Associations between Depressive Symptoms and Social Support in Adults with Diabetes: Comparing Directionality Hypotheses with a Longitudinal Cohort

A study of the relationship between social support, depression, alexithymia and glycemic control in patients with type 2 diabetes mellitus: a structural equation modeling approach

Aim

The aim of this research was to ascertain the correlations between alexithymia, social support, depression, and glycemic control in patients diagnosed with type 2 diabetes mellitus. Additionally, this study sought to delve into the potential mediating effects of social support and depression in the relationship between alexithymia and glycemic control.

Method

A purposive sampling methodology was employed to select a cohort of 318 patients afflicted with type 2 diabetes mellitus, hailing from a care establishment situated in Chengdu City. This investigation embraced a cross-sectional framework, wherein instruments such as the General Information Questionnaire, the Toronto Alexithymia Scale 20, the Social Support Rating Scale, and the Hamilton Depression Scale were judiciously administered. The primary objective of this endeavor was to unravel the interplay that exists amongst alexithymia, social support, depression, and glycemic control. The inquiry discerned these interrelationships through both univariate and correlational analyses, subsequently delving into a comprehensive exploration of the mediating ramifications engendered by social support and depression in the nexus between alexithymia and glycemic control.

Results

The HbA1c level of patients diagnosed with type 2 diabetes mellitus was recorded as (8.85 ± 2.107), and their current status with regards to alexithymia, social support, and depression were measured as (58.05 ± 4.382), (34.29 ± 4.420), and (7.17 ± 3.367), respectively. Significant correlations were found between HbA1c and alexithymia (R=0.392, P<0.01), social support (R=-0.338, P<0.01), and depression (R=0.509, P<0.01). Moreover, alexithymia correlation with social support (R=-0.357, P<0.01) and with depression (R=0.345, P<0.01). Regarding the mediation analysis, the direct effect of alexithymia on HbA1c was calculated to be 0.158, while the indirect effect through social support and depression were 0.086 and 0.149, respectively. The total effect value was determined to be 0.382, with the mediating effect accounting for 59.95%, and the direct effect accounting for 40.31%.

Conclusion

Alexithymia exerts both direct and indirect adverse effects on glycemic control, thereby exacerbating disease outcomes. Hence, it is imperative to prioritize the mental health status of individuals with type 2 diabetes to enhance overall well-being, ameliorate diabetes-related outcomes, elevate patients' quality of life, and alleviate the psychological distress and financial burden associated with the condition.

Predicting Mood Based on the Social Context Measured Through the Experience Sampling Method, Digital Phenotyping, and Social Networks

Social interactions are essential for well-being. Therefore, researchers increasingly attempt to capture an individual's social context to predict well-being, including mood. Different tools are used to measure various aspects of the social context. Digital phenotyping is a commonly used technology to assess a person's social behavior objectively. The experience sampling method (ESM) can capture the subjective perception of specific interactions. Lastly, egocentric networks are often used to measure specific relationship characteristics. These different methods capture different aspects of the social context over different time scales that are related to well-being, and combining them may be necessary to improve the prediction of well-being. Yet, they have rarely been combined in previous research. To address this gap, our study investigates the predictive accuracy of mood based on the social context. We collected intensive within-person data from multiple passive and self-report sources over a 28-day period in a student sample (Participants: N = 11, ESM measures: N = 1313). We trained individualized random forest machine learning models, using different predictors included in each model summarized over different time scales. Our findings revealed that even when combining social interactions data using different methods, predictive accuracy of mood remained low. The average coefficient of determination over all participants was 0.06 for positive and negative affect and ranged from - 0.08 to 0.3, indicating a large amount of variance across people. Furthermore, the optimal set of predictors varied across participants; however, predicting mood using all predictors generally yielded the best predictions. While combining different predictors improved predictive accuracy of mood for most participants, our study highlights the need for further work using larger and more diverse samples to enhance the clinical utility of these predictive modeling approaches.

Mediation role of anxiety on social support and depression among diabetic patients in elderly caring social organizations in China during COVID-19 pandemic: a cross-sectional study

BACKGROUND

Diabetes has become a prominent global public health problem, which is an important cause of death, disease burden, and medical and health economic burden. Previous studies have reported that majority of persons diagnosed with diabetes later presented with psychological and mental health diseases. The study aimed to explore the mediation role of anxiety on social support and depression among diabetic patents in elderly caring social organizations (SOs).

METHODS

A multi-stage stratified cluster random sampling method was used in this cross-sectional study, and a questionnaire consisting of demographic questionnaire, MSPSS, GAD-7, and CES-D-10 was utilized to gather data. SPSS 22.0 and MPLUS 7.4 were used for statistical analysis. Spearman correlation analysis was employed to investigate correlations of key variables. A generalized linear model was used to exam factors associated with depression. Finally, the mediation effect among study variables was investigated by structural equation modeling (SEM).

RESULTS

The average scores of social support, anxiety, and depression were 58.41 ± 14.67, 2.95 ± 3.95, and 7.24 ± 5.53, respectively. The factors of gender, social support, and anxiety were identified as significantly influential factors related to depression among diabetic patients in elderly caring SOs. The effect of social support on depression was significantly mediated by anxiety (β = -0.467, 95%CI: -0.813 to -0.251). Furthermore, anxiety partially mediated the relationship between family support and depression (β = -0.112, 95%CI: -0.229 to -0.012), and anxiety functioned as a complete mediator in the effect of significant others' support and depression (β = -0.135, 95%CI: -0.282 to -0.024).

CONCLUSIONS

The indirect effect of social support on depression through anxiety among diabetic patients in elderly caring SOs was elucidated. Social support played a key role in maintaining and regulating their mental health, particularly from family and significant others. Social support provided by both family and significant others exerted an important influence on maintaining and regulating their mental health. In light of this pathway, the elderly caring SOs should enhance the magnitude of social support from these two sources, thereby diminishing the likelihood of experiencing anxiety and depression.

Association between social supports and depression among patients with diabetes mellitus in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

The adverse effects of poor social support on quality of life and adherence to treatment are established. However, the relationship between social support and depression is not well understood. In this systematic review and meta-analysis, we aim to examine the association between social support and depressive symptoms among type 2 patients with diabetes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

We searched PubMed, African Journals Online, Web of Science, and the Cochrane Library electronic databases. Some studies were also identified through manual Google search and Google scholar.

ELIGIBILITY CRITERIA

We systematically searched electronic databases for studies published up to October 2020. Only English-language articles were included.

DATA EXTRACTION AND SYNTHESIS

Screening, data extraction and quality appraisal were conducted by two independent reviewers. A random-effect model was applied to estimate ORs with 95% CIs. The Higgins I² test was used to assess the heterogeneity between the studies. The risk of publication bias was estimated using the Egger test. Leave-one-out analysis was done. Data were analysed using Stata V.11.

RESULTS

Seven studies were included in the meta-analysis. The findings from included studies revealed that poor social support increases the odds of depression among patients with diabetes (adjusted OR=2.14, 95% CI 1.34 to 3.43, p=0.003). There was no risk of publication bias (p=0.064), and heterogeneity was substantial (I²=70.7%). The leave-one-out analysis confirmed the consistency of the findings.

CONCLUSIONS

Our meta-analysis revealed that patients who had poor social support were significantly associated with an increased level of depression. Additional studies exploring factors that might moderate or mediate this association are needed. Targeted interventions for comorbid depression should be implemented in clinical practice.

SYSTEMATIC REVIEW REGISTRATION

We have submitted the protocol for registration at the PROSPERO on 9 October 2020. But we have not yet received a registration number.

A multisystemic perspective on the temporal interplay between adolescent depression and resilience-supporting individual and social resources

BACKGROUND

Adolescent depression can severely interfere with age-appropriate and lifetime development and functionality. Physical functioning in daily life (as a means of individual support) as well as social support from family and friends have been shown to enhance adolescent resilience against depression. By applying a multisystemic model of resilience, this study investigates how these resources reciprocally influence each other and how they interact with depression over time.

METHODS

Longitudinal data (three assessments over three years) from the Resilient Youth in Stressed Environments project was analyzed using panel network analysis to investigate short- and long-term uni- and bidirectional effects. The sample consisted of N = 500 adolescents from Canada (mean age = 18.49, SD = 3.01, 56.40% young women) at the first assessment.

RESULTS

Depression seemed to fluctuate, while the resources showed significant stability over the course of the study. Perceived family and friend support were not significantly influenced by depression while they had significantly negative temporal effects on depression. Only physical functioning showed a negative feedback loop, notably with somatic symptoms of depression. Family and friend support shared a reinforcing feedback loop, while physical functioning was not related to either type of support.

LIMITATIONS

Future studies should address the low average of depressive symptomatology and subjective, global measures of social support.

CONCLUSIONS

The resources show potential time-dependent effects: symptom-specific resources need to be applied in the short-term, while a pool of multisystemic resilience resources seems necessary over the long-term to increase the resilience to depression among adolescents.

Increased mortality associated with frequent exacerbations in COPD patients with mild-to-moderate lung function impairment, and smokers with normal spirometry

Background:

Methods:

Results:

Conclusions:

Why Do Users of Online Mental Health Communities Get Likes and Reposts: A Combination of Text Mining and Empirical Analysis

An online community is one of the important ways for people with mental disorders to receive assistance and obtain support. This study aims to help users with mental disorders to obtain more support and communication through online communities, and to provide community managers with the possible influence mechanisms based on the information adoption model. We obtained a total of 49,047 posts of an online mental health communities in China, over a 40-day period. Then we used a combination of text mining and empirical analysis. Topic and sentiment analysis were used to derive the key variables—the topic of posts that the users care about most, and the emotion scores contained in posts. We then constructed a theoretical model based on the information adoption model. As core independent variables of information quality, on online mental health communities, the topic of social experience in posts (0.368 ***), the topic of emotional expression (0.353 ***), and the sentiment contained in the text (0.002 *) all had significant positive relationships with the number of likes and reposts. This study found that the users of online mental health communities are more attentive to the topics of social experience and emotional expressions, while they also care about the non-linguistic information. This study highlights the importance of helping community users to post on community-related topics, and gives administrators possible ways to help users gain the communication and support they need.

Discordant Quantitative and Visual CT Assessments in the Diagnosis of Emphysema

Purpose

Visual assessment of computed tomography (CT) of the lung is routinely employed in the diagnosis of emphysema. Quantitative CT (QCT) can complement visual CT but must be well validated. QCT emphysema is defined as ≥5% of lung volume occupied by low attenuation areas ≤-950 Hounsfield units (LAA-950). Discordant visual and QCT assessments are not uncommon. We examined the association between visual and quantitative chest CT evaluation within a large cohort of subjects to identify variables that may explain discordant visual and QCT findings.

Materials and Methods

Volumetric inspiratory CT scans of 1221 subjects enrolled in phase 1 of the COPDGene study conducted at the University of Iowa were reviewed. Participants included never smokers, smokers with normal spirometry, preserved ratio impaired spirometry, and Global Initiative for Obstructive Lung Disease (GOLD) stages I-IV. CT scans were quantitatively scored and visually interpreted by both the COPDGene Imaging Center and the University of Iowa radiologists. Individual-level visual assessments were compared with QCT measurements. Agreement between the two sets of radiologists was calculated using kappa statistic. We assessed variables associated with discordant results using regression methods.

Results

There was a fair agreement for the presence or absence of emphysema between our center's radiologists and QCT (61% concordance, kappa 0.22 [0.17-0.28]). Similar comparisons showed a slight agreement between the COPDGene Imaging Center and QCT (56% concordance, kappa 0.16 [0.11-0.21]), and a moderate agreement between both sets of visual assessments (80% concordance, kappa 0.60 [0.54-0.65]). Current smoking and female gender were significantly associated with QCT-negative but visually detectable emphysema.

Conclusion

The slight-to-fair agreement between visual and quantitative CT assessment of emphysema highlights the need to utilize both modalities for a comprehensive radiologic evaluation. Discordant results may be attributable to one or more factors that warrant further exploration in larger studies.

Clinical Trial Registration

ClinicalTrials.gov Identifier NCT000608764.

Focus on the Positive: A Qualitative Study of Positive Experiences Living With Type 1 or Type 2 Diabetes

The purpose of this study was to identify positive experiences associated with diabetes from the perspective of adults diagnosed with type 1 or type 2 diabetes. We conducted in-depth face-to-face and telephone interviews with adults with diabetes. Participants focused on positive and supportive experiences with their peers and community, improved health behaviors, personal growth, and engagement in diabetes advocacy. Communicating positive experiences about diabetes may help clinicians and educators reframe the negative messages commonly shared with people with diabetes.

Ratio of FEV1/Slow Vital Capacity of < 0.7 Is Associated With Clinical, Functional, and Radiologic Features of Obstructive Lung Disease in Smokers With Preserved Lung Function

BACKGROUND

Mild expiratory flow limitation may not be recognized using traditional spirometric criteria based on the ratio of FEV₁/FVC.

RESEARCH QUESTION

Does slow vital capacity (SVC) instead of FVC increase the sensitivity of spirometry to identify patients with early or mild obstructive lung disease?

STUDY DESIGN AND METHODS

We included 854 current and former smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study cohort with a postbronchodilator FEV₁/FVC ≥ 0.7 and FEV₁ % predicted of ≥ 80% at enrollment. We compared baseline characteristics, chest CT scan features, exacerbations, and progression to COPD (postbronchodilator FEV₁/FVC, < 0.7) during the follow-up period between 734 participants with postbronchodilator FEV₁/SVC of ≥ 0.7 and 120 with postbronchodilator FEV₁/SVC < 0.7 at the enrollment. We performed multivariate linear and logistic regression models and negative binomial and interval-censored proportion hazards regression models adjusted for demographics and smoking exposure to examine the association of FEV₁/SVC < 0.7 with those characteristics and outcomes.

RESULTS

Participants with FEV₁/SVC < 0.7 were older and had lower FEV₁ and more emphysema than those with FEV₁/SVC ≥ 0.7. In adjusted analysis, individuals with postbronchodilator FEV₁/SVC < 0.7 showed a greater percentage of emphysema by 0.45% (95% CI, 0.09%-0.82%), percentage of gas trapping by 2.52% (95% CI, 0.59%-4.44%), and percentage of functional small airways disease based on parametric response mapping by 2.78% (95% CI, 0.72%-4.83%) at baseline than those with FEV₁/SVC ≥ 0.7. During a median follow-up time of 1,500 days, an FEV₁/SVC < 0.7 was not associated with total exacerbations (incident rate ratio [IRR], 1.61; 95% CI, 0.97-2.64), but was associated with severe exacerbations (IRR, 2.60; 95% CI, 1.04-4.89). An FEV₁/SVC < 0.7 was associated with progression to COPD during a 3-year follow-up even after adjustment for demographics and smoking exposure (hazard ratio, 3.93; 95% CI, 2.71-5.72). We found similar results when we examined the association of prebronchodilator FEV₁/SVC < 0.7 or FEV₁/SVC less than the lower limit of normal with chest CT scan features and progression to COPD.

INTERPRETATION

Low FEV₁ to SVC in current and former smokers with normal spirometry results can identify individuals with CT scan features of COPD who are at risk for severe exacerbations and is associated with progression to COPD in the future.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01969344T4; URL: www.clinicaltrials.gov.

A three-gene signature based on tumour microenvironment predicts overall survival of osteosarcoma in adolescents and young adults

Evidences shows that immune and stroma related genes in the tumour microenvironment (TME) play a key regulator in the prognosis of Osteosarcomas (OSs). The purpose of this study was to develop a TME-related risk model for assessing the prognosis of OSs. 82 OSs cases aged ≤25 years from TARGET were divided into two groups according to the immune/stromal scores that were analyzed by the Estimate algorithm. The differentially expressed genes (DEGs) between the two groups were analyzed and 122 DEGs were revealed. Finally, three genes (COCH, MYOM2 and PDE1B) with the minimum AIC value were derived from 122 DEGs by multivariate cox analysis. The three-gene risk model (3-GRM) could distinguish patients with high risk from the training (TARGET) and validation (GSE21257) cohort. Furthermore, a nomogram model included 3-GRM score and clinical features were developed, with the AUC values in predicting 1, 3 and 5-year survival were 0.971, 0.853 and 0.818, respectively. In addition, in the high 3-GRM score group, the enrichment degrees of infiltrating immune cells were significantly lower and immune-related pathways were markedly suppressed. In summary, this model may be used as a marker to predict survival for OSs patients in adolescent and young adults.

A simplified critical illness severity scoring system (CISSS): Development and internal validation

PURPOSE

To create a simplified critical illness severity scoring system with high prediction accuracy for 30-day mortality using only commonly available variables.

MATERIALS AND METHODS

This is a retrospective cohort study of ICU admissions 2010-2015 in 306 ICUs in 117 Veterans Affairs (VA) hospitals. We randomly divided our cohort into a training dataset (75%) and a validation dataset (25%). We created a critical illness severity scoring system (CISSS) using age, comorbidities, heart rate, mean arterial blood pressure, temperature, respiratory rate, hematocrit, white blood cell count, creatinine, sodium, glucose, albumin, bilirubin, bicarbonate, use of invasive mechanical ventilation, and whether the admission was surgical or not. We validated the performance of CISSS to predict 30-day mortality internally.

RESULTS

After excluding 31,743 re-admissions, we divided our sample (n = 534,001) into a training (n = 400,613) and a validation dataset (n = 133,388). In the training dataset, the area under the curve (AUC) of CISSS was 0.847(95%CI = 0.845-0.850). In the validation dataset, the AUC was 0.848 (95%CI = 0.844-0.852), the standardized mortality ratio (SMR) was 1.00 (95%CI = 0.98-1.02), and Brier's score for 30-day mortality was 0.058 (95%CI = 0.057-0.059). CISSS calibration was acceptable.

CONCLUSIONS

CISSS has very good performance and requires only commonly used variables that can be easily extracted by electronic health records.

Social Support, Social Network Size, Social Strain, Stressful Life Events, and Coronary Heart Disease in Women With Type 2 Diabetes: A Cohort Study Based on the Women's Health Initiative

OBJECTIVE

We studied associations between social support, social network size, social strain, or stressful life events and risk of coronary heart disease (CHD) in postmenopausal women with type 2 diabetes.

RESEARCH DESIGN AND METHODS

From the Women's Health Initiative, 5,262 postmenopausal women with type 2 diabetes at baseline were included. Cox proportional hazards regression models adjusted for demographics, depressive symptoms, anthropometric variables, and lifestyle factors were used to examine associations between social factors and CHD.

RESULTS

A total of 672 case subjects with CHD were observed during an average 12.79 (SD 6.29) years of follow-up. There was a significant linear trend toward higher risk of CHD as the number of stressful life events increased (P for trend = 0.01; hazard ratio [HR] [95% CI] for the third and fourth quartiles compared with first quartile: 1.27 [1.03-1.56] and 1.30 [1.04-1.64]). Being married or in an intimate relationship was related to decreased risk of CHD (HR 0.82 [95% CI 0.69-0.97]).

CONCLUSIONS

Among postmenopausal women with type 2 diabetes, higher levels of stressful life events were associated with higher risk of CHD. Experience of stressful life events might be considered as a risk factor for CHD among women with type 2 diabetes.

The Relationship Between Health Literacy, Social Support, Depression, and Frailty Among Community-Dwelling Older Patients With Hypertension and Diabetes in China

Population aging is one of the major challenges facing modern society and has attracted global attention. With population aging becoming a global phenomenon, the impact of age-related diseases on health is increasing rapidly. Frailty is one of the most pressing issues facing older adults. The purpose of this study was to explore the interrelationship between health literacy, social support, depression, and frailty among older patients with hypertension and diabetes in China. No studies have investigated the mediating effects of social support and depression between health literacy and frailty. The findings of this study can be applied to help ameliorate frailty in older hypertensive and diabetic patients. Data were collected from 637 older hypertensive and diabetic patients aged 65 years and older in Sichuan Province, China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. The results showed that 42.4% of the participants suffered from frailty. The mean scores for health literacy, social support, depression, and frailty were 13.6 ± 5.7, 35.7 ± 6.5, 4.0 ± 3.4, and 3.5 ± 2.1, respectively. Social support had a direct negative association with frailty (β = −0.128, 95%CI: [−0.198, −0.056]), and depression had a direct positive association with frailty (β = 0.326, 95%CI: [0.229, 0.411]), while social support had no direct association with depression. Health literacy had a direct positive association with social support (β = 0.151, 95%CI: [0.077, 0.224]) and a direct negative association with depression (β = −0.173, 95%CI: [−0.246, −0.1]), while health literacy had an indirect negative association with frailty through the mediating effect of social support and depression. To mitigate frailty in older patients with hypertension and diabetes, measures that provide social support, and enhance health literacy, while alleviating depression, should be considered, along with greater attention to patients who are divorced, widowed, or unmarried, those with comorbidities, and those with lower socioeconomic status.

Profiles of immune cell infiltration and immune-related genes in the tumor microenvironment of osteosarcoma

This work aimed to investigate tumor-infiltrating immune cells (TIICs) and immune-associated genes in the tumor microenvironment of osteosarcoma. An algorithm known as ESTIMATE was applied for immune score assessment, and osteosarcoma cases were assigned to the high and low immune score groups. Immune-associated genes between these groups were compared, and an optimal immune-related risk model was built by Cox regression analyses. The deconvolution algorithm (referred to as CIBERSORT) was applied to assess 22 TIICs for their amounts in the osteosarcoma microenvironment. Osteosarcoma cases with high immune score had significantly improved outcome (P<0.01). The proportions of naive B cells and M0 macrophages were significantly lower in high immune score tissues compared with the low immune score group (P<0.05), while the amounts of M1 macrophages, M2 macrophages, and resting dendritic cells were significantly higher (P<0.05). Important immune-associated genes were determined to generate a prognostic model by Cox regression analysis. Interestingly, cases with high risk score had poor outcome (P<0.01). The areas under the curve (AUC) for the risk model in predicting 1, 3 and 5-year survival were 0.634, 0.781, and 0.809, respectively. Gene set enrichment analysis suggested immunosuppression in high-risk osteosarcoma patients, in association with poor outcome.

Optimism and depressive symptoms following a diabetes diagnosis: Results from the Health and Retirement Study

Depression is common among individuals with diabetes and contributes to poorer prognoses. Optimism is associated with enhanced mental health. Therefore, this study tested whether optimism buffered against increases in depressive symptoms following a diabetes diagnosis. Participants were drawn from the Health and Retirement Study (n = 328, M_age = 65.8). Optimism, assessed before diagnosis, was inversely associated with depressive symptoms within 2 (B = -.30, p = .004, ΔR² = .02) and 6 (B = -.29, p = .008, ΔR² = .02) years of a diabetes diagnosis. Results suggest that optimism is a protective factor for comorbid depressive symptoms.

Trajectories of social support in adults with type 2 diabetes: Associations with depressive symptoms and functional disability

OBJECTIVES

Little is known about temporal trajectories of social support in adults with type 2 diabetes (T2D) and how they are associated with diabetes-related outcomes. This study identified and explored different trajectories of social support in a community sample of adults with T2D, as well as the extent to which different trajectories were prospectively associated with depressive symptoms and functional disability.

METHODS

Data came from five annual waves of the Evaluation of Diabetes Treatment study (N = 1077). Social support, depressive symptoms, and functional disability were assessed via self-report. Separate analyses were conducted to examine the associations between social support trajectories, depressive symptoms, and functional disability, adjusting for demographic characteristics, diabetes-related covariates, and baseline depressive symptoms and functional disability.

RESULTS

Latent class growth modeling identified four distinct social support trajectories. Trajectory Groups 1 and 2 comprised participants with persistently low and persistently moderate-low social support, respectively. Trajectory Groups 3 and 4 included participants with persistently moderate-high and persistently high social support, respectively. People with persistently low social support reported higher functional disability relative to those with persistently moderate-high and persistently high social support.

CONCLUSIONS

The findings of the present study indicate that temporal patterns of social support are a predictor of future functional disability among adults with T2D.

Depression predicts longitudinal declines in social support among women with newly diagnosed breast cancer

OBJECTIVE

Among breast cancer survivors, low social support is associated with adverse clinical and psychosocial outcomes. This study prospectively examined longitudinal trends in perceived social support in women with newly diagnosed breast cancer as a function of depression status prior to initiation of cancer treatment.

METHODS

One hundred ten patients with newly diagnosed breast cancer and 59 age-matched noncancer controls completed behavioral measures at four assessments: prior to treatment and at 1 month, 1 year, and 2 years post-treatment. Participants reported their perceived tangible and emotional/informational support using the Medical Outcomes Study Social Support Survey and were categorized as "depressed" or "non-depressed" based on the Brief Symptom Inventory-18 (BSI-18). Analyses first compared longitudinal trends in support between patients and controls and then examined differences in longitudinal trends as a function of depression status in patients only, controlling for key covariates.

RESULTS

Both tangible and emotional/informational support decreased among breast cancer patients but increased or remained unchanged among noncancer controls across the assessments. Among patients, depressed individuals experienced a significant decline in both tangible (P = 0.004) and emotional/informational support (P = 0.013) between 1 month and 1 year post-treatment, which remained unchanged between 1 year and 2 years post-treatment. In contrast, nondepressed individuals had stable levels across all assessments. Depressed patients also had lower levels of both support types compared with nondepressed patients across all assessments.

CONCLUSIONS

Breast cancer patients with depressive symptomatology have an elevated risk for declines in perceived social support over time.

Predictive value of prebronchodilator and postbronchodilator spirometry for COPD features and outcomes

Introduction

We compared the predictive value of prebronchodilator and postbronchodilator spirometry for chronic obstructive pulmonary disease (COPD) features and outcomes.

Methods

We analysed COPDGene data of 10 192 subjects with smoking history. We created regressions models with the following dependent variables: clinical, functional and radiographic features, and the following independent variables: prebronchodilator airflow obstruction (PREO) and postbronchodilator airflow obstruction (POSTO), prebronchodilator and postbronchodilator FEV₁% predicted. We compared the model performance using the Akaike information criterion (AIC).

Results

The COPD prevalence was higher using PREO. About 8.5% had PREO but no airflow obstruction in postbronchodilator spirometry (POSTN) (PREO-POSTN) and 3% of all subjects had no aiflow obstruction in prebronchodilator spirometry (PREN) but POSTO (PREN-POSTO). We found no difference in COPD features and outcomes between PREO-POSTN and PREN-POSTO subjects. Although, both prebronchodilator and postbronchodilator spirometries are both associated with chronic bronchitis, dyspnoea, exercise capacity and COPD radiographic findings, models that included postbronchodilator spirometric measures performed better than models with prebronchodilator measures to predict these COPD features. The predictive value of prebronchodilator and postbronchodilator spirometries for respiratory exacerbations, change in forced expiratory volume in 1 s, dyspnoea and exercise capacity during a 5-year period is relatively similar, but postbronchodilator spirometric measures are better predictors of mortality based on AIC.

Conclusions

Postbronchodilator spirometry may be a more accurate predictor of COPD features and outcomes.

New directions for diabetes prevention and management in behavioral medicine

Accelerating diabetes rates have resulted in a global public health epidemic. Lifestyle change is a cornerstone of care, yet regimen demands may result in adherence difficulties. Distress, depression, and other psychosocial concerns are higher in those with diabetes. While interventions, such as the Diabetes Prevention Program appear to be effective, further research is needed to support the translation of interventions to prevent diabetes. Studies assessing optimal approaches to promoting effective decision making, coping and adherence are needed. More information is needed to evaluate the influence and potential of emerging technologies on intervention delivery and quality of life in children and adults with diabetes. Theoretically informed, interdisciplinary studies that consider ecological models are needed to develop a roadmap for policies and diabetes management recommendations. Reduction of diabetes-related health disparities is a critical area for future studies. Behavioral medicine scientists and practitioners are poised to address these and other proposed future research directions to advance diabetes prevention and management.