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Harasymiw LA, Grosse SD, Cullen KR, Bitsko RH, Perou R, Sarafoglou K. Depressive and anxiety disorders and antidepressant prescriptions among insured children and young adults with congenital adrenal hyperplasia in the United States. Front Endocrinol (Lausanne) 2023; 14:1129584. [PMID: 37664854 PMCID: PMC10470620 DOI: 10.3389/fendo.2023.1129584] [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: 12/22/2022] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background Dysfunction in the hypothalamic-pituitary-adrenal axis has been associated with depressive and anxiety disorders. Little is known about the risk for these disorders among individuals with congenital adrenal hyperplasia (CAH), a form of primary adrenal insufficiency. Objective We investigated the prevalence of depressive and anxiety disorders and antidepressant prescriptions in two large healthcare databases of insured children, adolescents, and young adults with CAH in the United States. Methods We conducted a retrospective cohort study using administrative data from October 2015 through December 2019 for individuals aged 4-25 years enrolled in employer-sponsored or Medicaid health plans. Results Adjusting for age, the prevalence of depressive disorders [adjusted prevalence ratio (aPR) = 1.7, 95% confidence interval (CI): 1.4-2.0, p<0.001], anxiety disorders [aPR = 1.7, 95% CI: 1.4-1.9, p<0.001], and filled antidepressant prescriptions [aPR = 1.7, 95% CI: 1.4-2.0, p<0.001] was higher among privately insured youth with CAH as compared to their non-CAH peers. Prevalence estimates were also higher among publicly insured youth with CAH for depressive disorders [aPR = 2.3, 95% CI: 1.9-2.9, p<0.001], anxiety disorders [aPR = 2.0, 95% CI: 1.6-2.5, p<0.001], and filled antidepressant prescriptions [aPR = 2.5, 95% CI: 1.9-3.1, p<0.001] as compared to their non-CAH peers. Conclusions The elevated prevalence of depressive and anxiety disorders and antidepressant prescriptions among youth with CAH suggests that screening for symptoms of depression and anxiety among this population might be warranted.
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Affiliation(s)
- Lauren A. Harasymiw
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Rebecca H. Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ruth Perou
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kyriakie Sarafoglou
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Minnesota Medical School, Minneapolis, MN, United States
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
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Mersha AG, Tollosa DN, Bagade T, Eftekhari P. A bidirectional relationship between diabetes mellitus and anxiety: A systematic review and meta-analysis. J Psychosom Res 2022; 162:110991. [PMID: 36081182 DOI: 10.1016/j.jpsychores.2022.110991] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Due to the existence of inconsistencies in the evidence regarding the direction and extent of association between diabetes and anxiety disorders, the anxiety-diabetes comorbidity remains an issue of debate. AIM To estimate the proportion and risk of diabetes among individuals with anxiety disorder and vice versa. METHODS A systematic review was conducted using studies retrieved from databases and grey literature, with the last database search being conducted on April 15, 2021. The methodological rigor of studies was assessed using the National Institute of Health quality assessment tool. Prevalence and effect size (ES) estimates were pooled using a random effect model. Heterogeneity was assessed using the Higgins' I2 statistical test, and subgroup analysis conducted. RESULTS We included 68 studies presenting data from 2,128,029 participants. The prevalence of anxiety disorders in diabetic patients was 28% (95% CI: 26%, 31%); however, subgroup analysis showed significant differences based on type of anxiety assessment scales, study location, and type of diabetes. The prevalence of diabetes among patients with anxiety disorders was 12% (95% CI: 9%, 16%). Patients with anxiety disorders were found to have a 19% higher risk of diabetes (pooled effect size (ES) = 1.19, 95% CI: 1.13, 1.26). Diabetic patients were found to have a 41% higher risk of developing anxiety disorders (ES = 1.41, 95% CI: 1.19, 1.62). CONCLUSIONS There is a higher risk of anxiety disorders in patients with diabetes mellitus and vice versa. It is recommended to screen diabetic patients for anxiety at initial diagnosis and follow-up visits. Similarly, patients with anxiety disorders should have regular screening for diabetes. REVIEW REGISTRATION PROSPERO registration number CRD42021252475.
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Affiliation(s)
- Amanual Getnet Mersha
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle 2308, New South Wales, Australia.
| | - Daniel Nigusse Tollosa
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle 2308, New South Wales, Australia.
| | - Tanmay Bagade
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle 2308, New South Wales, Australia; Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, Newcastle 2305, NSW, Australia.
| | - Parivash Eftekhari
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle 2308, New South Wales, Australia; Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, Newcastle 2305, NSW, Australia.
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Chaturvedi SK, Manche Gowda S, Ahmed HU, Alosaimi FD, Andreone N, Bobrov A, Bulgari V, Carrà G, Castelnuovo G, de Girolamo G, Gondek T, Jovanovic N, Kamala T, Kiejna A, Lalic N, Lecic-Tosevski D, Minhas F, Mutiso V, Ndetei D, Rabbani G, Somruk S, Srikanta S, Taj R, Valentini U, Vukovic O, Wölwer W, Cimino L, Nouwen A, Lloyd C, Sartorius N. More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus. Gen Psychiatr 2019; 32:e100076. [PMID: 31552386 PMCID: PMC6738670 DOI: 10.1136/gpsych-2019-100076] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 01/02/2023] Open
Abstract
Background Anxiety disorder, one of the highly disabling, prevalent and common mental disorders, is known to be more prevalent in persons with type 2 diabetes mellitus (T2DM) than the general population, and the comorbid presence of anxiety disorders is known to have an impact on the diabetes outcome and the quality of life. However, the information on the type of anxiety disorder and its prevalence in persons with T2DM is limited. Aims To assess the prevalence and correlates of anxiety disorder in people with type 2 diabetes in different countries. Methods People aged 18–65 years with diabetes and treated in outpatient settings were recruited in 15 countries and underwent a psychiatric interview with the Mini-International Neuropsychiatric Interview. Demographic and medical record data were collected. Results A total of 3170 people with type 2 diabetes (56.2% women; with mean (SD) duration of diabetes 10.01 (7.0) years) participated. The overall prevalence of anxiety disorders in type 2 diabetic persons was 18%; however, 2.8% of the study population had more than one type of anxiety disorder. The most prevalent anxiety disorders were generalised anxiety disorder (8.1%) and panic disorder (5.1%). Female gender, presence of diabetic complications, longer duration of diabetes and poorer glycaemic control (HbA1c levels) were significantly associated with comorbid anxiety disorder. A higher prevalence of anxiety disorders was observed in Ukraine, Saudi Arabia and Argentina with a lower prevalence in Bangladesh and India. Conclusions Our international study shows that people with type 2 diabetes have a high prevalence of anxiety disorders, especially women, those with diabetic complications, those with a longer duration of diabetes and poorer glycaemic control. Early identification and appropriate timely care of psychiatric problems of people with type 2 diabetes is warranted.
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Affiliation(s)
- Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Shayanth Manche Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Helal Uddin Ahmed
- Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | - Fahad D Alosaimi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | | | - Alexey Bobrov
- National Research Centre for Psychiatry and Narcology, Moscow, Russia
| | - Viola Bulgari
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | | | - Tomasz Gondek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Thummala Kamala
- Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India
| | | | | | | | - Fareed Minhas
- Center for Global Mental Health, Rawalpindi, Pakistan
| | | | | | - Golam Rabbani
- Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | | | - Sathyanarayana Srikanta
- Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India
| | - Rizwan Taj
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Umberto Valentini
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany
| | | | - Arie Nouwen
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.,Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh.,Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.,IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.,National Research Centre for Psychiatry and Narcology, Moscow, Russia.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University of Milano-Bicocca, Bicocca, Italy.,Department of Psychology, Catholic University, Milan, Italy.,Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.,Institute of Mental Health, Belgrade, Serbia.,Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India.,University of Lower Silesia, Wroclaw, Poland.,Center for Global Mental Health, Rawalpindi, Pakistan.,University of Nairobi, Nairobi, Kenya.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pakistan Institute of Medical Sciences, Islamabad, Pakistan.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.,ProConsult, Owings Mills, Maryland, USA
| | - Cathy Lloyd
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.,Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh.,Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.,IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.,National Research Centre for Psychiatry and Narcology, Moscow, Russia.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University of Milano-Bicocca, Bicocca, Italy.,Department of Psychology, Catholic University, Milan, Italy.,Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.,Institute of Mental Health, Belgrade, Serbia.,Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India.,University of Lower Silesia, Wroclaw, Poland.,Center for Global Mental Health, Rawalpindi, Pakistan.,University of Nairobi, Nairobi, Kenya.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pakistan Institute of Medical Sciences, Islamabad, Pakistan.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.,ProConsult, Owings Mills, Maryland, USA
| | - Norman Sartorius
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.,Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh.,Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.,IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.,National Research Centre for Psychiatry and Narcology, Moscow, Russia.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University of Milano-Bicocca, Bicocca, Italy.,Department of Psychology, Catholic University, Milan, Italy.,Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.,Institute of Mental Health, Belgrade, Serbia.,Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India.,University of Lower Silesia, Wroclaw, Poland.,Center for Global Mental Health, Rawalpindi, Pakistan.,University of Nairobi, Nairobi, Kenya.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pakistan Institute of Medical Sciences, Islamabad, Pakistan.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.,ProConsult, Owings Mills, Maryland, USA
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Deschênes SS, Burns RJ, Schmitz N. Trajectories of anxiety symptoms and associations with incident cardiovascular disease in adults with type 2 diabetes. J Psychosom Res 2018; 104:95-100. [PMID: 29275792 DOI: 10.1016/j.jpsychores.2017.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/24/2017] [Accepted: 11/26/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Trajectories of anxiety symptoms in people with type 2 diabetes (T2D) and their associations with diabetes health outcomes have not been investigated. This study examined latent longitudinal trajectories of anxiety symptoms in adults with T2D and their associations with incident cardiovascular disease (CVD). METHODS Data were from the Evaluation of Diabetes Treatment Study, a community-based cohort study of adults aged 40-76years with T2D. Anxiety and CVD were assessed by self-report at baseline and at four annual follow-up assessments. N=832 participants without cardiovascular disease at baseline and 12-month follow-up were included in the present study. Group-based trajectories of anxiety at baseline, 12-month follow-up, and 24-month follow-up were modelled using latent class growth modeling. Associations between anxiety trajectories and CVD reported at 24-, 36-, or 48-month follow-ups were examined with logistic regression analysis adjusted for sociodemographic and lifestyle characteristics. RESULTS Four distinct anxiety trajectories were identified, reflecting chronically low (39.4%), chronically moderate-low (47.4%), chronically moderate-high (11.1%), and chronically high (2.2%) anxiety. The likelihood of CVD was greater for the chronically moderate-low (OR=2.23, 95% CI=1.36-3.66), chronically moderate-high (OR=3.05, 95% CI=1.54-6.02), and chronically high (OR=3.61, 95% CI=1.09-12.00) anxiety trajectory groups compared to the chronically low anxiety group. CONCLUSION The identified latent trajectories reflected three groups with chronic courses of anxiety symptoms at different levels of severity and one group with chronically low levels of anxiety. Chronic anxiety, even at subthreshold levels, was associated with an increased risk of CVD among people with T2D.
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Affiliation(s)
- Sonya S Deschênes
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Rachel J Burns
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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