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Cavdar VC, Ballica B, Aric M, Karaca ZB, Altunoglu EG, Akbas F. Exploring depression, comorbidities and quality of life in geriatric patients: a study utilizing the geriatric depression scale and WHOQOL-OLD questionnaire. BMC Geriatr 2024; 24:687. [PMID: 39143531 DOI: 10.1186/s12877-024-05264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The increasing prevalence of depression among older adults is a growing concern. Chronic health conditions, cognitive impairments, and hospitalizations amplify emotional distress and depression levels in this population. Assessing the quality of life is crucial for the well-being of older adults. AIMS Our study aimed to examine how comorbidities affect depression and quality of life in geriatric patients in both outpatient and hospital settings. METHODS 100 patients (50 from internal medicine outpatient clinic and 50 from internal medicine ward) were included in the study according to inclusion and exclusion criteria. Patients were classified into different age groups (65-74 years, 75-84 years and ≥ 85 years). Data on patients' location of application, age, sex, living alone or with family status, number of comorbid diseases, types of accompanying diseases were recorded and WHOQOL-OLD and Geriatric Depression Scale (GDS) questionnaires were administered. Results were evaluated using SPSS. RESULTS The WHOQOL-OLD questionnaire score was higher in the 65-74 age group compared to other groups, but there was no significant difference between outpatient group and hospitalized group. Patients with comorbid diseases had lower WHOQOL-OLD questionnaire scores compared to those without comorbid diseases. In the 75-84 and ≥ 85 age groups, the GDS scores were higher compared to the 65-74 age group. In hospitalized group, GDS scores were higher than outpatient clinic group. In patients with comorbid diseases, GDS scores were higher than the ones without comorbid diseases. DISCUSSION Our findings indicate that quality of life is higher among those aged 65-74, with lower incidence of depression compared to other age groups. Hospitalization correlates with higher depression rates but not quality of life. As number of comorbid diseases increases in older adults, the frequency of depression rises and the quality of life declines. CONCLUSIONS Early detection and intervention for depression are crucial for enhancing older adults' well-being.
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Affiliation(s)
- Vahit Can Cavdar
- University of Health Sciences, Department of Internal Medicine, Istanbul Training and Research Hospital, Abdurrahman Nafiz Gürman Cad. Etyemez, Samatya, Istanbul, 34098, Turkey
| | - Basak Ballica
- Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Mert Aric
- University of Health Sciences, Department of Internal Medicine, Istanbul Training and Research Hospital, Abdurrahman Nafiz Gürman Cad. Etyemez, Samatya, Istanbul, 34098, Turkey
| | - Zekiye Busra Karaca
- Department of Internal Medicine, Beylikduzu State Hospital, Istanbul, Turkey
| | | | - Feray Akbas
- University of Health Sciences, Department of Internal Medicine, Istanbul Training and Research Hospital, Abdurrahman Nafiz Gürman Cad. Etyemez, Samatya, Istanbul, 34098, Turkey.
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Mangoulia P, Milionis C, Vlachou E, Ilias I. The Interrelationship between Diabetes Mellitus and Emotional Well-Being: Current Concepts and Future Prospects. Healthcare (Basel) 2024; 12:1457. [PMID: 39057600 PMCID: PMC11276337 DOI: 10.3390/healthcare12141457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/19/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
Diabetes mellitus is a lifelong metabolic disorder that impacts people's well-being and biopsychosocial status. Psychiatric problems and diabetes mellitus have a complex, reciprocal interaction in which one condition affects the other. In this narrative review, we provide an overview of the literature on the psychological effects of diabetes, expound on the evaluation of emotional disorders in the setting of diabetes, and suggest interventions aimed at enhancing both mental and physical health. Diabetes can make daily life complicated and stressful. Frequent blood glucose testing, taking medications on a regular basis, adhering to a tight diet plan, and exercising are some examples of the suggested daily routine of subjects with diabetes. Furthermore, comorbid diseases and typical diabetic complications can have a detrimental impact on quality of life. When mental health conditions coexist with diabetes mellitus, there is a greater likelihood of medication noncompliance, a decreased commitment to diabetes-related self-care, increased functional impairment, inadequate glycemic control, a higher risk of complications, and overall higher healthcare expenses. Thus, evaluation of the mental health status of patients with diabetes is crucial. When treating psychological issues and psychiatric disorders, a comprehensive biopsychosocial approach should be taken, and where appropriate, psychopharmacological therapies or psychotherapy should be applied. The goal of continuous education and assistance for self-care is to give individuals with the disease the information and abilities they need to control their condition over time.
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Affiliation(s)
- Polyxeni Mangoulia
- Faculty of Nursing, National and Kapodistrian University of Athens, GR-11527 Athens, Greece;
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes, and Metabolism, Elena Venizelou General Hospital, GR-11521 Athens, Greece;
| | - Eugenia Vlachou
- Department of Nursing, University of West Attica, GR-12243 Athens, Greece;
| | - Ioannis Ilias
- Department of Endocrinology, Hippokration General Hospital, GR-11527 Athens, Greece
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Al-Jabi SW. Emerging global interest: Unraveling the link between diabetes mellitus and depression. World J Psychiatry 2024; 14:1127-1139. [PMID: 39050204 PMCID: PMC11262933 DOI: 10.5498/wjp.v14.i7.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/03/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Studies have shown a strong bidirectional association between diabetes and depression, with diabetes increasing the risk of developing depression and vice versa. Depression among patients with diabetes is associated with poor glycemic control, complications, and poor self-care. AIM To explore the present state of research globally concerning diabetes and depression, to aid understanding the current research landscape and identify potential future areas of research. METHODS A bibliometric approach was used, utilizing the Scopus database to gather pertinent research articles released from 2004 to 2023. Analyses encompassed publication patterns, significant contributors, research focal points, prevalent themes, and the most influential articles, aimed at discerning emerging research subjects. RESULTS A total of 3229 publications that met the search criteria were identified. A significant increase in the number of publications related to diabetes and depression has been observed in the past two decades. The most productive nation was the USA (n = 1015; 31.43%), followed by China (n = 325; 10.07%), the UK (n = 236; 7.31%), and Germany (n = 218; 6.75%). Three principal themes in research on depression and diabetes were delineated by the analysis. First, the exploration of the elevated prevalence and etiology of this comorbidity; second, the focus on interventions, particularly randomized controlled trials, aimed at enhancing diabetes management among individuals with depression; and finally, the investigation of the involved risk factors and biological mechanisms underlying this bidirectional relationship. CONCLUSION There has been a recent surge of interest in the relationship between diabetes and depression. This could aid researchers to identify areas lacking in the literature and shape future research.
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Affiliation(s)
- Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine
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Waszczak-Jeka M, Żuchowski P, Dura M, Bielewicz-Zielińska A, Kułakowski M, Góralczyk A. Interleukin levels and depressive symptoms in psoriatic arthritis patients: insights from a case-control study on socio-demographic factors and disease perception. Rheumatol Int 2024; 44:1337-1343. [PMID: 38727810 DOI: 10.1007/s00296-024-05599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/15/2024] [Indexed: 06/15/2024]
Abstract
In the course of psoriatic arthritis (PsA), depression occurs much more often than in the general population. Depression can be considered a poor prognostic factor. The aim of the study was to assess the relationships between the occurrence of depression and the levels of proinflammatory cytokines in patients with PsA. The study included 86 (47F/39M) patients with PsA. Only patients with high disease activity (DAPSA > 28) were enrolled in the study. The severity of depressive symptoms was assessed using the Beck Depression Inventory II (BDI-II) for all patients. Additionally, sociodemographic data were collected. All patients were also assessed for the levels of interleukins (IL): IL-1, IL-6, IL-17A, IL-23, and tumor necrosis factor alpha (TNF-α) using the enzyme-linked immunosorbent assay (ELISA) test. In the study group, depression (BDI-II ≥ 14) was diagnosed in 45 patients (52%). Patients with coexisting depression reported higher levels of pain and disease activity on the visual analogue scale compared to patients without depression (8.5 vs. 7.7, p < 0.001 and 9.3 vs. 8.4, p < 0.001, respectively). The mean levels of proinflammatory cytokines [pg/ml], IL-1 and IL-6, were also higher in the group of patients with depression (46.4 vs. 4.7, p < 0.001 and 10.5 vs. 4.9, p < 0.001, respectively). The coexistence of depression in the course of Psoriatic Arthritis (PsA) is associated with higher levels of IL-1 and IL-6. Depression has a negative impact on the perception of the underlying disease and is linked to reduced social and occupational activity.
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Affiliation(s)
| | - Paweł Żuchowski
- Clinic of Rheumatology and Connective Tissue Diseases, Jan Biziel University Hospital No 2 in Bydgoszcz, Bydgoszcz, Poland
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Marta Dura
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
- Department of Radiology, Jan Biziel University Hospital No 2 in Bydgoszcz, Bydgoszcz, Poland
| | | | - Michał Kułakowski
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
- Clinical Department of Orthopaedics and Traumatology, Jan Biziel University Hospital No 2 in Bydgoszcz, Bydgoszcz, Poland
| | - Alicja Góralczyk
- Clinic of Rheumatology and Connective Tissue Diseases, Jan Biziel University Hospital No 2 in Bydgoszcz, Bydgoszcz, Poland
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Almeida OP, Fong Z, Hill Almeida LM, Sanfilippo FM, Page A, Etherton-Beer C. Cross-sectional, case-control and longitudinal associations between exposure to glucagon-like peptide-1 receptor agonists and the dispensing of antidepressants. Diabetes Obes Metab 2024; 26:2925-2932. [PMID: 38650544 DOI: 10.1111/dom.15616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
AIM To determine if the dispensing of glucagon-like peptide (GLP)-1 receptor agonists is associated with increased dispensing of antidepressants. MATERIALS AND METHODS We used cross-sectional, case-control and retrospective cohort study designs to examine the association between dispensed GLP-1 receptor agonists and antidepressants between 2012 and 2022 in the 10% random sample of the Australian Pharmaceutical Benefits Scheme (PBS) data. PBS-listed GLP-1 receptor agonists, exenatide, dulaglutide and semaglutide were the exposures. Outcomes were the odds ratio [ORs; 99% confidence interval (CI)] and hazard ratio (99% CI) of being dispensed any antidepressant. Analyses were adjusted for demographic measures and the dispensing of medicines to manage cardiovascular diseases or anxiety/insomnia. Statistical tests were two-sided at the 1% level of significance. RESULTS In total, 358 075 of 1 746 391 individuals were dispensed antidepressants, and 8495 of the 24 783 dispensed a GLP-1 receptor agonist were also dispensed an antidepressant in 2022 (OR 1.44; 99% CI 1.38-1.50); 24 103 of the 1 746 391 participants had been dispensed a GLP-1 receptor agonist between 2012 and 2021, and of these 8083 were dispensed antidepressants in 2022 (OR 1.52; 99% CI 1.46-1.59). The 2012 cohort included 1 213 316 individuals who had not been dispensed antidepressants that year. The hazard ratio of being dispensed an antidepressant between 2013 and 2022 following the dispensing of a GLP-1 receptor agonist was 1.19 (99% CI 1.12-1.27). Additional analyses restricting the time of exposure confirmed these associations for all PBS-listed GLP-1 receptor agonists. CONCLUSIONS Individuals exposed to GLP-1 receptor agonists are at greater risk of being dispensed antidepressants. The possible impact of GLP-1 receptor agonists on the mood of consumers requires ongoing vigilance and further research.
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Affiliation(s)
- Osvaldo P Almeida
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Zheng Fong
- Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Frank M Sanfilippo
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Amy Page
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
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Ye ML, Wang JK. Association of total bilirubin with depression risk in adults with diabetes: A cross-sectional study. World J Clin Cases 2024; 12:3428-3437. [PMID: 38983435 PMCID: PMC11229937 DOI: 10.12998/wjcc.v12.i18.3428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/30/2024] [Accepted: 05/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Individuals with diabetes mellitus are more likely to experience depression, although most patients remain undiagnosed. The relation between total bilirubin and depression has been increasingly discussed, but limited studies have examined the association of total bilirubin with depression risk in adults with diabetes, which warrants attention. AIM To investigate the association between total bilirubin levels and the risk of depression in adults with diabetes. METHODS The study included adults with diabetes from the National Health and Nutrition Examination Survey 2007-2018. Depression was determined using the Patient Health Questionnaire-9. Multivariable logistic regression, propensity score-matched analysis and restricted cubic spline models were utilized to investigate the association between total bilirubin levels and depression risk in adults with diabetes. RESULTS The study included 4758 adults with diabetes, of whom 602 (12.7%) were diagnosed with depression. After adjusting for covariates, we found that diabetic adults with lower total bilirubin levels had a higher risk of depression (OR = 1.230, 95%CI: 1.006-1.503, P = 0.043). This association was further confirmed after propensity score matching (OR = 1.303, 95%CI: 1.034-1.641, P = 0.025). Subgroup analyses showed no significant dependence of age, body mass index, sex, race or hypertension on this association. Restricted cubic spline models displayed an inverted U-shaped association of total bilirubin levels with depression risk within the lower range of total bilirubin levels. The depression risk heightened with the increasing levels of total bilirubin, reaching the highest risk at 6.81 μmol/L and decreasing thereafter. CONCLUSION In adults with diabetes, those with lower levels of total bilirubin were more likely to have depressive symptoms. Serum total bilirubin levels may be used as an additional indicator to assess depression risk in adults with diabetes.
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Affiliation(s)
- Man-Li Ye
- Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Jie-Ke Wang
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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Yu SY, Lee SK, Yang B, Lee H, Jeon HJ, Lee DH. Glycemic Control and Oral Health Outcomes in Patients With Diabetes: Insights From a Nationwide Korean Survey. J Korean Med Sci 2024; 39:e209. [PMID: 38915285 PMCID: PMC11196857 DOI: 10.3346/jkms.2024.39.e209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/04/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Diabetes is recognized as a risk factor for various inflammatory conditions, including periodontitis. There exists a bidirectional relationship between glycemic control and oral health in individuals with diabetes. This study aimed to analyze the link between glycemic control and oral health status among Korean patients with diabetes. METHODS Using data from a population-based nationwide survey conducted between 2007 and 2019, we identified 70,554 adults with diabetes-related information. The study population included 9,090 individuals diagnosed with diabetes and 61,164 healthy controls. The association between glycemic control, defined by mean glycated hemoglobin (HbA1c) values, and various oral health measures, such as tooth brushing frequency, periodontitis, denture wearing, Decayed, Missing, and Filled Teeth (DMFT) index, number of remaining teeth, and past-year dental clinic visits, was evaluated using multivariate logistic regression analyses. RESULTS Compared to the control group, patients with diabetes exhibited a higher prevalence of periodontitis (88.6% vs. 73.3%), complete dentures (5.0% vs. 1.5%), and elevated DMFT index (33.2% vs. 26.7%) (all P < 0.001). Multivariate analyses revealed significant associations between diabetes and several oral health factors: denture status (No denture: adjusted odds ratio [aOR], 0.784; 95% confidence interval [CI], 0.627-0.979), and having fewer permanent teeth (0-19) (aOR, 1.474; 95% CI, 1.085-2.003). Additionally, a positive correlation was found between higher HbA1c levels and the risk of having fewer remaining teeth (0-19) (HbA1c < 6.5%: aOR, 1.129; 95% CI, 0.766-1.663; 6.5% ≤ HbA1c < 8.0%: aOR, 1.590; 95% CI, 1.117-2.262; HbA1c ≥ 8%: aOR, 1.910; 95% CI, 1.145-3.186) (P for trends = 0.041). CONCLUSION We found a positive association between diabetes and poor oral health, as well as a noteworthy relationship between reduced permanent teeth (≤ 19) and glycemic control. These insights emphasize the critical role of oral health management in diabetic care and underscore the importance of maintaining effective glycemic control strategies for overall health and well-being in patients with diabetes.
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Affiliation(s)
- Song-Yi Yu
- Department of Prosthodontics, Dental Clinic Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Sun-Kyung Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Mathematics, College of Natural Sciences, Hanyang University, Seoul, Korea
| | - Bumhee Yang
- Division of Pulmonary Medicine, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju, Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju, Korea
| | - Dong-Hwa Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju, Korea.
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Li C, Cao J, Chen Z, Su Z, Bao H, Li X, Liu L, Xiao Z, Duan J, Zhou T, Xu F. Gastrodin alleviates the deterioration of depressive-like behavior and glucolipid metabolism promoted by chronic stress in type 2 diabetic mice. Eur J Pharmacol 2024; 973:176582. [PMID: 38642668 DOI: 10.1016/j.ejphar.2024.176582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024]
Abstract
The growing burden of psychological stress among diabetes patients has contributed to a rising incidence of depression within this population. It is of significant importance to conduct research on the impact of stress on diabetes patients and to explore potential pharmacological interventions to counteract the stress-induced exacerbation of their condition. Gastrodin is a low molecular weight bioactive compound extracted from the rhizome of Gastrodiae elata Blume, and it may be a preventive strategy for diabetes and a novel treatment for depression symptoms. However, its relevant pharmacological mechanisms for protecting against the impacts of psychological stress in diabetic patients are unclear. In this study, we performed 5 weeks CUMS intervention and simultaneously administered gastrodin (140 mg/kg, once daily) on T2DM mice, to investigate the potential protective effects of gastrodin. The protective effect of gastrodin was evaluated by behavioral tests, biochemical analysis, histopathological examination, RT-qPCR and gut microbiota analysis. We found that the depressive-like behavior and glucolipid metabolism could be deteriorated by chronic stress in type 2 diabetic mice, while gastrodin showed a protective effect against these exacerbations by regulating HPA hormones, activating FXR and Cyp7a1, reducing inflammatory and oxidative stress responses, and regulating ileal gut microbiota abundance. Gastrodin might be a potential therapeutic agent for mitigating the deterioration of diabetes conditions due to chronic stress.
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MESH Headings
- Animals
- Benzyl Alcohols/pharmacology
- Benzyl Alcohols/therapeutic use
- Glucosides/pharmacology
- Glucosides/therapeutic use
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/psychology
- Depression/drug therapy
- Depression/metabolism
- Male
- Mice
- Stress, Psychological/drug therapy
- Stress, Psychological/complications
- Stress, Psychological/metabolism
- Stress, Psychological/psychology
- Gastrointestinal Microbiome/drug effects
- Behavior, Animal/drug effects
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/complications
- Mice, Inbred C57BL
- Oxidative Stress/drug effects
- Chronic Disease
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Affiliation(s)
- Canye Li
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China
| | - Jinming Cao
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China
| | - Zhicong Chen
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China
| | - Zuanjun Su
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China
| | - Huimin Bao
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China
| | - Xue Li
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China
| | - Luping Liu
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China
| | - Zhijun Xiao
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China
| | - Jingjing Duan
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China
| | - Ting Zhou
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China.
| | - Feng Xu
- Fengxian Hospital, School of Pharmaceutical Sciences, Southern Medical University, Shanghai, China.
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Hong SN, Lai FTT, Wang B, Choi EPH, Wong ICK, Lam CLK, Wan EYF. Age-specific Multimorbidity Patterns and Burden on All-Cause Mortality and Public Direct Medical Expenditure: A Retrospective Cohort Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00256-y. [PMID: 38869775 DOI: 10.1007/s44197-024-00256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE To evaluate age-specific multimorbidity patterns and morbidity burden on mortality and healthcare expenditure across age groups. PATIENTS AND METHODS Retrospective observational study between January 1, 2009 to December 31, 2017 using electronic health records in Hong Kong: Individuals were stratified by age (< 50, 50-64, 65-79, ≥ 80), and sub-classified by number of morbidities (0, 1, 2, 3, ≥ 4) out of 21 common chronic conditions. Clustering analyses were conducted to identify specific patterns of multimorbidity. Association between the number as well as combinations of morbidities and all-cause mortality and public expenditure was examined. RESULTS 4,562,832 individuals with a median follow-up of 7 years were included. Mental disorders were the top morbidities among young individuals, while cardiovascular diseases were prevalent in the elderly. An increased number of morbidities was associated with a greater relative risk for mortality and medical expenditure, and this relationship was stronger among younger patients. Compared to individuals in the same age group without morbidity, the hazard ratios (HR; 95% CI) of all-cause mortality in patients aged < 50 and ≥ 80 with two comorbidities 3.81 (3.60-4.03) and 1.38 (1.36-1.40), respectively, which increased to 14.22 (9.87-20.47) and 2.20 (2.13-2.26), respectively, as the number of morbidities increased to ≥ 4. The stroke-hypertension cluster was shown to be associated with the highest HR of mortality 2.48 (2.43-2.53) among all identified clusters arising from the clustering analysis. CONCLUSION Given the stronger association between multimorbidity and all-cause mortality and greater opportunity costs in younger populations, prevention and management of early-onset multimorbidity are warranted. (248 words).
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Affiliation(s)
- Sabrina Nan Hong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Science Park, Hong Kong SAR, China
| | - Boyuan Wang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Science Park, Hong Kong SAR, China
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, United Kingdom
- School of Pharmacy, Medical Sciences Division, Macau University of Science and Technology, Macau, Macau SAR
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Family Medicine, the University of Hong Kong Shenzhen Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Shu C, Zheng C, Du X, Luo D. Exploring the role of vitamin D in cognitive function: mediation by depression with diabetes modulation in older U.S. adults, a NHANES weighted analysis. Front Nutr 2024; 11:1356071. [PMID: 38895660 PMCID: PMC11183290 DOI: 10.3389/fnut.2024.1356071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background The relationship between vitamin D levels, depressive symptoms, and cognitive function has yet to be definitively understood in the elderly, particularly when considering the impact of chronic diseases. This study focuses on how depression mediates the impact of 25-hydroxyvitamin D3 (25(OH)D3) on cognitive performance in older U.S. adults. Methods We analyzed data from 2,745 elderly individuals extracted from the NHANES 2011-2014 cycles, applying weighted processing to account for the complex multi-stage sampling design characteristic of NHANES data. Utilizing weighted data for covariate and model selection, we conducted mediation analyses on both the overall population and subgroup data. Significant mediation pathways were validated using a stratified weighted bootstrap approach. For significant subgroup pathways, we explored interactive mechanisms through interactive mediation analysis. Results Mediation analyses, thoroughly accounting for the impact of chronic conditions, revealed significant pathways in both the weighted overall population and the weighted diabetes subgroup. After 1,000 stratified weighted bootstrap replications, the proportion of mediation effects were 10.6% [0.040, 0.268] and 20.9% [0.075, 0.663], respectively. Interactive mediation analysis for diabetes indicated that the interaction between diabetes and depression was not significant in the direct pathway (estimates = 0.050, p = 0.113) but was significant in the mediation pathway, yielding the largest effect size compared to other covariates (estimates = 0.981, p < 0.001). Conclusion This study highlights the mediating role of depression in the relationship between vitamin D levels and cognitive function in the elderly, particularly emphasizing diabetes as a key moderator. Our findings suggest targeted interventions addressing both vitamin D sufficiency and depression could significantly benefit cognitive health, especially in diabetic individuals.
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Affiliation(s)
- Chang Shu
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Chenguang Zheng
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Xin Du
- Tianjin Huanhu Hospital, Tianjin, China
| | - Da Luo
- Tianjin Huanhu Hospital, Tianjin, China
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Shamim MA, Shukla R, Swami MK, Srivastav S, Pradhan A, Yadav SS, Anil A, Saravanan A, Varthya SB, Singh S, Dwivedi P. Targeting self-care adherence for glycaemic control in multimorbid type 2 diabetes mellitus with depression using bupropion: a protocol for cross-over randomised controlled trial. BMJ Open 2024; 14:e077975. [PMID: 38834315 PMCID: PMC11163640 DOI: 10.1136/bmjopen-2023-077975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Diabetes and depression are among the 10 biggest health burdens globally. They often coexist and exhibit a strong bidirectional relationship. Depression leads to decreased adherence to self-care activities. This impacts glycaemic control and worsens type 2 diabetes mellitus (T2D). Both conditions have a synergistic effect and lead to greater complications, hospitalisations, healthcare expenditure and a worse quality of life. There is no consensus on managing people with comorbid T2D and depression. Bupropion is an efficacious antidepressant with many properties suitable for T2D with depression, including a favourable metabolic profile, persistent weight loss and improvement in sexual dysfunction. We will assess the efficacy and safety of add-on bupropion compared with standard care in people with T2D and mild depression. This study can give valuable insights into managing the multimorbidity of T2D and depression. This can help mitigate the health, social and economic burden of both these diseases. RESEARCH DESIGN AND METHODS This cross-over randomised controlled trial will recruit people with T2D (for 5 years or more) with mild depression. They will be randomised to add-on bupropion and standard care. After 3 months of treatment, there will be a washout period of 1 month (without add-on bupropion while standard treatment will continue). Following this, the two arms will be swapped. Participants will be assessed for glycosylated haemoglobin, adherence to diabetes self-care activities, lipid profile, urine albumin-to-creatinine ratio, autonomic function, sexual function, quality of life and adverse events. ETHICS AND DISSEMINATION The Institutional Ethics Committee at All India Institute of Medical Sciences, Jodhpur has approved this study (AIIMS/IEC/2022/4172, 19 September 2022). We plan to disseminate the research findings via closed group discussions at the site of study, scientific conferences, peer-reviewed published manuscripts and social media. TRIAL REGISTRATION NUMBER CTRI/2022/10/046411.
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Affiliation(s)
- Muhammad Aaqib Shamim
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravindra Shukla
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mukesh Kumar Swami
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shival Srivastav
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anindita Pradhan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Suraj Singh Yadav
- Centre of Excellence for Tribal Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- School of Pharmacy, National Forensic Sciences University, Gandhinagar, Gujarat, India
| | - Abhishek Anil
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Aswini Saravanan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shoban Babu Varthya
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Dwivedi
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- Centre of Excellence for Tribal Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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12
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Baenas I, Camacho-Barcia L, Granero R, Razquin C, Corella D, Gómez-Martínez C, Castañer-Niño O, Martínez JA, Alonso-Gómez ÁM, Wärnberg J, Vioque J, Romaguera D, López-Miranda J, Estruch R, Tinahones FJ, Lapetra J, Serra-Majem JL, Cano-Ibáñez N, Tur JA, Martín-Sánchez V, Pintó X, Gaforio JJ, Matía-Martín P, Vidal J, Vázquez C, Daimiel L, Ros E, Jiménez-Murcia S, Dalsgaard S, Garcia-Arellano A, Babio N, Sorli JV, Lassale C, García-de-la-Hera M, Gómez-García E, Zulet MA, Konieczna J, Martín-Peláez S, Tojal-Sierra L, Basterra-Gortari FJ, de Las Heras-Delgado S, Portoles O, Muñoz-Pérez MÁ, Arenas-Larriva AP, Compañ-Gabucio L, Eguaras S, Shyam S, Fitó M, Baños RM, Salas-Salvadó J, Fernández-Aranda F. Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population. J Endocrinol Invest 2024; 47:1405-1418. [PMID: 38218741 PMCID: PMC11142971 DOI: 10.1007/s40618-023-02278-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/07/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up. METHODS n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control. RESULTS The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up. CONCLUSIONS This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.
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Affiliation(s)
- I Baenas
- Eating Disorders Unit, Clinical Psychology Department, University Hospital of Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute-IDIBELL, 08908, Barcelona, Spain
- Doctoral Program in Medicine and Translational Research, University of Barcelona, 08007, Barcelona, Spain
| | - L Camacho-Barcia
- Eating Disorders Unit, Clinical Psychology Department, University Hospital of Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute-IDIBELL, 08908, Barcelona, Spain
| | - R Granero
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute-IDIBELL, 08908, Barcelona, Spain
- Department de Psicobiologia I Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| | - C Razquin
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, 31008, Pamplona, Spain
| | - D Corella
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, 46010, Valencia, Spain
| | - C Gómez-Martínez
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Human Nutrition Unit ANUT-DSM, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), 43007, Reus, Spain
| | - O Castañer-Niño
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d`Investigació Médica (IMIM), 08003, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - J A Martínez
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008, Pamplona, Spain
- Precision Nutrition and Cardiometabolic Health Program, IMDEA Food, CEI UAM + CSIC, 28049, Madrid, Spain
| | - Á M Alonso-Gómez
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Cardiovascular, Respiratory and Metabolic Area, Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01009, Vitoria-Gasteiz, Spain
| | - J Wärnberg
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Nursing, University of Málaga, Institute of Biomedical Research in Malaga (IBIMA), 29590, Málaga, Spain
| | - J Vioque
- CIBER de Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010, Alicante, Spain
| | - D Romaguera
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, 07120, Palma, Spain
| | - J López-Miranda
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004, Cordoba, Spain
| | - R Estruch
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036, Barcelona, Spain
| | - F J Tinahones
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria Hospital, University of Málaga, 29590, Málaga, Spain
| | - J Lapetra
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013, Seville, Spain
| | - J L Serra-Majem
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria and Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, 35016, Las Palmas de Gran Canaria, Spain
| | - N Cano-Ibáñez
- CIBER de Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (IBS.GRANADA), 18012, Granada, Spain
| | - J A Tur
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, 07122, Palma, Spain
| | - V Martín-Sánchez
- CIBER de Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Institute of Biomedicine (IBIOMED), University of León, 24071, León, Spain
| | - X Pintó
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, 08908, Barcelona, Spain
| | - J J Gaforio
- CIBER de Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Departamento de Ciencias de la Salud, Instituto Universitario de Investigación en Olivar y Aceites de Oliva, Universidad de Jaén, 23071, Jaén, Spain
| | - P Matía-Martín
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain
| | - J Vidal
- CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain
- Department of Endocrinology, Institut d` Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036, Barcelona, Spain
| | - C Vázquez
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Fundación Jimenez Díaz, Instituto de Investigaciones Biomédicas IISFJD. University Autonoma, 28024, Madrid, Spain
| | - L Daimiel
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, 28668, Madrid, Spain
| | - E Ros
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Lipid Clinic, Hospital Clínic, 08036, Barcelona, Spain
| | - S Jiménez-Murcia
- Eating Disorders Unit, Clinical Psychology Department, University Hospital of Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute-IDIBELL, 08908, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907, Barcelona, Spain
| | - S Dalsgaard
- NCRR-National Centre for Register-Based Research, Aarhus University, 8210, Aarhus, Denmark
- iPSYCH-The Lundbeck Foundation Initiative for Integrative Psychiatric Research, 8210, Aarhus, Denmark
- CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, 8210, Aarhus, Denmark
| | - A Garcia-Arellano
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, 31008, Pamplona, Spain
| | - N Babio
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Human Nutrition Unit ANUT-DSM, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), 43007, Reus, Spain
| | - J V Sorli
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, 46010, Valencia, Spain
| | - C Lassale
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Barcelona Institute for Global Health (ISGlobal), 08036, Barcelona, Spain
| | - M García-de-la-Hera
- CIBER de Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010, Alicante, Spain
| | - E Gómez-García
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Nursing, University of Málaga, Institute of Biomedical Research in Malaga (IBIMA), 29590, Málaga, Spain
| | - M A Zulet
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008, Pamplona, Spain
- Precision Nutrition and Cardiometabolic Health Program, IMDEA Food, CEI UAM + CSIC, 28049, Madrid, Spain
| | - J Konieczna
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, 07120, Palma, Spain
| | - S Martín-Peláez
- CIBER de Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
| | - L Tojal-Sierra
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Cardiovascular, Respiratory and Metabolic Area, Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01009, Vitoria-Gasteiz, Spain
| | - F J Basterra-Gortari
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, 31008, Pamplona, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario de Navarra, IdiSNA, Universidad Pública de Navarra, 31008, Pamplona, Spain
| | - S de Las Heras-Delgado
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Human Nutrition Unit ANUT-DSM, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), 43007, Reus, Spain
| | - O Portoles
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, 31008, Pamplona, Spain
| | - M Á Muñoz-Pérez
- Unitat de Suport a la Recerca en Atenció Primaria de Barcelona. IDIAP Jordi Gol. Primary Care Division, Institut Català de La Salut, 08007, Barcelona, Spain
| | - A P Arenas-Larriva
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004, Cordoba, Spain
| | - L Compañ-Gabucio
- CIBER de Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010, Alicante, Spain
| | - S Eguaras
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, 31008, Pamplona, Spain
| | - S Shyam
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Human Nutrition Unit ANUT-DSM, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), 43007, Reus, Spain
| | - M Fitó
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d`Investigació Médica (IMIM), 08003, Barcelona, Spain
| | - R M Baños
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment of the University of Valencia, 46010, Valencia, Spain
| | - J Salas-Salvadó
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain.
- Human Nutrition Unit ANUT-DSM, Biochemistry and Biotechnology Department, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201, Reus, Spain.
- Institut d'Investigació Sanitària Pere Virgili (IISPV), 43007, Reus, Spain.
| | - F Fernández-Aranda
- Eating Disorders Unit, Clinical Psychology Department, University Hospital of Bellvitge, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain.
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute-IDIBELL, 08908, Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907, Barcelona, Spain.
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Herhaus B, Kruse J, Hinz A, Brähler E, Petrowski K. Depression, anxiety, and health-related quality of life in normal weight, overweight and obese individuals with diabetes: a representative study in Germany. Acta Diabetol 2024; 61:725-734. [PMID: 38430257 PMCID: PMC11101582 DOI: 10.1007/s00592-024-02248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/29/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Diabetes in the course of lifetime is related to a higher risk for mental disorders. The present study addresses the comparison of individuals with diabetes and non-diabetic individuals in depressive symptoms, generalized anxiety symptoms, and health-related quality of life. Furthermore, mediator effect of BMI and health-related quality of life (HRQOL) on the association between diabetes, depression, and generalized anxiety was analyzed. METHODS In this cross-sectional study, the three questionnaires PHQ-9, GAD-7, EQ-5D-5L were measured in a representative sample of the German population (N = 2386). In addition, the presence of diabetes and BMI were assessed via self-report. RESULTS There were higher values in depressive and anxiety symptoms as well as lower score in HRQOL in individuals with diabetes compared to non-diabetic individuals. Obese individuals with diabetes showed the highest rates in depressive symptoms and generalized anxiety as well as lowest score in HRQOL. With regard to the mediator analyses, association between diabetes, depressive symptoms, and anxiety symptoms is partially mediated by the BMI and fully mediated by the HRQOL. CONCLUSIONS In conclusion, individuals with diabetes have an increased risk in the development of depressive and anxiety symptoms as well as lower health-related quality of life. Future research and strategies in the public health policies among individuals with diabetes should take into account that the association between diabetes, depression, and anxiety is mediated by BMI and HRQOL.
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Affiliation(s)
- Benedict Herhaus
- Medical Psychology and Medical Sociology, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Duesbergweg 6, 55128, Mainz, Germany.
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Philipps University Marburg, Marburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Duesbergweg 6, 55128, Mainz, Germany
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Gillett AC, Hagenaars SP, Handley D, Casanova F, Young KG, Green H, Lewis CM, Tyrrell J. The impact of major depressive disorder on glycaemic control in type 2 diabetes: a longitudinal cohort study using UK Biobank primary care records. BMC Med 2024; 22:211. [PMID: 38807170 PMCID: PMC11134616 DOI: 10.1186/s12916-024-03425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND This study evaluates longitudinal associations between glycaemic control, measured by mean and within-patient variability of glycated haemaglobin (HbA1c) levels, and major depressive disorder (MDD) in individuals with type 2 diabetes (T2D), focusing on the timings of these diagnoses. METHODS In UK Biobank, T2D was defined using self-report and linked health outcome data, then validated using polygenic scores. Repeated HbA1c measurements (mmol/mol) over the 10 years following T2D diagnosis were outcomes in mixed effects models, with disease duration included using restricted cubic splines. Four MDD exposures were considered: MDD diagnosis prior to T2D diagnosis (pre-T2D MDD), time between pre-T2D MDD diagnosis and T2D, new MDD diagnosis during follow-up (post-T2D MDD) and time since post-T2D MDD diagnosis. Models with and without covariate adjustment were considered. RESULTS T2D diagnostic criteria were robustly associated with T2D polygenic scores. In 11,837 T2D cases (6.9 years median follow-up), pre-T2D MDD was associated with a 0.92 increase in HbA1c (95% CI: [0.00, 1.84]), but earlier pre-T2D MDD diagnosis correlated with lower HbA1c. These pre-T2D MDD effects became non-significant after covariate adjustment. Post-T2D MDD individuals demonstrated increasing HbA1c with years since MDD diagnosis ( β = 0.51 , 95% CI: [0.17, 0.86]). Retrospectively, across study follow-up, within-patient variability in HbA1c was 1.16 (95% CI: 1.13-1.19) times higher in post-T2D MDD individuals. CONCLUSIONS The timing of MDD diagnosis is important for understanding glycaemic control in T2D. Poorer control was observed in MDD diagnosed post-T2D, highlighting the importance of depression screening in T2D, and closer monitoring for individuals who develop MDD after T2D.
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Affiliation(s)
- Alexandra C Gillett
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
| | - Saskia P Hagenaars
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Dale Handley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Francesco Casanova
- Clinical and Biomedical Science, Institute of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Katherine G Young
- Clinical and Biomedical Science, Institute of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Harry Green
- Clinical and Biomedical Science, Institute of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jess Tyrrell
- Clinical and Biomedical Science, Institute of Health and Life Sciences, University of Exeter, Exeter, UK
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Ranjan S, Thakur R. The effect of socioeconomic status, depression, and diabetes symptoms severity on diabetes patient's life satisfaction in India. Sci Rep 2024; 14:12210. [PMID: 38806560 PMCID: PMC11133318 DOI: 10.1038/s41598-024-62814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
Evidence suggests that diabetes is on the rise in India, affecting many people's life satisfaction. Comprehensive estimation of life satisfaction among diabetes patients does not exist in the country. This study examined the effects of socioeconomic status, depression, and diabetes symptoms severity on the life satisfaction of diabetes patients by controlling various demographic variables. It was a cross-sectional study comprising 583 diabetes patients from Punjab, India. Patients were interviewed using a multi-stage purposeful random sampling method. Descriptive analysis and partial least squares structural equation modelling were used in the study to test the hypotheses. Results revealed that socioeconomic status, depression and diabetes symptoms severity significantly influence the life satisfaction of diabetes patients. A 1% drop in diabetes symptoms severity corresponds to a 0.849% increase in life satisfaction, whereas a 1% decrease in depression results in a 0.898% increase in life satisfaction. Patients with higher diabetes symptoms severity were coping with common mental disorders. Women reported higher diabetes symptoms severity and depression than men, resulting in lower life satisfaction. An experimental evaluation of the effects of socioeconomic status, depression and diabetes symptoms severity, and numerous demographic factors on life satisfaction was reported. The findings will help policymakers understand the problem associated with life satisfaction among diabetes patients in the country.
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Affiliation(s)
- Shubham Ranjan
- School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Mandi, India
| | - Ramna Thakur
- School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Mandi, India.
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Gannu L, Devine F, Popadic L, Lal S, Witte M, Potter M, Hass S. Characterizing the treatment patterns, medication burden, and patient demographics of older adults with major depressive disorder treated with antidepressants with or without selected comorbidities. Curr Med Res Opin 2024:1-12. [PMID: 38693906 DOI: 10.1080/03007995.2024.2348603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Evaluate clinical characteristics, comorbidity burden, major depressive disorder (MDD)-related healthcare resource utilization (HCRU), medication burden, and antidepressant treatment (ADT) patterns among older adults with MDD with and without selected comorbidities. METHODS Using Komodo's Healthcare Map claims data (1/1/2016-9/30/2022), patients with MDD (≥65 years) treated with ADTs were assessed 24 months preceding (baseline) and 12 months following (follow-up) first observed ADT prescription fill (index). Patients were separated into cohorts of those with ≥1 of 5 selected comorbidities and those without. Clinical characteristics, comorbidities, and MDD-related HCRU were assessed during baseline; treatment patterns were assessed during follow-up. Baseline and follow-up all-cause and comorbidity-specific medication burdens (mean prescription claims/month) were determined. RESULTS Among the total cohort (N = 417,643), 97.1% had ≥1 of 5 selected comorbidities: hypertension (80.3%), hyperlipidemia (75.4%), diabetes (54.2%), anxiety disorder (39.0%), and chronic obstructive pulmonary disorder (19.5%). Baseline and follow-up all-cause medication burdens per month were 3.8 and 4.5 for patients with selected comorbidities and 1.7 and 2.3 for those without. During baseline, most patients (96.0% with selected comorbidities, 96.2% without) had ≥1 outpatient visit, and a numerically higher percentage of those with vs. without selected comorbidities had MDD-related emergency room (13.9% vs. 6.0%) and inpatient (13.5% vs. 4.1%) visits. The majority of both cohorts (61.0% with selected comorbidities, 59.5% without) underwent treatment pattern changes. CONCLUSION This study highlights the medication burden and ADT patterns in older adults with MDD, assessing these outcomes among patients with and without comorbidities. Numerically higher medication burdens among those with selected comorbidities suggests future studies could investigate the impact of comorbidities on MDD-related care.
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Affiliation(s)
- Laxmi Gannu
- HEOR Real-World Evidence (RWE), Sage Therapeutics, Inc., Cambridge, MA, USA
| | | | | | - Sagar Lal
- HEOR, Komodo Health, Inc., San Francisco, CA, USA
| | - Michael Witte
- Global Medical Affairs, Sage Therapeutics, Inc., Cambridge, MA, USA
| | - Marci Potter
- Neuropsychiatry, US Medical, Biogen Inc, Cambridge, MA, USA
| | - Steve Hass
- HEOR Real-World Evidence (RWE), Sage Therapeutics, Inc., Cambridge, MA, USA
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Shell AL, Crawford CA, Cyders MA, Hirsh AT, Stewart JC. Depressive disorder subtypes, depressive symptom clusters, and risk of obesity and diabetes: A systematic review. J Affect Disord 2024; 353:70-89. [PMID: 38432462 DOI: 10.1016/j.jad.2024.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Overlapping but divided literatures suggest certain depression facets may pose greater obesity and diabetes risk than others. Our objectives were to integrate the major depressive disorder (MDD) subtype and depressive symptom cluster literatures and to clarify which facets are associated with the greatest cardiometabolic disease risk. METHODS We conducted a systematic review of published studies examining associations of ≥2 MDD subtypes or symptom clusters with obesity or diabetes risk outcomes. We report which facets the literature is "in favor" of (i.e., having the strongest or most consistent results). RESULTS Forty-five articles were included. Of the MDD subtype-obesity risk studies, 14 were in favor of atypical MDD, and 8 showed similar or null associations across subtypes. Of the symptom cluster-obesity risk studies, 5 were in favor of the somatic cluster, 1 was in favor of other clusters, and 5 were similar or null. Of the MDD subtype-diabetes risk studies, 7 were in favor of atypical MDD, 3 were in favor of other subtypes, and 5 were similar or null. Of the symptom cluster-diabetes risk studies, 7 were in favor of the somatic cluster, and 5 were similar or null. LIMITATIONS Limitations in study design, sample selection, variable measurement, and analytic approach in these literatures apply to this review. CONCLUSIONS Atypical MDD and the somatic cluster are most consistently associated with obesity and diabetes risk. Future research is needed to establish directionality and causality. Identifying the depression facets conferring the greatest risk could improve cardiometabolic disease risk stratification and prevention programs.
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Affiliation(s)
- Aubrey L Shell
- Department of Psychiatry, Indiana University Health, United States of America
| | | | - Melissa A Cyders
- Department of Psychology, Indiana University-Indianapolis, United States of America
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Indianapolis, United States of America
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Indianapolis, United States of America.
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Derese A, Gebreegzhiabhere Y, Medhin G, Sirgu S, Hanlon C. Impact of depression on self-efficacy, illness perceptions and self-management among people with type 2 diabetes: A systematic review of longitudinal studies. PLoS One 2024; 19:e0302635. [PMID: 38709771 PMCID: PMC11073729 DOI: 10.1371/journal.pone.0302635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Treating comorbid depression does not always improve outcomes for people with type 2 diabetes. Evidence is lacking on potential psychological and behavioural intermediaries of the impact of depression on diabetes outcomes. OBJECTIVE To synthesise evidence on the impact of comorbid depression on self-efficacy, illness perceptions, and self-management in people with type 2 diabetes. DATA SOURCES We searched PubMed, Embase, PsycINFO, and Global Health databases from inception up to 29th March 2023. STUDY ELIGIBILITY CRITERIA Only prospective studies (cohort or intervention studies) were included, with no restrictions on language. The outcomes were self-efficacy, illness perceptions, and self-management. PARTICIPANTS People with type 2 diabetes in community or health settings. EXPOSURE Comorbid depression or depressive symptoms in people with type 2 diabetes. SYNTHESIS OF RESULTS A narrative review of heterogeneous studies. RISK OF BIAS The risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. RESULTS Twenty-five studies were included, all from high-income countries. Depression was associated with lower self-efficacy (2 studies), poor illness perception (1 study), and poor self-management practices (17 studies) in people with type 2 diabetes. In 6/7 studies, depressive symptoms predicted less adherence to dietary recommendations, 8/10 studies found depressive symptoms were associated with poor medication adherence, 1/3 study found that depressive symptoms were associated with poor weight control, 3/4 with less physical exercise, and 2/3 with general self-care practices. LIMITATIONS There were no studies from low- and middle-income countries and non-Western settings, and we cannot assume the mechanisms linking comorbid depression with diabetes outcomes are similar. CONCLUSIONS Comorbid depression was associated with lower self-efficacy, poorer self-management, and less adaptive illness perceptions among people with diabetes.
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Affiliation(s)
- Andualem Derese
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Gebreegzhiabhere
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sisay Sirgu
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Service and Population Research Department and WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Busili A, Kumar K, Kudrna L, Busaily I. The risk factors for mental health disorders in patients with type 2 diabetes: An umbrella review of systematic reviews with and without meta-analysis. Heliyon 2024; 10:e28782. [PMID: 38617916 PMCID: PMC11015102 DOI: 10.1016/j.heliyon.2024.e28782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024] Open
Abstract
Background Patients with type 2 diabetes have a nearly twofold higher rate of diagnosed mental disorders than those without diabetes. The association between type 2 diabetes and mental disorders is well established in the literature and recognized as a bidirectional relationship. This study aims to conduct an umbrella review of risk and protective factors for mental health disorders in patients with type 2 diabetes and assess the credibility of the evidence for the association between each factor and mental health disorders. Methods A comprehensive search was conducted of Medline via PubMed, Web of Science, EMBASE, CINHAL, and PsycINFO from inception to November 17, 2022, to identify systematic reviews with and without meta-analyses examining associations of factors with mental health disorders in patients with type 2 diabetes. For each association, we recalculated the summary effect size and 95% confidence intervals using random-effects models. We also reported the 95% prediction interval and between-group heterogeneity. Results The study included 11 systematic reviews that met the inclusion criteria, comprising eight meta-analyses and three without meta-analyses. This involved approximately 489,930 participants and encompassed 26 unique factors. Six factors were rated as having suggestive evidence at the Class III level. These factors were obesity (n = 18,456, OR 1.75 [1.2 to 2.59], I2 97.7%), neuropathy (n = 3898, OR 2.01 [1.60 to 2.54], I2 44.5%), diabetes complications (n = 1769, OR 1.90 [1.53 to 2.36], I2 39.3%), peripheral blood concentrations of CRP (n = 1742, SMD 0.31 [0.16 to 0.45], I2 84.1%), female sex (n = 35,162, OR 1.36 [1.19 to 1.54], I2 64.5%), and social support (n = 3151, OR 2.02 [1.51 to 2.70], I2 87.2%). Conclusions Several factors associated with mental health disorders in patients with type 2 diabetes were identified with varying degrees of supporting evidence. Significantly, obesity, neuropathy, complications, peripheral blood CRP concentrations, female sex, and social support emerged with suggestive evidence. An investigation of these factors should be conducted to target interventions accordingly. It may be helpful to prioritize patients who have these risk factors as high-risk groups and to implement plans and policies to enhance support before mental health disorders occur.
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Affiliation(s)
- Amani Busili
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Laura Kudrna
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Idris Busaily
- Lecture, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
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20
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Lee S, Cho Y, Ji Y, Jeon M, Kim A, Ham BJ, Joo YY. Multimodal integration of neuroimaging and genetic data for the diagnosis of mood disorders based on computer vision models. J Psychiatr Res 2024; 172:144-155. [PMID: 38382238 DOI: 10.1016/j.jpsychires.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
Mood disorders, particularly major depressive disorder (MDD) and bipolar disorder (BD), are often underdiagnosed, leading to substantial morbidity. Harnessing the potential of emerging methodologies, we propose a novel multimodal fusion approach that integrates patient-oriented brain structural magnetic resonance imaging (sMRI) scans with DNA whole-exome sequencing (WES) data. Multimodal data fusion aims to improve the detection of mood disorders by employing established deep-learning architectures for computer vision and machine-learning strategies. We analyzed brain imaging genetic data of 321 East Asian individuals, including 147 patients with MDD, 78 patients with BD, and 96 healthy controls. We developed and evaluated six fusion models by leveraging common computer vision models in image classification: Vision Transformer (ViT), Inception-V3, and ResNet50, in conjunction with advanced machine-learning techniques (XGBoost and LightGBM) known for high-dimensional data analysis. Model validation was performed using a 10-fold cross-validation. Our ViT ⊕ XGBoost fusion model with MRI scans, genomic Single Nucleotide polymorphism (SNP) data, and unweighted polygenic risk score (PRS) outperformed baseline models, achieving an incremental area under the curve (AUC) of 0.2162 (32.03% increase) and 0.0675 (+8.19%) and incremental accuracy of 0.1455 (+25.14%) and 0.0849 (+13.28%) compared to SNP-only and image-only baseline models, respectively. Our findings highlight the opportunity to refine mood disorder diagnostics by demonstrating the transformative potential of integrating diverse, yet complementary, data modalities and methodologies.
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Affiliation(s)
- Seungeun Lee
- Department of Mathematics, Korea University, Anamro 145, Seoungbuk-gu, Seoul, 02841, Republic of Korea
| | - Yongwon Cho
- Department of Computer Science and Engineering, Soonchunhyang University, South Korea, Republic of Korea
| | - Yuyoung Ji
- Division of Life Science, Korea University, Anamro 145, Seoungbuk-gu, Seoul, 02841, Republic of Korea
| | - Minhyek Jeon
- Division of Biotechnology, Korea University, Anamro 145, Seoungbuk-gu, Seoul, 02841, Republic of Korea; Computational Biology Department, Carnegie Mellon University, Pittsburgh, PA, 15213, United States
| | - Aram Kim
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University Anam Hospital, 73, Goryeodae-ro, Seoungbuk-gu, Seoul, 02841, Republic of Korea.
| | - Yoonjung Yoonie Joo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, 115 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Republic of Korea.
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Andreeva-Gateva P, Hristov M, Strokova-Stoilova M, Ivanova N, Sabit Z, Surcheva S, Beliakov M, Karakashev G, Sukhov I, Belinskaya D, Shestakova N. Therapeutic potential of orally applied KB-R7943 in streptozotocin-induced neuropathy in rats. Heliyon 2024; 10:e27367. [PMID: 38524546 PMCID: PMC10958225 DOI: 10.1016/j.heliyon.2024.e27367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
Both peripheral neuropathy and depression can be viewed as neurodegeneration's consequences of diabetes, at least in part coexisting with or resulting from sodium-calcium dysbalance. This study aims to assess the therapeutic potential of the orally applied reverse-mode inhibitor of the sodium-calcium exchanger (NCX) KB-R7943 in the streptozotocin (STZ) diabetes model in rats. A pilot pharmacokinetic (PK) study with high-performance liquid chromatography with high-resolution tandem mass spectrometric detection revealed higher drug exposure (AUC), lower volume of distribution (Vd) and clearance (Cl), and faster decline of the plasma concentration (ƛ) in rats with diabetes vs. controls. Brain and heart accumulation and urinary excretion of the unmetabolized KB-R7943 at least 24 h were also demonstrated in all rats. However, heart and hippocampus KB-R7943 penetration (AUCtissue/AUCplasma) was higher in controls vs. diabetic rats. The development of thermal, mechanical, and chemical-induced allodynia was assessed with the Cold plate test (CPT), Randall-Stiletto (R-S) test, and 0.5% formalin test (FT). Amitriptyline 10 mg/kg, KB-R7943 5 mg/kg, or 10 mg/kg p.o once daily was applied from the 28th to the 49th day. The body weight, coat status, CPT, R-S, and FT were evaluated on days (-5), 0, and 42. On day 41, a forced swim test and 24-h spontaneous physical activities were assessed. The chronic treatment effects were calculated as % of the maximum. A dose-depended amelioration of neuropathic and depression-like effects was demonstrated. The oral application of KB-R7943 for potentially treating neurodegenerative consequences of diabetes merits further studies. The brain, heart, and kidneys are essential contributors to the PKs of this drug, and their safety involvement needs to be further characterized.
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Affiliation(s)
- Pavlina Andreeva-Gateva
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University of Sofia, Bulgaria
| | - Milen Hristov
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University of Sofia, Bulgaria
| | | | - Natasha Ivanova
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University of Sofia, Bulgaria
- Institute of Neurobiology, BAS, Bulgaria
| | - Zafer Sabit
- Department of Pathophysiology, Faculty of Medicine, Medical University of Sofia, Bulgaria
| | - Slavina Surcheva
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University of Sofia, Bulgaria
| | - Mihail Beliakov
- Laboratory of Chemical Analytical Control and Biotesting, Research Institute of Hygiene, Occupational Pathology and Human Ecology, St Petersburg, Russia
| | - Georgi Karakashev
- Laboratory of Chemical Analytical Control and Biotesting, Research Institute of Hygiene, Occupational Pathology and Human Ecology, St Petersburg, Russia
| | - Ivan Sukhov
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St Petersburg, Russia
| | - Daria Belinskaya
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St Petersburg, Russia
| | - Natalia Shestakova
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St Petersburg, Russia
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Vendrell-Serres J, Soto-Angona Ó, Rodríguez-Urrutia A, Inzoli B, González AL, Ramos-Quiroga JA. Treating Treatment-resistant Depression with Esketamine Nasal Spray When All Therapeutic Options Have Been Exhausted: Clinical Experience from a Spanish Cohort of Expanded Use. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:159-168. [PMID: 38247422 PMCID: PMC10811393 DOI: 10.9758/cpn.23.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 01/23/2024]
Abstract
Objective : Treatment Resistant Depression (TRD) is commonly defined as the lack of response to two or more anti-depressants with different mechanisms of action. Up to 30% of patients diagnosed with major depressive disorder might be considered to present TRD. The objective of this study was to assess the effectiveness and tolerability of esketamine in patients diagnosed with TRD, who were referred to our program after exhausting all available treatments. A secondary objective consisted in researching the relationship between response and previous use of electroconvulsive therapy. Methods : A prospective, observational study was carried out in patients enrolled in the expanded use of esketamine in our center. They received esketamine prior to its marketing authorisation, for therapeutic purposes. Sixteen subjects were analyzed. Effectiveness was assessed with the Montgomery-Asberg depression rating scale (MADRS). Patients were followed up to 4 months after the administration. Results : Esketamine showed a rapid, robust effect in improving depressive symptoms, with no specific correlation between outcome and any demographic or clinical traits evaluated. No differences were found between patients that previously received Electroconvulsive Therapy, and those that didn't. 10 out of 16 patients responded (> 50% change in baseline MADRS scores), but only five achieved remission (< 12 points in the global MADRS score). We provide some recommendations, based on clinical experience, to improve tolerability and adherence, and to manage adverse effects. Conclusion : Results suggest that esketamine is a safe, effective and rapid-acting option for TRD. More studies are needed to properly assess predictors of response outcome.
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Affiliation(s)
- Júlia Vendrell-Serres
- Department of Mental Health, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Óscar Soto-Angona
- Department of Mental Health, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amanda Rodríguez-Urrutia
- Department of Mental Health, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Benedetta Inzoli
- Department of Mental Health, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | | | - Josep Antoni Ramos-Quiroga
- Department of Mental Health, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
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Kim H, Kim H, Suh HJ, Choi HS. Lactobacillus brevis-Fermented Gamma-Aminobutyric Acid Ameliorates Depression- and Anxiety-Like Behaviors by Activating the Brain-Derived Neurotrophic Factor-Tropomyosin Receptor Kinase B Signaling Pathway in BALB/C Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:2977-2988. [PMID: 38300259 DOI: 10.1021/acs.jafc.3c07260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
This study investigated the effects of Lactobacillus brevis-fermented gamma-aminobutyric acid (LB-GABA) on depressive and anxiety-like behaviors with the underlying molecular mechanism in a chronic stress model of BALB/c mice. LB-GABA attenuates both neuronal cell death and the increase of monoamine oxidase activity induced by hydrogen peroxide. Behavioral tests revealed that GABA significantly increased sucrose preference and reduced immobility time in both tail suspension and forced swimming tests. LB-GABA increased exploration of the open arms in the elevated plus maze and restored activity in the open field. Moreover, LB-GABA lowered stress hormone and inflammatory mediator levels. Mechanistically, LB-GABA increased protein levels of BDNF and TrkB, activating downstream targets (AKT, ERK, and CREB), crucial for neuronal survival and plasticity. Furthermore, LB-GABA protected hippocampal neurons from stress-induced cell death and increased serotonin and dopamine levels. Overall, LB-GABA has the potential to alleviate stress-induced depression and anxiety-like symptoms and neuroinflammation by activating the BDNF-TrkB signaling pathway.
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Affiliation(s)
- Hyeongyeong Kim
- Department of Integrated Biomedical and Life Science, Graduate School, Korea University, Seoul 02841, Republic of Korea
- Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul 02841, Republic of Korea
| | - Hoon Kim
- College of Biotechnology and Natural Resources, Chung-Ang University, Anseong 17546, Republic of Korea
| | - Hyung Joo Suh
- Department of Integrated Biomedical and Life Science, Graduate School, Korea University, Seoul 02841, Republic of Korea
| | - Hyeon-Son Choi
- Department of Food Nutrition, Sangmyung University, Seoul 03016, Republic of Korea
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24
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Jennings HM, Anas A, Asmat S, Naz A, Afaq S, Ahmed N, Aslam F, Gomez GZ, Siddiqi N, Ekers D. Living with depression and diabetes: A qualitative study in Bangladesh and Pakistan. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002846. [PMID: 38271347 PMCID: PMC10810509 DOI: 10.1371/journal.pgph.0002846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/29/2023] [Indexed: 01/27/2024]
Abstract
Diabetes and depression are both serious health conditions. While their relationship is bidirectional and each condition adversely affects outcomes for the other, they are treated separately. In low and middle income countries, such as Bangladesh and Pakistan, health systems are already stretched and the integration of diabetes and depression care is rarely a priority. Within this context through interviews with patients, healthcare workers and policy makers the study explored: lived experiences of people living with depression and diabetes, current practice in mental health and diabetes care and barriers and perspectives on integrating a brief psychological therapy into diabetes care. The findings of the study included: differing patient and practitioner understandings of distress/depression, high levels of stigma for mental health and a lack of awareness and training on treating depression. While it was apparent there is a need for more holistic care and the concept of a brief psychological intervention appeared acceptable to participants, many logistical barriers to integrating a mental health intervention into diabetes care were identified. The study highlights the importance of context and of recognising drivers and understandings of distress when planning for more integrated mental and physical health services, and specifically when adapting and implementing a new intervention into existing services.
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Affiliation(s)
- Hannah Maria Jennings
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Ashraful Anas
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Sara Asmat
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Anum Naz
- Institute of Psychiatry (IoP), Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Saima Afaq
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Faiza Aslam
- Institute of Psychiatry (IoP), Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - David Ekers
- Department of Health Sciences, University of York, York, United Kingdom
- Tees Esk and Wear Valleys NHS FT, Darlington, United Kingdom
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25
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Kazemipoor N, Arefzadeh A, Dalil D, Shiehmorteza M, Hosseini SM. Serum melatonin levels in type 2 diabetic patients with depressive symptoms compared to non-depressed individuals. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:421-429. [PMID: 39011437 PMCID: PMC11246691 DOI: 10.22088/cjim.15.3.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/14/2023] [Accepted: 10/02/2023] [Indexed: 07/17/2024]
Abstract
Background Melatonin, mainly regulating the body's circadian rhythm, may have protective effects against type 2 diabetes mellitus (DM2)-induced depression due to its antioxidant and regulatory impact in the pathogenesis of both DM2 and depression. This study aimed to find the association of serum melatonin levels with depression in DM2 patients. Methods A total of 50 DM2 patients were recruited in this retrospective cross-sectional study and divided into 25 patients with depression (DM2-DP) and 25 without depression symptoms (DM2-NDP). Depression was diagnosed using the Hospital Anxiety and Depression Scale (HADS) assessment. Fasting blood samples were collected and examined for the level of serum melatonin and other biomarkers. All statistical analysis was performed by SPSS software Version 22, and a p-value less than 0.05 was considered statistically significant for all tests. Results The depression score was significantly lower in DM2-NDP than DM2-DP (p< 0.001). The mean weight was significantly lower in the DM2-DP group (P= 0.021). Total cholesterol, triglyceride, and anxiety scores were higher, and the melatonin level was lower in DM2-DP. The correlation of melatonin levels was positive with age, DBP, HbA1C, FBS, and TG. In contrast, it was negative with male gender, BMI, diabetes duration, SBP, TC, family history of DM, depression score, and anxiety score. However, no significant differences were seen. Conclusion Lower melatonin may be associated with depression and anxiety in patients with DM2. The serum melatonin level might be a strong predictor of depression in DM2 patients.
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Affiliation(s)
- Neda Kazemipoor
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Alireza Arefzadeh
- Department of Endocrinology, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Davood Dalil
- Student Research Committee, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Shiehmorteza
- Department of Clinical Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
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Lord J, Reid K, Duclos C, Mai A, Odoi A. Investigation of predictors of severity of diabetes complications among hospitalized patients with diabetes in Florida, 2016-2019. BMC Public Health 2023; 23:2424. [PMID: 38053065 PMCID: PMC10698929 DOI: 10.1186/s12889-023-17288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Severe diabetes complications impact the quality of life of patients and may lead to premature deaths. However, these complications are preventable through proper glycemic control and management of risk factors. Understanding the risk factors of complications is important in guiding efforts to manage diabetes and reduce risks of its complications. Therefore, the objective of this study was to identify risk factors of severe diabetes complications among adult hospitalized patients with diabetes in Florida. METHODS Hospital discharge data from 2016 to 2019 were obtained from the Florida Agency for Health Care Administration through a Data Use Agreement with the Florida Department of Health. Adapted Diabetes Complications Severity Index (aDCSI) scores were computed for 1,061,140 unique adult patients with a diagnosis of diabetes. Severe complications were defined as those with an aDCSI ≥ 4. Population average models, estimated using generalized estimating equations, were used to identify individual- and area-level predictors of severe diabetes complications. RESULTS Non-Hispanic Black patients had the highest odds of severe diabetes complications compared to non-Hispanic White patients among both males (Odds Ratio [OR] = 1.20, 95% Confidence Interval [CI]: 1.17, 1.23) and females (OR = 1.27, 95% CI: 1.23, 1.31). Comorbidities associated with higher odds of severe complications included hypertension (OR = 2.30, 95% CI: 2.23, 2.37), hyperlipidemia (OR = 1.29, 95% CI: 1.27, 1.31), obesity (OR = 1.24, 95% CI: 1.21, 1.26) and depression (OR = 1.09, 95% CI: 1.07, 1.11), while the odds were lower for patients with a diagnosis of arthritis (OR = 0.81, 95% CI: 0.79, 0.82). Type of health insurance coverage was associated with the severity of diabetes complications, with significantly higher odds of severe complications among Medicare (OR = 1.85, 95% CI: 1.80, 1.90) and Medicaid (OR = 1.83, 95% CI: 1.77, 1.90) patients compared to those with private insurance. Residing within the least socioeconomically deprived ZIP code tabulation areas (ZCTAs) in the state had a protective effect compared to residing outside of these areas. CONCLUSIONS Racial, ethnic, and socioeconomic disparities in the severity of diabetes complications exist among hospitalized patients in Florida. The observed disparities likely reflect challenges to maintaining glycemic control and managing cardiovascular risk factors, particularly for patients with multiple chronic conditions. Interventions to improve diabetes management should focus on populations with disproportionately high burdens of severe complications to improve quality of life and decrease premature mortality among adult patients with diabetes in Florida.
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Affiliation(s)
- Jennifer Lord
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Keshia Reid
- Florida Department of Health, Tallahassee, FL, USA
| | - Chris Duclos
- Florida Department of Health, Tallahassee, FL, USA
| | - Alan Mai
- Florida Department of Health, Tallahassee, FL, USA
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA.
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Mehdi S, Wani SUD, Krishna K, Kinattingal N, Roohi TF. A review on linking stress, depression, and insulin resistance via low-grade chronic inflammation. Biochem Biophys Rep 2023; 36:101571. [PMID: 37965066 PMCID: PMC10641573 DOI: 10.1016/j.bbrep.2023.101571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/09/2023] [Accepted: 10/29/2023] [Indexed: 11/16/2023] Open
Abstract
Stress is a disturbance in homeostasis caused by psychological, physiological, or environmental factors. Prolonged reactions to chronic stress can be detrimental, resulting in various metabolic abnormalities, referred to as metabolic syndrome (MS). There is a reciprocal increased risk between MS and major depressive disorder. Recent studies established an association between inflammation and insulin signaling in type 2 diabetes mellitus with depression. In the present review, we discuss chronic low-grade inflammation, pathways of insulin resistance, and brain glucose metabolism in the context of neuroinflammation and depression. Specific attention is given to psychotropic drugs such as bupropion, mirtazapine, and nefazodone, anti-inflammatory drugs like Celecoxib (COX-2 inhibitor), Etanercept, adalimumab, IL-4Ra antagonist, Anti-IL- 17A antibody (Ixekizumab) and lifestyle modifications including exercise, dietary changes, and sleep hygiene. These therapeutic solutions offer potential in treating depression by targeting metabolic conditions like insulin resistance and inflammatory pathways. The article further explains the significance of a nutrition and antioxidants-rich diet, emphasizing the role of omega-3 fatty acids, vitamin D, zinc, and polyphenols, to improve immunity and activate anti-inflammatory signaling pathways.
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Affiliation(s)
- Seema Mehdi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore, 570 015, India
| | - Shahid Ud Din Wani
- Department of Pharmaceutical Sciences, School of Applied Sciences and Technology, University of Kashmir, Srinagar, 190006, India
| | - K.L. Krishna
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore, 570 015, India
| | - Nabeel Kinattingal
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore, 570 015, India
| | - Tamsheel Fatima Roohi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore, 570 015, India
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Borozdenko DA, Gonchar DI, Bogorodova VI, Tarasenko DV, Kramarova EP, Khovanova SS, Golubev YV, Kiseleva NM, Shmigol TA, Ezdoglian AA, Sobyanin KA, Negrebetsky VV, Baukov YI. The Antidepressant Activity of a Taurine-Containing Derivative of 4-Phenylpyrrolidone-2 in a Model of Chronic Unpredictable Mild Stress. Int J Mol Sci 2023; 24:16564. [PMID: 38068887 PMCID: PMC10705968 DOI: 10.3390/ijms242316564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
This study investigates the therapeutic potential of a new compound, potassium 2-[2-(2-oxo-4-phenylpyrrolidin-1-yl) acetamido]ethanesulfonate (Compound I), in depression. Willner's chronic unpredictable mild stress model of male Wistar rats was used as a depression model. The rats were randomized into four groups, including an intact group, a Compound I group, a Fluoxetine group, and a control group with saline. Behavioral tests, such as the Porsolt forced swim test, hole-board test, elevated plus maze test, and light-dark box, were used to assess the animals' conditions. Our results demonstrated that Compound I effectively reduced the immobilization time of rats in the forced swim test, increased orientation and exploratory behavior, and decreased the latency period of going into the dark compartment compared to the control group. Hippocampal and striatal serotonin concentrations were increased in the Compound I group, and the compound also reduced the level of corticosterone in the blood plasma of rats compared to the intact animals. These results suggest that Compound I has reliable antidepressant activity, comparable to that of the reference antidepressant Fluoxetine.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Yuri I. Baukov
- Institute of Pharmacy and Medicinal Chemistry, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (D.I.G.); (V.I.B.); (D.V.T.); (E.P.K.); (S.S.K.); (Y.V.G.); (N.M.K.); (T.A.S.); (A.A.E.); (K.A.S.); (V.V.N.)
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29
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McCready RG, Gilley KR, Kusumo LE, Hall GM, Vichaya EG. Chronic Stress Exacerbates Hyperglycemia-Induced Affective Symptoms in Male Mice. Neuroimmunomodulation 2023; 30:302-314. [PMID: 37852199 PMCID: PMC10641805 DOI: 10.1159/000534669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Among chronically ill populations, affective disorders remain underdiagnosed and undertreated. A high degree of comorbidity exists between diabetes and affective disorders, particularly depression and anxiety. The mechanisms underlying stress-induced affective dysregulation are likely distinct from those induced by diabetes. A direct comparison between stress- and hyperglycemia-induced affective dysregulation could provide insight into distinct mechanistic targets for depression/anxiety associated with these different conditions. METHODS To this end, the present study used male C57BL/6J mice to compare the independent and combined behavioral and neuroinflammatory effects of two models: (1) unpredictable chronic mild stress and (2) pharmacologically induced hyperglycemia. RESULTS Streptozotocin-induced hyperglycemia was associated with a set of behavioral changes reflective of the neurovegetative symptoms of depression (i.e., reduced open field activity, reduced grooming, increased immobility in the forced swim task, and decreased marble burying), increased hippocampal Bdnf and Tnf expression, and elevations in frontal cortex Il1b expression. Our chronic stress protocol produced alterations in anxiety-like behavior and decreased frontal cortex Il1b expression. DISCUSSION While the combination of chronic stress and hyperglycemia produced limited additive effects, their combination exacerbated total symptom burden. Overall, the data indicate that stress and hyperglycemia induce different symptom profiles via distinct mechanisms.
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Affiliation(s)
- Riley G McCready
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Kayla R Gilley
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Laura E Kusumo
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Grace M Hall
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Elisabeth G Vichaya
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
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30
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Isfandari S, Roosihermiatie B, Tuminah S, Mihardja LK. The risk associated with psychiatric disturbances in patients with diabetes in Indonesia (2018): a cross-sectional observational study. Osong Public Health Res Perspect 2023; 14:368-378. [PMID: 37920894 PMCID: PMC10626316 DOI: 10.24171/j.phrp.2023.0144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The global prevalence of psychiatric disturbances is rising, detrimentally affecting the quality of care and treatment outcomes for individuals, particularly those with diabetes.This study investigated the association of risk factors for psychiatric disturbances among productive-age patients with diabetes (ages 30-59 years), considering sociodemographic characteristics and co-existing diseases. The risk factors considered included sociodemographic factors (e.g., residence, age, sex, marital status, education, and occupation) and co-existing diseases (e.g., hypertension, heart disease, stroke, renal failure, rheumatism, asthma, and cancer). METHODS This cross-sectional study utilized data from the 2018 Indonesian National Health Survey (Riskesdas). The study population comprised respondents aged between 30 and 59 years who had diabetes and had completed the 20-question self-reporting questionnaire (SRQ-20). After the exclusion of incomplete SRQ-20 data, the sample included 8,917 respondents. Data were analyzed using logistic regression. RESULTS Approximately 18.29% of individuals with diabetes displayed symptoms indicative of psychiatric disturbances. After adjusting for sociodemographic factors such as age, sex, education level, occupation, marital status, and place of residence, patients with diabetes who had co-existing conditions such as hypertension, heart diseases, rheumatic disorders, asthma, or cancer had a higher risk for developing psychiatric disturbances than those with diabetes alone (adjusted odds ratio, 6.67; 95% confidence interval, 4.481-9.928; p<0.001). CONCLUSION The elevated risk of psychiatric disturbances among patients with diabetes who had comorbidities underscores the importance of addressing mental health issues in the management of diabetes, especially in patients with concurrent disease conditions.
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Affiliation(s)
- Siti Isfandari
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Bandung, Indonesia
| | - Betty Roosihermiatie
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Bandung, Indonesia
| | - Sulistyowati Tuminah
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Bandung, Indonesia
| | - Laurentia Konadi Mihardja
- Research Center for Pre-Clinical and Clinical Medicine, Research Organization for Health, National Research and Innovation Agency, Bandung, Indonesia
- Faculty of Medicine, University of Malahayati, Bandar Lampung, Indonesia
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31
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Basiri R, Seidu B, Rudich M. Exploring the Interrelationships between Diabetes, Nutrition, Anxiety, and Depression: Implications for Treatment and Prevention Strategies. Nutrients 2023; 15:4226. [PMID: 37836510 PMCID: PMC10574484 DOI: 10.3390/nu15194226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Across the world, diabetes, depression, and anxiety symptoms have gained widespread recognition as significant public health issues. Recent research has unveiled a mutually influential relationship between diabetes and these two mental health conditions, where each disorder impacts the course and outcomes of the others. The role of nutrition emerges as pivotal in preventing and treating depression, anxiety, and diabetes. A thorough literature review was undertaken to investigate the reciprocal effects between anxiety, depression, and diabetes, including their impact on the development and severity of each condition. Additionally, the effects of nutrition on the prevention and management of depression, anxiety, diabetes, and related complications in at-risk individuals were assessed. Our findings show that mental disorders, such as depression and anxiety, increase the risk of developing type 2 diabetes and are associated with poorer glycemic control, increased diabetes-related complications, and higher mortality rates. Conversely, diabetes is also linked with an increased risk of developing depression and anxiety. The biological, psychological, and social factors that contribute to the comorbidity between these two conditions are complex and multifaceted. Therefore, an integrated approach to the management of both conditions is critical for improving patient outcomes and reducing the overall burden of disease. Nutritional interventions should be utilized to reduce the risk of diabetes in patients with anxiety and depression as well as enhance mental health in patients with diabetes.
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Affiliation(s)
- Raedeh Basiri
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
- Institute for Biohealth Innovation, George Mason University, Fairfax, VA 22030, USA
| | - Blessing Seidu
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
| | - Mark Rudich
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
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32
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Byeon H. Developing a nomogram for predicting depression in diabetic patients after COVID-19 using machine learning. Front Public Health 2023; 11:1150818. [PMID: 37533521 PMCID: PMC10390766 DOI: 10.3389/fpubh.2023.1150818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 08/04/2023] Open
Abstract
Objective This study identified major risk factors for depression in community diabetic patients using machine learning techniques and developed predictive models for predicting the high-risk group for depression in diabetic patients based on multiple risk factors. Methods This study analyzed 26,829 adults living in the community who were diagnosed with diabetes by a doctor. The prevalence of a depressive disorder was the dependent variable in this study. This study developed a model for predicting diabetic depression using multiple logistic regression, which corrected all confounding factors in order to identify the relationship (influence) of predictive factors for diabetic depression by entering the top nine variables with high importance, which were identified in CatBoost. Results The prevalence of depression was 22.4% (n = 6,001). This study calculated the importance of factors related to depression in diabetic patients living in South Korean community using CatBoost to find that the top nine variables with high importance were gender, smoking status, changes in drinking before and after the COVID-19 pandemic, changes in smoking before and after the COVID-19 pandemic, subjective health, concern about economic loss due to the COVID-19 pandemic, changes in sleeping hours due to the COVID-19 pandemic, economic activity, and the number of people you can ask for help in a disaster situation such as COVID-19 infection. Conclusion It is necessary to identify the high-risk group for diabetes and depression at an early stage, while considering multiple risk factors, and to seek a personalized psychological support system at the primary medical level, which can improve their mental health.
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Affiliation(s)
- Haewon Byeon
- Department of Digital Anti-aging Healthcare (BK21), Graduate School of Inje University, Gimhae, Republic of Korea
- Department of Medical Big Data, College of AI Convergence, Inje University, Gimhae, Republic of Korea
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Sung MC, Chung KP, Cheng SH. Impact of a diabetes pay-for-performance program on nonincentivized mental disorders: a panel study based on claims database analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:41. [PMID: 37415154 DOI: 10.1186/s12962-023-00450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Diabetes is one of the most prevalent chronic diseases with subsequent complications. The positive effects of diabetes pay-for-performance (P4P) programs on treatment outcomes have been reported. The program provides financial incentives based on physiological care indicators, but common mental disorder complications such as depression are not covered. METHODS This study employed a natural experimental design to examine the spillover effects of diabetes P4P program on patients with nonincentivized depressive symptoms. The intervention group consisted of diabetes patients enrolled in the DM P4P program from 2010 to 2015. Unenrolled patients were selected by propensity score matching to form the comparison group. Difference-in-differences analyses were conducted to evaluate the effects of P4P programs. We employed generalized estimating equation (GEE) models, difference-in-differences analyses and difference-in-difference-in-differences analyses to evaluate the net effect of diabetes P4P programs. Changes in medical expenses (outpatient and total health care costs) over time were analysed for the treatment and comparison groups. RESULTS The results showed that enrolled patients had a higher incidence of depressive symptoms than unenrolled patients. The outpatient and total care expenses of diabetes patients with depressive symptoms were lower in the intervention group than in the comparison group. Diabetes patients with depressive symptoms enrolled in the DM P4P program had lower expenses for depression-related care than those not enrolled in the program. CONCLUSIONS The DM P4P program benefits diabetes patients by screening for depressive symptoms and lowering accompanying health care expenses. These positive spillover effects may be an important aspect of physical and mental health in patients with chronic disease enrolled in disease management programs while contributing to the control of health care expenses for chronic diseases.
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Affiliation(s)
- Ming-Chan Sung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Population Health Research Center, National Taiwan University, 17, Xu-Zhou Road, Taipei, 100, Taiwan.
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Otten D, Ernst M, Werner AM, Tibubos AN, Reiner I, Brähler E, Wiltink J, Michal M, Nagler M, Wild PS, Münzel T, König J, Lackner KJ, Peiffer N, Beutel ME. Depressive symptoms predict the incidence of common chronic diseases in women and men in a representative community sample. Psychol Med 2023; 53:4172-4180. [PMID: 35443907 PMCID: PMC10317822 DOI: 10.1017/s0033291722000861] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression, the most frequent and harmful mental disorder, has been associated with specific somatic diseases as the leading cause of death. The purposes of this prospective study were to predict incident chronic diseases based on baseline depressive symptoms and to test sex-dependent effects. METHODS In a representative German community sample of over 12 000 participants, baseline depressive symptoms (assessed using the Patient Health Questionnaire-9) were tested as a predictor of new onset of cardiovascular disease (CVD), chronic obstructive lung disease, diabetes, cancer, and migraine at 5-year follow-up. To study disease incidence, we created subsamples for each chronic disease by excluding participants who already had the respective disease at baseline. Potential confounders were included in logistic regression models and sex-specific analyses were performed. RESULTS Controlling for demographic characteristics and loneliness, in men and women, baseline depressive symptoms were predictive of CVD, chronic obstructive lung disease, diabetes, and migraine, but not of cancer. When we additionally adjusted for metabolic and lifestyle risk factors, there was an 8% increase of chronic obstructive lung disease and migraine per point of depressive symptoms. There was a trend for CVD (4%; p = 0.053). Sex-sensitive analyses revealed trends for the relevance of depressive symptoms for CVD in men (p = 0.065), and for diabetes in women (p = 0.077). CONCLUSIONS These findings underscore the need to implement screening for depression in the treatment of major somatic illnesses. At the same time, depressed patients should be screened for metabolic and lifestyle risk factors and for somatic diseases and offered lifestyle interventions.
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Affiliation(s)
- Daniëlle Otten
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Antonia M. Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ana N. Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Iris Reiner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Markus Nagler
- Preventive Cardiology and Preventive Medicine – Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine – Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology – Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Norbert Peiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Carrillo-Balam G, Li YM, Silverman-Retana O. Sex differences in the association between diabetes and depressive symptoms: findings from Mexican National Health and Nutrition Survey 2018-2019. J Epidemiol Community Health 2023; 77:454-459. [PMID: 37105723 DOI: 10.1136/jech-2022-219557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
AIMS We set out to investigate the potential sex differences in the association between diabetes and depressive symptoms by conducting an interaction analysis, and to investigate whether sex mediates the effect of diabetes on depressive symptoms. METHODS We conducted analyses on cross-sectional data of adults aged 20 years or older in the Mexican National Health and Nutrition Survey 2018-2019 (ENSANUT 2018-2019). Diabetes was defined by self-reported medical diagnosis, and depressive symptoms were measured using the seven-item Centre for Epidemiologic Studies Depression scale. First, an unadjusted interaction analysis was conducted. Second, the inverse probability of treatment weighting was applied to account for imbalances and biases. Third, the four-way decomposition method was used to estimate the potential mediating effect of sex. RESULTS In the study population (N=43 074), the prevalence of diabetes was 9.3% for men and 11.7% for women. Depressive symptoms were more prevalent in women (19.0%) than in men (9.5%). Women with diabetes had the greatest odds of having depressive symptoms, compared with men without diabetes (ORwomen-diabetes3.49 (95% CI: 3.16 to 3.86)). The interaction analysis indicated that diabetes and sex interact on both, multiplicative and additive scales (ratio of ORs (95% CI) 1.22 (1.02 to 1.45), and relative excess risk due to interaction (95% CI) 0.99 (0.63 to 1.36)). The four-way decomposition analysis showed that the interaction effect between diabetes and sex is larger than the mediation effect. CONCLUSIONS We found a positive interaction between diabetes and sex in the odds of having depressive symptoms. Mental health and diabetes care services planning would benefit from adopting a sex-informed approach.
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Affiliation(s)
| | - Yu-Mei Li
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Omar Silverman-Retana
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
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Zhang X, Ma L, Mu S, Yin Y. The Hidden Burden-Exploring Depression Risk in Patients with Diabetic Nephropathy: A Systematic Review and Meta-Analysis. Diabetes Ther 2023:10.1007/s13300-023-01436-y. [PMID: 37368150 PMCID: PMC10363103 DOI: 10.1007/s13300-023-01436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Diabetic nephropathy is a common complication among patients with diabetes mellitus, and it has been linked to a higher risk of depression. However, the magnitude of this association remains unclear. This study aimed to systematically review and meta-analyse the risk of depression in patients with diabetic nephropathy compared to diabetes patients without nephropathy. METHODS We conducted a systematic literature review, searching multiple databases from January 1964 to March 2023, and included randomized controlled trials, non-randomized controlled trials, and observational studies. We assessed the risk of bias using the Newcastle Ottawa scale for observational studies. The statistical analysis was performed using STATA version 14.2, and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. A total of 60 studies were included. RESULTS The pooled OR for the risk of depression among patients with diabetic nephropathy was 1.78 (95% CI 1.56-2.04; I2 = 83%; n = 56), indicating a significantly higher risk compared to diabetes patients without nephropathy (p < 0.001). Pooling the effect size across these studies showed that the pooled OR was 1.15 (95% CI 1.14-1.16; I2 = 88%; n = 32). Subgroup analyses based on the type of diabetes and study region revealed no significant differences in the pooled estimates. CONCLUSION This study demonstrates that patients with diabetic nephropathy have a significantly higher risk of depression compared to diabetes patients without nephropathy. These findings highlight the importance of assessing and addressing the mental health of patients with diabetic nephropathy as part of their overall healthcare management.
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Affiliation(s)
- Xiaoli Zhang
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China
| | - Liang Ma
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China
| | - Shumin Mu
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yonghui Yin
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China.
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Cooper DH, Ramachandra R, Ceban F, Di Vincenzo JD, Rhee TG, Mansur RB, Teopiz KM, Gill H, Ho R, Cao B, Lui LMW, Jawad MY, Arsenault J, Le GH, Ramachandra D, Guo Z, McIntyre RS. Glucagon-like peptide 1 (GLP-1) receptor agonists as a protective factor for incident depression in patients with diabetes mellitus: A systematic review. J Psychiatr Res 2023; 164:80-89. [PMID: 37331261 DOI: 10.1016/j.jpsychires.2023.05.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/20/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023]
Abstract
Glucagon-like peptide 1 (GLP-1) receptor agonists are widely used for glycemic control in patients with diabetes mellitus (DM) and are primarily indicated for type 2 diabetes mellitus (T2DM). GLP-1 receptor agonists have also been shown to have neuroprotective and antidepressant properties. Replicated evidence suggests that individuals with DM are significantly more likely to develop depression. Herein, we aim to investigate whether GLP-1 receptor agonists can be used prophylactically on patients with DM to lower the risk of incident depression. We conducted a systematic search for English-language articles published on the PubMed/MEDLINE, Scopus, Embase, APA, PsycInfo, Ovid and Google Scholar databases from inception to June 6, 2022. Four retrospective observational studies were identified that evaluated the neuroprotective effects of GLP-1 receptor agonists on incident depression in patients with DM. We found mixed results with regards to lowering the risk of incident depression, with two studies demonstrating a significant reduction in risk and two studies showing no such effect. A single study found that dulaglutide may lower susceptibility to depression. Our results were limited by high interstudy heterogeneity, paucity of literature, and lack of controlled trials. While we did not find evidence of GLP-1 receptor agonists significantly lowering risk of incident depression in patients with DM, promising neuroprotective data presented in two of the included papers, specifically on dulaglutide where information is scarce, provide the impetus for further investigation. Future research should focus on better elucidating the neuroprotective potential of different classes and doses of GLP-1 receptor agonists using controlled trials.
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Affiliation(s)
- Daniel H Cooper
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
| | - Ranuk Ramachandra
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Taeho Greg Rhee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA; VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada.
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada.
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore.
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, PR China.
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada.
| | | | - Juliet Arsenault
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Gia Han Le
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Diluk Ramachandra
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
| | - Ziji Guo
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Ahmed A, Zeng G, Azhar M, Wang F, Wang J, Fan B, Liu X, Jiang D, Wang Q. Combination of Shengmai San and Radix puerariae ameliorates depression-like symptoms in diabetic rats at the nexus of PI3K/BDNF/SYN protein expression. Animal Model Exp Med 2023; 6:211-220. [PMID: 37317044 PMCID: PMC10272924 DOI: 10.1002/ame2.12333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/03/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Hyperglycemia is a characteristic feature of diabetes that often results in neuropsychological complications such as depression. Diabetic individuals are more vulnerable to experience depression compared to the normal population. Thus, novel treatment approaches are required to reduce depressive symptoms among diabetic individuals. Traditional Chinese medicines (TCMs) such as Shengmai San (SMS) and Radix puerariae (R) are usually widely used to treat ailments such as neurological complications since ancient time. METHODS In this study, SMS was combined with R to prepare an R-SMS formulation and screened for their antidepressant activity in diabetic rats. The antidepressant potential of the prepared combination was evaluated behaviorally using open field test, novelty-induced hypophagia, and forced swim test in diabetic rats with biochemical and protein expression (PI3K, BDNF [brain-derived neurotrophic factor], and SYN [presynaptic vesicle protein]) analysis. RESULTS Diabetic rats (streptozotocin, 45 mg/kg) showed elevated fasting blood glucose (FBG) >12 mM with depressive symptoms throughout the study. Treatment with R-SMS (0.5, 1.5, and 4.5 g/kg) significantly reverted depressive symptoms in diabetic rats as evinced by significantly (p < 0.05) reduced immobility time with an increased tendency to eat food in a novel environment. Treatment with R-SMS also significantly increased the protein expression of PI3K, BDNF, and SYN protein, which play a crucial role in depression. CONCLUSION This study showed that R-SMS formulation antagonized depressive symptoms in diabetic rats; thus, this formulation might be studied further to develop as an antidepressant.
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Affiliation(s)
- Ayaz Ahmed
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological SciencesUniversity of KarachiKarachiPakistan
| | - Guirong Zeng
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
- Institute of Drug Discovery TechnologyNingbo UniversityNingboChina
- Research Center for Pharmacodynamic, Material Basis and Mechanism of ActionCollege of Pharmacy, Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Mudassar Azhar
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological SciencesUniversity of KarachiKarachiPakistan
| | - Fengzhong Wang
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
| | - Jingru Wang
- Research Center for Pharmacodynamic, Material Basis and Mechanism of ActionCollege of Pharmacy, Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Bei Fan
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
| | - Xinmin Liu
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological SciencesUniversity of KarachiKarachiPakistan
- Institute of Drug Discovery TechnologyNingbo UniversityNingboChina
| | - Dejiang Jiang
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
| | - Qiong Wang
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
- Sino‐Portugal TCM International Cooperation CenterThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhouChina
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Arsh A, Afaq S, Carswell C, Bhatti MM, Ullah I, Siddiqi N. Effectiveness of physical activity in managing co-morbid depression in adults with type 2 diabetes mellitus: A systematic review and meta-analysis. J Affect Disord 2023; 329:448-459. [PMID: 36868385 DOI: 10.1016/j.jad.2023.02.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Physical activity may be effective in alleviating depressive symptoms and improving glycaemic control; however, evidence to guide practice is limited. The current review was conducted to assess the effects of physical activity on depression and glycaemic control in people with type 2 diabetes mellitus. METHODS Randomized controlled clinical trials, from the earliest record to October 2021, which recruited adults with the diagnosis of type 2 diabetes mellitus and compared physical activity with no interventions or usual care for the management of depression were included. The outcomes were change in depression severity and glycaemic control. RESULTS In 17 trials, including 1362 participants, physical activity was effective in reducing the severity of depressive symptoms (SMD = -057; 95%CI = -0.80, -0.34). However, physical activity did not have a significant effect in improving markers of glycaemic control (SMD = -0.18; 95%CI = -0.46, 0.10). LIMITATIONS There was substantial heterogeneity in the included studies. Furthermore, risk of bias assessment showed that most of the included studies were of low quality. CONCLUSIONS Physical activity can effectively reduce the severity of depressive symptoms, nonetheless, it appears that physical activity is not significantly effective in improving glycaemic control in adults who have both type 2 diabetes mellitus and depressive symptoms. The latter finding is surprising, however, given the limited evidence on which this is based, future research on the effectiveness of physical activity for depression in this population should include high quality trials with glycaemic control as an outcome.
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Affiliation(s)
- Aatik Arsh
- Department of Health Sciences, University of York, United Kingdom; Institute of Physical Medicine & Rehabilitation, Khyber Medical University, Pakistan.
| | - Saima Afaq
- Institute of Public Health, Khyber Medical University, Pakistan
| | - Claire Carswell
- Department of Health Sciences, University of York, United Kingdom
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Pakistan
| | - Najma Siddiqi
- Department of Health Sciences, University of York, United Kingdom
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Karami F, Jamaati H, Coleman-Fuller N, Zeini MS, Hayes AW, Gholami M, Salehirad M, Darabi M, Motaghinejad M. Is metformin neuroprotective against diabetes mellitus-induced neurodegeneration? An updated graphical review of molecular basis. Pharmacol Rep 2023; 75:511-543. [PMID: 37093496 DOI: 10.1007/s43440-023-00469-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 04/25/2023]
Abstract
Diabetes mellitus (DM) is a metabolic disease that activates several molecular pathways involved in neurodegenerative disorders. Metformin, an anti-hyperglycemic drug used for treating DM, has the potential to exert a significant neuroprotective role against the detrimental effects of DM. This review discusses recent clinical and laboratory studies investigating the neuroprotective properties of metformin against DM-induced neurodegeneration and the roles of various molecular pathways, including mitochondrial dysfunction, oxidative stress, inflammation, apoptosis, and its related cascades. A literature search was conducted from January 2000 to December 2022 using multiple databases including Web of Science, Wiley, Springer, PubMed, Elsevier Science Direct, Google Scholar, the Core Collection, Scopus, and the Cochrane Library to collect and evaluate peer-reviewed literature regarding the neuroprotective role of metformin against DM-induced neurodegenerative events. The literature search supports the conclusion that metformin is neuroprotective against DM-induced neuronal cell degeneration in both peripheral and central nervous systems, and this effect is likely mediated via modulation of oxidative stress, inflammation, and cell death pathways.
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Affiliation(s)
- Fatemeh Karami
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Natalie Coleman-Fuller
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN, 55108, USA
| | - Maryam Shokrian Zeini
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Wallace Hayes
- University of South Florida College of Public Health and Institute for Integrative Toxicology, Michigan State University, East Lansing, USA
| | - Mina Gholami
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Salehirad
- Cognitive and Neuroscience Research Center (CNRC), Amir-Almomenin Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mohammad Darabi
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Motaghinejad
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Zavala GA, Jennings HM, Afaq S, Alam A, Ahmed N, Aslam F, Arsh A, Coales K, Ekers D, Nabi M, Naz A, Shakur N, Siddiqi N, Wright JM, Kellar I. Effectiveness and implementation of psychological interventions for depression in people with non-communicable diseases in South Asia: Systematic review and meta-analysis. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2023; 52:260-284. [PMID: 38013979 PMCID: PMC10461698 DOI: 10.1080/00207411.2023.2202431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
We evaluate the effectiveness of psychological interventions for depression in people with NCDs in South Asia and explore the individual, organizational, and policy-level barriers and facilitators for the implementation and scaling up of these interventions. Eight databases (and local web pages) were searched in May 2022. We conducted random effects models to evaluate the pooled effect of psychological interventions on depression in people with NCDs. We extracted the individual, organizational, and policy level barriers and facilitators. We found five randomized control trials, nine qualitative studies, and 35 policy documents that fitted the inclusion criteria. The pooled standardized mean difference in depression comparing psychological interventions with usual care was -2.31 (95% CI, -4.16 to -0.45; p = .015, I2 = 96.0%). We found barriers and facilitators to intervention delivery, mental health appears in the policy agenda in Bangladesh and Pakistan. However, there is a lack of policies relating to training in mental health for NCD health providers and a lack of integration of mental health care with NCD care. All of the psychological interventions reported to be effective in treating depression in this population. There are important delivery and policy barriers to the implementation and scaling up of psychological interventions for people with NCDs.
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Affiliation(s)
- Gerardo A. Zavala
- Department of Health Sciences, University of York, York, United Kingdom
| | - Hannah Maria Jennings
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Saima Afaq
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Ashraful Alam
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Faiza Aslam
- Institute of Psychiatry (IoP), Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Aatik Arsh
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Karen Coales
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Ekers
- Department of Health Sciences, University of York, York, United Kingdom
- Tees Esk and Wear Valleys NHS FT, York, United Kingdom
| | | | - Anum Naz
- Institute of Psychiatry (IoP), Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Judy M. Wright
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
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Aldossari B, Alhossan A, Ahmad A. The Association between Type-1 Diabetes Mellitus and Risk of Depression among Saudi Patients: A Cross-Sectional Study. J Pers Med 2023; 13:jpm13040654. [PMID: 37109040 PMCID: PMC10146660 DOI: 10.3390/jpm13040654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND AIMS The importance of screening type-1 diabetic patients in Saudi Arabia is related to a high incidence rate of diabetes mellitus (DM) and the susceptibility to developing depression during or after the diagnosis. The objectives of the present study were to establish the relationship between type-1 diabetes mellitus (T1DM), depression, and depression risk among Saudi patients; estimating the prevalence and examining the relationship of depression with duration of diagnosis, the effect of glycemic control, and the presence of comorbidities. METHODS For this observational retrospective chart review, an analytical tool was used. The population of our study comprised Saudi patients with T1DM at King Khaled University Hospital, Riyadh. Data were collected from the hospital's electronic medical records. A depression screening tool (Patient Health Questionnaire "PHQ-9") was used to measure the depression risk of the diabetic patients, who had not been assessed before. The SPSS program was used to analyze the data. RESULTS The present study included 167 males (~45.75%) and 198 females (~54.25%). Patients with a normal body mass index (BMI) constituted 52%, while 21% were underweight, 19% were overweight, and 9% were obese. The investigators randomly selected 120 patients from the total of 365, and called them to assess their risk of developing depression. The results of the depression assessment were as follows: positive, 17 patients out of 22 (77.27%); negative, five patients out of 22 (22.73%). In total, 75 out of 120 (62.50%) patients were at risk of developing depression, while 45 patients out of 120 (37.50%) were not at risk of depression. There was a relationship between glycemic non-control, comorbidities with depression, and risk of developing depression in DM. The presence of complications was associated with diabetic and depressed patients, and the risk of developing depression may be increased with T1DM. CONCLUSIONS To overcome the negative consequences of undiagnosed depression, screening for depression is recommended for patients with T1DM who have multiple comorbidities, glycemic non-control, diabetic complications, and unfavorable lifestyles, as well as those undergoing combination therapy with metformin.
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Affiliation(s)
- Bashair Aldossari
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Ajaz Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
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Sachar A, Breslin N, Ng SM. An integrated care model for mental health in diabetes: Recommendations for local implementation by the Diabetes and Mental Health Expert Working Group in England. Diabet Med 2023; 40:e15029. [PMID: 36537609 DOI: 10.1111/dme.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT In 2019, NHS England and Diabetes UK convened an Expert Working Group (EWG) in order to develop a Model and recommendations to guide commissioning and provision of mental health care in diabetes pathways and diabetes care in mental health pathways. The recommendations are based on a combination of evidence, national guidance, case studies and expert opinion from across the UK and form other long term conditions. THE CASE FOR INTEGRATION There is good the evidence around the high prevalence of co-morbidity between diabetes and mental illness of all severities and, the poorer diabetes and mental health outcomes for patients when this co-morbidity exists. Detecting and managing the mental health co-morbidity improves these outcomes, but the evidence suggests that detection of mental illness is poor in the context of diabetes care in community and acute care settings and that when it is detected, the access to appropriate mental health resource is variable and generally inadequate. THE MODEL OF INTEGRATED CARE FOR DIABETES The EWG developed a one-page Model with five core principles and five operational work-streams to support the delivery of integration, with examples of local case studies for local implementation. The five core principals are: Care for all-describing how care for all PWD needs to explore what matters to them and that emotional wellbeing is supported at diagnosis and beyond; Support and information-describing how HCPs should appropriately signpost to mental health support and the need for structured education programmes to include mental healthcare information; Needs identified-describing how PWD should have their mental health needs identified and acted on; Integrated care-describing how people with mental illness and diabetes should have their diabetes considered within their mental health care; Specialist care-describing how PWD should be able to access specialist diabetes mental health professionals. The five cross cutting work-streams for operationalising the principles are: Implementing training and upskilling of HCPs; Embedding mental health screening and assessment into diabetes pathways; Ensuring access to clear, integrated local pathways; Ensuring addressing health inequalities is incorporated at every stage of service development; Improving access to specialist mental health services through commissioning. DISCUSSION AND CONCLUSIONS The Model can be implemented in part or completely, at an individual level, all the way up to system level. It can be adapted across the life span and the UK, and having learnt from other long term conditions, there is a lot of transferability across all long term conditions There is an opportunity for ICBs to consider economies of scale across multiple long term conditions for which there will be a significant overlap of patients within the local population. Any local implementation should be in co-production with experts by experience and third sector providers.
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Affiliation(s)
- Amrit Sachar
- Liaison Psychiatry Service, Charing Cross and Hammersmith Hospitals, Imperial College Healthcare NHS Trust and West London NHS Trust, London, United Kingdom
| | | | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Southport, United Kingdom
- Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom
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Mui JV, Li L, Chou OHI, Azfar N, Lee A, Hui J, Lee S, Tse G, Zhou J. Comparing sodium-glucose cotransporter 2 inhibitors and dipeptidyl peptidase-4 inhibitors on new-onset depression: a propensity score-matched study in Hong Kong. Acta Diabetol 2023; 60:917-927. [PMID: 37000300 DOI: 10.1007/s00592-023-02063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/24/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION The risk of new onset depression associated with sodium-glucose co-transporter 2 inhibitor (SGLT2I) use in patients with type 2 diabetes mellitus (T2DM) remains unclear. This study investigated the risk of new onset depression between SGLT2I and dipeptidyl peptidase 4 inhibitor (DPP4I) users. METHODS This was a population-based cohort study of T2DM patients in Hong Kong between January 1st, 2015, and December 31st, 2019. T2DM patients over 18 with either SGLT2I or DPP4I use were included. 1:1 propensity-score matching using the nearest-neighbour method was conducted based on demographics, past comorbidities and non-DPP4I/SGLT2I medication use. Cox regression analysis models were used to identify significant predictors for new onset depression. RESULTS The study cohort included a total of 18,309 SGLT2I users and 37,269 DPP4I users (55.57% male, mean age: 63.5 ± 12.9 years) with a median follow-up duration of 5.56 (IQR: 5.23-5.8) years. After propensity score matching, SGLT2I use was associated with a lower risk of new onset depression compared to DPP4I use (HR: 0.52, 95% CI: [0.35, 0.77], P = 0.0011). These findings were confirmed by Cox multivariable analysis and sensitive analyses. CONCLUSION SGLT2I use is associated with significantly lower risk of depression compared to DPP4 use in T2DM patients using propensity score matching and Cox regression analyses.
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Affiliation(s)
- Jonathan V Mui
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Lifang Li
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Oscar Hou In Chou
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Nida Azfar
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Athena Lee
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Hui
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Gary Tse
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China.
- Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
- Kent and Medway Medical School, Canterbury, UK.
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
- Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
| | - Jiandong Zhou
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Sher L. Depression and suicide in patients with diabetes. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:84. [PMID: 35809260 PMCID: PMC9976919 DOI: 10.47626/1516-4446-2022-2680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Leo Sher
- Inpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, USA. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA
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46
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Management of depression in patients with coronary artery disease: A systematic review. Asian J Psychiatr 2023; 83:103534. [PMID: 36871435 DOI: 10.1016/j.ajp.2023.103534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
Depression is an independent risk factor for coronary artery disease (CAD). Both illnesses contribute significantly to the global burden of disease. This systematic literature review examines treatment interventions for CAD patients with comorbid depression. We systematically reviewed The Cochrane Library, MEDLINE, EMBASE, PsycINFO, PUBMED, CINAHL and the ISRCTN Registry for English language randomised control trials investigating treatment interventions for depression in adults with CAD and comorbid depression. Data extracted included author name(s), year published, number of participants, enrolment criteria, depression definition/measures (standardised interviews, rating scales), description of control arms and interventions (psychotherapy and/or medications), randomisation, blinding, follow-up duration, follow-up loss, depression scores and medical outcome. The database search revealed 4464 articles. The review yielded 19 trials. Antidepressant and/or psychotherapy did not significantly influence CAD outcomes in the overall population. There was no difference between antidepressant use and aerobic exercises. Psychological interventions and pharmacological interventions provide small effect on depression outcomes in CAD patients. Patient autonomy in choice of treatment is associated with greater depression treatment satisfaction, but the majority of studies are underpowered. More research is required to explore the role of neurostimulation treatment, complementary and alternative treatments.
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Identifying depressive symptoms in patients with type 2 diabetes mellitus: the role of glucose variability and concomitant hypothyroidism. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-023-01177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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Lee DY, Cho YH, Kim M, Jeong CW, Cha JM, Won GH, Noh JS, Son SJ, Park RW. Association between impaired glucose metabolism and long-term prognosis at the time of diagnosis of depression: Impaired glucose metabolism as a promising biomarker proposed through a machine-learning approach. Eur Psychiatry 2023; 66:e21. [PMID: 36734114 PMCID: PMC9970146 DOI: 10.1192/j.eurpsy.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Predicting the course of depression is necessary for personalized treatment. Impaired glucose metabolism (IGM) was introduced as a promising depression biomarker, but no consensus was made. This study aimed to predict IGM at the time of depression diagnosis and examine the relationship between long-term prognosis and predicted results. METHODS Clinical data were extracted from four electronic health records in South Korea. The study population included patients with depression, and the outcome was IGM within 1 year. One database was used to develop the model using three algorithms. External validation was performed using the best algorithm across the three databases. The area under the curve (AUC) was calculated to determine the model's performance. Kaplan-Meier and Cox survival analyses of the risk of hospitalization for depression as the long-term outcome were performed. A meta-analysis of the long-term outcome was performed across the four databases. RESULTS A prediction model was developed using the data of 3,668 people, with an AUC of 0.781 with least absolute shrinkage and selection operator (LASSO) logistic regression. In the external validation, the AUCs were 0.643, 0.610, and 0.515. Through the predicted results, survival analysis and meta-analysis were performed; the hazard ratios of risk of hospitalization for depression in patients predicted to have IGM was 1.20 (95% confidence interval [CI] 1.02-1.41, p = 0.027) at a 3-year follow-up. CONCLUSIONS We developed prediction models for IGM occurrence within a year. The predicted results were related to the long-term prognosis of depression, presenting as a promising IGM biomarker related to the prognosis of depression.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Yong Hyuk Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea.,Department of Medical Sciences, Graduate School of Ajou University, Suwon, South Korea
| | | | - Chang-Won Jeong
- Medical Convergence Research Center, Wonkwang University, Iksan, Korea
| | - Jae Myung Cha
- Department of Gastroenterology, Gang Dong Kyung Hee University Hospital, Seoul, Korea
| | - Geun Hui Won
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jai Sung Noh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
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Barrett CE, Zhou X, Mendez I, Park J, Koyama AK, Claussen AH, Newsome K, McKeever Bullard K. Prevalence of Mental, Behavioral, and Developmental Disorders Among Children and Adolescents with Diabetes, United States (2016-2019). J Pediatr 2023; 253:25-32. [PMID: 36113638 PMCID: PMC11000210 DOI: 10.1016/j.jpeds.2022.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the association of diabetes and mental, behavioral, and developmental disorders in youth, we examined the magnitude of overlap between these disorders in children and adolescents. STUDY DESIGN In this cross-sectional study, we calculated prevalence estimates using the 2016-2019 National Survey of Children's Health. Parents reported whether their child was currently diagnosed with diabetes or with any of the following mental, behavioral, or developmental disorders: attention-deficit/hyperactivity disorder, autism spectrum disorder, learning disability, intellectual disability, developmental delay, anxiety, depression, behavioral problems, Tourette syndrome, or speech/language disorder. We present crude prevalence estimates weighted to be representative of the US child population and adjusted prevalence ratios (aPRs) adjusted for age, sex, and race/ethnicity. RESULTS Among children and adolescents (aged 2-17 years; n = 121 312), prevalence of mental, behavioral, and developmental disorders varied by diabetes status (diabetes: 39.9% [30.2-50.4]; no diabetes: 20.3% [19.8-20.8]). Compared with children and adolescents without diabetes, those with diabetes had a nearly 2-fold higher prevalence of mental, behavioral, and developmental disorders (aPR: 1.72 [1.31-2.27]); mental, emotional, and behavioral disorders (aPR: 1.90 [1.38-2.61]) and developmental, learning, and language disorders (aPR: 1.89 [1.35-2.66]). CONCLUSIONS These results suggest that approximately 2 in 5 children and adolescents with diabetes have a mental, behavioral, or developmental disorder. Understanding potential causal pathways may ultimately lead to future preventative strategies for mental, behavioral, and developmental disorders and diabetes in children and adolescents.
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Affiliation(s)
- Catherine E Barrett
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Xilin Zhou
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Isabel Mendez
- Oak Ridge Institute for Science and Education (ORISE) Fellow, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joohyun Park
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alain K Koyama
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kim Newsome
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Decreasing patterns of depression in living alone across middle-aged and older men and women using a longitudinal mixed-effects model. Soc Sci Med 2023; 317:115513. [PMID: 36450172 DOI: 10.1016/j.socscimed.2022.115513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022]
Abstract
There is little evidence regarding the association between living arrangement and depression, and no studies have examined the age- and gender-specific differences in this association. The present study sought to examine the longitudinal changes in depression patterns between isolative living versus living in company among middle-aged and older men and women by obtaining data from waves 1-7 of the Korean Longitudinal Study of Aging (KloSA), which comprises a sample of persons at least 45 years of age in the Republic of Korea (2273 middle-aged and 1387 older men, 2805 middle aged and 1862 older women). Depression scores were based on the self-reported Center for Epidemiologic Studies Depression Scale (CES-D-10) short forms. Using mixed-effect linear regression models, we estimated depression patterns by living arrangement across age- and gender groups. Our findings from the mixed-effects model revealed that over a 14-year follow-up period, there were significant decreasing patterns of depression were among middle-aged men and women, and older men living alone compared to living with a spouse and living with others. However, living alone still had the highest depression compared to other living arrangement types. On the other hand, the depression of older women living alone changed to a level similar to those living with others during the follow-up period. In conclusion, these findings indicate that living alone significantly increases the risk of depression, but the risk decreases over time. Additionally, depression patterns by living arrangement proved to differ across age and gender groups.
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