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Su M, Yan Z, Wang Y, Cai J, Dong J, Luo J, Chen D, Liu A, Ye H. Depression Exacerbates Hepatic Steatosis in C57BL/6J Mice by Activating the Hypothalamic-Pituitary-Adrenal Axis. In Vivo 2024; 38:1677-1689. [PMID: 38936893 PMCID: PMC11215574 DOI: 10.21873/invivo.13618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND/AIM Depression is associated with metabolic disorders, including non-alcoholic fatty liver disease (NAFLD). However, the mechanisms underlying the interaction between them are still poorly known. MATERIALS AND METHODS In this study, mice on a choline deficiency, L-amino acid-defined, high-fat diet (CDAHFD) developing steatosis were challenged with chronic restraint stress (CRS), a protocol widely used to induce depression. The development of depression and steatosis was evaluated using histopathology analysis, ELISA, q-PCR and Western Blot. RESULTS The contribution of the activated HPA axis to hepatic steatosis progress was fully established, which was validated using a hepatocyte model. Histopathological and biochemical analysis indicated that steatosis was exacerbated by CRS challenge, and behavioral tests indicated that the mice developed depression. Among the screened endocrinal pathways, the hypothalamic-pituitary-adrenal (HPA) axis was significantly activated and the synergistic effect of CDAHFD and CRS in activating the HPA axis was observed. In the hypothalamus, expression of corticotropin-releasing hormone (CRH) was increased by 86% and the protein levels of hypothalamic CRH were upregulated by 25% to 33% by CRS treatment. Plasma CRH levels were elevated by 45-56% and plasma adrenocorticotropic hormone (ACTH) levels were elevated by 29-58% by CRS treatment. In the liver, target genes of the HPA axis were activated, accompanied by disruption of the lipid metabolism and progression of steatohepatitis. The lipid metabolism in the Hepa1-6 cell line treated with endogenous corticosterone (CORT) was in accordance with the aforementioned in vivo responses. CONCLUSION Depression aggravated hepatic steatosis in CDAHFD-fed mice by activating the HPA axis. The risk of NAFLD development should be fully considered in depressive patients and improvement of psychotic disorders could be an etiological treatment strategy for them.
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Affiliation(s)
- Mingli Su
- Department of Gastroenterology, the Affiliated Lihuili Hospital, Ningbo University, Ningbo, P.R. China
- Zhejiang Key Laboratory of Pathophysiology, Department of Physiology and Pharmacology, Health Science Center, Ningbo University, Ningbo, P.R. China
| | - Zheng Yan
- Zhejiang Key Laboratory of Pathophysiology, Department of Physiology and Pharmacology, Health Science Center, Ningbo University, Ningbo, P.R. China
| | - Ying Wang
- Zhejiang Key Laboratory of Pathophysiology, Department of Physiology and Pharmacology, Health Science Center, Ningbo University, Ningbo, P.R. China
| | - Jiacheng Cai
- Zhejiang Key Laboratory of Pathophysiology, Department of Physiology and Pharmacology, Health Science Center, Ningbo University, Ningbo, P.R. China
| | - Jia Dong
- Zhejiang Key Laboratory of Pathophysiology, Department of Physiology and Pharmacology, Health Science Center, Ningbo University, Ningbo, P.R. China
| | - Jia Luo
- Zhejiang Key Laboratory of Pathophysiology, Department of Physiology and Pharmacology, Health Science Center, Ningbo University, Ningbo, P.R. China
| | - Dahua Chen
- Department of Gastroenterology, the Affiliated Lihuili Hospital, Ningbo University, Ningbo, P.R. China
| | - Aiming Liu
- Zhejiang Key Laboratory of Pathophysiology, Department of Physiology and Pharmacology, Health Science Center, Ningbo University, Ningbo, P.R. China
| | - Hua Ye
- Department of Gastroenterology, the Affiliated Lihuili Hospital, Ningbo University, Ningbo, P.R. China;
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Herhaus B, Kruse J, Hinz A, Brähler E, Petrowski K. Depression, anxiety, and health-related quality of life in normal weight, overweight and obese individuals with diabetes: a representative study in Germany. Acta Diabetol 2024; 61:725-734. [PMID: 38430257 PMCID: PMC11101582 DOI: 10.1007/s00592-024-02248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/29/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Diabetes in the course of lifetime is related to a higher risk for mental disorders. The present study addresses the comparison of individuals with diabetes and non-diabetic individuals in depressive symptoms, generalized anxiety symptoms, and health-related quality of life. Furthermore, mediator effect of BMI and health-related quality of life (HRQOL) on the association between diabetes, depression, and generalized anxiety was analyzed. METHODS In this cross-sectional study, the three questionnaires PHQ-9, GAD-7, EQ-5D-5L were measured in a representative sample of the German population (N = 2386). In addition, the presence of diabetes and BMI were assessed via self-report. RESULTS There were higher values in depressive and anxiety symptoms as well as lower score in HRQOL in individuals with diabetes compared to non-diabetic individuals. Obese individuals with diabetes showed the highest rates in depressive symptoms and generalized anxiety as well as lowest score in HRQOL. With regard to the mediator analyses, association between diabetes, depressive symptoms, and anxiety symptoms is partially mediated by the BMI and fully mediated by the HRQOL. CONCLUSIONS In conclusion, individuals with diabetes have an increased risk in the development of depressive and anxiety symptoms as well as lower health-related quality of life. Future research and strategies in the public health policies among individuals with diabetes should take into account that the association between diabetes, depression, and anxiety is mediated by BMI and HRQOL.
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Affiliation(s)
- Benedict Herhaus
- Medical Psychology and Medical Sociology, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Duesbergweg 6, 55128, Mainz, Germany.
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Philipps University Marburg, Marburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Duesbergweg 6, 55128, Mainz, Germany
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Yeung YL, Lee KL, Lau ESH, Yung TF, Yang A, Wu H, Wong KTC, Kong APS, Chow EYK, Ma RCW, Yeung T, Loo KM, Ozaki R, Luk AOY, Lui JNM, Chan JCN. Associations of comorbid depression with cardiovascular-renal events and all-cause mortality accounting for patient reported outcomes in individuals with type 2 diabetes: a 6-year prospective analysis of the Hong Kong Diabetes Register. Front Endocrinol (Lausanne) 2024; 15:1284799. [PMID: 38586459 PMCID: PMC10999250 DOI: 10.3389/fendo.2024.1284799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background Psychosocial status and patient reported outcomes (PRO) [depression and health-related quality-of-life (HRQoL)] are major health determinants. We investigated the association between depression and clinical outcomes in Chinese patients with type 2 diabetes (T2D), adjusted for PRO. Methods Using prospective data from Hong Kong Diabetes Register (2013-2019), we estimated the hazard-ratio (HR, 95%CI) of depression (validated Patient Health Questionnaire 9 (PHQ-9) score≥7) with incident cardiovascular disease (CVD), ischemic heart disease (IHD), chronic kidney disease (CKD: eGFR<60 ml/min/1.73m2) and all-cause mortality in 4525 Chinese patients with T2D adjusted for patient characteristics, renal function, medications, self-care and HRQoL domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression measured by EQ-5D-3L) in linear-regression models. Results In this cohort without prior events [mean ± SD age:55.7 ± 10.6, 43.7% women, median (IQR) disease duration of 7.0 (2.0-13.0) years, HbA1c, 7.2% (6.6%-8.20%), 26.4% insulin-treated], 537(11.9%) patients had depressive symptoms and 1923 (42.5%) patients had some problems with HRQoL at baseline. After 5.6(IQR: 4.4-6.2) years, 141 patients (3.1%) died, 533(11.8%) developed CKD and 164(3.6%) developed CVD. In a fully-adjusted model (model 4) including self-care and HRQoL, the aHR of depression was 1.99 (95% confidence interval CI):1.25-3.18) for CVD, 2.29 (1.25-4.21) for IHD. Depression was associated with all-cause mortality in models 1-3 adjusted for demographics, clinical characteristics and self-care, but was attenuated after adjusting for HRQoL (model 4- 1.54; 95%CI: 0.91-2.60), though HR still indicated same direction with important magnitude. Patients who reported having regular exercise (3-4 times per week) had reduced aHR of CKD [0.61 (0.41-0.89)]. Item 4 of PHQ-9 (feeling tired, little energy) was independently associated with all-cause mortality with aHR of 1.66 (1.30-2.12). Conclusion Depression exhibits significant association with CVD, IHD, and all-cause mortality in patients with diabetes, adjusting for their HRQoL and health behaviors. Despite the association between depression and all-cause mortality attenuated after adjusting for HRQoL, the effect size remains substantial. The feeling of tiredness or having little energy, as assessed by item Q4 of the PHQ-9 questionnaire, was found to be significantly associated with an increased risk of all-cause mortality after covariate adjustments. Our findings emphasize the importance of incorporating psychiatric evaluations into holistic diabetes management.
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Affiliation(s)
- Yiu-Lam Yeung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Ka-Long Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Eric SH. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Tsun-Fung Yung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Kelly TC. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Alice PS. Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Elaine YK. Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Ronald CW. Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Theresa Yeung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Kit-man Loo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Andrea OY. Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Juliana NM. Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Juliana CN. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
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Donyaei A, Kiani E, Bahrololoum H, Moser O. Effect of combined aerobic-resistance training and subsequent detraining on brain-derived neurotrophic factor (BDNF) and depression in women with type 2 diabetes mellitus: A randomized controlled trial. Diabet Med 2024; 41:e15188. [PMID: 37470787 DOI: 10.1111/dme.15188] [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: 01/19/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
AIMS In this study, we assessed the effects of a 12-week combined aerobic-resistance training and subsequent detraining on Beck Depression Inventory (BDI) score and mediating role of BDNF and also investigated whether exercise-induced alterations are maintained following a short period of detraining in women with type 2 diabetes (T2D). MATERIALS AND METHODS Thirty-four women with T2D were randomly assigned to experimental or control group (age: 60.6 ± 6.3, body mass index (BMI): 30.2 ± 1.3 kg/m2 , HbA1c: 8.09 ± 0.73%). The exercise training comprised of combined aerobic-resistance programme (50%-70% heart rate reserve for aerobic exercise, and 50%-70% 1 repetition maximum for resistance exercise, respectively) performed three sessions per week over 12 weeks. The intervention period was followed by an 8-week detraining period. Data were collected at baseline and also following exercise intervention and detraining. Data were analysed by linear mixed model at p < 0.05. RESULTS After 12 weeks of combined exercise training and 8 weeks of detraining, there was a significant difference in BDNF (0.08; 95% confidence interval [CI] = 0.07-0.10; p = 0.001), fasting blood glucose (FBG) (-45.41; CI = -50.83, -39.98; p = 0.001), insulin (-6.47; CI = -7.04, -5.9; p = 0.001), HOMA-IR (-3.76; CI = -4.07, -3.45; p = 0.001) and BDI score (-17.17; CI = -20.29, -14.05; p = 0.001) between the experimental and control group. Multiple mediation analysis indicated that BDNF seems to have a mediating role in exercise-induced improvement of depression (p = 0.04). After the detraining period, BDI score remained unchanged and it showed a significant increase compared to before the start of training (p = 0.001). CONCLUSIONS It may be concluded that exercise training improves depression that is likely to be explained by increased BDNF concentration in TD2. In spite of decreased BDNF concentration following an 8-week detraining, depression score was maintained.
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Affiliation(s)
- Adel Donyaei
- Faculty of Physical Education, Shahrood University of Technology, Shahrood, Semnan, Iran
| | - Elina Kiani
- Faculty of Physical Education, Shahrood University of Technology, Shahrood, Semnan, Iran
| | - Hassan Bahrololoum
- Faculty of Physical Education, Shahrood University of Technology, Shahrood, Semnan, Iran
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Institute of Sport Science, University of Bayreuth, Bayreuth, Germany
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
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Lenzi J, Messina R, Rosa S, Iommi M, Rucci P, Pia Fantini M, Di Bartolo P. A multi-state analysis of disease trajectories and mental health transitions in patients with type 2 diabetes: A population-based retrospective cohort study utilizing health administrative data. Diabetes Res Clin Pract 2024; 209:111561. [PMID: 38325659 DOI: 10.1016/j.diabres.2024.111561] [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: 12/15/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
AIMS To investigate the risk of major depression and dementia in patients with type 2 diabetes, including dementia resulting from depression, and their impact on diabetes-related complications and mortality. METHODS We conducted a population-based retrospective cohort study including 11,441 incident cases of diabetes in 2015-2017, with follow-up until 2022. A multi-state survival analysis was performed on a seven-state model with 15 transitions to capture disease progression and onset of mental disorders. RESULTS Eight-year probabilities of depression, dementia, diabetes-related complications, and death were 9.7% (95% CI 8.7-10.7), 0.9% (95% CI 0.5-1.3), 10.4% (95% CI 9.5-11.4), and 14.8% (95% CI 13.9-15.7), respectively. Depression increased the risk of dementia up to 3.7% (95% CI 2.0-5.4), and up to 10.3% (95% CI 0.3-20.4) if coupled with diabetes complications. Eight-year mortality was 37.5% (95% CI 33.1-42.0) after depression, 74.1% (95% CI 63.7-84.5) after depression plus complications, 76.4% (95% CI 68.8-83.9) after dementia, and 98.6% (95% CI 96.1-100.0) after dementia plus complications. CONCLUSIONS The interconnections observed across depression, dementia, complications, and mortality underscore the necessity for comprehensive and integrated approaches in managing diabetes. Early screening for depression, followed by timely and targeted interventions, may mitigate the risk of dementia and improve diabetes prognosis.
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Affiliation(s)
- Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Rossella Messina
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Di Bartolo
- Diabetes Unit, Local Healthcare Authority of Romagna, Ravenna, Italy
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Basiri R, Seidu B, Rudich M. Exploring the Interrelationships between Diabetes, Nutrition, Anxiety, and Depression: Implications for Treatment and Prevention Strategies. Nutrients 2023; 15:4226. [PMID: 37836510 PMCID: PMC10574484 DOI: 10.3390/nu15194226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Across the world, diabetes, depression, and anxiety symptoms have gained widespread recognition as significant public health issues. Recent research has unveiled a mutually influential relationship between diabetes and these two mental health conditions, where each disorder impacts the course and outcomes of the others. The role of nutrition emerges as pivotal in preventing and treating depression, anxiety, and diabetes. A thorough literature review was undertaken to investigate the reciprocal effects between anxiety, depression, and diabetes, including their impact on the development and severity of each condition. Additionally, the effects of nutrition on the prevention and management of depression, anxiety, diabetes, and related complications in at-risk individuals were assessed. Our findings show that mental disorders, such as depression and anxiety, increase the risk of developing type 2 diabetes and are associated with poorer glycemic control, increased diabetes-related complications, and higher mortality rates. Conversely, diabetes is also linked with an increased risk of developing depression and anxiety. The biological, psychological, and social factors that contribute to the comorbidity between these two conditions are complex and multifaceted. Therefore, an integrated approach to the management of both conditions is critical for improving patient outcomes and reducing the overall burden of disease. Nutritional interventions should be utilized to reduce the risk of diabetes in patients with anxiety and depression as well as enhance mental health in patients with diabetes.
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Affiliation(s)
- Raedeh Basiri
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
- Institute for Biohealth Innovation, George Mason University, Fairfax, VA 22030, USA
| | - Blessing Seidu
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
| | - Mark Rudich
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
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Gorska-Ciebiada M, Ciebiada M. Association between Serum Irisin and Leptin Levels and Risk of Depressive Symptoms in the Diabetic Elderly Population. J Clin Med 2023; 12:4283. [PMID: 37445318 DOI: 10.3390/jcm12134283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Adipokines are considered to be involved in the pathogenesis of diabetes and depression. The associations of serum levels of leptin and irisin with depressive symptoms were investigated in elderly patients with type 2 diabetes (T2DM). METHODS 189 elderly diabetics were assessed with the 30-item Geriatric Depression Scale (GDS-30), and 57 patients with depressive symptoms and 132 controls were selected. Blood biochemical parameters, including serum irisin and leptin, were measured. RESULTS Serum irisin levels were decreased and leptin concentrations were significantly higher in T2DM patients with depressive symptoms compared to controls. In all subjects, the irisin level was inversely correlated with the leptin level and the GDS-30 score, whereas the leptin level was highly correlated with BMI and the GDS-30 score. Higher levels of leptin and lower concentrations of irisin are, among other factors, variables indicative of predictive capacity for depressive symptoms in elderly patients with T2DM. CONCLUSIONS The results indicated that irisin and leptin levels may be used as diagnostic markers of depressive symptoms in diabetic, elderly patients and as potential therapeutic targets for the treatment. Further prospective and more extensive studies are needed to clarify the role of these adipokines in the common pathogenesis of depression and diabetes.
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Affiliation(s)
| | - Maciej Ciebiada
- Department of General and Oncological Pneumology, Medical University of Lodz, 90-549 Lodz, Poland
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Hsu JW, Chen LC, Huang KL, Tsai SJ, Bai YM, Su TP, Chen TJ, Chen MH. Risk of type 2 diabetes mellitus between adolescents with antidepressant-resistant and antidepressant-responsive depression: A cohort study of 15,651 adolescents. J Affect Disord 2023; 328:210-214. [PMID: 36806660 DOI: 10.1016/j.jad.2023.02.065] [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: 08/25/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Whether response to antidepressants is related to the risk of developing type 2 diabetes mellitus (T2DM) in adolescents with depression remains unknown. METHODS This study used the Taiwan National Health Insurance Research Database to enroll 1739 adolescents with antidepressant-resistant depression, 6956 with antidepressant-responsive depression, and 6956 controls between 2001 and 2010, with an end-of-2011 follow-up. Physician-diagnosed T2DM was identified at follow-up. T2DM-related risk factors, namely hypertension, dyslipidemia, and obesity, were assessed and controlled for as confounding factors. RESULTS Adolescents with antidepressant-resistant depression (hazard ratio [HR], 95 % confidence interval [CI]: 4.62, 2.75-7.75) and those with antidepressant-responsive depression (HR, 95 % CI: 3.06, 1.98-4.72) had a higher risk of developing T2DM at follow-up than did the control group. Those with antidepressant-resistant depression were more likely to receive a diagnosis of T2DM (HR, 95 % CI: 1.51, 1.04-2.19) later in life than were those with antidepressant-responsive depression. DISCUSSION Clinicians should closely monitor factors related to T2DM, such as fasting blood sugar, in high-risk populations, especially in adolescents with antidepressant-resistant depression.
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Affiliation(s)
- Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Chi Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Mezuk B, Kelly K, Bennion E, Concha JB. Leveraging a genetically-informative study design to explore depression as a risk factor for type 2 diabetes: Rationale and participant characteristics of the Mood and Immune Regulation in Twins Study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1026402. [PMID: 37008275 PMCID: PMC10064086 DOI: 10.3389/fcdhc.2023.1026402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
BackgroundComorbidity between depression and type 2 diabetes is thought to arise from the joint effects of psychological, behavioral, and biological processes. Studies of monozygotic twins may provide a unique opportunity for clarifying how these processes inter-relate. This paper describes the rationale, characteristics, and initial findings of a longitudinal co-twin study aimed at examining the biopsychosocial mechanisms linking depression and risk of diabetes in mid-life.MethodsParticipants in the Mood and Immune Regulation in Twins (MIRT) Study were recruited from the Mid-Atlantic Twin Registry. MIRT consisted of 94 individuals who do not have diabetes at baseline, representing 43 twin pairs (41 monozygotic and 2 dizygotic), one set of monozygotic triplets, and 5 individuals whose co-twin did not participate. A broad set of variables were assessed including psychological factors (e.g., lifetime history major depression (MD)); social factors (e.g., stress perceptions and experiences); and biological factors, including indicators of metabolic risk (e.g., BMI, blood pressure (BP), HbA1c) and immune functioning (e.g., pro- and anti-inflammatory cytokines), as well as collection of RNA. Participants were re-assessed 6-month later. Intra-class correlation coefficients (ICC) and descriptive comparisons were used to explore variation in these psychological, social, and biological factors across time and within pairs.ResultsMean age was 53 years, 68% were female, and 77% identified as white. One-third had a history of MD, and 18 sibling sets were discordant for MD. MD was associated with higher systolic (139.1 vs 132.2 mmHg, p=0.05) and diastolic BP (87.2 vs. 80.8 mmHg, p=0.002) and IL-6 (1.47 vs. 0.93 pg/mL, p=0.001). MD was not associated with BMI, HbA1c, or other immune markers. While the biological characteristics of the co-twins were significantly correlated, all within-person ICCs were higher than the within-pair correlations (e.g., HbA1c within-person ICC=0.88 vs. within-pair ICC=0.49; IL-6 within-person ICC=0.64 vs. within-pair=0.54). Among the pairs discordant for MD, depression was not substantially associated with metabolic or immune markers, but was positively associated with stress.ConclusionsTwin studies have the potential to clarify the biopsychosocial processes linking depression and diabetes, and recently completed processing of RNA samples from MIRT permits future exploration of gene expression as a potential mechanism.
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Affiliation(s)
- Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Briana Mezuk,
| | - Kristen Kelly
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Erica Bennion
- Office of Maternal and Child Health, Utah Department of Health and Human Services, Salt Lake, UT, United States
| | - Jeannie B. Concha
- College of Health Sciences, University of Texas at El Paso, El Paso, TX, United States
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10
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Spiga F, Gibson M, Dawson S, Tilling K, Davey Smith G, Munafò MR, Higgins JPT. Tools for assessing quality and risk of bias in Mendelian randomization studies: a systematic review. Int J Epidemiol 2023; 52:227-249. [PMID: 35900265 PMCID: PMC9908059 DOI: 10.1093/ije/dyac149] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of Mendelian randomization (MR) in epidemiology has increased considerably in recent years, with a subsequent increase in systematic reviews of MR studies. We conducted a systematic review of tools designed for assessing risk of bias and/or quality of evidence in MR studies and a review of systematic reviews of MR studies. METHODS We systematically searched MEDLINE, Embase, the Web of Science, preprints servers and Google Scholar for articles containing tools for assessing, conducting and/or reporting MR studies. We also searched for systematic reviews and protocols of systematic reviews of MR studies. From eligible articles we collected data on tool characteristics and content, as well as details of narrative description of bias assessment. RESULTS Our searches retrieved 2464 records to screen, from which 14 tools, 35 systematic reviews and 38 protocols were included in our review. Seven tools were designed for assessing risk of bias/quality of evidence in MR studies and evaluation of their content revealed that all seven tools addressed the three core assumptions of instrumental variable analysis, violation of which can potentially introduce bias in MR analysis estimates. CONCLUSION We present an overview of tools and methods to assess risk of bias/quality of evidence in MR analysis. Issues commonly addressed relate to the three standard assumptions of instrumental variables analyses, the choice of genetic instrument(s) and features of the population(s) from which the data are collected (particularly in two-sample MR), in addition to more traditional non-MR-specific epidemiological biases. The identified tools should be tested and validated for general use before recommendations can be made on their widespread use. Our findings should raise awareness about the importance of bias related to MR analysis and provide information that is useful for assessment of MR studies in the context of systematic reviews.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Mark Gibson
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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11
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Liu S, Leone M, Ludvigsson JF, Lichtenstein P, Gudbjörnsdottir S, Landén M, Bergen SE, Taylor MJ, Larsson H, Kuja-Halkola R, Butwicka A. Early-Onset Type 2 Diabetes and Mood, Anxiety, and Stress-Related Disorders: A Genetically Informative Register-Based Cohort Study. Diabetes Care 2022; 45:2950-2956. [PMID: 36251507 PMCID: PMC9862460 DOI: 10.2337/dc22-1053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/23/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the association and familial coaggregation between early-onset type 2 diabetes (diagnosed before age 45 years) and mood, anxiety, and stress-related disorders and estimate the contribution of genetic and environmental factors to their co-occurrence. RESEARCH DESIGN AND METHODS This population-based cohort study included individuals born in Sweden during 1968-1998, from whom pairs of full siblings, half-siblings, and cousins were identified. Information on diagnoses of early-onset type 2 diabetes and mood (including unipolar depression and bipolar disorder), anxiety, and stress-related disorders was obtained from the National Patient Register. Logistic and Cox regression models were used to assess the phenotypic association and familial coaggregation between type 2 diabetes and psychiatric disorders. Quantitative genetic modeling was conducted in full and maternal half-sibling pairs to estimate the relative contributions of genetic and environmental factors to the association. RESULTS Among a total of 3,061,192 individuals, 7,896 (0.3%) were diagnosed with early-onset type 2 diabetes. These individuals had higher risks of any diagnosis (odds ratio [OR] 3.62 [95% CI 3.44, 3.80]) and specific diagnosis of unipolar depression (3.97 [3.75, 4.22]), bipolar disorder (4.17 [3.68, 4.73]), anxiety (3.76 [3.54, 3.99]), and stress-related disorders (3.35 [3.11, 3.61]). Relatives of individuals with early-onset type 2 diabetes also had higher overall risks of the examined psychiatric disorders (ORs 1.03-1.57). These associations are largely explained by genetic factors (51-78%), with the rest explained by nonshared environmental factors. CONCLUSIONS Our findings highlight the burden of mood, anxiety, and stress-related disorders in early-onset type 2 diabetes and demonstrate that shared familial liability may contribute to their co-occurrence, suggesting that in the future research investigators should aim to identify shared risk factors and ultimately refine preventive and intervention strategies.
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Affiliation(s)
- Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Marica Leone
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden.,Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland.,Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
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12
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Jespersen A, Yilmaz Z, Vilhjálmsson BJ. Harnessing the Power of Population Cohorts to Study the Relationship Between Endocrine-Metabolic Disorders and Depression. Am J Psychiatry 2022; 179:788-790. [PMID: 36317332 DOI: 10.1176/appi.ajp.20220798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Anders Jespersen
- National Center for Register-Based Research (Jespersen, Yilmaz, Vilhjálmsson), Department of Biomedicine (Yilmaz), and Bioinformatics Research Center (Vilhjálmsson), Aarhus University, Aarhus, Denmark; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Yilmaz)
| | - Zeynep Yilmaz
- National Center for Register-Based Research (Jespersen, Yilmaz, Vilhjálmsson), Department of Biomedicine (Yilmaz), and Bioinformatics Research Center (Vilhjálmsson), Aarhus University, Aarhus, Denmark; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Yilmaz)
| | - Bjarni J Vilhjálmsson
- National Center for Register-Based Research (Jespersen, Yilmaz, Vilhjálmsson), Department of Biomedicine (Yilmaz), and Bioinformatics Research Center (Vilhjálmsson), Aarhus University, Aarhus, Denmark; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Yilmaz)
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13
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Leone M, Kuja-Halkola R, Leval A, Butwicka A, Skov J, Zhang R, Liu S, Larsson H, Bergen SE. Genetic and Environmental Contribution to the Co-Occurrence of Endocrine-Metabolic Disorders and Depression: A Nationwide Swedish Study of Siblings. Am J Psychiatry 2022; 179:824-832. [PMID: 36128682 DOI: 10.1176/appi.ajp.21090954] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Depression is common in individuals with endocrine-metabolic disorders and vice versa, and a better understanding of the underlying factors contributing to the comorbidity of these disorders is needed. This study investigated the familial coaggregation of depression and endocrine-metabolic disorders and estimated the contribution of genetic and environmental factors to their co-occurrence. METHODS This population-based cohort study included 2.2 million individuals born in Sweden between 1973 and 1996, with follow-up through 2013. Participants were linked to their biological parents, allowing identification of full siblings, maternal half siblings, and paternal half siblings. Diagnoses of depression and endocrine-metabolic conditions were investigated, with the latter grouped into autoimmune disorders (autoimmune hypothyroidism, Graves' disease, and type 1 diabetes) and non-autoimmune disorders (type 2 diabetes, obesity, and polycystic ovary syndrome). Logistic regression and Cox regression were used to estimate the associations between endocrine-metabolic disorders and depression within the same individual and across siblings. Quantitative genetic modeling was performed to investigate the relative contribution of genetic and environmental influences. RESULTS Individuals with endocrine-metabolic disorders had a significantly higher risk of depression, with odds ratios ranging from 1.43 (95% CI=1.30, 1.57) for Graves' disease to 3.48 (95% CI=3.25, 3.72) for type 2 diabetes. Increased risks extended to full and half siblings. These correlations were mainly explained by shared genetic influences for non-autoimmune conditions, and by nonshared environmental factors for autoimmune disorders, especially for type 1 diabetes. CONCLUSIONS These findings provide phenotypic and etiological insights into the co-occurrence of depression and various endocrine-metabolic conditions, which could guide future research aiming at identifying pathophysiological mechanisms and intervention targets.
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Affiliation(s)
- Marica Leone
- Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden (Leone, Leval); Department of Medical Epidemiology and Biostatistics (Leone, Kuja-Halkola, Leval, Butwicka, Zhang, Liu, Larsson, Bergen) and Department of Molecular Medicine and Surgery (Skov), Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden (Butwicka); Department of Child Psychiatry, Medical University of Warsaw, Warsaw (Butwicka); Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland (Butwicka); Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden (Skov); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson)
| | - Ralf Kuja-Halkola
- Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden (Leone, Leval); Department of Medical Epidemiology and Biostatistics (Leone, Kuja-Halkola, Leval, Butwicka, Zhang, Liu, Larsson, Bergen) and Department of Molecular Medicine and Surgery (Skov), Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden (Butwicka); Department of Child Psychiatry, Medical University of Warsaw, Warsaw (Butwicka); Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland (Butwicka); Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden (Skov); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson)
| | - Amy Leval
- Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden (Leone, Leval); Department of Medical Epidemiology and Biostatistics (Leone, Kuja-Halkola, Leval, Butwicka, Zhang, Liu, Larsson, Bergen) and Department of Molecular Medicine and Surgery (Skov), Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden (Butwicka); Department of Child Psychiatry, Medical University of Warsaw, Warsaw (Butwicka); Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland (Butwicka); Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden (Skov); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson)
| | - Agnieszka Butwicka
- Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden (Leone, Leval); Department of Medical Epidemiology and Biostatistics (Leone, Kuja-Halkola, Leval, Butwicka, Zhang, Liu, Larsson, Bergen) and Department of Molecular Medicine and Surgery (Skov), Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden (Butwicka); Department of Child Psychiatry, Medical University of Warsaw, Warsaw (Butwicka); Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland (Butwicka); Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden (Skov); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson)
| | - Jakob Skov
- Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden (Leone, Leval); Department of Medical Epidemiology and Biostatistics (Leone, Kuja-Halkola, Leval, Butwicka, Zhang, Liu, Larsson, Bergen) and Department of Molecular Medicine and Surgery (Skov), Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden (Butwicka); Department of Child Psychiatry, Medical University of Warsaw, Warsaw (Butwicka); Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland (Butwicka); Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden (Skov); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson)
| | - Ruyue Zhang
- Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden (Leone, Leval); Department of Medical Epidemiology and Biostatistics (Leone, Kuja-Halkola, Leval, Butwicka, Zhang, Liu, Larsson, Bergen) and Department of Molecular Medicine and Surgery (Skov), Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden (Butwicka); Department of Child Psychiatry, Medical University of Warsaw, Warsaw (Butwicka); Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland (Butwicka); Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden (Skov); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson)
| | - Shengxin Liu
- Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden (Leone, Leval); Department of Medical Epidemiology and Biostatistics (Leone, Kuja-Halkola, Leval, Butwicka, Zhang, Liu, Larsson, Bergen) and Department of Molecular Medicine and Surgery (Skov), Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden (Butwicka); Department of Child Psychiatry, Medical University of Warsaw, Warsaw (Butwicka); Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland (Butwicka); Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden (Skov); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson)
| | - Henrik Larsson
- Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden (Leone, Leval); Department of Medical Epidemiology and Biostatistics (Leone, Kuja-Halkola, Leval, Butwicka, Zhang, Liu, Larsson, Bergen) and Department of Molecular Medicine and Surgery (Skov), Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden (Butwicka); Department of Child Psychiatry, Medical University of Warsaw, Warsaw (Butwicka); Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland (Butwicka); Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden (Skov); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson)
| | - Sarah E Bergen
- Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden (Leone, Leval); Department of Medical Epidemiology and Biostatistics (Leone, Kuja-Halkola, Leval, Butwicka, Zhang, Liu, Larsson, Bergen) and Department of Molecular Medicine and Surgery (Skov), Karolinska Institutet, Solna, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden (Butwicka); Department of Child Psychiatry, Medical University of Warsaw, Warsaw (Butwicka); Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland (Butwicka); Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden (Skov); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson)
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14
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Abrantes AM, Garnaat SL, Stein MD, Uebelacker LA, Williams DM, Carpenter LL, Greenberg BD, Desaulniers J, Audet D. A pilot randomized clinical trial of tDCS for increasing exercise engagement in individuals with elevated depressive symptoms: Rationale, design, and baseline characteristics. Contemp Clin Trials Commun 2022; 29:100972. [PMID: 36092972 PMCID: PMC9449741 DOI: 10.1016/j.conctc.2022.100972] [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: 11/18/2021] [Revised: 07/11/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
Regular exercise protects against overweight/obesity as well as numerous chronic diseases. Yet, less than half of Americans exercise sufficiently. Elevated levels of depressive symptoms have been identified as an important correlate of physical inactivity as well as poor adherence to exercise programs. Individuals with depression are less sensitive to rewards and demonstrate an attentional bias toward negative stimuli. These, and other features of depression, may place them at increased risk for effectively managing the affective experience of exercise. Lower baseline levels of activation of the left (vs right) frontal cortex, an area implicated in affect regulation, have also been found in depression, potentially pointing to this region as a potential target for intervening on affect regulation during exercise. Transcranial direct current stimulation (tDCS) has shown promise in impacting a variety of cognitive and affective processes in a large number of individuals, including people with depression. Some findings have suggested that tDCS targeting the left dorsolateral prefrontal cortex (DLPFC), specifically, may improve emotion regulation. Transcranial direct current stimulation could theoretically be a novel and potentially promising approach to improving the affective experience of exercise, thereby increasing exercise adherence among individuals with depressive symptoms. Here we present the rationale, design, and baseline characteristics of a pilot randomized controlled trial of tDCS versus sham delivered 3x/week for 8 weeks in the context of supervised aerobic exercise (AE) program among 51 low-active individuals with elevated depressive symptoms (86.3% female; mean age = 49.5). Follow-up assessments were conducted at end of treatment, and three and six months after enrollment to examine changes in levels of objectively-measured moderate-to-vigorous physical activity (MVPA). If effective, this approach could have high public health impact on preventing obesity and chronic diseases among these at-risk individuals.
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Affiliation(s)
- Ana M Abrantes
- Butler Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Sarah L Garnaat
- Butler Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | | | - Lisa A Uebelacker
- Butler Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - David M Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, USA
| | - Linda L Carpenter
- Butler Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Benjamin D Greenberg
- Butler Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA.,VAMC, Providence, RI, USA
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15
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Nolde M, Holtfreter B, Kocher T, Alayash Z, Reckelkamm SL, Ehmke B, Baurecht H, Baumeister SE. No bidirectional relationship between depression and periodontitis: A genetic correlation and Mendelian randomization study. Front Immunol 2022; 13:918404. [PMID: 35935963 PMCID: PMC9355660 DOI: 10.3389/fimmu.2022.918404] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Observational and in-vivo research suggested a bidirectional relationship between depression and periodontitis. We estimated the genetic correlation and examined directionality of causation. Methods The study used summary statistics from published genome wide association studies, with sample sizes ranging from 45,563 to 797,563 individuals of European ancestry. We performed linkage disequilibrium score regression (LDSC) to estimate global correlation and used Heritability Estimation from Summary Statistics (ρ-HESS) to further examine local genetic correlation. Latent Heritable Confounder Mendelian randomization (LHC-MR), Causal Analysis using Summary Effect estimates (CAUSE), and conventional MR approaches assessed bidirectional causation. Results LDSC observed only weak genetic correlation (rg = 0.06, P-Value = 0.619) between depression and periodontitis. Analysis of local genetic correlation using ρ-HESS did not reveal loci of significant local genetic covariance. LHC-MR, CAUSE and conventional MR models provided no support for bidirectional causation between depression and periodontitis, with odds ratios ranging from 1.00 to 1.06 in either direction. Conclusions Results do not support shared heritability or a causal connection between depression and periodontitis.
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Affiliation(s)
- Michael Nolde
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
- *Correspondence: Michael Nolde,
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Zoheir Alayash
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | - Stefan Lars Reckelkamm
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | - Benjamin Ehmke
- Clinic for Periodontology and Conservative Dentistry, University of Münster, Münster, Germany
| | - Hansjörg Baurecht
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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16
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Sun Y, Yu Y, Zhang H, Wang B, Chen C, Wang Y, Tan X, Zhang J, Chen Y, Xia F, Lu Y, Wang N. Joint Exposure to Positive Affect, Life Satisfaction, Depressive Symptoms, and Neuroticism and Incident Type 2 Diabetes. J Clin Endocrinol Metab 2022; 107:e3186-e3193. [PMID: 35552706 DOI: 10.1210/clinem/dgac304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Indexed: 01/05/2023]
Abstract
CONTEXT Whether the psychological wellbeing status could be a risk factor for type 2 diabetes is unclear. OBJECTIVE We aimed to measure the association between combined psychological wellbeing factors and type 2 diabetes and investigate whether this association was modified by genetic predisposition. METHODS Prospective cohort study from the UK Biobank. In total, 127 496 participants who completed a psychological wellbeing questionnaire and did not have type 2 diabetes at baseline (2006-2010) were included; among them, 88 584 (69.5%) were analyzed to determine their genetic predisposition. The main outcome measure was incident type 2 diabetes. RESULTS During the median follow-up of 10.0 years, 2547 incident type 2 diabetes cases were documented. Moderate to extreme unhappiness, satisfaction score ≤3, presence of broad depression, and a neuroticism score ≥3 were all significantly and independently associated with an increased risk of diabetes. When considered as a combination indicator, compared with individuals in the highest quartile of the psychological wellbeing score, the fully adjusted hazard ratios (95% CI) of type 2 diabetes were 1.41 (1.21-1.65) in the third quartile, 1.45 (1.24-1.69) in the second quartile, and 1.73 (1.48-2.01) in the lowest quartile. In the stratified analysis, we observed significant interactions between age and physical activity, and type 2 diabetes (Pinteraction < .001 and 0.049, respectively). However, there was no significant interaction between the psychological wellbeing score and genetic susceptibility to diabetes (Pinteraction = .980). CONCLUSION Worse overall psychological wellbeing was associated with a significantly increased risk of type 2 diabetes in a dose-response fashion regardless of genetic predisposition.
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Affiliation(s)
- Ying Sun
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuefeng Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Haojie Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiao Tan
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Jihui Zhang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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17
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Troshneva A, Ametov A. Parkinson’s disease and type 2 diabetes mellitus: interrelation of pathogenetic mechanisms and general therapeutic approaches. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:12-18. [DOI: 10.17116/jnevro202212211212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Messina R, Iommi M, Rucci P, Reno C, Fantini MP, Lunghi C, Altini M, Bravi F, Rosa S, Nicolucci A, Di Bartolo P. Is it time to consider depression as a major complication of type 2 diabetes? Evidence from a large population-based cohort study. Acta Diabetol 2022; 59:95-104. [PMID: 34495396 PMCID: PMC8758621 DOI: 10.1007/s00592-021-01791-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/19/2021] [Indexed: 12/26/2022]
Abstract
AIMS Depression in type 2 diabetes may heavily affect the course of the disease. In this study, we investigated, among new cases with type 2 diabetes, the incidence and clinical predictors of depression and determined the extent to which depression constitutes a risk factor for acute and long-term diabetes complications and mortality. METHODS In this population-based retrospective cohort study, incident cases of type 2 diabetes without a prior history of depression were identified from the administrative databases of the Emilia-Romagna Region, Italy, between 2008 and 2017 and followed up until 2020. Logistic regression models were used to identify the predictors of depression. Cox regression models were used to estimate the risk of acute complications over three years, and the risk of long-term complications and mortality over ten years. RESULTS Incident cases with type 2 diabetes were 30,815, of whom 5146 (16.7%) developed depression. The predictors of depression onset were as follows: female sex, age > 65 years, living in rural areas and comorbid diseases. Depression in type 2 diabetes was associated with a 2.3-fold risk of developing acute complications, 1.6-fold risk of developing long-term complications and 2.8-fold mortality risk. CONCLUSIONS Our findings highlight that depression is associated with an increased risk for complications in type 2 diabetes and mortality and should not be neglected. Therefore, it is important to promote screening activities and introduce targeted and personalized treatment for depression in order to reduce the risk of poor short- and long-term outcomes of diabetes.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy.
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Chiara Reno
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Carlotta Lunghi
- Department of Health Sciences, Université du Québec À Rimouski, Rimouski, Canada
- Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Québec, Canada
| | - Mattia Altini
- Health Directorate, Romagna Local Health Authority, Bologna, Emilia-Romagna Region, Italy
| | - Francesca Bravi
- Health Directorate, Romagna Local Health Authority, Bologna, Emilia-Romagna Region, Italy
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, BO, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
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19
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Kokkinopoulou I, Diakoumi A, Moutsatsou P. Glucocorticoid Receptor Signaling in Diabetes. Int J Mol Sci 2021; 22:ijms222011173. [PMID: 34681832 PMCID: PMC8537243 DOI: 10.3390/ijms222011173] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
Stress and depression increase the risk of Type 2 Diabetes (T2D) development. Evidence demonstrates that the Glucocorticoid (GC) negative feedback is impaired (GC resistance) in T2D patients resulting in Hypothalamic-Pituitary-Adrenal (HPA) axis hyperactivity and hypercortisolism. High GCs, in turn, activate multiple aspects of glucose homeostasis in peripheral tissues leading to hyperglycemia. Elucidation of the underlying molecular mechanisms revealed that Glucocorticoid Receptor (GR) mediates the GC-induced dysregulation of glucose production, uptake and insulin signaling in GC-sensitive peripheral tissues, such as liver, skeletal muscle, adipose tissue, and pancreas. In contrast to increased GR peripheral sensitivity, an impaired GR signaling in Peripheral Blood Mononuclear Cells (PBMCs) of T2D patients, associated with hyperglycemia, hyperlipidemia, and increased inflammation, has been shown. Given that GR changes in immune cells parallel those in brain, the above data implicate that a reduced brain GR function may be the biological link among stress, HPA hyperactivity, hypercortisolism and hyperglycemia. GR polymorphisms have also been associated with metabolic disturbances in T2D while dysregulation of micro-RNAs—known to target GR mRNA—has been described. Collectively, GR has a crucial role in T2D, acting in a cell-type and context-specific manner, leading to either GC sensitivity or GC resistance. Selective modulation of GR signaling in T2D therapy warrants further investigation.
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20
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Wium-Andersen IK, Hengeveld EM, Rungby J, Jørgensen MB, Osler M, Wium-Andersen MK. Hemoglobin A1c-levels and subsequent risk of depression in individuals with and without diabetes. J Diabetes Complications 2021; 35:107946. [PMID: 34053797 DOI: 10.1016/j.jdiacomp.2021.107946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/15/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND It has been suggested that long-term glycemic load as reflected in plasma levels of Glycosylated Hemoglobin, Type A1C (HbA1c) is associated with higher risk of depression, however results have been conflicting. We examined the potential association between HbA1c and risk of depression in a large population-based cohort without baseline diabetes (the Glostrup cohort) defined by either self-reported diabetes, registry diagnosis of diabetes or use of antidiabetic medication at baseline and in a national diabetes cohort (the Danish Adult Diabetes Database). METHODS A total of 16,124 middle-aged individuals from the Glostrup cohort and 93,544 patients registered in the Danish Adult Diabetes Database were followed from the first registered HbA1c measurement (1999-2014) for subsequent diagnosis of depression or use of antidepressant medication in nation-wide Danish registers. The association was analyzed using a Cox proportional hazards regression model with HbA1c on both a continuous scale using restricted cubic splines and categorized based on the groups found in the spline model. We adjusted for relevant sociodemographic and clinical variables including previous depression and tested for interaction of both gender, insulin use and diabetes type. RESULTS During follow-up, 2694 (17%) in the Glostrup cohort and 29,234 (31%) in the diabetes cohort developed depression. In the Glostrup cohort, we found an indication of a positive linear association between HbA1c and depression in women, while no clear association was found in men. In patients with diabetes, we found a U-shaped association between HbA1c and depression in both men and women with the lowest risk estimates for HbA1c levels of 58 mmol/mol (7.5%) in men and of 60 mmol/mol (7.6%) in women. When HbA1c was categorized, men with the highest HbA1c-levels had significantly elevated risk of depression (HRHbA1c>9.4 1.16 (95%CI 1.10-1.23)) after multifactorial adjustment compared to the reference group with HbA1c of 42.1-56.2 mmol/mol (6.0-7.3%). Women in the lowest and highest category of HbA1c had significantly higher risk of depression HRHbA1c<6.0 1.15 (95% CI 1.09-1.22) and HRHbA1c>9.3 1.10 (95% CI 1.04-1.16), respectively, compared to the reference group with HbA1c 42.1-55.0 mmol/mol (7.2-9.3%). There was a significant interaction with gender, but no interaction for insulin use or diabetes type. CONCLUSIONS In a population without baseline diabetes, higher HbA1c levels seemed associated with higher depression risk in women, whereas a U-shaped association was found in patients with known diabetes.
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Affiliation(s)
- I K Wium-Andersen
- Psychiatric Center Copenhagen, Department O, Copenhagen, Denmark; Center for Clinical Research and Prevention, Frederiksberg Hospital, Denmark
| | - E M Hengeveld
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Denmark
| | - J Rungby
- Department of Endocrinology and Copenhagen Center for Translational Research, Bispebjerg-Frederiksberg, Denmark
| | - M B Jørgensen
- Psychiatric Center Copenhagen, Department O, Copenhagen, Denmark
| | - M Osler
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Denmark; Section for Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - M K Wium-Andersen
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Denmark.
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21
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Lindekilde N, Rutters F, Erik Henriksen J, Lasgaard M, Schram MT, Rubin KH, Kivimäki M, Nefs G, Pouwer F. Psychiatric disorders as risk factors for type 2 diabetes: An umbrella review of systematic reviews with and without meta-analyses. Diabetes Res Clin Pract 2021; 176:108855. [PMID: 33965448 DOI: 10.1016/j.diabres.2021.108855] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/19/2021] [Accepted: 05/04/2021] [Indexed: 12/14/2022]
Abstract
Having a psychiatric disorder may increase the risk of developing type 2 diabetes[T2D] and this umbrella review aims to determine whether people with a psychiatric disorder have an increased risk of developing T2D and to investigate potential underlying mechanisms. A literature search was performed to identify systematic reviews of longitudinal studies investigating different psychiatric disorders as risk factors for incident T2D in humans (≥18 years). A total of 8612 abstracts were identified, 180 full-text articles were read, and 25 systematic reviews were included. Six categories of psychiatric disorders were identified. Except for eating disorders, all psychiatric disorders were associated with increased risk of incident T2D ranging from RR = 1.18 [95% CI 1.12-1.24] to RR = 1.60 [95% CI 1.37-1.88] for depression; from RR = 1.27 [95% CI 1.19-1.35] to OR = 1.50 [95% CI 1.08-2.10] for use of antidepressant medication; from OR = 1.93 [1.37-2.73] to OR = 1.94 [1.34-2.80] for use of antipsychotic medication; from RR = 1.55 [95% CI 1.21-1.99] to RR = 1.74 [95% CI 1.30-2.34] for insomnia, and finally showed OR = 1.47 [95% CI 1.23-1.75] for anxiety disorders. Plausible underlying mechanisms were discussed, but in most reviews corrections for mechanisms did not explain the association. Notable, only 16% of the systematic reviews had a high methodological quality.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Femke Rutters
- Department Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam UMC, location VUMC, Amsterdam, the Netherlands.
| | - Jan Erik Henriksen
- STENO Diabetes Centre Odense, Odense University Hospital, Odense, Denmark.
| | - Mathias Lasgaard
- DEFACTUM - Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark.
| | - Miranda T Schram
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Katrine Hass Rubin
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University of College London, London, United Kingdom; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, the Netherlands; Diabeter, National treatment and research center for children, adolescents and young adults with type 1 diabetes, Rotterdam, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands.
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; STENO Diabetes Centre Odense, Odense University Hospital, Odense, Denmark; School of Psychology, Deakin University, Geelong, Australia.
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22
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Abstract
Chronic diseases commonly entail disability and are highly comorbid with mental health problems, particularly depression. Prevalence of depression across different disabling conditions affecting adult patients, as well as risk factors for depression in these patient groups are reviewed in the current work, with a particular focus on the literature published in the past 5 years. The prevalence of depression in disabling conditions is higher than in the general population and is associated with different factors. Examples of disease-specific factors include neurological implications of stoke, diabetic related conditions (e.g. amputation), limitations imposed by vision loss caused by age-related eye diseases, fatigue in rheumatoid arthritis, and pain in cancer. Common factors identified across different conditions include pre-morbid depression, history of mental health problems, poor social support, disease-related disability, multi-morbidity, and less adaptive coping strategies. We also reviewed studies suggesting a potential bidirectional relationship between depression and chronic disease, particularly for stroke, cardiovascular disease, diabetes, and potential factors mediating that relationship. Current findings suggested that long-term depression might be associated with an increased risk of subsequent physical health problems, although the nature of that relationship and its underlying mechanisms are still unclear.
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Affiliation(s)
- Hugo Senra
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), University of Coimbra, Coimbra, Portugal.,School of Health and Social Care, University of Essex, Colchester, UK
| | - Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
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