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Fisekovic Kremic MB. Factors associated with depression, anxiety and stress among patients with diabetes mellitus in primary health care: Many questions, few answers. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:54-61. [PMID: 33329863 PMCID: PMC7735874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION People with diabetes mellitus (DM) may have concurrent mental health disorders and have been shown to have poorer disease outcomes. OBJECTIVE The aim of this study to determine the prevalence of DASS in patients with diabetes mellitus without mental disorders, aged 20 years or more, in primary health care, and to determine any association between DASS and patients' sociodemographic and clinical attributes. METHODS This was a cross-sectional study conducted in a primary health care center, in the department of general practice. Patients with DM who visited the doctor and agreed to fill in the questionnaire were included in the study. Data were collected using the questionnaire DASS-21. Descriptive statistics, the Pearson chi-square test, and logistic regression analysis were used to analyze the data. RESULTS Out of a total of 102 respondents with DM, 29 (28.4%) had some form of psychological symptoms. The prevalence of DASS was 16.7%, 16.6%, and 23.5%, respectively. There was no significant difference between sociodemographic variables according to stress status. Respondents aged 40-49 years more often showed emotional states of depression and anxiety. There was a significant association between emotional status of DASS and HbA1c values. Logistic regression analysis indicated that age (OR=2.57, 95% CI: 1.59-4.13) was a predictor of depression and anxiety. CONCLUSION Unpleasant emotional states DASS are common in patients with DM, depression (16.7%), anxiety (16.6%), and stress (23.5%). Age is the strongest predictor of DASS status. The screening and monitoring of unpleasant emotional states in people with diabetes should be performed from a young age.
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Almeida OP, McCaul K, Hankey GJ, Yeap BB, Golledge J, Norman PE, Flicker L. Duration of diabetes and its association with depression in later life: The Health In Men Study (HIMS). Maturitas 2016; 86:3-9. [PMID: 26921921 DOI: 10.1016/j.maturitas.2016.01.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine if diabetes and duration of diabetes are direct or indirect causes of depression in later life. RESEARCH DESIGN AND METHODS Cross-sectional study of a community-derived sample of 5462 men aged 70-89 years. Men with 'current depression' scored 7 or more on the abbreviated Geriatric Depression Scale (GDS-15), whereas men with 'ever depression' were either currently depressed or reported history or treatment for past depression. The presence of diabetes was established by self-reported history, fasting glucose ≥7 mmol/L (126 mg/dL), or use of insulin or hypoglycemic drugs. Duration of diabetes relied on self-report. Other measured factors included age, place of birth, education, smoking history, and the FRAIL scale. RESULTS Diabetes was associated with increased odds ratio (OR) of ever (OR=1.49, 95%CI=1.25, 1.76) and current depression (OR=1.94, 95%CI=1.15, 2.48). The association between duration of diabetes and risk of current depression was 'J-shaped' with odds ratios of 1.92 (95%CI=1.44, 2.54), 1.56 (95%CI=0.89, 2.75), 2.49 (95%CI=1.16, 5.32) and 3.13 (95%CI=1.28, 7.63) for <10, 10-19.9, 20-29.9 and ≥30 years of diabetes history compared with older men without diabetes. The strength of these associations was attenuated after the analyses were adjusted for other measured factors, but the shape of the curve did not change. Structural equation modeling showed that frailty mediated some of the association between diabetes duration and depression (about 15%) and was a strong predictor of depression in the sample. CONCLUSIONS In older men, the association between time lived with the diagnosis of diabetes and the risk of depression is 'J-shaped'. Frailty mediates some of the association between diabetes and depression, although other unmeasured factors are also likely to play a role. The introduction of strategies that are effective at decreasing diabetes-related complications may also contribute to decrease the risk of depression among older men.
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Affiliation(s)
- Osvaldo P Almeida
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia; WA Centre for Health & Ageing of Centre for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia; Department of Psychiatry, Royal Perth Hospital, Perth, Australia.
| | - Kieran McCaul
- WA Centre for Health & Ageing of Centre for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Endocrinology, Fiona Stanley Hospital, Perth, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
| | - Paul E Norman
- School of Surgery, University of Western Australia & Department of Surgery, Fiona Stanley Hospital, Australia
| | - Leon Flicker
- WA Centre for Health & Ageing of Centre for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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Depression, Help-Seeking and Self-Recognition of Depression among Dominican, Ecuadorian and Colombian Immigrant Primary Care Patients in the Northeastern United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10450-74. [PMID: 26343691 PMCID: PMC4586621 DOI: 10.3390/ijerph120910450] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/07/2015] [Accepted: 08/19/2015] [Indexed: 12/31/2022]
Abstract
Latinos, the largest minority group in the United States, experience mental health disparities, which include decreased access to care, lower quality of care and diminished treatment engagement. The purpose of this cross-sectional study of 177 Latino immigrants in primary care is to identify demographic factors, attitudes and beliefs, such as stigma, perceived stress, and ethnic identity that are associated with depression, help-seeking and self-recognition of depression. Results indicated that 45 participants (25%) had depression by Patient Health Questionnaire (PHQ-9) criteria. Factors most likely to be associated with depression were: poverty; difficulty in functioning; greater somatic symptoms, perceived stress and stigma; number of chronic illnesses; and poor or fair self-rated mental health. Fifty-four people endorsed help-seeking. Factors associated with help-seeking were: female gender, difficulty in functioning, greater somatic symptoms, severity of depression, having someone else tell you that you have an emotional problem, and poor or fair self-rated mental health. Factors most likely to be associated with self-recognition were the same, but also included greater perceived stress. This manuscript contributes to the literature by examining attitudinal factors that may be associated with depression, help-seeking and self-recognition among subethnic groups of Latinos that are underrepresented in research studies.
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Austin AW, Gordon JL, Lavoie KL, Arsenault A, Dasgupta K, Bacon SL. Differential association of insulin resistance with cognitive and somatic symptoms of depression. Diabet Med 2014; 31:994-1000. [PMID: 24754892 DOI: 10.1111/dme.12465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/09/2014] [Accepted: 03/28/2014] [Indexed: 11/29/2022]
Abstract
AIM To examine the associations of depressive symptoms with insulin resistance, evaluating somatic and cognitive depressive symptoms separately. METHODS A total of 328 individuals (mean age 60 years) referred for exercise stress testing, taking part in the Mechanisms and Outcomes of Silent Myocardial Ischemia study, completed the Beck Depression Inventory II. A fasting venous blood sample was collected for assessments of insulin and glucose level; the HOMA-IR (homeostatic model assessment of insulin resistance) was calculated. In principal component analysis, Beck Depression Inventory II items were forced to load onto two components (somatic and cognitive depressive symptoms). Adjusting for age, sex, BMI, medication use, smoking, physical activity, diabetes and cardiovascular disease, general linear model analyses were conducted to examine the associations between the components and log HOMA-IR . RESULTS Principal component analysis showed that nine items loaded onto a cognitive depressive symptoms component and 10 items loaded onto a somatic depressive symptoms component. When examined separately, both components were significantly associated with log HOMA-IR however, when including both components simultaneously in the model, only somatic depressive symptoms remained significantly associated with log HOMA-IR. Back-transformed, a one-unit change in somatic depressive symptoms was associated with a 1.07 (95% CI 1.002, 1.14) change in HOMA-IR and a one-unit change in cognitive depressive symptoms was associated with a 1.03 (95% CI 0.97, 1.14) change in HOMA-IR. CONCLUSION Somatic depressive symptoms seem to be more strongly associated with insulin resistance than do cognitive depressive symptoms. Monitoring somatic depressive symptoms may be more appropriate than monitoring cognitive depressive symptoms among depressed individuals with high insulin resistance.
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Affiliation(s)
- A W Austin
- Montreal Behavioural Medicine Centre, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada; Department of Exercise Science, Concordia University, Montreal, Quebec, Canada; Research Centre, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
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Camara A, Baldé NM, Enoru S, Bangoura JS, Sobngwi E, Bonnet F. Prevalence of anxiety and depression among diabetic African patients in Guinea: association with HbA1c levels. DIABETES & METABOLISM 2014; 41:62-8. [PMID: 24880857 DOI: 10.1016/j.diabet.2014.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
Abstract
AIM The prevalence and risk factors associated with symptoms of anxiety and depression were determined in African people with diabetes. METHODS This cross-sectional study involved 491 outpatients with type 2 diabetes (T2D) recruited from four diabetes clinics (Conakry, Labé, Boké and Kankan) in Guinea. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate symptoms of anxiety and depression. Logistic regression analysis stratified by gender was performed to identify the associated risk factors. RESULTS Anxiety and depression symptoms were present in 58.7% and 34.4%, respectively, of the 491 patients with T2D (62.7% women, mean±SD age: 57.9±10.2years). Odds ratios (95% CI) of risk factors independently associated with anxiety were urban residence [2.98 (1.81-4.89)] in women, and low socioeconomic status [0.19 (0.05-0.70)] and HbA1c≥9.0% [2.61 (1.0-6.39)] in men. Factors associated with depression were urban residence [2.13 (1.27-3.58)], older age [1.03 (1.01-1.06)], low socioeconomic status [2.21 (1.34-3.66)] and no previous measurement of HbA1c [12.45 (1.54-100.34)] in women, and insulin therapy [2.28 (1.05-4.92)] and HbA1c≥9.0% [3.85 (1.02-14.48)] in men. CONCLUSION Anxiety and depression symptoms in people with type T2D are common in Guinea. Urban residence, low socioeconomic status and high levels of HbA1c were significantly associated with a greater risk of anxiety and depression, highlighting the psychological burden related to diabetes in Africa.
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Affiliation(s)
- A Camara
- Department of Endocrinology, University Hospital, Conakry, Guinea; Inserm, CIC 0203, University Hospital of Pontchaillou, Rennes, France.
| | - N M Baldé
- Department of Endocrinology, University Hospital, Conakry, Guinea
| | - S Enoru
- Central Hospital and Faculty of Medicine and Biomedical Sciences University, Yaounde, Cameroon
| | - J S Bangoura
- Department of Endocrinology, University Hospital, Conakry, Guinea
| | - E Sobngwi
- Central Hospital and Faculty of Medicine and Biomedical Sciences University, Yaounde, Cameroon
| | - F Bonnet
- Inserm, CIC 0203, University Hospital of Pontchaillou, Rennes, France; Department of Endocrinology, University Hospital, Rennes, France
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Abstract
There is a controversy regarding whether depression and type 2 diabetes are causally linked. To assess this issue, we review key findings for the association between depression and diabetes, and its underlying mechanisms. Findings from meta-analyses of cohort studies show a modestly sized bidirectional association between depression and type 2 diabetes (ie, depression predicts diabetes onset and diabetes predicts future depression). However, depression-related biological alterations in the hypothalamic-pituitary-adrenal cortex axis and the sympathetic nervous system, and subclinical inflammation, are not consistently linked with increased diabetes risk. The evidence for an association between depression and glycaemic traits (eg, glucose, insulin, insulin sensitivity, and insulin secretion) is also mixed. Diabetes increases the risk of depression to the same extent as do other chronic disorders (eg, cardiac diseases, osteoarthritis, lung disease, and poor hearing). At present, the available evidence suggests that pathophysiological changes preceding the onset of type 2 diabetes might not cause depression, nor might depression directly increase the risk of developing type 2 diabetes. Despite insufficient robust causal evidence, treating physicians should be aware of the co-occurrence of depression and type 2 diabetes.
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Affiliation(s)
- Adam G Tabák
- Department of Epidemiology and Public Health, University College London, London, UK; Semmelweis University Faculty of Medicine, 1st Department of Medicine, Budapest, Hungary.
| | - Tasnime N Akbaraly
- Department of Epidemiology and Public Health, University College London, London, UK; Inserm U 1061, Montpellier, France; University Montpellier I, Montpellier, France
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
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