Diabetes, cardiovascular disease, and health care use in people with and without schizophrenia

Schizophrenia and type 2 diabetes risk: a systematic review and meta-analysis

Objectives

The metabolic syndrome in patients with schizophrenia has consistently been a challenge for clinicians. Previous studies indicate that individuals with schizophrenia are highly prone to developing type 2 diabetes mellitus (T2DM). In recent years, a continuous stream of new observational studies has been reported, emphasizing the pressing need for clinicians to gain a more precise understanding of the association between schizophrenia and T2DM. The objective of this meta-analysis is to integrate new observational studies and further explore the potential link between schizophrenia and the risk of T2DM.

Methods

We conducted a comprehensive search of PubMed, Cochrane Library, Embase, and Web of Science using medical subject headings (MeSH) and relevant keywords. The risk of bias in cohort studies and case-control studies was assessed using the Newcastle-Ottawa Scale (NOS), while cross-sectional studies were evaluated using the Agency for Healthcare Research and Quality scale (AHRQ), scoring was based on the content of the original studies. A fixed-effects model was employed if P > 0.1 and I2 ≤ 50%, indicating low heterogeneity. Conversely, a random-effects model was utilized if I2 > 50%, indicating substantial heterogeneity. Publication bias was assessed using funnel plots and Egger's test. Statistical analyses were carried out using Stata statistical software version 14.0.

Results

This meta-analysis comprised 32 observational studies, involving a total of 2,007,168 patients with schizophrenia and 35,883,980 without schizophrenia, published from 2004 to 2023. The pooled analysis revealed a significant association between a history of schizophrenia and an increased risk of T2DM (Odds Ratio [OR] = 2.15; 95% Confidence Interval [CI]: 1.83-2.52; I2 = 98.9%, P < 0.001). Stratified by gender, females with schizophrenia (OR = 2.12; 95% CI: 1.70-2.64; I2 = 90.7%, P < 0.001) had a significantly higher risk of T2DM than males (OR = 1.68; 95% CI: 1.39-2.04; I2 = 91.3%, P < 0.001). Regarding WHO regions, EURO (OR = 2.73; 95% CI: 2.23-3.35; I2 = 97.5%, P < 0.001) exhibited a significantly higher risk of T2DM compared to WPRO (OR = 1.72; 95% CI: 1.32-2.23; I2 = 95.2%, P < 0.001) and AMRO (OR = 1.82; 95% CI: 1.40-2.37; I2 = 99.1%, P < 0.001). In terms of follow-up years, the >20 years subgroup (OR = 3.17; 95% CI: 1.24-8.11; I2 = 99.4%, P < 0.001) showed a significantly higher risk of T2DM than the 10-20 years group (OR = 2.26; 95% CI: 1.76-2.90; I2 = 98.6%, P < 0.001) and <10 years group (OR = 1.68; 95% CI: 1.30-2.19; I2 = 95.4%, P < 0.001).

Conclusions

This meta-analysis indicates a strong association between schizophrenia and an elevated risk of developing diabetes, suggesting that schizophrenia may function as an independent risk factor for T2DM.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023465826.

The risk of stroke and post-stroke mortality in people with schizophrenia: A systematic review and meta-analysis study

Sources of heterogeneity in risk of stroke and mortality risk following acute-stroke in schizophrenia are understudied. We systematically searched four electronic-databases until 1-November-2022, and conducted meta-analysis to synthesize estimates of stroke-risk and post-stroke mortality for schizophrenia patients relative to non-schizophrenia counterparts. Subgroup-analyses and meta-regression models stratified by sex, nature of sample (incident/prevalent), geographical region, study-period and time-frame following stroke were conducted when applicable. Fifteen and 5 studies were included for meta-analysis of stroke-risk (n=18,368,253; 129,095 schizophrenia patients) and all-cause post-stroke mortality (n=289,231; 4,477 schizophrenia patients), respectively. Schizophrenia patients exhibited elevated stroke-risk (relative-risk =1.55[95% CI:1.31-1.84]) relative to non-schizophrenia controls. Schizophrenia was associated with increased stroke-risk in both sexes, study-periods of 1990s and 2000s, and irrespective of nature of sample and geographical regions. Meta-regression revealed regional differences in relative-risk for stroke, but limited by small number of studies. After removal of an outlier study, meta-analysis demonstrated that schizophrenia was associated with increased overall (hazard-ratio=1.37[1.30-1.44]), short-term (≤90 days; 1.29[1.14-1.46]) and longer-term (≥1 year; 1.45[1.32-1.60]) post-stroke mortality rates. Raised post-stroke mortality rate for schizophrenia was observed irrespective of nature of sample, geographical regions and study-periods. Taken together, schizophrenia is associated with increased stroke-risk and post-stroke mortality. Multilevel-interventions are required to reduce these physical-health disparities.

Electrocardiogram abnormalities and associated factors among psychiatric patients attending follow up at Jimma Medical Center Psychiatry Clinic, Jimma, Ethiopia: an institution-based cross-sectional study

BACKGROUND

Psychiatric patients have two to three-fold higher risk of cardiovascular morbidity and mortality as compared to the general population. Despite the high rate of cardiovascular disease, about 80% of patients with psychiatric disorders have fewer opportunities for cardiovascular disease screening. Early detection of subclinical cardiovascular disease using an electrocardiogram can improve the clinical outcomes of these patients. However, in Ethiopia, no previous study had been conducted on electrocardiogram abnormalities and associated factors among psychiatric patients. Hence, this study aimed to assess the electrocardiogram abnormalities and associated factors among psychiatric patients attending follow-up at Jimma Medical Center, Jimma, Ethiopia.

METHODS

An institution-based cross-sectional study was carried out among psychiatric patients attending Jimma Medical Center Psychiatry Clinic from October 14 to December 10, 2021. An interviewer-administered structured questionnaire was used to collect socio-demographic data, behavioral factors, disease-related and medication-related data. Anthropometry and blood pressure were measured following the standard protocols. A resting 12 lead ECG was recorded according to the standard recording protocol of the Minnesota code. Data were entered into Epi data version 4.6 and exported to SPSS version 25. Results of the descriptive analysis were summarized by frequencies, means, and proportions, and presented by using tables and figures. Bivariable and multivariable logistic regressions were performed. p value < 0.05 was considered statistically significant.

RESULT

A total of 315 psychiatric patients were included in the present study. The mean age (SD) of the respondents was 36.27 ± 10.85 years. ECG abnormalities were identified among 191 (60.6%) respondents. Age older than 40 years [AOR = 3.31: 95% CI 1.58-6.89], treatment with antipsychotics [AOR = 4.16: 95% CI 1.25-13.79], polytherapy [AOR = 3.13: 95% CI 1.15-8.62], having schizophrenia [AOR = 3.11: 95% CI 1.20-8.11], and illness duration of > 10 years [AOR = 4.25: 95% CI 1.72-10.49] were significantly associated with ECG abnormalities.

CONCLUSIONS

In the present study, six out of ten respondents had ECG abnormalities. Age of the respondents, treatment with antipsychotics, having schizophrenia, polytherapy and illness duration of > 10 years were significant predictors of ECG abnormalities. Routine ECG investigation should be performed in the psychiatry treatment setting and further studies are recommended to delineate factors affecting ECG abnormalities.

[The global cardiovascular risk of patients with schizophrenia hospitalized in psychiatry at the university hospital of Saint-Étienne]

CONTEXT

Patients suffering from schizophrenia present with a risk of cardiovascular death which is two to three times as high as the general population.

OBJECTIVES

Our study aims to evaluate the global cardiovascular risk according to SCORE and Framingham on patients suffering from schizophrenia who have been hospitalized in psychiatric institutions and also to assess whether being under the care of a physician affects that risk.

METHODS

A prospective descriptive epidemiologic study was conducted from April 2005 to March 2016. The study population consisted of adult patients suffering from schizophrenia who were hospitalized in the psychiatric unit of the CHU de Saint-Étienne. The data was collected during the clinical admission examination. The software CARDIORISK was used to compute the global cardiovascular risk according to SCORE and Framingham.

RESULTS

The average cardiovascular risk was about four times as high for males as it was for females according to the SCORE model and twice as high according to the Framingham model. According to the SCORE model, 16.5 % of the patients presented a high cardiovascular risk versus 6.6 % according to the Framingham model. There was no statistically significant difference between patients who were under the care of a physician and those who were not, both in terms of the prevalence of the risk factors and in terms of the global cardiovascular risk.

CONCLUSION

Using the global cardiovascular risk approach as a primary prevention measure could allow patients suffering from schizophrenia to be admitted earlier. Also, regularly reevaluating that risk could allow initiation of behavioral changes and/or important cardiovascular treatments.

Temporal trends in cardiovascular disease risk factor profiles in a population-based schizophrenia sample: a repeat cross-sectional study

Background

People with schizophrenia have an increased burden of cardiovascular diseases (CVD); however, little is known about the cardiovascular risk factor profiles of non-institutionalised individuals with schizophrenia. This study estimated the prevalence of CVD risk factors in a population-based sample of Canadians with and without schizophrenia.

Methods

Ontario respondents of the Canadian Community Health Survey were linked to administrative health databases; using a validated algorithm, we identified 1103 non-institutionalised individuals with schizophrenia and 156 376 without schizophrenia. We examined the prevalence of eight CVD risk factors: smoking, diabetes, hypertension, obesity, physical inactivity, fruit/vegetables consumption, psychosocial stress and binge drinking. To examine temporal trends, we compared prevalence estimates from 2001–2005 to 2007–2010.

Results

The prevalence of most CVD risk factors was significantly higher among those with schizophrenia than the general population. Obesity and diabetes prevalence increased by 39% and 71%, respectively, in the schizophrenia group vs 11% and 24%, respectively, in the non-schizophrenia group between the two time periods. Unlike the general population, smoking rates among those with schizophrenia did not decline. Almost 90% of individuals with schizophrenia had at least one CVD risk factor and almost 40% had ≥3 co-occurring risk factors.

Conclusion

Individuals with schizophrenia had a greater prevalence of individual and multiple CVD risk factors compared with those without schizophrenia, which persisted over time. Our findings suggest that public health efforts to reduce the burden of CVD risk factors have not been as effective in the schizophrenia population, thus highlighting the need for more targeted interventions and prevention strategies.

Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls

People with severe mental illness (SMI) - schizophrenia, bipolar disorder and major depressive disorder - appear at risk for cardiovascular disease (CVD), but a comprehensive meta-analysis is lacking. We conducted a large-scale meta-analysis assessing the prevalence and incidence of CVD; coronary heart disease; stroke, transient ischemic attack or cerebrovascular disease; congestive heart failure; peripheral vascular disease; and CVD-related death in SMI patients (N=3,211,768) versus controls (N=113,383,368) (92 studies). The pooled CVD prevalence in SMI patients (mean age 50 years) was 9.9% (95% CI: 7.4-13.3). Adjusting for a median of seven confounders, patients had significantly higher odds of CVD versus controls in cross-sectional studies (odds ratio, OR=1.53, 95% CI: 1.27-1.83; 11 studies), and higher odds of coronary heart disease (OR=1.51, 95% CI: 1.47-1.55) and cerebrovascular disease (OR=1.42, 95% CI: 1.21-1.66). People with major depressive disorder were at increased risk for coronary heart disease, while those with schizophrenia were at increased risk for coronary heart disease, cerebrovascular disease and congestive heart failure. Cumulative CVD incidence in SMI patients was 3.6% (95% CI: 2.7-5.3) during a median follow-up of 8.4 years (range 1.8-30.0). Adjusting for a median of six confounders, SMI patients had significantly higher CVD incidence than controls in longitudinal studies (hazard ratio, HR=1.78, 95% CI: 1.60-1.98; 31 studies). The incidence was also higher for coronary heart disease (HR=1.54, 95% CI: 1.30-1.82), cerebrovascular disease (HR=1.64, 95% CI: 1.26-2.14), congestive heart failure (HR=2.10, 95% CI: 1.64-2.70), and CVD-related death (HR=1.85, 95% CI: 1.53-2.24). People with major depressive disorder, bipolar disorder and schizophrenia were all at increased risk of CVD-related death versus controls. CVD incidence increased with antipsychotic use (p=0.008), higher body mass index (p=0.008) and higher baseline CVD prevalence (p=0.03) in patients vs.

CONTROLS

Moreover, CVD prevalence (p=0.007), but not CVD incidence (p=0.21), increased in more recently conducted studies. This large-scale meta-analysis confirms that SMI patients have significantly increased risk of CVD and CVD-related mortality, and that elevated body mass index, antipsychotic use, and CVD screening and management require urgent clinical attention.

Resveratrol Supplementation in Schizophrenia Patients: A Randomized Clinical Trial Evaluating Serum Glucose and Cardiovascular Risk Factors

BACKGROUND

Patients with schizophrenia (SZ) are generally overweight or obese and have several metabolic disorders. Additionally, such patients have a lower life expectancy and the main cause of their increased mortality is cardiovascular disease (CVD). The objective of this study was to determine the efficacy of resveratrol supplementation on serum glucose and CVD risk factors in individuals with SZ.

METHODS AND RESULTS

This is a four-week randomized, double-blind controlled trial (registration No.: NCT 02062190) in which 19 men with a diagnosis of SZ, aged 18 to 65, were assigned to either a resveratrol supplement group (200 mg/day) or a placebo group (200 mg/day). In short, we did not observe significant changes after resveratrol supplementation. In the placebo group, we found a significant increase in total cholesterol levels (p = 0.024) and in LDL-cholesterol (p = 0.002), as well as a decrease in body fat percentage (p = 0.038). The placebo group also showed an increase in triglycerides (9.19%) and a reduction in HDL-cholesterol (4.88%). In the resveratrol group, triglycerides decreased (7.64%).

CONCLUSION

In summary, oral resveratrol in reasonably low dosages (200 mg daily) brought no differences to body weight, waist circumference, glucose, and total cholesterol. It was possible to note that the lipid profile in the placebo group worsened and, although no significant differences were found, we can assume that resveratrol might prevent lipid profile damage and that the intervention affected the lipoprotein metabolism at various levels.

An evaluation of variation in published estimates of schizophrenia prevalence from 1990─2013: a systematic literature review

BACKGROUND

There is a lack of consistency in findings across studies on the prevalence of schizophrenia, and no recent systematic review of the literature exists. The purpose of this study is to provide an updated systematic review of population-based prevalence estimates and to understand the factors that could account for this variation in prevalence estimates.

METHODS

MEDLINE, Embase, and PsycInfo databases were searched for observational studies describing schizophrenia prevalence in general populations from 2003-2013 and supplemented by studies from a prior review covering 1990-2002. Studies reporting prevalence estimates from specialized populations such as institutionalized, homeless, or incarcerated persons were excluded. Prevalence estimates were compared both across and within studies by factors that might contribute to variability using descriptive statistics.

RESULTS

Sixty-five primary studies were included; thirty-one (48 %) were from Europe and 35 (54 %) were conducted in samples of ≥50,000 persons. Among 21 studies reporting 12-month prevalence, the median estimate was 0.33 % with an interquartile range (IQR) of 0.26 %-0.51 %. The median estimate of lifetime prevalence among 29 studies was 0.48 % (IQR: 0.34 %-0.85 %). Prevalence across studies appeared to vary by study design, geographic region, time of assessment, and study quality scores; associations between study sample size and prevalence were not observed. Within studies, age-adjusted estimates were higher than crude estimates by 17 %-138 %, the use of a broader definition of schizophrenia spectrum disorders compared to schizophrenia increased case identification by 18 %-90 %, identification of cases from inpatient-only settings versus any setting decreased prevalence by 60 %, and no consistent trends were noted by differing diagnostic criteria.

CONCLUSIONS

This review provides updated information on the epidemiology of schizophrenia in general populations, which is vital information for many stakeholders. Study characteristics appear to play an important role in the variation between estimates. Overall, the evidence is still sparse; for many countries no new studies were identified.

The prevalence and predictors of type two diabetes mellitus in people with schizophrenia: a systematic review and comparative meta-analysis

OBJECTIVE

To conduct a meta-analysis investigating the prevalence of type two diabetes mellitus (T2DM) in people with schizophrenia compared to controls.

METHOD

Systematic review of electronic databases from inception till November 2014. Articles reporting the prevalence of T2DM in people with schizophrenia and healthy controls (without mental illness) were included. Two independent authors conducted searches and extracted data. A random effects relative risks (RR) meta-analysis was conducted.

RESULTS

Twenty-five studies including 145,718 individuals with schizophrenia (22.5-54.4 years) and 4,343,407 controls were included. The prevalence of T2DM in people with schizophrenia was 9.5% (95% CI = 7.0-12.8, n = 145,718) and 10.75% (95% CI 7.44-14.5%, n = 2698) in studies capturing T2DM according to recognized criteria. The pooled RR across all studies was 1.82 (95% CI = 1.56-2.13; = 4,489,125). Subgroup analyses found a RR of 2.53 (95% CI = 1.68-3.799, n = 17,727) in studies ascertaining T2DM according to recognized criteria and RR 1.65 (95% CI = 1.34-2.03, n = 4,243,389) in studies relying on T2DM determined through medical records.

CONCLUSION

People with schizophrenia are at least double the risk of developing T2DM according to recognized T2DM criteria. Proactive lifestyle and screening programmes should be given clinical priority.

A meta-analysis of cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia versus general population controls

A meta-analysis was conducted to explore the risk for cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia and age- and gender- or cohort-matched general population controls. Our literature search generated 203 relevant studies, of which 136 were included. The final dataset comprised 185,606 unique patients with schizophrenia, and 28 studies provided data for age- and gender-matched or cohort-matched general population controls (n=3,898,739). We found that multi-episode patients with schizophrenia were at increased risk for abdominal obesity (OR=4.43; CI=2.52-7.82; p<0.001), hypertension (OR=1.36; CI=1.21-1.53; p<0.001), low high-density lipoprotein cholesterol (OR=2.35; CI=1.78-3.10; p<0.001), hypertriglyceridemia (OR=2.73; CI=1.95-3.83; p<0.001), metabolic syndrome (OR=2.35; CI=1.68-3.29; p<0.001), and diabetes (OR=1.99; CI=1.55-2.54; p<0.001), compared to controls. Multi-episode patients with schizophrenia were also at increased risk, compared to first-episode (p<0.001) and drug-naïve (p<0.001) patients, for the above abnormalities, with the exception of hypertension and diabetes. Our data provide further evidence supporting WPA recommendations on screening, follow-up, health education and lifestyle changes in people with schizophrenia.

Detection of subclinical atherosclerosis and diastolic dysfunction in patients with schizophrenia

BACKGROUND

Patients with schizophrenia have a higher risk for cardiovascular diseases, which is associated with early mortality compared with the nonschizophrenic population. Early diagnosis of cardiovascular diseases in asymptomatic periods in patients with schizophrenia would enhance their quality of life and reduce mortality. Echocardiography, carotid ultrasonography, and ankle brachial index (ABI) measurement are known to be beneficial methods of detecting subclinical cardiovascular diseases and of risk stratification. The present study investigated carotid intima media thickness (CIMT) and ABI and echocardiographic parameters measured via conventional and tissue Doppler echocardiography in patients with schizophrenia in comparison with a control group.

METHODS

The present case-control study included 116 patients with schizophrenia and 88 healthy patients. Participants with any current comorbid psychiatric disorder, current or lifetime neurological and medical problems, current coronary artery disease, diabetes, hypertension, hypothyroidism, or hyperthyroidism or who were using antihypertensives, antidiabetic agents, or antiobesity drugs were excluded. High-resolution B-mode ultrasound images were used to measure CIMT. Conventional and tissue Doppler measurements were performed according to the recommendations of the American Society of Echocardiography.

RESULTS

Low ABI, mitral ratio of the early (E) to late (A) ventricular filling velocities, septal E', septal S', lateral E', lateral S', septal E'/septal A', lateral E'/lateral A', and high septal A', mitral E/septal E', mitral E/lateral E', and CIMT values were observed in the schizophrenia group compared with the control group.

CONCLUSION

Doppler parameters supported the hypothesis that patients with schizophrenia are at high risk for cardiovascular diseases.

Ethnic differences in primary care management of diabetes and cardiovascular disease in people with serious mental illness

BACKGROUND

Patients with serious mental illness (SMI) have high rates of cardiovascular disease (CVD). In contrast to widespread perception, their access to effective chronic disease management is as high as for the general population. However, previous studies have not included analysis by ethnicity.

AIM

To identify differences in CVD and diabetes management, by ethnicity, among people with SMI.

DESIGN AND SETTING

Three inner east London primary care trusts with an ethnically diverse and socially deprived population. Data were obtained from 147 of 151 general practices.

METHOD

Coded demographic and clinical data were obtained from GP electronic health records using EMIS Web. The sample used was the GP registered population on diabetes or CVD registers (52,620); of these, 1223 also had SMI.

RESULTS

The population prevalence of CVD and diabetes is 7.2%; this rises to 18% among those with SMI. People with SMI and CVD or diabetes were found to be as likely to achieve clinical targets as those without SMI. Blood pressure control was significantly better in people with SMI; however, they were more likely to smoke and have a body mass index above 30 kg/m(2). Ethnic differences in care were identified, with south Asian individuals achieving better cholesterol control and black African or Caribbean groups achieving poorer blood pressure control.

CONCLUSION

Risk factor management for those with SMI shows better control of blood pressure and glycosylated haemoglobin than the general population. However, smoking and obesity rates remain high and should be the target of public health programmes. Ethnic differences in management mirror those in the general population. Ethnic monitoring for vulnerable groups provides evidence to support schemes to reduce health inequalities.

No association between the type 2 diabetes mellitus susceptibility gene, SLC30A8 and schizophrenia in a Chinese population

BACKGROUND

The co-occurrence of schizophrenia and type 2 diabetes mellitus (T2DM) has been well documented. Recent genome-wide association studies and meta-analyses have shown robust associations of the solute carrier family 30 member 8 (SLC30A8) gene variants with T2DM in various populations. We examined the involvement of the SLC30A8 in the susceptibility to schizophrenia in a Han Chinese population.

METHODS

The SLC30A8 rs13266634 gene polymorphism was genotyped in 837 chronic schizophrenic and 1109 unrelated healthy controls by using a case control design. We also assessed clinical symptoms.

RESULTS

There were no significant differences in the rs13266634 genotype (χ(2)  = 1.95, df = 2, p = 0.38) and allele (χ(2)  = 0.47, df = 1, p = 0.50) distributions between the patient and control groups. There was no association between rs13266634 and clinical symptoms.

CONCLUSION

The SLC30A8 gene variation does not appear to contribute a genetic basis for the co-occurrence of schizophrenia and T2DM.

Reduced serum non-enzymatic antioxidant defense and increased lipid peroxidation in schizophrenic patients on a hypocaloric diet

INTRODUCTION

Growing evidence suggests that oxidative stress (OS) may be associated with the pathophysiology underlying schizophrenia (SZ). Some studies indicate that nutritional supplements offer protection from OS, but there is no data about the effect of a hypocaloric diet on OS in this population. Therefore, we aimed to study the effect of a hypocaloric dietary intervention on OS in subjects with SZ.

METHODS

A cross-sectional study of 96 participants in outpatient treatment for SZ comprised patients separated into two groups: one group of subjects followed a hypocaloric diet (HD) program (n=42), while the other group followed a regular diet (RD) with no nutritional restrictions (n=54). The serum total radical-trapping antioxidant parameter (TRAP), total antioxidant reactivity (TAR) and thiobarbituric acid reactive species (TBARS) levels were assessed.

RESULTS

TRAP levels were lower and TBARS levels were higher in the HD group than in the RD group (p=0.022 and p=0.023, respectively). There were no differences in TAR levels between the groups. Additionally, there was a positive correlation between TRAP and TBARS levels after adjusting for BMI and clozapine dose (partial correlation=0.42, p<0.001). There were no correlations among the length of illness or diet and the levels of TRAP, TBARS, and TAR.

CONCLUSIONS

Subjects with SZ on a hypocaloric diet displayed different OS parameters than those not following a HD. Serum TRAP levels were lower and TBARS levels were higher among SZ subjects with HD compared to SZ subjects without HD. Lower TRAP levels may reflect decreased oxidative stress, whereas higher TBARS levels most likely reflect a biochemical reaction to the decreased TRAP levels. Additionally, TAR levels were similar between groups, suggesting a similar quality of antioxidant defenses, despite quantitative differences between the two dietary protocols in SZ patients under outpatient care.

Serious psychological distress and diabetes: a review of the literature

With the development of a measure of serious psychological distress (SPD) in 2002, more attention is being paid to the association of SPD with diabetes outcomes and processes of care. We review the literature on the relationship between SPD and diabetes processes of care and outcomes, as well as the literature on the relationship between specific mental health diagnoses and diabetes processes of care and outcomes during the 2010 to 2011 period. There is an extensive literature on the association of mental health diagnoses with diabetes outcomes, especially for depression. Because the Kessler scale measures a much broader range of mental health issues than any specific DSM-IV/Structured Clinical Interview for DSM Disorders diagnosis and is designed to assess SPD at the population level, additional research needs to be conducted both in clinical settings and using large administrative datasets to examine the association between SPD and diabetes outcomes and processes of care.