32; P = 0.001; 296 participants; two trials) were increased in psychological interventions compared to usual care. Evidence regarding glycaemic control in psychological intervention trials was heterogeneous and inconclusive. QoL did not improve significantly based on the results of three psychological intervention trials compared to usual care. Healthcare costs and adherence to diabetes and depression medication were examined in only one study and reliable conclusions cannot be drawn. Diabetes complications and death from any cause have not been investigated in the included psychological intervention trials.With regards to the comparison of pharmacological interventions versus placebo (eight trials; 377 participants; duration of intervention three weeks to six months, no follow-up after treatment) there was a moderate beneficial effect of antidepressant medication on short-term depression severity (all studies: SMD -0.61; 95% CI -0.94 to -0.27; P = 0.0004; 306 participants; seven trials; selective serotonin reuptake inhibitors (SSRI): SMD -0.39; 95% CI -0.64 to -0.13; P = 0.003; 241 participants; five trials). Short-term depression remission was increased in antidepressant trials (OR 2.50; 95% CI 1.21 to 5.15; P = 0.01; 136 participants; three trials). Glycaemic control improved in the short term (mean difference (MD) for glycosylated haemoglobin A1c (HbA1c) -0.4%; 95% CI -0.6 to -0.1; P = 0.002; 238 participants; five trials). HRQoL and adherence were investigated in only one trial each showing no statistically significant differences. Medium- and long-term depression and glycaemic control outcomes as well as healthcare costs, diabetes complications and mortality have not been examined in pharmacological intervention trials. The comparison of pharmacological interventions versus other pharmacological interventions (three trials, 93 participants, duration of intervention 12 weeks, no follow-up after treatment) did not result in significant differences between the examined pharmacological agents, except for a significantly ameliorated glycaemic control in fluoxetine-treated patients (MD for HbA1c -1.0%; 95% CI -1.9 to -0.2; 40 participants) compared to citalopram in one trial. AUTHORS' CONCLUSIONS Psychological and pharmacological interventions have a moderate and clinically significant effect on depression outcomes in diabetes patients. Glycaemic control improved moderately in pharmacological trials, while the evidence is inconclusive for psychological interventions. Adherence to diabetic treatment regimens, diabetes complications, death from any cause, health economics and QoL have not been investigated sufficiently. Overall, the evidence is sparse and inconclusive due to several low-quality trials with substantial risk of bias and the heterogeneity of examined populations and interventions.
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Affiliation(s)
- Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
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Tsenkova VK, Albert MA, Georgiades A, Ryff CD. Trait anxiety and glucose metabolism in people without diabetes: vulnerabilities among black women. Diabet Med 2012; 29:803-6. [PMID: 22587407 PMCID: PMC3395206 DOI: 10.1111/j.1464-5491.2011.3534.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS We examined whether the relationship between anxiety and indicators of glucose metabolism in people without diabetes varies by race and gender. METHODS Participants were 914 adults (777 white, 137 black) without diabetes in the MIDUS (Midlife in the USA) II study. Glucose metabolism was characterized by fasting glucose, insulin, HOMA-IR (homeostasis model of assessment--insulin resistance), and HbA(1c). Hierarchical linear regressions stratified by race and gender examined whether anxiety was associated with glucose metabolism. RESULTS After adjustment for potential confounders, positive relationships between anxiety and fasting glucose (P = 0.04), insulin (P = 0.01), and HOMA-IR (P = 0.02) but not HbA(1c), were observed in black women only. CONCLUSIONS Our findings extend previous evidence for the links between psychosocial vulnerabilities and impaired glucose metabolism in black women, by documenting significant associations between anxiety and clinical indicators of glycaemic control among black women without diabetes. Thus, anxiety might constitute an intervention target in black women, a subgroup disproportionately affected by Type 2 diabetes, its complications, and premature mortality.
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Affiliation(s)
- V K Tsenkova
- Center for Women's Health and Health Disparities Research, University of Wisconsin-Madison, Madison, WI 53706, USA.
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Sieu N, Katon W, Lin EH, Russo J, Ludman E, Ciechanowski P. Depression and incident diabetic retinopathy: a prospective cohort study. Gen Hosp Psychiatry 2011; 33:429-35. [PMID: 21762993 PMCID: PMC3175259 DOI: 10.1016/j.genhosppsych.2011.05.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 05/26/2011] [Accepted: 05/28/2011] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study examined whether depression is associated with a higher incidence of diabetic retinopathy among adults with type 2 diabetes after controlling for sociodemographic factors, health risk behaviors and clinical characteristics. METHOD This study included 2359 patients enrolled in Pathways Epidemiologic Follow-Up Study, a prospective cohort study investigating the impact of depression in primary care patients with type 2 diabetes. The predictor of interest was baseline severity of depressive symptoms assessed with the Patient Health Questionnaire-9 (PHQ-9). The outcome was incident diabetic retinopathy. Risk of diabetic retinopathy was assessed using logistic regression, and time to incident diabetic retinopathy was examined using Cox proportional hazard models. RESULTS Over a 5-year follow-up period, severity of depression was associated with an increased risk of incident retinopathy [odds ratio =1.026; 95% confidence interval (CI) 1.002-1.051] as well as time to incident retinopathy (hazard ratio=1.025; 95% CI 1.009-1.041). The risk of incident diabetic retinopathy was estimated to increase by up to 15% for every significant increase in depressive symptoms severity (5-point increase on the PHQ-9 score). CONCLUSION Diabetic patients with comorbid depression have a significantly higher risk of developing diabetic retinopathy. Improving depression treatment in patients with diabetes could contribute to diabetic retinopathy prevention.
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Affiliation(s)
- Nida Sieu
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | | | - Joan Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Evette Ludman
- Group Health Research Institute, Group Health, Seattle, Washington
| | - Paul Ciechanowski
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Fornaro M, Iovieno N, Clementi N, Boscaro M, Paggi F, Balercia G, Fava M, Papakostas GI. Diagnosis of co-morbid axis-I psychiatric disorders among women with newly diagnosed, untreated endocrine disorders. World J Biol Psychiatry 2010; 11:991-6. [PMID: 20569197 DOI: 10.3109/15622975.2010.491126] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the prevalence of major depressive disorder (MDD) and other selected axis-I disorders among women with newly diagnosed, untreated endocrine disorders. METHODS Two hundred and eighteen consecutive women, aged 18-65, with newly diagnosed, untreated endocrine disorders were referred for potential diagnosis of co-morbid axis-I disorders with the use of the Structured Clinical Interview for Axis I-Patient Edition (SCID-P). The SCID-P was re-administered after 12 weeks. RESULTS At baseline, 64 (29.3%) women met criteria for at least one axis-I disorder. Women who were diagnosed with hyperthyroidism were more likely to meet criteria for generalized anxiety disorder and panic disorder than women without hyperthyroidism. Nine of 154 (5.8 %) women who did not meet criteria for an axis-I disorder at baseline met criteria for at least one axis-I disorder during follow-up. Among them, the presence of diabetes mellitus was statistically correlated with a higher probability of developing major depressive disorder at follow-up. CONCLUSIONS Although preliminary, our findings are consistent with previous studies and suggest an increased prevalence of MDD and other axis-I disorders among women with newly diagnosed endocrine disorders, providing further evidence suggesting that women with endocrine abnormalities may be at increased risk of depression and/or anxiety disorders.
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Affiliation(s)
- Michele Fornaro
- Department of Neuroscience, Section of Psychiatry, University of Genova, Genoa, Italy.
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Held RF, DePue J, Rosen R, Bereolos N, Nu'usolia O, Tuitele J, Goldstein M, House M, McGarvey S. Patient and health care provider views of depressive symptoms and diabetes in American Samoa. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2010; 16:461-467. [PMID: 21058808 PMCID: PMC3050566 DOI: 10.1037/a0020089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
High Type 2 diabetes prevalence, associated with recent cultural changes in diet and physical activity, characterizes the U.S. territory of American Samoa. Comorbid diabetes and depression rates are high worldwide and contribute to negative diabetes outcomes; these rates have not been assessed in American Samoa. In this study, 6 focus groups were conducted with 39 American Samoan adults with diabetes; questions on perceptions of diabetes and depressive symptoms were included. Thirteen health care staff interviews were conducted to gain insight into diabetes care in American Samoa. Focus groups and health care staff interviews were translated, transcribed, and entered into NVivo 8 to facilitate analysis. Thematic analysis showed that diabetes patients saw depressive symptoms as directly contributing to high blood sugar. However, these symptoms were rarely mentioned spontaneously, and providers reported they seldom assess them in patients. Many patients and health care staff believed the best ways to respond to feelings of depression involved relaxing, leaving difficult situations, or eating. Staff also discussed cultural stigma associated with depression and the importance of establishing rapport before discussing it. Health care providers in American Samoa need training to increase their awareness of depressive symptoms' negative impact on diabetes management in patients who screen positive for depression. All providers must approach the subject in a supportive context after establishing rapport. This information will be used for cultural translation of a community health worker and primary care-coordinated intervention for adults with diabetes in American Samoa, with the goal of creating an effective and sustainable intervention.
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Affiliation(s)
- Rachel Forster Held
- Centers for Behavioral and Preventive Medicine, Alpert Medical School, Brown University, Providence, RI, USA.
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Abstract
Depression in its own right is a disabling condition impairing all aspects of human function. In persons with a chronic medical disease, depression often makes the management of chronic illness more difficult. Recently, vitamin D has been reported in the scientific and lay press as an important factor that may have significant health benefits in the prevention and the treatment of many chronic illnesses. Most individuals in this country have insufficient levels of vitamin D. This is also true for persons with depression as well as other mental disorders. Whether this is due to insufficient dietary intake, lifestyle (e.g., little outdoor exposure to sunshine), or other factors is addressed in this paper. In addition, groups at risk and suggested treatment for inadequate vitamin D levels are addressed. Effective detection and treatment of inadequate vitamin D levels in persons with depression and other mental disorders may be an easy and cost-effective therapy which could improve patients' long-term health outcomes as well as their quality of life.
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Affiliation(s)
- Sue Penckofer
- Loyola University Chicago, School of Nursing, Maywood, Illinois 60153, USA.
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Lin EHB, Rutter CM, Katon W, Heckbert SR, Ciechanowski P, Oliver MM, Ludman EJ, Young BA, Williams LH, McCulloch DK, Von Korff M. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care 2010; 33:264-9. [PMID: 19933989 PMCID: PMC2809260 DOI: 10.2337/dc09-1068] [Citation(s) in RCA: 336] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To prospectively examine the association of depression with risks for advanced macrovascular and microvascular complications among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A longitudinal cohort of 4,623 primary care patients with type 2 diabetes was enrolled in 2000-2002 and followed through 2005-2007. Advanced microvascular complications included blindness, end-stage renal disease, amputations, and renal failure deaths. Advanced macrovascular complications included myocardial infarction, stroke, cardiovascular procedures, and deaths. Medical record review, ICD-9 diagnostic and procedural codes, and death certificate data were used to ascertain outcomes in the 5-year follow-up. Proportional hazard models analyzed the association between baseline depression and risks of adverse outcomes. RESULTS After adjustment for prior complications and demographic, clinical, and diabetes self-care variables, major depression was associated with significantly higher risks of adverse microvascular outcomes (hazard ratio 1.36 [95% CI 1.05-1.75]) and adverse macrovascular outcomes (1.24 [1.0-1.54]). CONCLUSIONS Among people with type 2 diabetes, major depression is associated with an increased risk of clinically significant microvascular and macrovascular complications over the ensuing 5 years, even after adjusting for diabetes severity and self-care activities. Clinical and public health significance of these findings rises as the incidence of type 2 diabetes soars. Further research is needed to clarify the underlying mechanisms for this association and to test interventions to reduce the risk of diabetes complications among patients with comorbid depression.
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Affiliation(s)
- Elizabeth H B Lin
- Group Health Research Institute, Group Health, Seattle, Washington, USA.
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Affiliation(s)
- E. Mohandas
- Chief consultant, Elite Mission Hospital, Koorkkenchery, Trissur, Kerala
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Abstract
PURPOSE OF REVIEW The combination of depression and diabetes is common and especially harmful because depression has a strong impact on psychosocial as well as medical outcomes in patients with diabetes. Consequently, treatment for depression in diabetes is also aimed at improvement in glycemic control and risk reduction for diabetes complications and mortality. This review provides an overview of all published, randomized controlled trials on the treatment of depression in patients with diabetes and summarizes current, ongoing research. RECENT FINDINGS The best results for medical and psychological outcomes were observed for psychological treatments; however, the generalizability of these results is restricted by methodological limitations. Most antidepressants were effective treatments for depression in diabetes but failed to show benefits regarding diabetes-related medical variables. Algorithm-based care, including psychological and psychopharmacological approaches, provides the best scientific evidence for successful depression treatment but not for glycemic control. SUMMARY Depression can be treated with antidepressants, psychotherapy or a flexible combination of both with relatively good results that are comparable to those for patients who have depression but not diabetes. Up to now, no single treatment that consistently leads to better medical outcomes in patients with both depression and diabetes has been clearly identified.
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