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Sakimoto M, Igusa T, Kobayashi T, Uchida H, Fukazawa A, Machida C, Fujii H, Sekine K, Kurosaki M, Tsuchiya K, Kikuchi S, Hirao K. Effects of a video-viewing intervention with positive word stimulation on the depressive symptoms of older patients with cardiac disease and subthreshold depression: a pilot randomized controlled trial protocol. Biopsychosoc Med 2024; 18:16. [PMID: 39014477 PMCID: PMC11251332 DOI: 10.1186/s13030-024-00312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/11/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Intervention for older patients with cardiac disease and subthreshold depression (StD) may be an effective strategy to prevent the development of major depressive disorder. The subliminal priming with supraliminal reward stimulation (SPSRS) website developed by us is an advanced intervention that can improve depressive symptoms in individuals with StD by presenting positive word stimuli in videos. However, its efficacy for treating depressive symptoms in older patients with cardiac disease and StD has not been investigated. Here, we present a pilot randomized controlled trial protocol to investigate the preliminary efficacy of an intervention for older patients with cardiac disease with StD. METHODS The study was designed as a single-center, open-label, pilot, randomized, parallel-group trial. The participants will include 30 older patients with cardiac disease and StD who are hospitalized in acute wards. The Experimental group received the SPSRS intervention (video viewing with positive word stimuli; n = 15) and the Control group will receive the YouTube intervention (video viewing without positive word stimuli; n = 15). In both groups, the intervention will be administered for 10 min per day, five times per week for 1 week. The primary outcome will be the change in the scores on the Japanese version of the Beck Depression Inventory-II at 1 week after the baseline assessment. The secondary outcomes will be the changes in the Specific Activity Scale, New York Heart Association functional classification, as well as grip strength at 1 week after the baseline assessment. DISCUSSION This pilot randomized controlled trial will be the first to evaluate the SPSRS intervention for depressive symptoms in older patients with cardiac disease and StD who are admitted to acute wards. The results will provide tentative indications regarding the impact of the intervention on depressive symptoms among older patients with cardiac disease and StD who are admitted to acute wards, and will contribute to the planning of a full-scale study. TRIAL REGISTRATION UMIN, UMIN000052155. Registered September 8, 2023, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000059526 . This study was registered with the University Hospital Medical Information Network (UMIN) (UMIN000052155) in Japan.
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Affiliation(s)
- Masataka Sakimoto
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Takumi Igusa
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan
- Department of Rehabilitation, Medical Corporation Taiseikai, Uchida Hospital, Numata, Japan
| | - Takuya Kobayashi
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan
- Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan
| | - Hiroyuki Uchida
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Aya Fukazawa
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Chihaya Machida
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Hirokuni Fujii
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Keisuke Sekine
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Minori Kurosaki
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Senichiro Kikuchi
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan
| | - Kazuki Hirao
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, Japan.
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Vickery KD, Gelberg L, Hyson AR, Strother E, Carter J, Oranday Perez O, Franco M, Kavistan S, Gust S, Adair E, Anderson-Campbell A, Brito L, Butler A, Robinson T, Connett J, Evans MD, Emmons KM, Comulada WS, Busch AM. Pilot trial results of D-HOMES: a behavioral-activation based intervention for diabetes medication adherence and psychological wellness among people who have been homeless. Front Psychiatry 2024; 15:1329138. [PMID: 38487573 PMCID: PMC10937567 DOI: 10.3389/fpsyt.2024.1329138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction People living with type 2 diabetes who experience homelessness face a myriad of barriers to engaging in diabetes self-care behaviors that lead to premature complications and death. This is exacerbated by high rates of comorbid mental illness, substance use disorder, and other physical health problems. Despite strong evidence to support lay health coach and behavioral activation, little research has effectively engaged people living with type 2 diabetes who had experienced homelessness (DH). Methods We used community engaged research and incremental behavioral treatment development to design the Diabetes HOmeless MEdication Support (D-HOMES) program, a one-on-one, 3 month, coaching intervention to improve medication adherence and psychological wellness for DH. We present results of our pilot randomized trial (with baseline, 3 mo., 6 mo. assessments) comparing D-HOMES to enhanced usual care (EUC; brief diabetes education session and routine care; NCT05258630). Participants were English-speaking adults with type 2 diabetes, current/recent (<24 mo.) homelessness, and an HbA1c‗7.5%. We focused on feasibility (recruitment, retention, engagement) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Our primary clinical outcome was glycemic control (HbA1c) and primary behavioral outcome was medication adherence. Secondary outcomes included psychological wellness and diabetes self-care. Results Thirty-six eligible participants enrolled, 18 in each arm. Most participants identified as Black males, had high rates of co-morbidities, and lived in subsidized housing. We retained 100% of participants at 3-months, and 94% at 6-months. Participants reported high satisfaction (mean CSQ-8 scores=28.64 [SD 3.94] of 32). HbA1c reduced to clinically significant levels in both groups, but we found no between group differences. Mean blood pressure improved more in D-HOMES than EUC between baseline and 6 mo. with between group mean differences of systolic -19.5 mmHg (p=0.030) and diastolic blood pressure -11.1 mmHg (p=0.049). We found no significant between group differences in other secondary outcomes. Conclusion We effectively recruited and retained DH over 6 months. Data support that the D-HOMES intervention was acceptable and feasible. We observe preliminary blood pressure improvement favoring D-HOMES that were statistically and clinically significant. D-HOMES warrants testing in a fully powered trial which could inform future high quality behavioral trials to promote health equity. Clinical trial registration https://clinicaltrials.gov/study/NCT05258630?term=D-HOMES&rank=1, identifier NCT05258630.
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Affiliation(s)
- Katherine Diaz Vickery
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Audrey Rose Hyson
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Ella Strother
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Jill Carter
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Oscar Oranday Perez
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Moncies Franco
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Silvio Kavistan
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Susan Gust
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Edward Adair
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | | | - Lelis Brito
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Annette Butler
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Tahiti Robinson
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - John Connett
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - W. Scott Comulada
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
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Sommer J, Linnenkamp U, Gontscharuk V, Andrich S, Brüne M, Schmitz-Losem I, Kruse J, Evers SMAA, Hiligsmann M, Hoffmann B, Icks A. Prospective health care costs and lost work days associated with diabetes-related distress and depression symptoms among 1488 individuals with diabetes. Sci Rep 2024; 14:3621. [PMID: 38351084 PMCID: PMC10864264 DOI: 10.1038/s41598-024-52361-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
The aim of this study was to investigating the impact of major depression symptoms and diabetes-related distress on future health care costs and lost workdays in individuals with diabetes. We linked survey data from a random sample of a German statutory health insurance (SHI) with diabetes (n = 1488, 63.0% male, mean age 66.9 years) with their SHI data one year after the survey. Within the survey data we identified major depression symptoms (Patient Health Questionnaire-9) and diabetes-related distress (Problem Areas in Diabetes Scale). We retrieved health care costs and lost workdays from SHI data. To assess the impact of major depression symptoms and diabetes-related distress on health care costs and lost workdays, we adjusted regression models for age, sex, education, employment status, and diabetes duration, type, and severity. Major depression symptoms were associated with significantly higher costs (by a factor of 1.49; 95% CI: 1.18-1.88). Lost workdays were also more likely for respondents with depression symptoms (RR1.34; 0.97-1.86). Health care costs (by a factor of 0.81; 0.66-1.01) and the risk of lost workdays (RR 0.86; 0.62-1.18) may be lower among respondents with high diabetes-related distress. While major depression and diabetes-related distress have overlapping indicators, our results indicate different impacts on health care costs.
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Affiliation(s)
- Jana Sommer
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Düsseldorf at the Heinrich-Heine University Düsseldorf, Leibniz Center for Diabetes Research at the Heinrich Heine University, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany
| | - Ute Linnenkamp
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Düsseldorf at the Heinrich-Heine University Düsseldorf, Leibniz Center for Diabetes Research at the Heinrich Heine University, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany.
- German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany.
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Veronika Gontscharuk
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Düsseldorf at the Heinrich-Heine University Düsseldorf, Leibniz Center for Diabetes Research at the Heinrich Heine University, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Düsseldorf at the Heinrich-Heine University Düsseldorf, Leibniz Center for Diabetes Research at the Heinrich Heine University, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany
| | - Manuela Brüne
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Düsseldorf at the Heinrich-Heine University Düsseldorf, Leibniz Center for Diabetes Research at the Heinrich Heine University, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany
| | | | - Johannes Kruse
- Clinic for Psychosomatic and Psychotherapy, University Clinic Gießen, Friedrichstraße 33, 35392, Gießen, Germany
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Gurlittstr. 55/II, 40223, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Düsseldorf at the Heinrich-Heine University Düsseldorf, Leibniz Center for Diabetes Research at the Heinrich Heine University, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany
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Arend I, Moshier E, Azuri Y, Heymann A, Mamistavlov M, Soleimani L, Sano M, Beeri MS, Ravona-Springer R. Neuroticism is associated with increase in depression symptoms over time in older adults with type 2 diabetes. Int J Geriatr Psychiatry 2023; 38:e6011. [PMID: 37803500 DOI: 10.1002/gps.6011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES The likelihood of depression symptoms in those with type 2 diabetes (T2D) is high. Psychological risk factors enhancing comorbidity of depression symptoms in T2D are yet to be determined. The present study examines the cross-sectional and longitudinal relationship between personality traits and distinct depression dimensions in older adults with T2D. METHODS Participants were older adults (age ≥65yeas) with T2D from the Israel Diabetes and Cognitive Decline (IDCD) study (N = 356), with complete data on depression [Geriatric Depression Scale (GDS) - 15 item version] and its dimensions- namely, dysphoric mood, apathy, hopelessness, memory complains and anxiety, and on personality [Big Five Inventory (BFI)]. Logistic and mixed linear regression models examined cross-sectional and longitudinal associations while adjusting for socio-demographics, cognition, cardiovascular and diabetes-related factors. RESULTS Cross-sectionally, high neuroticism was associated with high scores in total GDS and in all depression-dimensions, except memory complaints. Higher extroversion was associated with lower total GDS and with lower scores on all depression dimensions, except anxiety. High levels of neuroticism were associated with increase in total number of depression symptoms over time. CONCLUSIONS In older adults with T2D, neuroticism and extroversion are associated with most depression dimensions suggesting that these traits relate to a global depression symptomatology rather than to any specific dimension or phenomenology. High neuroticism was associated with increase in depression symptoms over time, highlighting its role in the development of depression symptoms in older adults with T2D.
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Affiliation(s)
- Isabel Arend
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Erin Moshier
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yossi Azuri
- Department of Family Medicine, The Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Anthony Heymann
- Department of Family Medicine, The Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Mery Mamistavlov
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Laili Soleimani
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary Sano
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michal Schnaider Beeri
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, Melamed OC, Vallis M, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Houlden R, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Rabi D, Sherifali D, Senior P. Diabetes and Mental Health. Can J Diabetes 2023; 47:308-344. [PMID: 37321702 DOI: 10.1016/j.jcjd.2023.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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Davoudi M, Heydari A, Manzari ZS. Psychosocial Interventions by Nurses for Patients with HIV/ AIDS: A Systematic Review. J Caring Sci 2023; 12:94-102. [PMID: 37469749 PMCID: PMC10352634 DOI: 10.34172/jcs.2023.30726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/05/2022] [Indexed: 07/21/2023] Open
Abstract
Introduction Providing psychological support is one of the traditional roles of nurses for patients with HIV/AIDS. Searching the literature showed that various psychological interventions have been performed by nurses to support HIV/AIDS patients; however, no summary of these interventions is available. We aimed to systematically review the interventional studies which investigated the effectiveness of psychosocial interventions delivered by nurses to HIV/AIDS patients. Methods This systematic review was performed based on Cochrane's handbook of systematic reviews of interventional studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were used in this study. The databases of PubMed, Web of Science, Cochrane, Scopus and World Health Organization were searched from January 2009 to December 2022. Based on inclusion criteria, nine studies included in this systematic review. Cochrane data extraction form was used for the systematic review and the article's information was summarized using the modified Jadad scale. Results The interventions provided by the nurses included: virtual and face-to-face educational programs, written information resources, palliative care, motivational interview, case management, home visit, and care services, along with face-to-face and telephone follow-up. These interventions have a significant positive effect on the quality of life and management of high-risk behaviors, disease management, symptoms and complications, adherence to treatment, immune function, and mental health in patients with HIV/AIDS. Conclusion The results of the present study show that despite the fact that the interventions have a purely psychological content and can be done with various methods, they are able to have positive consequences in physical, psychological, behavioral, and laboratory health in HIV/AIDS patients.
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Affiliation(s)
- Malihe Davoudi
- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Arsh A, Afaq S, Carswell C, Bhatti MM, Ullah I, Siddiqi N. Effectiveness of physical activity in managing co-morbid depression in adults with type 2 diabetes mellitus: A systematic review and meta-analysis. J Affect Disord 2023; 329:448-459. [PMID: 36868385 DOI: 10.1016/j.jad.2023.02.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Physical activity may be effective in alleviating depressive symptoms and improving glycaemic control; however, evidence to guide practice is limited. The current review was conducted to assess the effects of physical activity on depression and glycaemic control in people with type 2 diabetes mellitus. METHODS Randomized controlled clinical trials, from the earliest record to October 2021, which recruited adults with the diagnosis of type 2 diabetes mellitus and compared physical activity with no interventions or usual care for the management of depression were included. The outcomes were change in depression severity and glycaemic control. RESULTS In 17 trials, including 1362 participants, physical activity was effective in reducing the severity of depressive symptoms (SMD = -057; 95%CI = -0.80, -0.34). However, physical activity did not have a significant effect in improving markers of glycaemic control (SMD = -0.18; 95%CI = -0.46, 0.10). LIMITATIONS There was substantial heterogeneity in the included studies. Furthermore, risk of bias assessment showed that most of the included studies were of low quality. CONCLUSIONS Physical activity can effectively reduce the severity of depressive symptoms, nonetheless, it appears that physical activity is not significantly effective in improving glycaemic control in adults who have both type 2 diabetes mellitus and depressive symptoms. The latter finding is surprising, however, given the limited evidence on which this is based, future research on the effectiveness of physical activity for depression in this population should include high quality trials with glycaemic control as an outcome.
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Affiliation(s)
- Aatik Arsh
- Department of Health Sciences, University of York, United Kingdom; Institute of Physical Medicine & Rehabilitation, Khyber Medical University, Pakistan.
| | - Saima Afaq
- Institute of Public Health, Khyber Medical University, Pakistan
| | - Claire Carswell
- Department of Health Sciences, University of York, United Kingdom
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Pakistan
| | - Najma Siddiqi
- Department of Health Sciences, University of York, United Kingdom
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Franquez RT, de Souza IM, Bergamaschi CDC. Interventions for depression and anxiety among people with diabetes mellitus: Review of systematic reviews. PLoS One 2023; 18:e0281376. [PMID: 36758047 PMCID: PMC9910656 DOI: 10.1371/journal.pone.0281376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
This review of systematic reviews of randomized clinical trials summarized the available evidence regarding the effectiveness and safety of interventions to treat depression and/or anxiety in people with type 1 and type 2 diabetes. The sources of information searched were the Cochrane Library, MEDLINE, EMBASE, Web of Science and LILACS, until up to December 1st, 2022. The interventions were compared with placebo, active control or usual care. The measured primary outcomes were improvement in depression and anxiety remission, reduction of diabetes-specific emotional distress; and improvement in quality of life. Two reviewers, independently, selected the reviews, extracted their data, and assessed their methodological quality using AMSTAR-2. A narrative synthesis of the findings was performed, according to the type of intervention and type of diabetes. Thirteen systematic reviews that included 28,307 participants were analyzed. The reviews had at least one critical methodological flaw. Cognitive Behavioral Therapy improved the mainly depression, glycemic values (n = 5 reviews) and anxiety (n = 1), in adults and elderly with diabetes. Collaborative care (n = 2) and health education (n = 1) improved depression and glycemic values, in adults with diabetes. Pharmacological treatment (n = 2) improved depression outcomes only. The quality of the evidence was low to moderate, when reported. The interventions reported in literature and mainly the Cognitive Behavioral Therapy can be effective to treat people with diabetes and depression; however, some findings must be confirmed. This study can guide patients, their caregivers and health professionals in making decisions concerning the use of these interventions in the mental healthcare of people with diabetes. Protocol Registration: PROSPERO (CRD42021224587).
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Affiliation(s)
| | - Isabela Muniz de Souza
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
- Dental School, University of Sorocaba, Sorocaba, São Paulo, Brazil
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Gregory JW, Cameron FJ, Joshi K, Eiswirth M, Garrett C, Garvey K, Agarwal S, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence. Pediatr Diabetes 2022; 23:857-871. [PMID: 36250644 PMCID: PMC9828225 DOI: 10.1111/pedi.13408] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- John W. Gregory
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Fergus J. Cameron
- Royal Children's HospitalMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia,Department of PaediatricsUniversity of MelbourneMelbourneAustralia
| | - Kriti Joshi
- Department of Endocrinology & DiabetesQueensland Children's HospitalSouth BrisbaneAustralia
| | - Mirjam Eiswirth
- Department of Anglophone StudiesUniversität Duisburg EssenEssenGermany
| | - Christopher Garrett
- Institute of Psychiatry, Psychology and NeuroscienceBart's Health and East London Foundation TrustLondonUK
| | - Katharine Garvey
- Division of EndocrinologyBoston Children's HospitalBostonMassachusettsUSA
| | - Shivani Agarwal
- Department of Medicine (Endocrinology), Albert Einstein College of MedicineMontefiore Medical CenterBronxNew YorkUSA
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de MedicinaUniversity of ChileSantiagoChile
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Oshima H, Takamura Y, Hirano T, Shimura M, Sugimoto M, Kida T, Matsumura T, Gozawa M, Yamada Y, Morioka M, Inatani M. Glycemic Control after Initiation of Anti-VEGF Treatment for Diabetic Macular Edema. J Clin Med 2022; 11:jcm11164659. [PMID: 36012896 PMCID: PMC9410407 DOI: 10.3390/jcm11164659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetic macular edema (DME) induces visual disturbance, and intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs are the accepted first-line treatment. We investigate its impact on glycemic control after starting VEGF treatment for DME on the basis of a questionnaire and changes in hemoglobin A1c (HbA1c). We conducted a retrospective multicenter study analyzing 112 patients with DME who underwent anti-VEGF therapy and their changes in HbA1c over two years. Central retinal thickness and visual acuity significantly improved at three months and throughout the period after initiating therapy (p < 0.0001); a significant change in HbA1c was not found. A total of 59.8% of patients became more active in glycemic control through exercise and diet therapy after initiating therapy, resulting in a significantly lower HbA1c at 6 (p = 0.0047), 12 (p = 0.0003), and 18 (p = 0.0117) months compared to patients who did not. HbA1c was significantly lower after 18 months in patients who stated that anti-VEGF drugs were expensive (p = 0.0354). The initiation of anti-VEGF therapy for DME affects HbA1c levels in relation to more aggressive glycemic control.
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Affiliation(s)
- Hideyuki Oshima
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
- Correspondence: ; Tel.: +81-776-61-8403
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano 390-0802, Matsumoto, Japan
| | - Masahiko Shimura
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Tokyo 193-0998, Hachioji, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Takehiro Matsumura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Makoto Gozawa
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Yutaka Yamada
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Masakazu Morioka
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Fukui, Japan
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11
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Mather S, Fisher P, Nevitt S, Cherry MG, Maturana C, Warren JG, Noble A. The limited efficacy of psychological interventions for depression in people with Type 1 or Type 2 diabetes: An Individual Participant Data Meta-Analysis (IPD-MA). J Affect Disord 2022; 310:25-31. [PMID: 35490884 DOI: 10.1016/j.jad.2022.04.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with either Type 1/Type 2 diabetes experiencing anxiety or depression experience worse clinical and social outcomes. Efficacy of available psychological and pharmacological treatments for anxiety and depression is unclear. Aggregate data meta-analyses (AD-MAs) have failed to consider the clinical relevance of any change these treatments elicit. Thus, we sought to complete an individual participant data meta-analysis (IPD-MA) to evaluate this. METHODS Eligible RCTs of psychological treatments (PTs) and pharmacological treatments (PhTs) were systematically identified and assessed using the Cochrane Risk of Bias Tool-2. IPD was requested and Jacobson's methodology was used to determine the clinical relevance of symptom-change. Traditional effect sizes were calculated to permit comparison of trials providing and not providing IPD and to compare with AD-MAs. RESULTS Sufficient data was obtained to conduct an IPD-MA for PTs (12/25) but not PhTs (1/5). Across PT trials, rates of 'recovery' for depression post-intervention were low. Whilst significantly more treated patients did recover (17% [95% CI 0.10, 0.25]) than controls (9% [95% CI 0.03, 0.17]), the difference was small (6% [95% CI 0.02, 0.10]). LIMITATIONS Only 50% of eligible trials provided IPD; we were also only able to examine outcomes immediately following the end of an intervention. CONCLUSION Current psychological interventions offer limited benefit in treating anxiety and depression in people with Type 1 or Type 2 diabetes (83% remain depressed). More efficacious interventions are urgently needed.
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Affiliation(s)
- Sarah Mather
- Department of Public Health, Policy and Systems, University of Liverpool, United Kingdom of Great Britain and Northern Ireland; Department of Psychology, University of Liverpool, United Kingdom of Great Britain and Northern Ireland.
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Sarah Nevitt
- Department of Health Data Science, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Camila Maturana
- Department of Health Sciences, University of York, United Kingdom of Great Britain and Northern Ireland
| | - Jasmine G Warren
- Department of Psychology, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Adam Noble
- Department of Public Health, Policy and Systems, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
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12
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Srisurapanont M, Suttajit S, Kosachunhanun N, Likhitsathian S, Suradom C, Maneeton B. Antidepressants for depressed patients with type 2 diabetes mellitus: A systematic review and network meta-analysis of short-term randomized controlled trials. Neurosci Biobehav Rev 2022; 139:104731. [PMID: 35691471 DOI: 10.1016/j.neubiorev.2022.104731] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
This network meta-analysis compared the short-term treatment effects of different antidepressants on depression severity and HbA1c in depressed patients with type 2 diabetes mellitus (T2DM). We searched 8- to 24-week randomized-controlled trials (RCTs) in PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov on November 22, 2021. We included 12 RCTs (N = 792) studying agomelatine, citalopram, escitalopram, fluoxetine, nortriptyline, no treatment, paroxetine, sertraline, vortioxetine, and placebo. Compared to placebo, the standardized mean differences and 95% confidence intervals (SMD, 95%CIs) for depression severity reduction revealed that escitalopram ranked first (-2.93, -3.92 to -1.94), followed by agomelatine (-0.68, -1.15 to -0.20). Compared to placebo, the mean differences (MDs, 95%CIs) for HbA1c reduction suggested that vortioxetine ranked first (-2.35, -4.13 to -0.57), followed by escitalopram (-1.00, -1.42 to -0.57) and agomelatine (-0.79, -1.16 to -0.42). Limited evidence from short-term trials in depressed patients with T2DM suggests that escitalopram and agomelatine may have a favorable profile in reducing depression and controlling glycemic goals, but more trials are required.
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Affiliation(s)
- Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand.
| | - Sirijit Suttajit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
| | | | | | - Chawisa Suradom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
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13
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Schmitt A, Kulzer B, Reimer A, Herder C, Roden M, Haak T, Hermanns N. Evaluation of a Stepped Care Approach to Manage Depression and Diabetes Distress in Patients with Type 1 Diabetes and Type 2 Diabetes: Results of a Randomized Controlled Trial (ECCE HOMO Study). PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:107-122. [PMID: 34875666 DOI: 10.1159/000520319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Depression is a common and serious complication of diabetes. Treatment approaches addressing the specific demands of affected patients are scarce. OBJECTIVE The aim of this work was to test whether a stepped care approach for patients with diabetes and depression and/or diabetes distress yields greater depression reduction than treatment-as-usual. METHODS Two-hundred and sixty patients with diabetes and elevated depressive symptoms (CES-D ≥16) and/or elevated diabetes distress (PAID ≥40) were randomized to stepped care for depression or diabetes treatment-as-usual. The primary outcome was the rate of meaningful depression reduction at the 12-month follow-up according to the HAMD (score <9 or reduction by ≥50%). Secondary outcomes were changes in depression scores (HAMD/CES-D), diabetes distress (PAID), diabetes acceptance (AADQ), well-being (WHO-5), quality of life (EQ-5D/SF-36), self-care behavior (SDSCA/DSMQ), HbA1c, and biomarkers of inflammation. RESULTS One-hundred and thirty-one individuals were assigned to stepped care and 129 to treatment-as-usual. Overall, 15.4% were lost to follow-up. Meaningful depression reduction was observed in 80.2 versus 51.2% in stepped care versus treatment-as-usual (p < 0.001, intention-to-treat analysis). Of the secondary measures, the HAMD (∆ -3.2, p < 0.001), WHO-5 (∆ 1.5, p = 0.007), and AADQ (∆ -1.0, p = 0.008) displayed significant treatment effects, while effects on CES-D (∆ -2.3, p = 0.065), PAID (∆ -3.5, p = 0.109), and SDSCA (∆ 0.20, p = 0.081) were not significantly different. Both groups showed comparable changes in EQ-5D/SF-36, DSMQ, HbA1c, and biomarkers of inflammation (all p ≥ 0.19). CONCLUSIONS The stepped care approach improved depression, well-being, and acceptance. The results support that increasing treatment intensity on demand is effective and can help provide more optimal treatment. The inclusion of diabetes-specific interventions may be beneficial for patients with diabetes and elevated depression.
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Affiliation(s)
- Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim, Diabetes Center Mergentheim, Bad Mergentheim, Germany.,German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim, Diabetes Center Mergentheim, Bad Mergentheim, Germany.,German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.,Department for Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - André Reimer
- Research Institute of the Diabetes Academy Mergentheim, Diabetes Center Mergentheim, Bad Mergentheim, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim, Diabetes Center Mergentheim, Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim, Diabetes Center Mergentheim, Bad Mergentheim, Germany.,German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.,Department for Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
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14
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A Within-Subject Before-After Study of the Impact of Antidepressants on Hemoglobin A1c and Low-Density Lipoprotein Levels in Type 2 Diabetes. J Clin Psychopharmacol 2022; 42:125-132. [PMID: 35001061 DOI: 10.1097/jcp.0000000000001508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE/BACKGROUND Data on the effect of treatment with antidepressant drugs on metabolic control in diabetes are sparse. In this controlled within-subject before-after study, the impact of initiation and discontinuation of antidepressant treatment on hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL) levels in type 2 diabetes was estimated. METHODS/PROCEDURES All individuals with newly developed type 2 diabetes (first HbA1c ≥ 6.5%) between 2000 and 2016 in Northern and Central Denmark were identified using register-based health care data. Among these, we identified individuals initiating and discontinuing antidepressant treatment. Using a within-subject before-after design, we examined HbA1c and LDL in the 16 months leading up to and the 16 months after antidepressant treatment initiation or discontinuation, respectively. For comparison, we ran similar time trend analyses in a reference population of age- and sex-matched type 2 diabetes individuals not receiving antidepressant treatment. FINDINGS/RESULTS Mean HbA1c decreased after initiation of antidepressant treatment (-0.16%; 95% confidence interval [CI], -0.18 to -0.13%). In the reference population, no material change in HbA1c over time (-0.03%; 95% CI, -0.04 to -0.01%) was seen. Mean LDL decreased not only in antidepressant initiators (-0.17 mmol/L; 95% CI, -0.19 to -0.15 mmol/L) but also in the reference population (-0.15 mmol/L; 95% CI, -0.16 to -0.13 mmol/L). Among antidepressant discontinuers, there was also a decrease in HbA1c (-0.32%; 95% CI, -0.37 to -0.28%), with no change in the reference population (-0.02%; 95% CI, -0.04 to 0.00%). Decreases in LDL were found both in antidepressant discontinuers (-0.09 mmol/L; 95% CI, -0.14 to -0.04 mmol/L) and in the reference population (-0.16 mmol/L0; 95% CI, -0.18 to -0.13 mmol/L). IMPLICATIONS/CONCLUSIONS Antidepressant treatment in type 2 diabetes may have a beneficial effect on glycemic control, as the decrease in HbA1c after discontinuation of antidepressants likely reflects remission of depression. Conversely, antidepressant treatment does not seem to affect LDL levels.
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15
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Wang T, Liu Y, Huang W. The Association between Serum Neutrophil Gelatinase-Associated Lipocalin and Depression in Patients with Type 2 Diabetes Mellitus. Exp Aging Res 2022; 48:444-454. [PMID: 35142261 DOI: 10.1080/0361073x.2022.2033591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients wtih type 2 diabetes mellitus (DM) have an increased risk of depressive symptoms. Whether serum neutrophil gelatinase-associated lipocalin (NGAL) is associated with depressive symptoms in old patients with type 2 DM is still uncertain. OBJECTIVE We aim to investigate whether serum NGAL levels were associated with elevated risk of depressive symptoms in patients with type 2 DM in an old population. METHODS Blood samples from 1012 hospitalized patients were measured for serum NGAL within the first 24 hours after admission. The Center for Epidemiological Studies Depression (CES-D) scale was performed to calculate depressive score. Cox analyses were used to examine the prognostic value of serum NGAL on detecting depressive symptoms during a median period of 5 years (range = 0.3-6.2 years). RESULTS 136 (36.6)% of all subjects have depressive symptoms during the follow-up period. Linear analysis showed that serum NGAL levels at baseline were associated with CES-D score after adjusting for clinically relevant variables in type 2 DM patients (Sβ = 0.118, 95% CI 0.106-0.171, P < .001) but not in non-DM patients (Sβ = 0.025, 95% CI, -0.047-0.083; P = .205). Cox analysis revealed that serum NGAL did have an independent prognostic value on predicting depressive symptoms (HR = 2.247, 95% CI 1.415-3.811, P-trend<0.001, Model 2) in type 2 DM patients but not in non-DM patients (HR = 1.811, 95% CI 1.209-3.292, P-trend = 0.189, Model 2) during follow-up period. CONCLUSIONS We found the first evidence that serum NGAL were strongly associated with depressive symptoms in patients with type 2 DM but not in non-DM patients. Further studies are needed to prove the underlying mechanism for the impact of type 2 DM on the association.
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Affiliation(s)
| | - Yue Liu
- School of Sports Medicine and Rehabilitation, Shandong First Medical University, Shandong, China
| | - Wenwu Huang
- Department of Clinical Psychology, The Affiliated Kangning Hospital of Wenzhou Medical University, wenzhou, China
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16
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Yang Q, Shao Q, Xu Q, Shi H, Li L. Art Therapy Alleviates the Levels of Depression and Blood Glucose in Diabetic Patients: A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:639626. [PMID: 33776864 PMCID: PMC7994617 DOI: 10.3389/fpsyg.2021.639626] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/18/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: To systematically analyze the effects of art therapy on the levels of depression, anxiety, blood glucose, and glycated hemoglobin in diabetic patients. Methods: We searched Cochrane Library, PubMed, Embase, and ClinicalTrials.gov databases from inception to January 24, 2021. The language of publication was limited to English. Randomized controlled trials (RCTs) that used art therapy to improve mental disorders in diabetic patients were involved. After selection of eligible studies, data were extracted, including the first author's full-name, year of publication, the first author's country of residence, number of intervention and control groups, the mean age of participants, method of intervention, duration of follow-up, and outcome measures. Assessment of quality of the included studies and data extraction were independently carried out by two researchers. RevMan 5.3 software was used to perform statistical analysis. Results: A total of 396 samples from five studies were included, and the eligible studies were RCTs with a parallel design. Methods of art therapy included music therapy and painting therapy. The results showed that compared with the control group, art therapy could positively affect the levels of depression [standardized mean difference (SMD), −1.36; 95% confidence interval (CI), (−1.63, −1.09); P < 0.00001] and blood glucose in diabetic patients [mean difference (MD), −0.90; 95% CI, (−1.03, −0.77); P < 0.0001], while it had no influence on the levels of anxiety [SMD, −0.31; 95% CI, (−0.93, 0.31); P = 0.32] and glycated hemoglobin [MD, 0.22; 95% CI, (−0.02, 0.46); P = 0.07]. Conclusion: Art therapy may have significant effects on the levels of depression and blood glucose for diabetic patients.
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Affiliation(s)
- Qingqi Yang
- Department of Dermatology, Air Force Medical Center, Beijing, China
| | - Qunhui Shao
- Department of Cardiovascular Medicine, People's Hospital of Zhongwei, Zhongwei, China
| | - Qiang Xu
- Department of Health Management Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Hui Shi
- Department of Health Management Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Lin Li
- Department of Health Management Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
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17
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van der Feltz‐Cornelis C, Allen SF, Holt RIG, Roberts R, Nouwen A, Sartorius N. Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis. Brain Behav 2021; 11:e01981. [PMID: 33274609 PMCID: PMC7882189 DOI: 10.1002/brb3.1981] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/02/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes. METHODS Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported. RESULTS Forty-three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta-analysis. Our meta-analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA1 c and depressive outcome. High baseline HbA1 c was associated with a greater reduction in HbA1 c. CONCLUSION All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group-based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA1 c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.
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Affiliation(s)
| | - Sarah F. Allen
- Department of Health SciencesHull York Medical SchoolUniversity of YorkYorkUK
| | - Richard I. G. Holt
- Human Development and HealthFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Richard Roberts
- Department of Family Medicine & Community HealthUniversity of WisconsinMadisonWIUSA
| | - Arie Nouwen
- Department of PsychologyMiddlesex UniversityLondonUK
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
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18
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Ebrahim M, Tamiru D, Hawulte B, Misgana T. Prevalence and associated factors of depression among diabetic outpatients attending diabetic clinic at public hospitals in Eastern Ethiopia: A cross-sectional study. SAGE Open Med 2021; 9:20503121211066244. [PMID: 34992781 PMCID: PMC8725011 DOI: 10.1177/20503121211066244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Depression is one of the most common comorbid psychiatric disorders among diabetic patients. Depression among diabetic people has led to poor treatment adherence, defective treatment outcomes, and consequently worsened quality of life. However, there is a limited study conducted to assess the magnitude and factors associated with depression among diabetic patients in Ethiopia including this study area. Objective: This study aimed to assess the prevalence and factors associated with depression among adult diabetic outpatients attending diabetic clinic in Eastern Ethiopia. Methods: An institution-based cross-sectional study was conducted among 407 adult diabetic outpatients on treatment in Ethiopia in 2020. Patient Health Questionnaire-9 was used to assess depression among randomly selected samples. Bivariate and multivariate logistic regression was fitted to identify factors associated with depression among diabetic outpatients. A p value less than 0.05 with a 95% confidence interval was considered statistically significant. Results: The overall prevalence of depression among diabetic outpatients was found to be 48.9% (95% confidence interval: 44.2%, 53.4%). Being female (adjusted odds ratio = 1.50, 95% confidence interval: 1.39, 2.73), Khat chewing (adjusted odds ratio = 1.88, 95% confidence interval: 1.22, 2.93), having poor and moderate social support (adjusted odds ratio = 1.79, 95% confidence interval: 1.07, 2.98 and adjusted odds ratio = 1.90, 95% confidence interval: 1.14, 3.17, respectively), taking both oral hypoglycemic agents and insulin medication (adjusted odds ratio = 1.33, 95% confidence interval: 1.13, 2.80) and duration of diabetes mellitus for more than 6 years (adjusted odds ratio = 5.40, 95% confidence interval: 3.42, 8.14) were significantly associated with depression. Conclusion: This study revealed a relatively high prevalence of depression in diabetic outpatients. A lesser level of social support, taking oral and insulin treatment regimes, longer duration of illness, using Khat, and being female were associated with depression among diabetic outpatients. Therefore, early screening and identification of such factors could help ameliorate some of the deleterious effects of depression in diabetic outpatients.
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Affiliation(s)
| | - Dawit Tamiru
- Department of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Misgana
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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19
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Chatwin H, Broadley M, Pouwer F. Comment on van Duinkerken et al. Biopsychosocial factors associated with a current depressive episode in diabetes: The ELSA-Brasil study. Diabet Med 2021; 38:e14418. [PMID: 33030264 DOI: 10.1111/dme.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- H Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - M Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - F Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
- STENO Diabetes Centre Odense, Odense, Denmark
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20
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Peng S, Zhang X, Liu Y, Fu X, Zhou M, Xu G, Xie C. The efficacy of 5-element therapy for senile diabetes with depression: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23622. [PMID: 33327337 PMCID: PMC7738127 DOI: 10.1097/md.0000000000023622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Senile diabetes with depression is a common and frequently-occurring disease, and it is also a difficult and hot point in domestic and international research. However, the efficiency of combination hypoglycemic agents and antidepressants in the treatment of senile diabetes with depression is poor, and new intervention methods are urgently needed. Research shows the 5-element therapy, as a Chinese traditional non-drug intervention, has definite curative effect on the prevention and treatment of various physical and mental diseases. The purpose of this systematic review and meta-analysis is to evaluate the efficacy of 5-element therapy on senile diabetes with depression. METHODS The electronic databases including Pubmed, Embase, Cochrane Library, Web of science, Chinese National Knowledge Infrastructure, Wanfang Database, Sino Med,China Biomedical Literature Database will be searched. The time limit for retrieving studies is from establishment to October 2020 for each database. Randomized controlled clinical trials related to 5-element therapy intervention on senile diabetes with depression will be included. Stata V.13.0 and Review manager 5.3 software will be implemented for data synthesis, sensitivity analysis, subgroup analysis, and the assessment of bias risk. We will use the grading of recommendations assessment, development, and evaluation system to assess the quality of evidence. RESULTS This study will provide a quantitative and standardized evaluation for the efficacy of 5-element therapy on senile diabetes with depression. CONCLUSION This systematic review and meta-analysis will provide the high-quality evidence to assess whether the 5-element therapy has a positive treatment effect for senile diabetes with depression. REGISTRATION NUMBER INPLASY2020100081.
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Chandra M, Raveendranathan D, Johnson Pradeep R., Patra S, Rushi, Prasad K, Brar JS. Managing Depression in Diabetes Mellitus: A Multicentric Randomized Controlled Trial Comparing Effectiveness of Fluoxetine and Mindfulness in Primary Care: Protocol for DIAbetes Mellitus ANd Depression (DIAMAND) Study. Indian J Psychol Med 2020; 42:S31-S38. [PMID: 33487800 PMCID: PMC7802038 DOI: 10.1177/0253717620971200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Suboptimal management of depression in type 2 diabetes mellitus (T2DM) often translates into poor glycemic control, medical complications, and impaired quality of life. Feasibility and effectiveness of collaborative care models of depression in diabetes in low- and middle-income countries (LMICs) remain unexplored. DIAbetes Mellitus ANd Depression (DIAMAND) study, a multicentric single-blind randomized controlled trial (SBRCT) comparing effectiveness of fluoxetine and mindfulness in primary care settings, addresses this gap in scientific literature. METHODS This trial conducted in diverse geographic settings of New Delhi, Bengaluru, and Bhubaneswar will comprise module-based training of primary care providers (PCPs) for screening, diagnosing, and managing depression in diabetes in phase I. Phase II will involve four-arm parallel group RCT on 350 participants with T2DM with comorbid depressive episode randomly allocated to receive fluoxetine, mindfulness therapy, fluoxetine plus mindfulness therapy, or treatment as usual at primary care settings. Interventions would include fluoxetine (up to 60 mg/day) and/or sessions of mindfulness for 16 weeks. Primary outcomes on standardized rating scales include depression scores (Hamilton Depression Rating Scale), treatment adherence (Adherence to Refill and Medication Scale), self-care (Diabetes Self-Management Questionnaire), diabetes-related distress (Diabetes Distress Scale), and glycemic control. Secondary outcomes include quality of life (World Health Organization Quality of Life Brief version [WHO-QOL BREF]) and mindfulness (Five Facets Mindfulness Questionnaire). DISCUSSION This RCT will investigate the effectiveness of module-based training of PCPs and feasibility of collaborative care model for managing depression in T2DM in primary care settings in LMICs and effectiveness of fluoxetine and/or mindfulness in improving diverse outcomes of T2DM with major depression.
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Affiliation(s)
- Mina Chandra
- Dept. of Psychiatry, Deaddiction Services & Resource Centre for Tobacco Control, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Johnson Pradeep R.
- Dept. of Psychiatry, Medical Ethics, Institutional Ethics Committee, St. John’s Medical College, Bengaluru, Karnataka, India
| | - Suravi Patra
- Dept. of Psychiatry, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Rushi
- Dept. of Clinical Psychology, Centre of Excellence in Mental Health, Deaddiction Services & Resource Centre for Tobacco Control, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Konasale Prasad
- Dept. of Psychiatry and Bioengineering, University of Pittsburgh, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Jaspreet S Brar
- Dept. of Psychiatry, Community Care Behavioral Health Organization, Western Psychiatric Hospital of UPMC, Pittsburgh, Pennsylvania, USA
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22
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Abdulai T, Runqi T, Lou Z, Amponsem-Boateng C, Zhang H, Liu X, Li L, Mao Z, Huo W, Hou J, Wang F, Wang C. Depressive symptoms are not associated with type 2 diabetes in a rural population in China: findings from the Henan rural cohort. J Affect Disord 2020; 274:841-847. [PMID: 32664023 DOI: 10.1016/j.jad.2020.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 04/13/2020] [Accepted: 05/10/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Depression is one of the most prevalent mental health challenges that affect all groups of persons. This study examines the association between type 2 diabetes and depressive symptoms (using PHQ-2) in a rural population. Other risk factors of depressive symptoms are examined. METHODS Data from 30,001 participants from the Henan rural cohort was analyzed. Multivariable logistic regression analyses were performed to examine the associations between depressive symptoms (DS) and type 2 diabetes and other risk factors. Adjusted odds ratios (aOR) with confidence intervals (CI) at 95% are reported. RESULTS The prevalence of DS in the study population is 5.86%, 6.69% in women, 4.74% in men, 5.80% in persons without diabetes and 6.81% in persons with diabetes (diagnosed and undiagnosed). DS prevalence was highest in persons with previously diagnosed diabetes (8.27%). No association was found between DS and diabetes (aOR = 0.95, CI at 95% 0.61-1.48; p=0.836). DS was associated with poor glycemic control (aOR=1.43, CI at 95% 1.04- 1.98; p= 0.034) in persons with previously diagnosed diabetes, persons with elevated triglycerides (aOR=1.19, CI at 95% 1.08-1.30; p<0.001), household income (aOR= 0.78, CI at 95% 0.63-0.97; p=0.027), marital status (aOR=1.37, CI at 95% 1.01-1.88, p=0.049) and hypertension treatment with medication (aOR=1.94, CI at 95% 1.48-2.55; p<0.001). LIMITATIONS DS was assessed through self-report and may suffer recall or information bias. CONCLUSIONS DS was not associated with diabetes in our study population. The association between poor glycemic control and DS calls for the integration of screening for depression among patients with diabetes.
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Affiliation(s)
- Tanko Abdulai
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China; University for Development Studies, Department of Community Health and Family Medicine, School of Medicine and Health Sciences, Tamale, Ghana
| | - Tu Runqi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhicheng Lou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Cecilia Amponsem-Boateng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Fang Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, PR. China.
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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23
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Padmapriya C, Pushkarapriya S, Shanmugapriya N, Sushmitha KP, Karthik S, Rajanandh MG. Effect of sertraline in patients with newly diagnosed depression and type 2 diabetes mellitus or hypertension: An observational study from south India. Diabetes Metab Syndr 2020; 14:1065-1068. [PMID: 32645649 DOI: 10.1016/j.dsx.2020.06.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Patients with either type II diabetes mellitus (T2DM) or hypertension (HTN) are more prone to develop depression when compared with the general population. Along with comorbid of either T2DM or HTN, treatment of depression may become an even bigger challenge. The present study aimed to observe the effect of sertraline in newly diagnosed depression patients with T2DM or HTN. METHODS A prospective, observational study was conducted in the T2DM or HTN patients who were newly diagnosed as depression patients. Parameters such as, glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP) and Hamilton Depression Rating Scale (HAM-D) score for depression were measured before and after initiating sertraline therapy (50 mg, twice daily). Paired t-test was used to find out the statistical significance. RESULT Of the 546 enrolled patients, 291 patients were in T2DM and 255 patients with HTN. No statistically significant difference (p > 0.05) was observed between baseline and 12th week of comparison with respect to HbA1c, SBP and DBP values. While at the end of treatment, the number of patients suffered from depression in severe state were improved to moderate to a mild state of depression. Statistically significant difference (p < 0.001) was observed in both T2DM and HTN groups when comparing the total score of HAM-D before and after sertraline treatment. CONCLUSION Sertraline is effective in the management of newly diagnosed depression among T2DM or HTN patients. However, the results should be confirmed by a double blinded placebo studies.
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Affiliation(s)
- C Padmapriya
- Department of Psychiatry, Sri Ramachandra Medical College and Research Institute, India
| | - S Pushkarapriya
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India
| | - N Shanmugapriya
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India
| | - K P Sushmitha
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India
| | - S Karthik
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India.
| | - M G Rajanandh
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India.
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24
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Abstract
Depression is one of the most common comorbidities of many chronic medical diseases including cancer and cardiovascular, metabolic, inflammatory and neurological disorders. Indeed, the prevalence of depression in these patient groups is often substantially higher than in the general population, and depression accounts for a substantial part of the psychosocial burden of these disorders. Many factors can contribute to the occurrence of comorbid depression, such as shared genetic factors, converging biological pathways, social factors, health behaviours and psychological factors. Diagnosis of depression in patients with a medical disorder can be particularly challenging owing to symptomatic overlap. Although pharmacological and psychological treatments can be effective, adjustments may need to be made for patients with a comorbid medical disorder. In addition, symptoms or treatments of medical disorders may interfere with the treatment of depression. Conversely, symptoms of depression may decrease adherence to treatment of both disorders. Thus, comprehensive treatment plans are necessary to optimize care.
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25
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Khapre M, Kant R, Sharma D, Sharma A. Antidepressant Use and Glycemic Control in Diabetic Population: A Meta-analysis. Indian J Endocrinol Metab 2020; 24:295-300. [PMID: 33088750 PMCID: PMC7540827 DOI: 10.4103/ijem.ijem_258_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/14/2020] [Accepted: 06/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Depression is prevalent in the diabetic population. Primary care physician is busy in treating diabetes and depression among them goes unnoticed. According to the American Diabetic Association, two out of three are not able to achieve glycaemic control. Diabetes and depression both share complex cause-effect relationship. OBJECTIVES To evaluate the effect of antidepressants on glycaemic control among the adult diabetic population suffering from depression. METHOD Cochrane database was systematically searched with search strategy andonly parallel randomized clinical trial with antidepressant and placebo group were considered. Outcome measures were HbA1c, Fasting blood glucose, weight, body mass index, treatment adherence. Data extraction form were adapted from Cochrane. Two researchers identified studies and extracted data independently. Revman was used for meta-analysis and risk of bias. Level of evidence was generated using Gradepro. RESULTS Out of 394 studies, six studies fulfilling the eligibility criteria were pooled for analysis. Using mean difference (MD), meta-analysis showed significant evidence of glycaemic control in favor of antidepressant treated diabetic population compared to placebo group (n = 6 studies) (MD = - 0.32%; 95% CI = - 0.57 to 0.08). Weight, BMI does not show a any significant mean difference between two groups. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS There is moderate level of evidence that antidepressants improve the glycaemic control in diabetic population suffering from depression. Understanding and treating the mental and psychological determinant with adequate control of depression should be emphasized for the diabetic population.
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Affiliation(s)
- Meenakshi Khapre
- Department of Community and Family Medicine and Rishikesh, Uttarakhand, India
| | - Ravi Kant
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Divanshi Sharma
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Anusha Sharma
- Department of Community and Family Medicine and Rishikesh, Uttarakhand, India
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26
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Rosenblat JD, Kurdyak P, Cosci F, Berk M, Maes M, Brunoni AR, Li M, Rodin G, McIntyre RS, Carvalho AF. Depression in the medically ill. Aust N Z J Psychiatry 2020; 54:346-366. [PMID: 31749372 DOI: 10.1177/0004867419888576] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. METHODS Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. RESULTS Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug-drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. LIMITATIONS Non-systematic review of the literature. CONCLUSION Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia.,Centre of Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Madeline Li
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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27
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Pouwer F, Schram MT, Iversen MM, Nouwen A, Holt RIG. How 25 years of psychosocial research has contributed to a better understanding of the links between depression and diabetes. Diabet Med 2020; 37:383-392. [PMID: 31909844 DOI: 10.1111/dme.14227] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 12/23/2022]
Abstract
This narrative review of the literature provides a summary and discussion of 25 years of research into the complex links between depression and diabetes. Systematic reviews have shown that depression occurs more frequently in people with type 1 or type 2 diabetes compared with people without diabetes. Currently, it remains unclear whether depression is also more common in people with impaired glucose metabolism or undiagnosed type 2 diabetes compared with people without diabetes. More prospective epidemiological research into the course of depression and an exploration of mechanisms in individuals with diabetes are needed. Depression in diabetes is associated with less optimal self-care behaviours, suboptimal glycaemic control, impaired quality of life, incident micro- and macrovascular diseases, and elevated mortality rates. Randomized controlled trails concluded that depression in diabetes can be treated with antidepressant medication, cognitive-behavioural therapy (individual, group-based or web-based), mindfulness-based cognitive therapy and stepped care. Although big strides forward have been made in the past 25 years, scientific evidence about depression in diabetes remains incomplete. Future studies should investigate mechanisms that link both conditions and test new diabetes-specific web- or app-based interventions for depression in diabetes. It is important to determine whether treatment or prevention of depression prevents future diabetes complications and lowers mortality rates.
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Affiliation(s)
- F Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- STENO Diabetes Center Odense, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
| | - M T Schram
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M M Iversen
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - A Nouwen
- Department of Psychology, Middlesex University, London
| | - R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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28
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Nouwen A, Adriaanse MC, van Dam K, Iversen MM, Viechtbauer W, Peyrot M, Caramlau I, Kokoszka A, Kanc K, de Groot M, Nefs G, Pouwer F. Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis. Diabet Med 2019; 36:1562-1572. [PMID: 31215077 DOI: 10.1111/dme.14054] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 01/10/2023]
Abstract
To conduct a systematic review and meta-analysis of longitudinal studies assessing the bi-directional association between depression and diabetes macrovascular and microvascular complications. Embase, Medline and PsycINFO databases were searched from inception through 27 November 2017. A total of 4592 abstracts were screened for eligibility. Meta-analyses used multilevel random/mixed-effects models. Quality was assessed using the Newcastle-Ottawa scale. Twenty-two studies were included in the systematic review. Sixteen studies examined the relationship between baseline depression and incident diabetes complications, of which nine studies involving over one million participants were suitable for meta-analysis. Depression was associated with an increased risk of incident macrovascular (HR = 1.38; 95% CI: 1.30-1.47) and microvascular disease (HR = 1.33; 95% CI: 1.25-1.41). Six studies examined the association between baseline diabetes complications and subsequent depression, of which two studies involving over 230 000 participants were suitable for meta-analysis. The results showed that diabetes complications increased the risk of incident depressive disorder (HR = 1.14; 95% CI: 1.07-1.21). The quality analysis showed increased risk of bias notably in the representativeness of selected cohorts and ascertainment of exposure and outcome. Depression in people with diabetes is associated with an increased risk of incident macrovascular and microvascular complications. The relationship between depression and diabetes complications appears bi-directional. However, the risk of developing diabetes complications in depressed people is higher than the risk of developing depression in people with diabetes complications. The underlying mechanisms warrant further research.
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Affiliation(s)
- A Nouwen
- Middlesex University, London, UK
| | | | | | - M M Iversen
- Western Norway University of Applied Sciences, Bergen, Norway
| | | | - M Peyrot
- Western Norway University of Applied Sciences, Bergen, Norway
- Loyola University Maryland, Baltimore, USA
| | | | | | - K Kanc
- Jazindiabetes (Diabetes & Me), Private Diabetes Centre, Ljubljana, Slovenia
| | - M de Groot
- Indiana University School of Medicine, Indianapolis, USA
| | - G Nefs
- Tilburg University, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
- Diabeter, Rotterdam, The Netherlands
| | - F Pouwer
- University of Southern Denmark, Odense, Denmark
- STENO Diabetes Center Odense, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
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29
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Psychological Treatment for Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:233-265. [PMID: 31784967 DOI: 10.1007/978-981-32-9271-0_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Depression is highly prevalent and causes unnecessary human suffering and economic loss. Therefore, its treatment and prevention are of utmost importance. There are several advantages of using psychotherapy either by itself or combined with pharmacological treatment methods in the treatment of depression. First, it is well known that combining biological treatment with psychosocial methods increases the chances of recovery. Second, in some individuals, psychotherapy continues to be the only solution. Third, the use of antidepressants contains some safety risks and side effects, but psychotherapy does not. Fourth, clinically, depressive patients prefer psychotherapy to drug therapy. Use of a depression-focused psychotherapy alone is recommended as an initial treatment choice for patients with mild to moderate depression, with clinical evidence supporting the use of cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), psychodynamic psychotherapy (PDP), and problem-solving therapy (PST) in individual and group formats. Important developments took place within the past 20 years in the psychotherapy of depression. In the present chapter, we introduced several key issues, such as, Are all psychotherapies equally effective? Who benefits from psychotherapies? Is telepsychotherapy effective? Finally, we introduce the psychotherapy for special populations.
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30
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Shomaker LB, Cox S, Lehman DP, Kelly NR, Thompson KA, Mehari RM, Brady SM, Galescu OA, Demidowich AP, Chen KY, Tanofsky-Kraff M, Yanovski JA. Depressive symptoms in adolescent girls at-risk for type 2 diabetes and their parents. PSYCHOL HEALTH MED 2019; 25:530-540. [PMID: 31684760 DOI: 10.1080/13548506.2019.1687914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Few studies have characterized the relation between parent's depression symptoms and adolescent's depression symptoms in adolescents at-risk for type 2 diabetes (T2D). We evaluated the associations of parental depression symptoms with the depression symptoms and metabolic functioning of adolescent offspring at-risk for T2D. One-hundred sixteen parents and adolescent girls with a family history of diabetes completed surveys of depression symptoms. Adolescents' degree of metabolic risk for T2D was estimated from body mass index (BMI; kg/m2) standard score, percent adiposity from dual-energy x-ray absorptiometry scan, and whole body insulin sensitivity index determined from glucose/insulin concentrations during a two-hour oral glucose tolerance test. Parents' and adolescents' depression symptoms were significantly associated, even after accounting for race/ethnicity, age, puberty, body composition, and parental diabetes/BMI. Adjusting for similar covariates, parent depression symptoms also were positively related to adolescents' BMI standard score and had a trend-level association with adiposity. There was an inverse relation between parental depression symptoms and adolescent insulin sensitivity, which was entirely accounted for by adolescent body composition. The associations of parental depression symptoms with more elevated depression symptoms and higher BMI in adolescents at-risk for T2D has potential implications for interventions addressing these co-morbid health conditions.
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Affiliation(s)
- Lauren B Shomaker
- Department of Human Development and Family Studies and Colorado School of Public Health, Colorado State University, Fort Collins, USA.,Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA.,Department of Medical and Clinical Psychology, Department of Defense (DOD), Uniformed Services University of the Health Sciences (USUHS), Bethesda, USA
| | - Shelby Cox
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, USA
| | - Devon P Lehman
- Department of Human Development and Family Studies and Colorado School of Public Health, Colorado State University, Fort Collins, USA
| | - Nichole R Kelly
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA.,Department of Medical and Clinical Psychology, Department of Defense (DOD), Uniformed Services University of the Health Sciences (USUHS), Bethesda, USA.,Department of Counseling Psychology and Human Services and the Prevention Science Institute, University of Oregon, Eugene, USA
| | - Katherine A Thompson
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Rim M Mehari
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Sheila M Brady
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Ovidiu A Galescu
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Andrew P Demidowich
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Kong Y Chen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, DHHS, Bethesda, USA
| | - Marian Tanofsky-Kraff
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA.,Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, USA
| | - Jack A Yanovski
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
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Tovilla-Zárate CA, Pérez-Mandujano A, Ramírez-González IR, Fresan A, Suarez-Mendez S, Martínez-Villaseñor E, Rodríguez-Sánchez E, Villar-Soto M, López-Narváez ML, González-Castro TB, Ble-Castillo JL, Juárez-Rojop IE. Vortioxetine versus sertraline in metabolic control, distress and depression in Mexican patients with type 2 diabetes. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:656. [PMID: 31930057 DOI: 10.21037/atm.2019.10.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Depression in patients with type 2 diabetes (T2D) is often undiagnosed and remains untreated, leading to poor therapy adherence and ill health-related outcomes. We evaluated the effect of vortioxetine versus sertraline in the treatment of depression, distress and metabolic control in subjects with T2D and depression. Methods Participants were selected from the Clinic for Diabetes, diagnosed with depression when the score was ≥14 in the Hamilton Depression Rating Scale, and verified by a psychiatrist in agreement with the DSM-5 instrument (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). The criteria for recruitment also included glycosylated hemoglobin ≥7.5%, 18 to 60 years of age, and written informed consent. Pharmacological treatment for depression was assigned randomly: vortioxetine (10 mg/day) or sertraline (75 mg/day) for 8 weeks. Biochemical parameters, anthropometric measures and depression symptoms were evaluated after antidepressant treatment. This was a randomized singled-blind study. Results Subjects that met the inclusion criteria were 50, of which only 21 patients with T2D and depression finished the treatment. Vortioxetine and sertraline showed partial remission of depression. Vortioxetine showed a major effect size in glycosylated hemoglobin and a moderate effect size on weight loss, fasting plasma glucose (FPG), cholesterol and triacylglycerol levels. On the other hand, patients treated with sertraline presented a slight increase in body weight, body mass index (BMI), and in all biochemical markers. Conclusions Vortioxetine may ameliorate depressive symptoms and metabolic control in patients with T2D and depression. Trial registration number: NCT03978286.
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Affiliation(s)
- Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México
| | - Antonia Pérez-Mandujano
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Iris Rubí Ramírez-González
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Ana Fresan
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, México
| | - Samuel Suarez-Mendez
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Esteban Martínez-Villaseñor
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México.,Hospital Civil de Guadalajara, Guadalajara, México
| | - Ester Rodríguez-Sánchez
- Hospital de Alta Especialidad Gustavo A. Rovirosa Pérez, Secretaría de Salud, Villahermosa, Tabasco, México
| | - Mario Villar-Soto
- Hospital de Alta Especialidad Gustavo A. Rovirosa Pérez, Secretaría de Salud, Villahermosa, Tabasco, México
| | | | - Thelma Beatriz González-Castro
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México.,Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, México
| | - Jorge L Ble-Castillo
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Isela Esther Juárez-Rojop
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
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Sex-specific roles of cellular inflammation and cardiometabolism in obesity-associated depressive symptomatology. Int J Obes (Lond) 2019; 43:2045-2056. [PMID: 31089263 PMCID: PMC6774832 DOI: 10.1038/s41366-019-0375-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 02/06/2019] [Accepted: 03/29/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Obesity and depression are complex conditions with stronger comorbid relationships among women than men. Inflammation and cardiometabolic dysfunction are likely mechanistic candidates for increased depression risk, and their prevalence differs by sex. Whether these relationships extend to depressive symptoms is poorly understood. Therefore, we analyzed sex in associations between inflammation and metabolic syndrome (MetS) criteria on depressive symptomatology. Specifically, we examined whether sex positively moderates the relationship between depressive symptoms and inflammation among women, and whether MetS has parallel effects among men. METHODS Depressive symptoms, MetS, and inflammation were assessed in 129 otherwise healthy adults. Depressive symptoms were assessed using Beck Depression Inventory (BDI-Ia). Monocyte inflammation regulation (BARIC) was quantified using flow cytometry measurement of TNF-α suppression by β-agonist. Moderation effects of sex on associations between BARIC, MetS criteria, and BDI were estimated using two-way ANOVA and linear regression, adjusting for BMI, and by sex subgroup analyses. RESULTS Obese individuals reported more depressive symptoms. Sex did not formally moderate this relationship, though BDI scores tended to differ by BMI among women, but not men, in subgroup analysis. Poorer inflammation control and higher MetS criteria were correlated with somatic depressive symptoms. Sex moderated associations between MetS criteria and somatic symptoms; among men, MetS criteria predicted somatic symptoms, not among women. Subgroup analysis further indicated that poorer inflammation control tended to be associated with higher somatic symptoms in women. CONCLUSIONS These results indicate that obesity-related inflammation and MetS factors have sex-specific effects on depressive symptoms in a non-clinical population. Although pathophysiological mechanisms underlying sex differences remain to be elucidated, our findings suggest that distinct vulnerabilities to depressive symptoms exist between women and men, and highlight the need to consider sex as a key biological variable in obesity-depression relationships. Future clinical studies on comorbid obesity and depression should account for sex, which may optimize therapeutic strategies.
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Schmidt EM, Barnes J, Chen C, Trafton J, Frayne S, Harris AHS. Patient and Health Care Factors Associated With Long-term Diabetes Complications Among Adults With and Without Mental Health and Substance Use Disorders. JAMA Netw Open 2019; 2:e1912060. [PMID: 31553472 PMCID: PMC6763972 DOI: 10.1001/jamanetworkopen.2019.12060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Among people with diabetes, co-occurring mental health (MH) or substance use (SU) disorders increase the risk of medical complications. Identifying how to effectively promote long-term medical benefits for at-risk populations, such as people with MH or SU disorders, is essential. Knowing more about how health care accessed before the onset of diabetes is associated with health benefits after the onset of diabetes could inform treatment planning and population health management. OBJECTIVE To analyze how preexisting MH or SU disorders and primary care utilization before a new diabetes diagnosis are associated with the long-term severity of diabetes complications. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed medical record data from US Department of Veterans Affairs health care systems nationwide and used mixed-effects regressions to test associations between prediabetes patient or health care factors and longitudinal progression of diabetes complication severity from 2006 to 2015. Participants included patients who received a new diabetes diagnosis in 2008 and who were aged 18 to 85 years at the time of their diagnosis. Data analysis was conducted from March to August 2017. EXPOSURES Patients were assigned to groups on the basis of a 2-year look-back period for MH or SU disorders status (MH disorder only, SU disorder only, MH and SU disorder, or no MH or SU disorder diagnoses) and on the basis of the amount of primary care utilization before diabetes was diagnosed. MAIN OUTCOMES AND MEASURES Nine-year trajectories of Diabetes Complication Severity Index (DCSI) scores. RESULTS Among 122 992 patients with newly diagnosed diabetes, the mean (SD) age was 62.3 (11.1) years, 118 810 (96.6%) were male, and 28 633 (23.3%) had preexisting MH or SU disorders diagnoses. From the onset of diabetes to 7 years later, patients' mean estimated DCSI scores increased from 0.84 (95% CI, 0.82-0.87) to 1.42 (95% CI, 1.36-1.47). Controlling for sociodemographic characteristics and medical comorbidities, SU disorders only (decrease in DCSI score, -0.09; 95% CI, -0.13 to -0.04; P < .001) or both MH and SU disorders (decrease in DCSI score, -0.13; 95% CI, -0.16 to -0.09; P < .001), but not MH disorders only, were associated with lower DCSI scores at the time of the onset of diabetes compared with no MH or SU disorders. More than 90% of patients with MH or SU disorders had primary care visits before diabetes was newly diagnosed, compared with approximately 58% of patients without MH or SU disorders. Patients who had primary care visits before the onset of diabetes had lower baseline DCSI scores, compared with patients who did not have primary care visits (decrease in DCSI score, -0.41 [95% CI, -0.43 to -0.39] for 1-2 visits, -0.50 [95% CI, -0.52 to -0.48] for 3-4 visits, -0.39 [95% CI, -0.41 to -0.37] for 5-8 visits, and -0.15 [95% CI, -0.17 to -0.12] for ≥9 visits; P < .001 for all). Patients with MH or SU disorders had lower overall, but more rapidly progressing, mean DCSI scores through year 7 after the onset of diabetes (MH disorder only, 0.006 [95% CI, 0.005-0.008], P < .001; SU disorder only, 0.005 [95% CI, 0.001-0.008], P = .004; or both MH and SU disorders, 0.008 [95% CI, 0.006-0.011], P < .001), compared with patients without MH or SU disorders. CONCLUSIONS AND RELEVANCE Access to and engagement in integrated health care may be associated with modest, albeit impermanent, long-term health benefits for patients with MH and/or SU disorders with newly diagnosed diabetes.
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Affiliation(s)
- Eric M. Schmidt
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Stanford Health Policy, Stanford University, Stanford, California
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - James Barnes
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Stanford Health Policy, Stanford University, Stanford, California
| | - Cheng Chen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Jodie Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Susan Frayne
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Division of Primary Care and Population Health, Stanford University, Stanford, California
| | - Alex H. S. Harris
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Department of Surgery, Stanford University, Stanford, California
- Department of Medicine, Stanford University, Stanford, California
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Danhauer SC, Brenes GA, Levine BJ, Young L, Tindle HA, Addington EL, Wallace RB, Naughton MJ, Garcia L, Safford M, Kim MM, LeBlanc ES, Snively BM, Snetselaar LG, Shumaker S. Variability in sleep disturbance, physical activity and quality of life by level of depressive symptoms in women with Type 2 diabetes. Diabet Med 2019; 36:1149-1157. [PMID: 30552780 PMCID: PMC6571069 DOI: 10.1111/dme.13878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
Abstract
AIMS To examine (1) the prevalence of depressive symptoms in women with Type 2 diabetes, (2) the associations between depressive symptoms and the following dependent variables: sleep disturbance; physical activity; physical health-related; and global quality of life, and (3) the potential moderating effects of antidepressants and optimism on the relationship between depressive symptoms and dependent variables. METHODS Participants in the Women's Health Initiative who had Type 2 diabetes and data on depressive symptoms (N=8895) were included in the analyses. In multivariable linear regression models controlling for sociodemographic, medical and psychosocial covariates, we examined the main effect of depressive symptoms, as well as the interactions between depressive symptoms and antidepressant use, and between depressive symptoms and optimism, on sleep disturbance, physical activity, physical health-related quality of life; and global quality of life. RESULTS In all, 16% of women with Type 2 diabetes reported elevated depressive symptoms. In multivariable analyses, women with depressive symptoms had greater sleep disturbance (P<0.0001) and lower global quality of life (P<.0001). We found evidence of significant statistical interaction in the models for quality-of-life outcomes: the increased risk of poor physical health-related quality of life associated with antidepressant use was stronger in women without vs with depressive symptoms, and the association between greater optimism and higher global quality of life was stronger in women with vs without depressive symptoms. CONCLUSIONS To improve health behaviours and quality of life in women with Type 2 diabetes, sociodemographic and medical characteristics may identify at-risk populations, while psychosocial factors including depression and optimism may be important targets for non-pharmacological intervention.
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Affiliation(s)
- S C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | - G A Brenes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - B J Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | - L Young
- Department of Medicine, Division of Endocrinology and Metabolism, Section on Gerontology and Geriatric Medicine, UNC School of Medicine, Chapel Hill, NC
| | - H A Tindle
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - E L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - R B Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - M J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - L Garcia
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA
| | - M Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - M M Kim
- Center for Biobehavioral Health Disparities Research, Department of Community and Family Medicine, Duke University, Durham, NC
| | - E S LeBlanc
- Kaiser Permanente Center for Health Research NW, Portland, OR, USA
| | - B M Snively
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, WinstonSalem, NC, USA
| | - L G Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - S Shumaker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
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The Association Between Selective Serotonin Reuptake Inhibitors and Glycemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Psychosom Med 2019; 81:570-583. [PMID: 31136376 DOI: 10.1097/psy.0000000000000707] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Individual studies have reported conflicting effects of selective serotonin reuptake inhibitors (SSRIs) on glycemia. We systematically reviewed the effects of SSRIs on glycemia and whether metabolic and psychological factors moderated these effects. METHODS We systematically searched for placebo-controlled randomized controlled trials investigating the effect of SSRIs on glycemia (fasting blood glucose or HbA1c) as a primary or secondary outcome. Random effects meta-analysis was conducted to compute an overall treatment effect. Meta-regression tested whether depression, type 2 diabetes, insulin resistance, treatment duration, and weight loss moderated treatment effects. RESULTS Sixteen randomized controlled trials (n = 835) were included and glycemia was usually a secondary outcome. Overall, SSRIs improved glycemia versus placebo (pooled effect size (ES) = -0.34, 95% confidence interval (CI) = -0.48 to -0.21; p < .001, I = 0%). Individually, fluoxetine (ES = -0.29, 95% CI = -0.54 to -0.05; p = .018) and escitalopram/citalopram (ES = -0.33, 95% CI = -0.59 to -0.07; p = .012) outperformed placebo, but paroxetine (ES = -0.19, 95% CI = -0.58 to 0.19; p = .33) did not. Results were similar in populations selected for depression as those not. Across studies, baseline insulin resistance (p = .46), treatment duration (p = .47), diabetes status (p = .41), and weight loss (p = .93) did not moderate changes. Heterogeneity for all analyses was nonsignificant. CONCLUSIONS SSRIs seem to have an association with improvement in glycemia, which is not moderated by depression status, diabetes status, or change in weight across studies. Future powered trials with longer treatment duration are needed to confirm these findings. REGISTRATION PROSPERO ID: CRD4201809239.
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Fugger G, Dold M, Bartova L, Kautzky A, Souery D, Mendlewicz J, Serretti A, Zohar J, Montgomery S, Frey R, Kasper S. Major Depression and Comorbid Diabetes - Findings from the European Group for the Study of Resistant Depression. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109638. [PMID: 31054944 DOI: 10.1016/j.pnpbp.2019.109638] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/01/2019] [Accepted: 04/30/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The major aim of this multicenter study of the European Group for the Study of Resistant Depression (GSRD) was to elucidate associations between major depressive disorder (MDD) and comorbid diabetes. METHODS Demographic and clinical information of 1410 patients with a primary MDD diagnosis according to DSM-IV were retrieved cross-sectionally between 2012 and 2016. By applying descriptive statistics, analyses of covariance (ANCOVA) and binary logistic regression analyses, a comparison between patient characteristics with and without comorbid diabetes was performed. RESULTS The point prevalence rate for comorbid diabetes across MDD patients was 6%. Individuals with MDD + comorbid diabetes were significantly older, heavier, more likely to be inpatient and diagnosed with additional comorbid chronic somatic diseases. In addition, current suicide risk was significantly increased and melancholic features were more likely pronounced. In general, patients in the MDD + diabetes group received a combination therapy with at least one additional antidepressant rather than various other augmentation strategies. CONCLUSION Our analyses depict a lower prevalence rate of diabetes in MDD patients than previous studies. However, in light of the prevalence of diabetes in the geographical area of the study, we found an increased risk for individuals with depression compared to the general population. Current suicide risk is markedly elevated and has to be thoroughly assessed in every patient with comorbid diabetes. Depression severity and treatment response remained unaffected by concurrent diabetes in MDD.
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Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Souery
- Université Libre de Bruxelles, Bruxelles, Belgium; Psy Pluriel Centre Européen de Psychologie Médicale, Bruxelles, Belgium
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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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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Lores T, Goess C, Mikocka-Walus A, Collins KL, Burke ALJ, Chur-Hansen A, Delfabbro P, Andrews JM. Integrated Psychological Care is Needed, Welcomed and Effective in Ambulatory Inflammatory Bowel Disease Management: Evaluation of a New Initiative. J Crohns Colitis 2019; 13:819-827. [PMID: 30721977 DOI: 10.1093/ecco-jcc/jjz026] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/12/2018] [Accepted: 01/31/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease is associated with psychosocial issues which reduce quality of life and impair medical management. However, these issues are rarely addressed in routine care. A model of integrated psychological screening and intervention was trialled to measure prevalence, patient participation, and potential benefits to mental health and/or quality of life. METHODS During a 12-month period, 490 adult patients at an established hospital-based service were approached to complete screening instruments for anxiety, depression, general distress, quality of life and medication adherence. Disease-specific and demographic data were also collected. Patients who scored highly on screening questionnaires were offered psychological intervention (in-service or externally referred). Participants were reassessed after 12 months. RESULTS Psychological screening was well accepted with 68% (N = 335) participating. Psychological care was 'needed', with 55% (N = 183) scoring highly for anxiety, depression and/or general distress. Half of those 'in need' (N = 91) accepted intervention. In those who accepted, levels of anxiety (mean at intake [M1] = 12.11 vs mean at follow-up [M2] = 9.59, p < 0.001), depression (M1 = 8.38 vs M2 = 6.42, p < 0.001), general distress (M1 = 17.99 vs M2 = 13.96, p < 0.001), mental health quality of life (M1 = 54.64 vs M2 = 59.70, p < 0.001) and overall quality of life (M1 = 57.60 vs M2 = 64.10, p < 0.001) each improved between intake and follow-up. Engagement in psychological intervention was six times greater for those treated in-service vs externally referred (χ2[1] = 13.06, p < 0.001, odds ratio = 6.47). CONCLUSIONS Mental health issues are highly prevalent in people with inflammatory bowel disease. Patients are open to psychological screening and treatment. Psychological care can improve patient mental health and quality of life, and works best when integrated into routine management.
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Affiliation(s)
- Taryn Lores
- IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Charlotte Goess
- IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Kathryn L Collins
- Psychology Department, Central Adelaide Local Health Network, Adelaide, Australia
| | - Anne L J Burke
- Psychology Department, Central Adelaide Local Health Network, Adelaide, Australia
| | - Anna Chur-Hansen
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Paul Delfabbro
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Jane M Andrews
- IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, Australia
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High Quality of Care Persists With Shifting Depression Services From VA Specialty to Integrated Primary Care. Med Care 2019; 57:654-658. [PMID: 31259785 DOI: 10.1097/mlr.0000000000001141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Offering depression collaborative care services in primary care (PC) settings can reduce use of nonintegrated mental health care resources and improve mental health care access, particularly for vulnerable PC patients. Tests of effects on depression care quality, however, are needed. We examined overall quality of depression care and tested whether increasing clinic engagement in Veterans Affairs (VA)'s Primary Care-Mental Health Integration (PC-MHI) services was associated with differences in depression care quality over time. METHODS We conducted a retrospective longitudinal cohort study of 80,136 Veterans seen in 26 Southern California VA PC clinics (October 1, 2008-September 30, 2013). Using multilevel regression models adjusting for year, clinic, and patient characteristics, we predicted effects of clinic PC-MHI engagement (ie, percent of PC patients receiving PC-MHI services) on 3 VA-developed longitudinal electronic population-based depression quality measures among Veterans newly diagnosed with depression (n=12,533). RESULTS Clinic PC-MHI engagement rates were not associated with significant depression care quality differences. Across all clinics, average rates of follow-up within 84 or 180 days were, 66.4% and 74.5%, respectively. Receipt of minimally appropriate treatment was 80.5%. Treatment probabilities were significantly higher for vulnerable PC patients (homeless: 4.5%, P=0.03; serious mental illness: 15.2%, P<0.001), than for otherwise similar patients without these characteristics. CONCLUSIONS/POLICY IMPLICATIONS Study patients treated in PC clinics with greater PC-MHI engagement received similarly high quality depression care, and even higher quality for vulnerable patients. Findings support increasing use of PC-MHI models to the extent that they confer some advantage over existing services (eg, access, patient satisfaction) other than quality of care.
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de Joode JW, van Dijk SE, Walburg FS, Bosmans JE, van Marwijk HW, de Boer MR, van Tulder MW, Adriaanse MC. Diagnostic accuracy of depression questionnaires in adult patients with diabetes: A systematic review and meta-analysis. PLoS One 2019; 14:e0218512. [PMID: 31220131 PMCID: PMC6586329 DOI: 10.1371/journal.pone.0218512] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Comorbid depression is common among patients with diabetes and has severe health consequences, but often remains unrecognized. Several questionnaires are used to screen for depression. A systematic review and meta-analysis regarding the diagnostic accuracy of depression questionnaires in adults with diabetes is unavailable. Our aim was to conduct a systematic review and meta-analysis to evaluate the diagnostic accuracy of depression questionnaires in adults with type 1 or type 2 diabetes. METHODS PubMed, Embase and PsycINFO were searched from inception to 28 February 2018. Studies were included when the diagnostic accuracy of depression questionnaires was assessed in a diabetes population and the reference standard was a clinical interview. Data extraction was performed by one reviewer and checked by another. Two reviewers independently conducted the quality assessment (QUADAS-2). Diagnostic accuracy was pooled in bivariate random effects models. The main outcome was diagnostic accuracy, expressed as sensitivity and specificity, of depression questionnaires in an adult diabetes population. This study is reported according to PRISMA-DTA and is registered with PROSPERO (CRD42018092950). RESULTS A total 6,097 peer-reviewed articles were screened. Twenty-one studies (N = 5,703 patients) met the inclusion criteria for the systematic review. Twelve different depression questionnaires were identified, of which the CES-D (n = 6 studies) and PHQ-9 (n = 7 studies) were the most frequently evaluated. Risk of bias was unclear for multiple domains in the majority of studies. In the meta-analyses, five (N = 1,228) studies of the CES-D (≥16), five (N = 1,642) of the PHQ-9 (≥10) and four (N = 822) of the algorithm of the PHQ-9 were included in the pooled analysis. The CES-D (≥16) had a pooled sensitivity of 85.0% (95%CI, 71.3-92.8%) and a specificity of 71.6% (95%CI, 62.5-79.2%); the PHQ-9 (≥10) had a sensitivity of 81.5% (95%CI, 57.1-93.5%) and a specificity of 79.7% (95%CI, 62.1-90.4%). The algorithm for the PHQ-9 had a sensitivity of 60.9% (95%CI, 52.3-90.8%) and a specificity of 64.0% (95%CI, 53.0-93.9%). CONCLUSIONS This review indicates that the CES-D had the highest sensitivity, whereas the PHQ-9 had the highest specificity, although confidence intervals were wide and overlapping. The algorithm for the PHQ-9 had the lowest sensitivity and specificity. Given the variance in results and suboptimal reporting of studies, further high quality studies are needed to confirm the diagnostic accuracy of these depression questionnaires in patients with diabetes.
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Affiliation(s)
- Johanna W. de Joode
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Susan E.M. van Dijk
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Knowledge Institute of Medical Specialists, Utrecht, The Netherlands
| | - Florine S. Walburg
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Harm W.J. van Marwijk
- Department of Primary Care and Public Health, University of Brighton, Brighton, United Kingdom
- Brighton and Sussex Medical School, Watson Building House, University of Brighton, Brighton, United Kingdom
| | - Michiel R. de Boer
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maurits W. van Tulder
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel C. Adriaanse
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Li HQ, Chi S, Dong Q, Yu JT. Pharmacotherapeutic strategies for managing comorbid depression and diabetes. Expert Opin Pharmacother 2019; 20:1589-1599. [PMID: 31149850 DOI: 10.1080/14656566.2019.1622090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The increasing prevalence of comorbid depression and diabetes exerts a heavy burden on global health. Co-occurrence of depression and diabetes is common, affecting 14% to 35.8% of patients with diabetes, leading to a higher mortality and morbidity rate, more micro- and macro-vascular diseases and more cognitive decline. Areas covered: In this paper, the authors address various areas from epidemiology, the association between depression and diabetes, treatment strategies and future directions based on the currently available literature to provide novel insight into the pharmacotherapeutic management of comorbid depression and diabetes. Expert opinion: Pharmacotherapy can help patients with comorbid depression and diabetes by relieving depressive symptoms and improving glycemic control. When combined with psychological therapy, as a collaborative care effort, pharmacological therapy based on selective serotonin reuptake inhibitors (SSRIs) is recommended for comorbid depression with diabetes. Furthermore, studies with larger sample sizes that can help to define different subtypes of diabetes and severity of depression are needed so that clinicians can draw up a precise and applicable management guidelines for the personalized therapy of these diseases.
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Affiliation(s)
- Hong-Qi Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
| | - Song Chi
- Department of Neurology, The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
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Mikocka‐Walus A, Prady SL, Pollok J, Esterman AJ, Gordon AL, Knowles S, Andrews JM. Adjuvant therapy with antidepressants for the management of inflammatory bowel disease. Cochrane Database Syst Rev 2019; 4:CD012680. [PMID: 30977111 PMCID: PMC6459769 DOI: 10.1002/14651858.cd012680.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD). Antidepressants are taken by approximately 30% of people with IBD. However, there are no current guidelines on treating co-morbid anxiety and depression in people with IBD with antidepressants, nor are there clear data on the role of antidepressants in managing physical symptoms of IBD. OBJECTIVES The objectives were to assess the efficacy and safety of antidepressants for treating anxiety and depression in IBD, and to assess the effects of antidepressants on quality of life (QoL) and managing disease activity in IBD. SEARCH METHODS We searched MEDLINE; Embase, CINAHL, PsycINFO, CENTRAL, and the Cochrane IBD Group Specialized Register from inception to 23 August 2018. Reference lists, trials registers, conference proceedings and grey literature were also searched. SELECTION CRITERIA Randomised controlled trials (RCTs) and observational studies comparing any type of antidepressant to placebo, no treatment or an active therapy for IBD were included. DATA COLLECTION AND ANALYSIS Two authors independently screened search results, extracted data and assessed bias using the Cochrane risk of bias tool. We used the Newcastle-Ottawa Scale to assess quality of observational studies. GRADE was used to evaluate the certainty of the evidence supporting the outcomes. Primary outcomes included anxiety and depression. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) or the Hamilton Anxiety Rating Scale (HARS). Depression was assessed using HADS or the Beck Depression Inventory. Secondary outcomes included adverse events (AEs), serious AEs, withdrawal due to AEs, quality of life (QoL), clinical remission, relapse, pain, hospital admissions, surgery, and need for steroid treatment. QoL was assessed using the WHO-QOL-BREF questionnaire. We calculated the risk ratio (RR) and corresponding 95% confidence intervals (CI) for dichotomous outcomes. For continuous outcomes, we calculated the mean difference (MD) with 95% CI. A fixed-effect model was used for analysis. MAIN RESULTS We included four studies (188 participants). Two studies were double-blind RCTs, one was a non-randomised controlled trial, and one was an observational retrospective case-matched study. The age of participants ranged from 27 to 37.8 years. In three studies participants had quiescent IBD and in one study participants had active or quiescent IBD. Participants in one study had co-morbid anxiety or depression. One study used duloxetine (60 mg daily), one study used fluoxetine (20 mg daily), one study used tianeptine (36 mg daily), and one study used various antidepressants in clinical ranges. Three studies had placebo controls and one study had a no treatment control group. One RCT was rated as low risk of bias and the other was rated as high risk of bias (incomplete outcome data). The non-randomised controlled trial was rated as high risk of bias (random sequence generation, allocation concealment, blinding). The observational study was rated as high methodological quality, but is still considered to be at high risk of bias given its observational design.The effect of antidepressants on anxiety and depression is uncertain. At 12 weeks, the mean anxiety score in antidepressant participants was 6.11 + 3 compared to 8.5 + 3.45 in placebo participants (MD -2.39, 95% -4.30 to -0.48, 44 participants, low certainty evidence). At 12 months, the mean anxiety score in antidepressant participants was 3.8 + 2.5 compared to 4.2 + 4.9 in placebo participants (MD -0.40, 95% -3.47 to 2.67, 26 participants; low certainty evidence). At 12 weeks, the mean depression score in antidepressant participants was 7.47 + 2.42 compared to 10.5 + 3.57 in placebo participants (MD -3.03, 95% CI -4.83 to -1.23, 44 participants; low certainty evidence). At 12 months, the mean depression score in antidepressant participants was 2.9 + 2.8 compared to 3.1 + 3.4 in placebo participants (MD -0.20, 95% -2.62 to 2.22, 26 participants; low certainty evidence).The effect of antidepressants on AEs is uncertain. Fifty-seven per cent (8/14) of antidepressant participants group reported AEs versus 25% (3/12) of placebo participants (RR 2.29, 95% CI 0.78 to 6.73, low certainty evidence). Commonly reported AEs include nausea, headache, dizziness, drowsiness, sexual problems, insomnia, fatigue, low mood/anxiety, dry mouth, muscle spasms and hot flushes. None of the included studies reported any serious AEs. None of the included studies reported on pain.One study (44 participants) reported on QoL at 12 weeks and another study (26 participants) reported on QoL at 12 months. Physical, Psychological, Social and Environmental QoL were improved at 12 weeks compared to placebo (all low certainty evidence). There were no group differences in QoL at 12 months (all low certainty evidence). The effect of antidepressants on maintenance of clinical remission and endoscopic relapse is uncertain. At 12 months, 64% (9/14) of participants in the antidepressant group maintained clinical remission compared to 67% (8/12) of placebo participants (RR 0.96, 95% CI 0.55 to 1.69; low certainty evidence). At 12 months, none (0/30) of participants in the antidepressant group had endoscopic relapse compared to 10% (3/30) of placebo participants (RR 0.14, 95% CI 0.01 to 2.65; very low certainty evidence). AUTHORS' CONCLUSIONS The results for the outcomes assessed in this review are uncertain and no firm conclusions regarding the efficacy and safety of antidepressants in IBD can be drawn. Future studies should employ RCT designs, with a longer follow-up and develop solutions to address attrition. Inclusion of objective markers of disease activity is strongly recommended as is testing antidepressants from different classes, as at present it is unclear if any antidepressant (or class thereof) has differential efficacy.
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Affiliation(s)
- Antonina Mikocka‐Walus
- Deakin University GeelongSchool of Psychology221 Burwood HighwayBurwood, VICVictoriaAustralia3025
| | - Stephanie L Prady
- University of YorkDepartment of Health SciencesSeebohm Rowntree Area 2YorkUKYO10 5DD
| | - Justyna Pollok
- The University of AdelaideFaculty of Health and Medical SciencesNorth TerraceAdelaideSouth AustraliaAustralia5005
| | - Adrian J Esterman
- University of South AustraliaDivision of Health SciencesAdelaideAustralia
- James Cook UniversityAustralian Institute of Tropical Health and MedicineCairnsAustralia
| | - Andrea L Gordon
- University of South AustraliaSchool of Pharmacy and Medical SciencesAdelaideAustralia
| | - Simon Knowles
- Swinburne University of TechnologyDepartment of Psychological SciencesATC1041 Hawthorn campusVictoriaAustralia
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Doyle F, Freedland K, Carney R, de Jonge P, Dickens C, Pedersen S, Sorensen J, Dempster M. Network meta-analysis of randomised trials of pharmacological, psychotherapeutic, exercise and collaborative care interventions for depressive symptoms in patients with coronary artery disease: hybrid systematic review of systematic reviews protocol. Syst Rev 2019; 8:71. [PMID: 30878039 PMCID: PMC6420728 DOI: 10.1186/s13643-019-0985-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/11/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Depression is common in patients with coronary artery disease (CAD) and is associated with poorer outcomes and higher costs. Several randomised controlled trials (RCTs) targeting depression, of various modalities (including pharmacological, psychotherapeutic and other approaches), have been conducted and summarised in pairwise meta-analytic reviews. However, no study has considered the cumulative evidence within a network, which can provide valuable indirect comparisons and information about the relative efficacy of interventions. Therefore, we will adopt a review of review methodology to develop a network meta-analysis (NMA) of depression interventions for depression in CAD. METHODS We will search relevant databases from inception for systematic reviews of RCTs of depression treatments for people with CAD, supplementing this with comprehensive searches for recent or ongoing studies. We will extract data from and summarise characteristics of individual RCTs, including participants, study characteristics, outcome measures and adverse events. Cochrane risk of bias ratings will also be extracted or if not present will be conducted by the authors. RCTs that compare depression treatments (grouped as pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) to placebo, usual care, waitlist control or attention controls, or directly in head-to-head comparisons, will be included. Primary outcomes will be the change in depressive symptoms (summarised with a standardised mean difference) and treatment acceptability (treatment discontinuation: % of people who withdrew). Secondary outcomes will include change in 6-month depression outcomes, health-related quality of life (HRQoL), mortality, cardiovascular morbidity, health services use and adverse events. Secondary analyses will form further networks with individual anti-depressants and psychotherapies. We will use frequentist, random effects multivariate network meta-analysis to synthesise the evidence for depression intervention and to achieve a ranking of treatments, using Stata. Rankograms and surface under the cumulative ranking curves will be used for treatment ranking. Local and global methods will evaluate consistency. GRADE will be used to assess evidence quality for primary outcomes. DISCUSSION The present review will address uncertainties about the evidence in terms of depression management in CAD and may allow for a ranking of treatments, including providing important information for future research efforts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018108293.
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Affiliation(s)
- Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. .,School of Psychology, Queen's University Belfast, University Road, Belfast, BT71NN, Northern Ireland, UK.
| | | | - Robert Carney
- Washington University School of Medicine, St. Louis, USA
| | | | | | | | - Jan Sorensen
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Robinson DJ, Coons M, Haensel H, Vallis M, Yale JF. Diabetes and Mental Health. Can J Diabetes 2018; 42 Suppl 1:S130-S141. [PMID: 29650085 DOI: 10.1016/j.jcjd.2017.10.031] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 01/28/2023]
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Chai S, Yao B, Xu L, Wang D, Sun J, Yuan N, Zhang X, Ji L. The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2. PATIENT EDUCATION AND COUNSELING 2018; 101:1427-1432. [PMID: 29622281 DOI: 10.1016/j.pec.2018.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/13/2018] [Accepted: 03/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of self-management education on psychological outcomes and glycemic control in type 2 diabetes mellitus. METHODS Patients were randomly assigned to education group and control group. Education group received professional education and control group received routine outpatient education. RESULTS A total of 118 patients were randomly assigned to two groups (education group, n = 63; control group, n = 55). Compared with control group, the anxiety score (36.00 vs. 42.50, P < 0.05) and depression score (35.50 vs. 44.00, P < 0.05) significantly decreased at the sixth month in education group, respectively. Compared with control group, fasting blood glucose (6.78 mmol/L vs. 7.70 mmol/L, P < 0.00), postprandial blood glucose (7.90 mmol/L vs. 10.58 mmol/L, P < 0.00) and glycosylated haemoglobin A1C level [6.20 (5.80, 6.60)% vs. 6.70 (6.40, 7.30)%, P < 0.01] significantly decreased after the sixth month in education group. CONCLUSION The psychological status and blood glucose of patients with diabetes receiving self-management education were significantly improved. PRACTICE IMPLICATIONS Type 2 diabetes mellitus has been usually linked to increased prevalence and risk of depression and anxiety, which can affect blood glucose levels. Through education, the mood of newly diagnosed patients with diabetes improved, resulting in better blood glucose control.
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Affiliation(s)
- Sanbao Chai
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Baoting Yao
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Lin Xu
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Danyang Wang
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Jianbin Sun
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Ning Yuan
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Xiaomei Zhang
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China; Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, 100044, China
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McCurley JL, Penedo F, Roesch SC, Isasi CR, Carnethon M, Sotres-Alvarez D, Schneiderman N, Gonzalez P, Chirinos DA, Camacho A, Teng Y, Gallo LC. Psychosocial Factors in the Relationship between Socioeconomic Status and Cardiometabolic Risk: the HCHS/SOL Sociocultural Ancillary Study. Ann Behav Med 2018; 51:477-488. [PMID: 28130624 DOI: 10.1007/s12160-016-9871-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND U.S. Hispanics/Latinos display a high prevalence of metabolic syndrome (MetSyn), a group of co-occurring cardiometabolic risk factors (abdominal obesity, impaired fasting glucose, dyslipidemia, elevated blood pressure) associated with higher cardiovascular disease and mortality risk. Low socioeconomic status (SES) is associated with higher risk for MetSyn in Hispanics/Latinos, and psychosocial factors may play a role in this relationship. PURPOSE This cross-sectional study examined psychosocial factors in the association of SES and MetSyn components in 4,996 Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. METHODS MetSyn components were measured at the baseline examination. Participants completed interviews to determine psychosocial risks (e.g., depression) and resources (e.g., social support) within 9 months of baseline (< 4 months in 72.6% of participants). Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to identify latent constructs and examine associations. RESULTS Participant mean age was 41.7 years (SE = 0.4) and 62.7% were female. CFA identified single latent factors for SES and psychosocial indicators, and three factors for MetSyn [blood pressure, lipids, metabolic factors]. SEMs showed that lower SES was related to MetSyn factors indirectly through higher psychosocial risk/lower resources (Y-Bχ2 (df = 420) = 4412.90, p < .05, RMSEA = .042, SRMR = .051). A statistically significant effect consistent with mediation was found from lower SES to higher metabolic risk (glucose/waist circumference) via psychosocial risk/resource variables (Mackinnon's 95% asymmetric CI = -0.13 to -0.02). CONCLUSIONS SES is related to metabolic variables indirectly through psychosocial factors in U.S. Hispanics/Latinos of diverse ancestries.
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Affiliation(s)
- Jessica L McCurley
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Carmen R Isasi
- Deptartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mercedes Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Diana A Chirinos
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Alvaro Camacho
- Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Yanping Teng
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA. .,South Bay Latino Research Center, 450 4th Ave, Suite 304, Chula Vista, CA, 91910, USA.
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Chlebowy DO, Batscha C, Kubiak N, Crawford T. Relationships of Depression, Anxiety, and Stress with Adherence to Self-Management Behaviors and Diabetes Measures in African American Adults with Type 2 Diabetes. J Racial Ethn Health Disparities 2018; 6:71-76. [DOI: 10.1007/s40615-018-0500-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/25/2018] [Accepted: 05/07/2018] [Indexed: 12/26/2022]
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Individual depressive symptoms and all-cause mortality In 6673 patients with myocardial infarction: Heterogeneity across age and sex subgroups. J Affect Disord 2018; 228:178-185. [PMID: 29253684 DOI: 10.1016/j.jad.2017.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 10/03/2017] [Accepted: 11/07/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Depression predicts poor prognosis in patients with myocardial infarction (MI). However, individual depressive symptoms may have different prognostic value, and age and sex could be important effect modifiers. This study compared the prognostic value of individual depressive symptoms across age and sex subgroups in post-MI patients. METHODS Individual patient-data were compiled for 6673 post-MI patients from seven studies. Depressive symptoms were measured with 10 items of the Beck Depression Inventory (BDI10). The endpoint was all-cause mortality (mean=3.8 years). Multilevel multivariable Cox regression analysis was used to estimate the mortality risk across age groups (≤55, 56-69 and ≥70 years) and sex for symptoms that potentially interacted with age and sex. RESULTS At follow-up, 995 (15%) post-MI patients had died. BDI10 depression scores were associated with an increased mortality risk (HR:1.20;95%CI:1.11-1.28,p<.001). Negative self-image (HR:1.53;1.06-2.21;p=.022) and indecisiveness (HR:1.53;1.15-2.04;p=.003) were associated with increased mortality in men <55. Dissatisfaction was associated with increased mortality in men aged 56-69 (HR:1.35;1.07-1.71;p=. 011), and dissatisfaction (HR:1.34;1.10-1.63;p=.003) and fatigue (HR:1.45;1.20-1.74;p<.001) in men >70. Fatigue was associated with mortality in women aged 56-69 (HR:1.54;1.09-2.15;p=.012), and suicidal ideation in women aged >70 (HR:1.58;1.03-2.43;p=.037). Left-ventricular ejection fraction (LVEF) accounted for much of the associations in men ≤55 years and women ≥70 years. LIMITATIONS Findings are sample-specific and need replication in future research; BDI10 items were derived from the original BDI assessment. CONCLUSIONS There is large heterogeneity in the prognostic value of individual depressive symptoms in post-MI patients across sex and age subgroups. LVEF partially explained the depression-prognosis association in specific subgroups.
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A Randomized Controlled Trial to Prevent Depression and Ameliorate Insulin Resistance in Adolescent Girls at Risk for Type 2 Diabetes. Ann Behav Med 2017; 50:762-774. [PMID: 27333897 DOI: 10.1007/s12160-016-9801-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Prospective data suggest depressive symptoms worsen insulin resistance and accelerate type 2 diabetes (T2D) onset. PURPOSE We sought to determine whether reducing depressive symptoms in overweight/obese adolescents at risk for T2D would increase insulin sensitivity and mitigate T2D risk. METHOD We conducted a parallel-group, randomized controlled trial comparing a 6-week cognitive-behavioral (CB) depression prevention group with a 6-week health education (HE) control group in 119 overweight/obese adolescent girls with mild-to-moderate depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D] ≥16) and T2D family history. Primary outcomes were baseline to post-intervention changes in CES-D and whole body insulin sensitivity index (WBISI), derived from 2-h oral glucose tolerance tests. Outcome changes were compared between groups using ANCOVA, adjusting for respective baseline outcome, puberty, race, facilitator, T2D family history degree, baseline age, adiposity, and adiposity change. Multiple imputation was used for missing data. RESULTS Depressive symptoms decreased (p < 0.001) in CB and HE from baseline to posttreatment, but did not differ between groups (ΔCESD = -12 vs. -11, 95 % CI difference = -4 to +1, p = 0.31). Insulin sensitivity was stable (p > 0.29) in CB and HE (ΔWBISI = 0.1 vs. 0.2, 95 % CI difference = -0.6 to +0.4, p = 0.63). Among all participants, reductions in depressive symptoms were associated with improvements in insulin sensitivity (p = 0.02). CONCLUSIONS Girls at risk for T2D displayed reduced depressive symptoms following 6 weeks of CB or HE. Decreases in depressive symptoms related to improvements in insulin sensitivity. Longer-term follow-up is needed to determine whether either program causes sustained decreases in depressive symptoms and improvements in insulin sensitivity. TRIAL REGISTRATION NUMBER The trial was registered with clinicaltrials.gov (NCT01425905).
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Schmitt A, Reimer A, Ehrmann D, Kulzer B, Haak T, Hermanns N. Reduction of depressive symptoms predicts improved glycaemic control: Secondary results from the DIAMOS study. J Diabetes Complications 2017; 31:1608-1613. [PMID: 28865713 DOI: 10.1016/j.jdiacomp.2017.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/11/2017] [Accepted: 08/05/2017] [Indexed: 01/20/2023]
Abstract
AIMS Evidence from randomised trials analysing effects of depression treatment on glycaemic control in group comparisons is inconsistent. The aim of this study was to test if the reduction of depressive symptoms would explain improved glycaemic control irrespective of treatment groups. METHODS The DIAMOS study tested effects of cognitive-behavioural therapy (CBT) versus usual care on depressive symptoms in a 12-month prospective trial; HbA1c was a secondary outcome. Since the results suggested superiority of CBT for improving depressive symptoms, but not HbA1c, we conducted this secondary analysis to test if reduction of depressive symptoms could explain improved glycaemic control when assessed irrespective of treatment group affiliation. Reduction of depressive symptoms was assessed using baseline-to-follow-up changes in the Center for Epidemiologic Studies Depression Scale (CES-D). We used multiple regression analyses, adjusting for baseline HbA1c and depression, group affiliation and covariates, to assess associations between reduction of depressive symptoms and follow-up HbA1c. RESULTS 181 participants provided eligible data. Depressive symptoms decreased between baseline and follow-up by averagely -5.1±11.8 CES-D points. Greater reduction of depressive symptoms predicted greater improvement of HbA1c at follow-up, while adjusting for baseline HbA1c and covariates (Beta=-0.24, P=0.004). Additionally, patients with greater reduction of depressive symptoms were more likely to reach in-target HbA1c (<7.5%) at follow-up (adjusted OR=1.04, 95% CI 1.01-1.08, P=0.023). CONCLUSIONS The findings suggest that reduction of depressive symptoms can explain improved glycaemic control. Behavioural treatments might aim to improve both affective and glycaemic outcomes.
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MESH Headings
- Adult
- Affective Symptoms/prevention & control
- Cognitive Behavioral Therapy
- Combined Modality Therapy/psychology
- Depression/complications
- Depression/physiopathology
- Depression/psychology
- Depression/therapy
- Depressive Disorder, Major/complications
- Depressive Disorder, Major/physiopathology
- Depressive Disorder, Major/psychology
- Depressive Disorder, Major/therapy
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Female
- Follow-Up Studies
- Germany
- Glycated Hemoglobin/analysis
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/prevention & control
- Male
- Middle Aged
- Models, Psychological
- Patient Compliance/psychology
- Psychiatric Status Rating Scales
- Self-Management/psychology
- Severity of Illness Index
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Affiliation(s)
- Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 Muenchen, Neuherberg, Germany.
| | - André Reimer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 Muenchen, Neuherberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany; Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 Muenchen, Neuherberg, Germany; Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 Muenchen, Neuherberg, Germany; Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany
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