1
|
Yu X, Liang S, Chen Y, Zhang T, Zou X, Ming WK, Guan B. A nomogram and online calculator for predicting depression risk in obese Americans. Heliyon 2024; 10:e33825. [PMID: 39044983 PMCID: PMC11263725 DOI: 10.1016/j.heliyon.2024.e33825] [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: 09/21/2023] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
Background Obese patients with depression face higher risks of adverse events. However, depression is often misdiagnosed and undertreated in this group. This study aimed to identify predictors of depression and create a nomogram and calculator to assess depression risk in obese Americans. Methods This cross-sectional study included 2674 patients from the National Health and Nutrition Examination Survey database (NHANES). These participants were randomly classified into the training and validation groups in a 7:3 ratio. Predictors were selected by LASSO and multivariate logistic regression analysis to create the nomogram. C-statistics, calibration plots, and decision curve analysis (DCA) were used to test the nomogram's discriminative ability, calibration quality, and clinical value. Internal validation with bootstrap resampling and external validation with the validation group were also conducted. Results The training and validation group consists of 1871 and 803 participants. Depression was presented in 11.4 % (203/2674) of these participants. Seven predictors were found, including gender, hypertension, weekday sleep duration, poverty to income ratio, history of seeing mental health doctor, diabetes, and feeling sleepy during the day. The nomogram showed good discrimination, with the area under the receiver operating characteristic curve (AUC) of 0.817 (95 % CI: 0.786-0.848) (0.806 through internal validation and 0.772 through external validation) and good calibration (P = 0.536). The DCA further confirmed the nomogram's clinical usefulness. Conclusion The nomogram and calculator effectively predict depression risk in obese Americans and can be used as auxiliary tools for early screening in primary care.
Collapse
Affiliation(s)
- Xuefen Yu
- Comprehensive Special Diagnosis Department, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Sihua Liang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Yanya Chen
- College of Nursing, Jinan University, Guangzhou, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | - Tieling Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaochun Zou
- School of Health, Dongguan Polytechnic, Dongguan, China
| | - Wai-kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | - Bingsheng Guan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
2
|
Ali SY, Seid AM, Hassen K, Abebe ST, Banjaw Z, Ibrahim M. Depression and glycaemic control among adult patients with type 2 diabetes: a cross-sectional study in a comprehensive specialised hospital, Jigjiga, Ethiopia. BMJ Open 2023; 13:e073123. [PMID: 38030246 PMCID: PMC10689400 DOI: 10.1136/bmjopen-2023-073123] [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: 03/01/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES The primary objective of this study was to evaluate the prevalence of depression and its sociodemographic predictors, clinical predictors and glycaemic control among adult patients with type 2 diabetes at Sheik Hassan Yabare Comprehensive Specialized Hospital (SHYCSH), Jigjiga, Ethiopia. DESIGN A hospital-based cross-sectional study was conducted. SETTING Patients with type 2 diabetes mellitus (T2DM) at Sheik Hassan Yabare Comprehensive Specialized Hospital, for chronic follow-up from 3 October 2022 to 13 November 2022. PARTICIPANTS Randomly selected 278 patients with T2DM age 18 years and older, with a duration of 1 year or more since diagnosis, who had a diabetic follow-up at SHYCSH. MAIN OUTCOME MEASURES Depression was assessed using the Patient Health Questionnaire. RESULTS A total of 263 participants were included, with a response rate of 94.6%. Of the respondents, 134 (51%) were male, making up more than half of the total. The overall prevalence of depression was 47.1% (95% CI 41.1 to 53.2). Depression was further classified, as follows, based on its severity: the majority (66 or 25.1%) had mild depression, followed by 44 (16.7%) with moderate depression, 9 (3.4%) with moderately severe depression and 5 (1.9%) with severe depression. A multivariable logistic regression analysis indicated that poor glycaemic control (adjusted OR (AOR)=1.93; 95% CI 1.05 to 3.53), DM complications (AOR=2.02; 95% CI 1.09 to 3.74) and DM duration of 6-10 years since diagnosis (AOR=2.29; 95% CI 1.21 to 4.34) were independently associated with depression. CONCLUSIONS Our study revealed a significant burden of depression among patients with T2DM receiving follow-up care at the hospital. Glycaemic control, the presence of complications and a longer duration of diabetes were identified as predictors of depression. Therefore, concerned stakeholders should work to improve blood sugar control and promote healthy behaviour, particularly among those with complications or who have been sick for an extended period of time.
Collapse
Affiliation(s)
| | | | - Kalkidan Hassen
- Nutrition and Dietetics, Jimma University College of Public Health and Medical Sciences, Jimma, Oromia, Ethiopia
| | - Samuel Taddese Abebe
- Biomedical Science, Jimma University College of Public Health and Medical Sciences, Jimma, Oromia, Ethiopia
| | - Zelalem Banjaw
- Biomedical Science, Jimma University College of Public Health and Medical Sciences, Jimma, Oromia, Ethiopia
| | - Mohammed Ibrahim
- Biomedical Science, Jimma University College of Public Health and Medical Sciences, Jimma, Oromia, Ethiopia
| |
Collapse
|
3
|
Zhang X, Ma L, Mu S, Yin Y. The Hidden Burden-Exploring Depression Risk in Patients with Diabetic Nephropathy: A Systematic Review and Meta-Analysis. Diabetes Ther 2023:10.1007/s13300-023-01436-y. [PMID: 37368150 PMCID: PMC10363103 DOI: 10.1007/s13300-023-01436-y] [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: 05/09/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Diabetic nephropathy is a common complication among patients with diabetes mellitus, and it has been linked to a higher risk of depression. However, the magnitude of this association remains unclear. This study aimed to systematically review and meta-analyse the risk of depression in patients with diabetic nephropathy compared to diabetes patients without nephropathy. METHODS We conducted a systematic literature review, searching multiple databases from January 1964 to March 2023, and included randomized controlled trials, non-randomized controlled trials, and observational studies. We assessed the risk of bias using the Newcastle Ottawa scale for observational studies. The statistical analysis was performed using STATA version 14.2, and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. A total of 60 studies were included. RESULTS The pooled OR for the risk of depression among patients with diabetic nephropathy was 1.78 (95% CI 1.56-2.04; I2 = 83%; n = 56), indicating a significantly higher risk compared to diabetes patients without nephropathy (p < 0.001). Pooling the effect size across these studies showed that the pooled OR was 1.15 (95% CI 1.14-1.16; I2 = 88%; n = 32). Subgroup analyses based on the type of diabetes and study region revealed no significant differences in the pooled estimates. CONCLUSION This study demonstrates that patients with diabetic nephropathy have a significantly higher risk of depression compared to diabetes patients without nephropathy. These findings highlight the importance of assessing and addressing the mental health of patients with diabetic nephropathy as part of their overall healthcare management.
Collapse
Affiliation(s)
- Xiaoli Zhang
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China
| | - Liang Ma
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China
| | - Shumin Mu
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yonghui Yin
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China.
| |
Collapse
|
4
|
Zeitoun MH, Abdel Reheem AA, Kharboush IF, Sheshtawy H, Assad DH, El Feky AY. Relationship between depressive and anxiety symptoms and fear of hypoglycemia among adolescents and adults with type 1 diabetes mellitus. Prim Care Diabetes 2023; 17:255-259. [PMID: 36925404 DOI: 10.1016/j.pcd.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND AIMS Emotional problems including anxiety, depression and fear of hypoglycemia (FOH) are common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the prevalence of depressive and anxiety symptoms among patients with T1DM and their relation to glycemic control, diabetes complications and to FOH. METHODS This study included 325 patients with T1DM. Anxiety and depressive symptoms were assessed by Hospital Anxiety and Depression Scale (HADS) and FOH was assessed by Hypoglycemia Fear Survey II (HFS-II). Glycemic control was assessed by both fasting plasma glucose and HbA1c. A subsample of 75 patients was screened for diabetes complications. RESULTS The prevalence of anxiety symptoms, depressive symptoms and FOH was 76.3%, 61.8% and 20% respectively. Female sex was related to depressive symptoms but not to anxiety symptoms. Logistic regression analysis showed that both HbA1c and HFS-II total score were independently correlated with both anxiety symptoms and depressive symptoms. Age showed independent correlation with both HFS-II (total score) and with Hypoglycemia Fear Survey-worry (HFS-W) while HbA1c showed independent correlation with Hypoglycemia Fear Survey-behavior (HFS-B). Both anxiety and depressive symptoms were positively correlated to HFS-B score, HFS-W score and HFS-II total score. CONCLUSIONS FOH is not uncommon among Egyptian patients with T1DM and it seems to be one of the factors contributing to the increased prevalence of anxiety and depressive symptoms among those individuals. Addressing and managing the different psychological aspects of diabetes should be integrated within the routine diabetes care services for people with T1DM.
Collapse
Affiliation(s)
| | | | - Ibrahim F Kharboush
- Department of Maternal and Child Health, High Institute of Public Health, Alexandria University, Egypt
| | - Hesham Sheshtawy
- Department of Neurology and Psychiatry, Alexandria University, Egypt
| | - Dalia H Assad
- Department of Internal Medicine, Abu Qir general hospital, Alexandria, Egypt
| | - Amr Y El Feky
- Department of Internal Medicine, Alexandria University, Egypt.
| |
Collapse
|
5
|
Zou L, Tian Y, Wang Y, Chen D, Lu X, Zeng Z, Chen Z, Lin C, Liang Y. High-cholesterol diet promotes depression- and anxiety-like behaviors in mice by impact gut microbe and neuroinflammation. J Affect Disord 2023; 327:425-438. [PMID: 36738999 DOI: 10.1016/j.jad.2023.01.122] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Neuropsychiatric disorders, including anxiety and depression, are one of the most common mental illnesses worldwide. A growing body of evidence shows that there is a complex relationship between dietary patterns and mental health. In our study, C57BL/6J mice were divided into three groups: control diet group (CON, 10 % kcal fat), high-cholesterol diet model group (HCD, 42.0 % kcal fat + 1.25 % kcal Cholesterol), and chronic restraint stress group (CRS, 10 % kcal fat) which as a positive control group for the depression model. Six weeks later, depressive- and anxiety-like behavior were evaluated for using the OFT, SPT and TST. Glucose intolerance and liver fat were detected by IGTT and liver lipid kit. The expression of peripheral and central inflammation was detected by LEGEND plex kits. 5-HT (also named 5-hydroxytryptamine, 5-HT) and related receptors expression were monitored by ELISA, RT-PCR and Western blot. Meantime, gut microbe of stool samples was performed by 16S rRNA gene sequencing. Similar to CRS model, short-term HCD intervention induced anxiety and depression-like behavior behavioral abnormalities in mice. HCD consumption resulted in significantly increased body weight, liver fat (LDL-C, TC, TG), peripheral inflammation (IL-1β, MCP-1, IL-17A) and neuroinflammation (MCP-1). The concentration of 5-HT increased in the hippocampus, meanwhile, the expression of 5-HT receptor HTR2A was distinct in different regions of the brain tissue. More importantly, we found that compared with the CON diet, HCD induced the decrease of intestinal flora diversity, especially the decrease the relative abundance of Akkermansia_muciniphila, which was statistically significant. Further, Pearson correlation analysis showed that Akkermansia_muciniphila was significantly negatively correlated with the concentration of MCP-1, IL-17A in serum and 5-HT in hippocampus. Therefore, we speculated that the disorder of neuroinflammation induced by HCD consumption promotes depression- and anxiety-like behaviors in mice through the gut microbe.
Collapse
Affiliation(s)
- Lili Zou
- School of Medicine, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Yaling Tian
- School of Medicine, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Yuanfei Wang
- School of Nursing, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Dongliang Chen
- School of Nursing, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Xiaomin Lu
- School of Nursing, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Ze Zeng
- School of Nursing, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Zumin Chen
- School of Nursing, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China
| | - Chenli Lin
- School of Medicine, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China; Health Science Center, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China.
| | - Yinji Liang
- School of Nursing, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China; Health Science Center, Jinan University, No. 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, China.
| |
Collapse
|
6
|
Denche-Zamorano A, Perez-Gomez J, Barrios-Fernandez S, Oliveira R, Adsuar JC, Brito JP. Relationships between Physical Activity Frequency and Self-Perceived Health, Self-Reported Depression, and Depressive Symptoms in Spanish Older Adults with Diabetes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2857. [PMID: 36833555 PMCID: PMC9958756 DOI: 10.3390/ijerph20042857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Diabetes is one of the most prevalent noncommunicable diseases in the world. This disease can affect both physical and mental health in the population. This study analyzed the prevalence of Self-Perceived Health (SPH), self-reported depression, and depressive symptoms in comparison with the Physical Activity Frequency (PAF) reported by Spanish older adults with diabetes. A cross-sectional study was carried out with data from 2799 self-reported diabetic participants, all of whom were residents of Spain, aged 50-79 years, and included in the European Health Surveys carried out in Spain (EHIS) both in 2014 and 2020. The relationships between the variables were analysed with a chi-squared test. A z-test for independent proportions was performed to analyze differences in proportions between the sexes. A multiple binary logistic regression was carried out on the prevalence of depression. Linear regressions were performed on depressive symptoms and SPH. Dependent relationships were found between the SPH, self-reported depression, and depressive symptoms with PAF. Most of the very active participants reported a higher prevalence of self-reported depression. Physical inactivity increased the risk of depression, major depressive symptoms, and negative SPH.
Collapse
Affiliation(s)
- Angel Denche-Zamorano
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Jorge Perez-Gomez
- Health, Economy, Motricity and Education (HEME) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Sabina Barrios-Fernandez
- Occupation, Participation, Sustainability and Quality of Life (Ability Research Group), Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain
| | - Rafael Oliveira
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal
- Research Center in Sport Sciences, Health Sciences and Human Development, Quinta de Prados, Edifício Ciências de Desporto, 5001-801 Vila Real, Portugal
- Life Quality Research Centre, 2040-413 Rio Maior, Portugal
| | - Jose C. Adsuar
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - João Paulo Brito
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal
- Research Center in Sport Sciences, Health Sciences and Human Development, Quinta de Prados, Edifício Ciências de Desporto, 5001-801 Vila Real, Portugal
- Life Quality Research Centre, 2040-413 Rio Maior, Portugal
| |
Collapse
|
7
|
Benton M, Cleal B, Prina M, Baykoca J, Willaing I, Price H, Ismail K. Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis. Gen Hosp Psychiatry 2023; 80:1-16. [PMID: 36493531 DOI: 10.1016/j.genhosppsych.2022.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Type 1 diabetes is associated with increased prevalence of individual categories of mental disorders. We aimed to systematically synthesise the prevalence of all the different categories of mental disorders to estimate the overall burden of psychiatric morbidity in the type 1 diabetes population. METHOD The electronic database of OVID was searched, and retrieved papers were screened for eligibility by two independent reviewers. Data were extracted using a standardised data extraction form and the quality of included papers was assessed. Where possible, comparisons with control groups without type 1 diabetes were made. Prevalence data were synthesised into Diagnostic and Statistical Manual of Mental Disorders version 5 categories, a narrative data-synthesis, and a subsequent meta-analysis where possible was conducted for mental disorder categories. RESULTS Thirty-eight articles were included. Depressive, anxiety, and feeding and eating disorders were the most examined mental disorders. Studies utilising diagnostic interviews reported higher prevalence of mental disorders than in studies utilising clinical registers, with an up to 24-fold difference respectively. In studies with a control group, the prevalence for nearly every mental disorder were increased for the type 1 diabetes samples. CONCLUSIONS There appears to be a high prevalence of mental disorders and associated need among people with type 1 diabetes, although the quality of research needs to improve. SYSTEMATIC REVIEW REGISTRATION This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020221530).
Collapse
Affiliation(s)
- Madeleine Benton
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom
| | - Bryan Cleal
- Steno Diabetes Center, Borgmester Ib Juuls Vej 83, 2730 Herlev, Copenhagen, Denmark
| | - Mathew Prina
- Social Epidemiology Research Group, King's College London, 18 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Jeni Baykoca
- Southern Health NHS Foundation Trust, Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom
| | - Ingrid Willaing
- Steno Diabetes Center, Borgmester Ib Juuls Vej 83, 2730 Herlev, Copenhagen, Denmark
| | - Hermione Price
- Southern Health NHS Foundation Trust, Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
| |
Collapse
|
8
|
Fang T, Zhang Q, Wang Z, Liu JP. Bidirectional association between depression and diabetic nephropathy by meta-analysis. PLoS One 2022; 17:e0278489. [PMID: 36538528 PMCID: PMC9767359 DOI: 10.1371/journal.pone.0278489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Studies suggested that the association between depression and diabetic nephropathy may be bi-directional, but this hypothesis remains investigating. In this meta-analysis, the bi-directional relationship between depression and diabetic nephropathy was investigated. METHODS A search for the publications on depression and diabetic nephropathy in the databases of PubMed, Web of science, and Embase from the earliest available to August 2022 was conducted. Two sets of pooled risk estimates were calculated using random effects models: diabetic nephropathy predicting depression and depression predicting diabetic nephropathy. Cross-sectional studies were assessed using Agency for Healthcare Research and Quality (AHRQ), cohort and case-control studies were assessed using Newcastle-Ottawa Scale (NOS). RESULT Of the 974,121 patients in 30 clinical studies, 24 studies met eligibility for diabetic nephropathy predicting onset of depression, representing 28,438 incident cases. The other 6 studies met criteria for depression predicting onset of diabetic nephropathy, representing 945,683 incident cases. The pooled odds ratio (OR) of diabetic nephropathy predicting depression was 1.46 (95% CI 1.27-1.67). The OR of depression predicting diabetic nephropathy was 1.22 (95% CI 1.13-1.31). CONCLUSION This meta-analysis shows that the relationship between depression and diabetic nephropathy may be bidirectional. Diabetic nephropathy may be a predictor of depression, and depression may also be an indicator of diabetic nephropathy. The mechanisms underlying the bidirectional relationship need to be further investigated and interventions of the comorbidity of depression and diabetic nephropathy need be studied in clinical practice.
Collapse
Affiliation(s)
- Tingting Fang
- Institute of Ageing Research, Hangzhou Normal University, School of Basic Medicine, Hangzhou, Zhejiang Province, China
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
- * E-mail: (TF); (JPL)
| | - Qiuling Zhang
- Department of Endocrinology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Zhiguo Wang
- Institute of Ageing Research, Hangzhou Normal University, School of Basic Medicine, Hangzhou, Zhejiang Province, China
| | - Jun-Ping Liu
- Institute of Ageing Research, Hangzhou Normal University, School of Basic Medicine, Hangzhou, Zhejiang Province, China
- Monash University Department of Immunology and Pathology, Central Clinical School, Faculty of Medicine, Prahran, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
- * E-mail: (TF); (JPL)
| |
Collapse
|
9
|
Molebatsi K, Ho-Foster A, Ntsayagae E, Bikimane B, Bauer AM, Suleiman K, Acosta E, Beidas R, Schnoll R. Implementation Planning for Integrating Depression Screening in Diabetes Mellitus and HIV Clinics in Botswana. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:384-393. [PMID: 36340843 PMCID: PMC9628413 DOI: 10.1007/s43477-022-00062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
Depression is highly prevalent and, when comorbid with other medical conditions, can worsen health outcomes. Implementing routine depression screening within medical clinics can ensure that patients receive suitable treatment and improve overall health outcomes. Unfortunately, depression screening within medical settings is rare, particularly in low- and middle-income countries. This qualitative study evaluated patient and clinician perspectives on implementing depression screening within HIV and diabetes clinics in Botswana. Seven clinicians and 23 patients within these clinics were purposively selected and interviewed using a guide informed by the Consolidated Framework for Implementation Research (CFIR) to understand barriers and facilitators to depression screening in medical clinics in Botswana. Interviews were recorded, transcribed, and analyzed using NVivo. Three general themes emerged: (1) Appropriateness and Acceptability: attitudes and beliefs from clinicians and patients about whether depression screening should occur in this setting; (2) Stigma as an important barrier: the need to address the negative associations with depression to facilitate screening; and (3) Recommendations to facilitate screening including improving knowledge and awareness about depression, offering incentives to complete the screening, providing staff training, ensuring resources for treatment, the need to preserve confidentiality, and utilizing leadership endorsement. These results offer insights into how to implement depression screening within medical clinics in Botswana. These results can help design implementation strategies to increase depression screening in these clinics, which can be tested in future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-022-00062-3.
Collapse
Affiliation(s)
- Keneilwe Molebatsi
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Ari Ho-Foster
- Research and Graduate Studies Office, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Esther Ntsayagae
- School of Nursing, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Boikanyo Bikimane
- Ministry of Health and Wellness, Gaborone Health District, Government of Botswana, Gaborone, Botswana
| | - Anna-Marika Bauer
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA 19143 USA
| | | | - Erika Acosta
- University of Pennsylvania, Philadelphia, PA USA
| | - Rinad Beidas
- Departments of Psychiatry, Medical Ethics and Health Policy, and Medicine, Penn Implementation Science Center (PISCE@LDI), Penn Medicine Nudge Unit, Center for Health Incentives and Behavioral Economics (CHIBE), Leonard Davis Institute of Health Economics, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
| |
Collapse
|
10
|
Habib S, Sangaraju SL, Yepez D, Grandes XA, Talanki Manjunatha R. The Nexus Between Diabetes and Depression: A Narrative Review. Cureus 2022; 14:e25611. [PMID: 35784974 PMCID: PMC9249007 DOI: 10.7759/cureus.25611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/30/2022] Open
Abstract
Comorbid diabetes and depression are a significant public health burden as the consequences of both diseases are worsened by each other. In this study, we have compiled and analyzed findings from various studies to demonstrate that diabetes has a strong association with depression. Both have a significant impact on the quality of life, although the exact mechanisms through which these two chronic diseases affect each other remain unknown. This article discussed the shared etiological factors of comorbidity between diabetes and depression, including physiological (e.g., deregulation of the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS) overactivity, microvascular dysfunction, arterial stiffening, inflammation, and cytokines), behavioral (e.g., diet and lifestyle modifications), and environmental (e.g., childhood adversity, poverty, and neighborhood environment). Included data from a range of settings have suggested that the prognosis of both diabetes and depression, in terms of complications, treatment efficacy, morbidity, and mortality, is worse for either disease when they occur concurrently than individually. The implication for the physical, mental, and social well-being of depression in diabetes causes poor self-care and adherence to medical treatment. This article also highlights the importance of regular screening and prompts the treatment of comorbid diabetes and depression with pharmacotherapy, face-to-face psychotherapy, and non-face-to-face models of alternative psychological interventions, including information and communication technologies (ICTs), computer-based diabetes self-management interventions, and digital mental health intervention, to improve the outcomes of both diseases.
Collapse
Affiliation(s)
- Salma Habib
- Internal Medicine, Institute of Applied Health Sciences (IAHS), Chittagong, BGD
| | - Sai Lahari Sangaraju
- Research, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | - Daniela Yepez
- General Medicine, Universidad Catolica de Santiago de Guayaquil, Guayaquil, ECU
| | - Xavier A Grandes
- General Medicine, Universidad Catolica de Santiago de Guayaquil, Guayaquil, ECU
| | | |
Collapse
|
11
|
Takaike H, Miura J, Ishizawa K, Babazono T. High prevalence of depressive symptoms among people with pediatric-onset and adolescent-onset type 1 diabetes: A cross-sectional analysis of the Diabetes Study from the Center of Tokyo Women's Medical University. J Diabetes Investig 2022; 13:1626-1632. [PMID: 35587633 PMCID: PMC9434570 DOI: 10.1111/jdi.13835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
AIMS To investigate the prevalence of depressive symptoms by the age of onset of type 1 diabetes and its association with the condition of individuals with pediatric- and adolescent-onset type 1 diabetes. MATERIALS AND METHODS This single-center cross-sectional study enrolled Japanese participants with type 1 diabetes. All participants completed a questionnaire about their diabetes-related condition and the Patient Health Questionnaire-9, which was used to evaluate depression. Individuals with a Patient Health Questionnaire-9 score of ≥10 points were defined as having moderate depressive symptoms. RESULTS A total of 1,267 participants (mean age, 40 years; mean duration of type 1 diabetes, 21 years; 68% female; mean glycated hemoglobin, 7.8%) were included and classified according to the age of onset of type 1 diabetes to identify the proportion of moderate depressive symptoms in each group: 21% (0-12 years), 18% (13-19 years), and 13% (20-40 years). The prevalence of moderate depressive symptoms was significantly higher among participants with pediatric-onset type 1 diabetes (p<0.05). Moderate depressive symptoms were associated with increased glycated hemoglobin, neuropathy, and hypoglycemia unawareness. CONCLUSIONS Regular screening for depressive symptoms and hypoglycemia awareness is important. Healthcare professionals should provide appropriate psychosocial care for people with pediatric-onset and adolescent-onset type 1 diabetes from childhood through to adulthood.
Collapse
Affiliation(s)
- Hiroko Takaike
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kaya Ishizawa
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Tetsuya Babazono
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| |
Collapse
|
12
|
Zhu X, Zhang YM, Zhang MY, Chen YJ, Liu YW. Hesperetin ameliorates diabetes-associated anxiety and depression-like behaviors in rats via activating Nrf2/ARE pathway. Metab Brain Dis 2021; 36:1969-1983. [PMID: 34273043 DOI: 10.1007/s11011-021-00785-6] [Citation(s) in RCA: 7] [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: 11/05/2020] [Accepted: 06/14/2021] [Indexed: 12/11/2022]
Abstract
Diabetes-associated affective disorders are of wide concern, and oxidative stress plays a vital role in the pathological process. This study was to investigate the cerebroprotective effects of hesperetin against anxious and depressive disorders caused by diabetes, exploring the potential mechanisms related to activation of Nrf2/ARE pathway. Streptozotocin-induced diabetic rats were intragastrically administrated with hesperetin (0, 50, and 150 mg/kg) for 10 weeks. Forced swimming test, open field test, and elevated plus maze were used to evaluate the anxiety and depression-like behaviors of rats. The brain was collected for assays of Nrf2/ARE pathway. Moreover, high glucose-cultured SH-SY5Y cells were used to further examine the neuroprotective effects of hesperetin and underlying mechanisms. Hesperetin showed anxiolytic and antidepressant effects in diabetic rats according to the behavior tests, and increased p-Nrf2 in cytoplasm and Nrf2 in nucleus followed by elevations in mRNA levels and protein expression of glyoxalase 1 (Glo-1) and γ-glutamylcysteine synthetase (γ-GCS) in brain, known target genes of Nrf2/ARE signaling. Moreover, hesperetin attenuated high glucose-induced neuronal damages through activation of the classical Nrf2/ARE pathway in SH-SY5Y cells. Further study indicated that PKC inhibition or GSK-3β activation pretreatment attenuated even abolished the effect of hesperetin on the protein expression of Glo-1 and γ-GCS in high glucose-cultured SH-SY5Y cells. In summary, hesperetin ameliorated diabetes-associated anxiety and depression-like behaviors in rats, which was achieved through activation of the Nrf2/ARE pathway. Furthermore, an increase in nuclear Nrf2 phosphorylation from PKC activation and GSK-3β inhibition contributed to the activation of Nrf2/ARE pathway by hesperetin.
Collapse
Affiliation(s)
- Xia Zhu
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, No. 209, Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Yu-Meng Zhang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, No. 209, Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Meng-Ya Zhang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, No. 209, Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Ya-Jing Chen
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, No. 209, Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Yao-Wu Liu
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, No. 209, Tongshan Road, Xuzhou, 221004, Jiangsu, China.
- Department of Pharmacology, School of Pharmacy, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.
| |
Collapse
|
13
|
Jeong M. Factors Associated with Depressive Symptoms in Korean Adults with Diabetes Mellitus: A Cross-Sectional Study. Healthcare (Basel) 2021; 9:healthcare9081049. [PMID: 34442186 PMCID: PMC8391106 DOI: 10.3390/healthcare9081049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
Depressive symptoms in adults with diabetes are influenced by sociodemographic status, health-related behaviors, and comorbid diseases. This study aimed to examine the factors related to depressive symptoms in Korean adults with diabetes, using data from the Korea National Health and Nutrition Examination Surveys for 2014, 2016, and 2018. A total of 1529 Korean adults with diabetes were selected as subjects for the analysis. The age group of the participants was 19-80 years, with a mean age of 63.34 ± 0.68 years. The depressive symptoms and severity were assessed using the Korean version of the Patient Health Questionnaire-9. Descriptive statistics, chi-squared tests, and univariate and multivariable logistic regression analyses were used by applying a complex sample analysis method. The findings showed that 9.6% of Korean adults with diabetes exhibited moderate to severe depressive symptoms, which gradually decreased during 2014-2018. The most significant independent factors of depressive symptoms were living without a spouse, unemployment, low household income, fair or poor subjective health conditions, high perceived stress, a diabetes duration of over 20 years, and stroke. In females, living without a spouse, low household income, poor subjective health condition, high perceived stress, stroke, and coronary heart disease were significantly associated with depressive symptoms. In males, living without a spouse, unemployment, poor subjective health condition, high perceived stress, and hypertension were significantly associated with depressive symptoms. These findings highlight the importance of regular screening for depressive symptoms in patients with diabetes as the prevalence of depressive symptoms in people with diabetes may be higher than those in the general population. Future studies should also examine the development and effectiveness of psychosocial intervention programs to decrease depressive symptoms in patients with diabetes, considering cost-effective and time-saving approaches.
Collapse
Affiliation(s)
- Mihyun Jeong
- Department of Nursing, Changshin University, Changwon 51352, Korea
| |
Collapse
|
14
|
Gupta J, Kapoor D, Sood V. Quality of Life and its Determinants in Patients with Diabetes Mellitus from Two Health Institutions of Sub-himalayan Region of India. Indian J Endocrinol Metab 2021; 25:211-219. [PMID: 34760676 PMCID: PMC8547395 DOI: 10.4103/ijem.ijem_246_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/15/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) causes serious deterioration in general quality of life (QoL) mainly affecting the health-related quality of life (HRQOL). Routine assessment of QoL improves communication with the patient, helps to predict treatment response, and supports clinical decision-making. QoL can predict an individual's capacity to manage the disease and maintain long-term health and wellbeing. AIMS To find out the QoL and its socio-demographic, anthropometric, and clinical determinants among DM patients attending health institutions from sub-Himalayan region, catering rural population. SETTINGS AND DESIGN This cross-sectional study was conducted in two hospitals mostly catering rural population from 2014 to 2018. Purposive sampling technique was used. MATERIALS AND METHODS Socio-demographic, anthropometric, and clinical data of DM patients (N = 300) were collected. They were administeredHindi translation of QoL Instrument for Indian Diabetes Patients (QOLID) and Patient Health Questionnaire-9 (PHQ-9). All statistical analyses were carried out using Statistical Package for Social Sciences (SSPS) (Version 17.0, USA). RESULTS About 10% had very poor, 13% poor, 11% average, 16% good, and 50% very good QoL on QOLID. General health (GH) and treatment satisfaction (TS) were the most affected domains. Fatigue was the most common symptom (79%) reported in QOLID. Age more than 55 years, rural background, and PHQ-9 score of more than 7 were predictors of poorer QoL. CONCLUSION There is a need for a holistic and collaborative care of DM patients, to maintain a good HRQoL. Screening of depression, fatigue, and regular assessment of QoL should be emphasized.
Collapse
Affiliation(s)
- Jyoti Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Dheeraj Kapoor
- Department of Medicine, Dr. Rajendra Prasad Government Medical College, Himachal Pradesh, India
| | - Vivek Sood
- Department of Medicine, Dr. Rajendra Prasad Government Medical College, Himachal Pradesh, India
| |
Collapse
|
15
|
Schmitt A, McSharry J, Speight J, Holmes-Truscott E, Hendrieckx C, Skinner T, Pouwer F, Byrne M. Symptoms of depression and anxiety in adults with type 1 diabetes: Associations with self-care behaviour, glycaemia and incident complications over four years - Results from diabetes MILES-Australia. J Affect Disord 2021; 282:803-811. [PMID: 33601721 DOI: 10.1016/j.jad.2020.12.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/28/2020] [Accepted: 12/25/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether symptoms of depression or anxiety predict glycaemia and incident diabetes complications four years later, and whether diabetes self-care behaviours mediate these associations, in adults with type 1 diabetes (T1DM). METHODS Data of 205 adults with T1DM from the 2011 and 2015 Diabetes MILES-Australia surveys were analysed. Variables of interest were: baseline depression and anxiety (PHQ-8 and GAD-7, respectively) symptoms; HbA1c and incident complications at four-year follow-up; and self-care behaviours at both time points. Longitudinal associations were analysed using structural equation modelling. RESULTS Forty-two participants (20.6%) reported incident complications. Baseline depressive symptoms predicted higher HbA1c at follow-up indirectly via less optimal self-care at follow-up (β = 0.19, P = 0.011). Baseline anxiety was not independently associated with HbA1c or self-care at follow-up (P ≥ 0.64). Neither depressive nor anxiety symptoms predicted incident complications, although depressive symptoms were associated with less optimal self-care at baseline (β = -0.67, P < 0.001), and this predicted microvascular complications (β = -0.38, P = 0.044); however, the indirect association via self-care was not significant (β = 0.25, P = 0.067). LIMITATIONS Participants were self-selected; all study variables were assessed using self-report measures; and adjusting for baseline HbA1c was not possible. CONCLUSIONS Depressive symptoms predicted suboptimal self-care behaviour and glycaemic outcome four years later, while anxiety symptoms did not. The findings suggest that tailored diabetes care should take the potential impact of comorbid depression into consideration to help people improve their diabetes self-care and achieve best possible health outcomes.
Collapse
Affiliation(s)
- Andreas Schmitt
- Diabetes Center Mergentheim, Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764 Muenchen-Neuherberg, Germany.
| | - Jennifer McSharry
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Melbourne, Victoria, Australia
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, Victoria, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense, Denmark
| | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
16
|
Ahola AJ, Harjutsalo V, Forsblom C, Pouwer F, Groop PH. Depression Is Associated With Progression of Diabetic Nephropathy in Type 1 Diabetes. Diabetes Care 2021; 44:174-180. [PMID: 33177173 DOI: 10.2337/dc20-0493] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between depression and diabetic nephropathy progression in type 1 diabetes. RESEARCH DESIGN AND METHODS Data from 3,730 participants without end-stage renal disease (ESRD) at baseline, participating in the Finnish Diabetic Nephropathy Study, were included. Depression was assessed in three ways. Depression diagnoses were obtained from the Finnish Care Register for Health Care. Antidepressant agent purchase data were obtained from the Drug Prescription Register. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Based on their urinary albumin excretion rate (AER), participants were classified as those with normal AER, microalbuminuria, and macroalbuminuria. Progression from normal AER to microalbuminuria, macroalbuminuria, or ESRD; from microalbuminuria to macroalbuminuria or ESRD; or from macroalbuminuria to ESRD, during the follow-up period, was investigated. RESULTS Over a mean follow-up period of 9.6 years, renal status deteriorated in 18.4% of the participants. Diagnosed depression and antidepressant purchases before baseline were associated with 53% and 32% increased risk of diabetic nephropathy progression, respectively. Diagnosed depression assessed during follow-up remained associated with increased risk of disease progression (32%). BDI-derived symptoms of depression showed no association with the progression, but the total number of antidepressant purchases modestly reduced the risk (hazard ratio 0.989 [95% CI 0.982-0.997]), P = 0.008). With the sample divided based on median age, the observations followed those seen in the whole group. However, symptoms of depression additionally predicted progression in those age ≤36.5 years. CONCLUSIONS Diagnosed depression and antidepressant purchases are associated with the progression of diabetic nephropathy in type 1 diabetes. Whether successful treatment of depression reduces the risk needs to be determined.
Collapse
Affiliation(s)
- Aila J Ahola
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - François Pouwer
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,School of Psychology, Deakin University, Geelong Waterfront Campus, Melbourne, Victoria, Australia.,Steno Diabetes Center Odense, Odense, Denmark
| | | | | |
Collapse
|
17
|
Podder V, Srivastava V, Kumar S, Nagarathna R, Sivapuram MS, Kaur N, Sharma K, Singh AK, Malik N, Anand A, Nagendra HR. Prevalence and Awareness of Stroke and Other Comorbidities Associated with Diabetes in Northwest India. J Neurosci Rural Pract 2020; 11:467-473. [PMID: 32753814 PMCID: PMC7394624 DOI: 10.1055/s-0040-1709369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objectives
The main purpose of this study is to investigate the prevalence of comorbid conditions in diabetic, prediabetic, and nondiabetic individuals. Additionally, the current study examines the levels of awareness of those comorbidities among North Indian population.
Methods
As a part of a national study (Niyantrit Madhumeh Bharat [NMB] screening program), different comorbidity parameters were screened in the northern part of India between April and September 2017. There were 1,215 participants recruited in this study. Biochemical analyses of hemoglobin A1c (HbA1c) were conducted on the study subjects. Subsequently, the study subjects were divided into diabetic, prediabetic, and nondiabetic groups based on their HbA1c results.
Results
The study analysis reveals a higher prevalence of peripheral vascular disease (21.2%), ocular diseases (18%), and hypertension (13.4%) in diabetics with other comorbidities. Furthermore, the study found that a vast majority of the participants were unaware of the presence of hypertension (67.2%), dyslipidemia (84.5%), kidney disease (95.2%), peripheral vascular disease (34.5%), and stroke (95.1%).
Conclusion
The study concluded that in the northern India, the prevalence of multiple comorbid conditions, such as peripheral vascular disease and hypertension, is higher among diabetic population. Also, the level of awareness of diabetic comorbidities is surprisingly low, which has implications for policymakers, health practitioners, and educators of alternate medicine to increase awareness about diabetes, comorbid conditions, health risk, and possible solution at community and rural level, such as periodic screening programs in this population.
Collapse
Affiliation(s)
- Vivek Podder
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
| | - Vinod Srivastava
- Department of Social Work, University of Kentucky, Lexington, Kentucky, United States
| | - Saurabh Kumar
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Madhava Sai Sivapuram
- Department of General Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinna-Avutapalli, Krishna, Andhra Pradesh, India
| | - Navneet Kaur
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.,Department of Physical Education, Panjab University, Chandigarh, India
| | - Kanupriya Sharma
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Neeru Malik
- Department of Yoga, Dev Samaj College of Education, Panjab University, Chandigarh, India
| | - Akshay Anand
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | |
Collapse
|
18
|
Hussain A, Wani ZA, Shah H, Zargar AH, Margoob MA, Qureshi W. Depression and diabetes: An experience from Kashmir. Indian J Psychiatry 2020; 62:167-171. [PMID: 32382176 PMCID: PMC7197822 DOI: 10.4103/psychiatry.indianjpsychiatry_46_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/06/2019] [Accepted: 12/25/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a common chronic metabolic disorder characterized by hyperglycemia. Minimal attention has been paid toward the relationship between diabetes and depression in developing countries such as India, despite a number of studies in developed countries, exploring casual pathway between the two highly prevalent conditions. The aim of this study was to estimate the prevalence and severity of depression among patients of diabetes attending the endocrinology department of a tertiary care hospital of Kashmir. METHODOLOGY A total of 527 patients having diabetes of ≥6 months with age ranging from 18 years to 60 years were screened for major depressive disorder (MDD) using Diagnostic and Statistical Manual IV-based criteria. Severity of depression was assessed by the Montgomery-Asberg Depression Rating Scale. RESULTS Depression was present in 39.65% of patients. Depression was more prevalent in the age group of 29-38 years, in females as compared to males, among literates and government employees. Prevalence of depression among Type 1 diabetic patients was 60%, while as in case of Type 2, it was 37.75%. Depressed patients had higher fasting blood glucose levels as compared to nondepressed diabetic patients. CONCLUSION MDD is inordinately high among adult diabetic patients, and majority of the depressive patients have moderate intensity of MDD.
Collapse
Affiliation(s)
- Arshad Hussain
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Zaid Ahmad Wani
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Hamidullah Shah
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Abdul Hamid Zargar
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mushtaq Ahmad Margoob
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Waseem Qureshi
- Department of Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
19
|
Gebre BB, Anand S, Assefa ZM. Depression and Its Predictors among Diabetes Mellitus Patients Attending Treatment in Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia. J Diabetes Res 2020; 2020:7138513. [PMID: 32405504 PMCID: PMC7204154 DOI: 10.1155/2020/7138513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/06/2019] [Accepted: 11/27/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with diabetes mellitus are at twice the risk of developing depression than the general population. The coexistence of diabetes and depression largely contributes to increased morbidity and mortality and results in high healthcare cost. OBJECTIVE The aim is to assess severity of depression and its determinants in diabetes outpatients at Hawassa University Comprehensive Specialized Referral Hospital, southern Ethiopia. METHODS An institutional-based cross-sectional study was done using a systematic sampling method. To assess the magnitude of depression, the patient health questionnaire-9 scale was used. Then, the data were entered into EpiData version 3.1 and exported to SPSS version 20 software. Binary logistic regression was used to assess the association between dependent variable and independent variables. RESULTS The magnitudes of depression were found to be 41.5%. The potential predictors were adhering to alcohol intake (adjusted odds ratio, AOR = 3.71, 95% CI: 1.52, 9.06), loss of someone very close or spouse (AOR = 6.83, 95% CI 3.07, 15.19), having no social support (AOR = 3.68, 95% CI: 1.63, 8.29), not adhering to the recommended dietary regimen (AOR = 6.83, 95% CI 3.07, 15.19), not adhering to physical activity (AOR = 4.1, 95% CI: 1.86,9.014), not adhering to medication (AOR = 4.2, 95% CI: 1.7, 10.31), and not having raised blood pressure of 140/90 mmHg and above (AOR = 7.42, 95% CI: 3.40, 16.17). CONCLUSION Depression was a common comorbidity associated with diabetes occurring in more than four in ten of the participants.
Collapse
Affiliation(s)
- Bereket Beyene Gebre
- School of Nursing, College of Health Science, Hawassa University, Southern Ethiopia, Ethiopia
| | - Suzan Anand
- Department of Nursing and Midwifery, College of Health Science, Jimma University, Southwest Ethiopia, Ethiopia
| | - Zebene Mekonnen Assefa
- College of Health Science, Department of Nursing, Wolkite University, Southern Ethiopia, Ethiopia
| |
Collapse
|
20
|
Lee J, Callaghan T, Ory M, Zhao H, Foster M, Bolin JN. Effect of Study Design and Survey Instrument to Identify the Association Between Depressive Symptoms and Physical Activity in Type 2 Diabetes, 2000-2018: A Systematic Review. DIABETES EDUCATOR 2019; 46:28-45. [DOI: 10.1177/0145721719893359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Previous studies have used a variety of survey measurement options for evaluating the association between physical activity (PA) and depressive symptoms, raising questions about the types of instruments and their effect on the association. This study aimed to identify measures of PA and depressive symptoms and findings of their association given diverse instruments and study characteristics in type 2 diabetes (T2DM). Methods Online databases, Medline, Embase, CINAHL, and PsycINFO were searched on July 20, 2018, and January 8, 2019. Our systematic review included observational studies from 2000 to 2018 that investigated the association between PA and depressive symptoms in T2DM. Results Of 2294 retrieved articles, 28 studies were retained in a focused examination and comparison of the instruments used. There were a range of standard measures, 10 for depressive symptoms and 7 for PA, respectively. Patient Health Questionnaire (PHQ) for depressive symptoms and study-specific methods for PA were the most popular. Overall, 71.9% found a significant association between PA and depressive symptoms. Among studies classified as high quality or reliability, the figure was 81.8%. Conclusion A majority of the sample found an association between depressive symptoms and PA, which is fairly consistent across study characteristics. The findings provide the evidence for the health benefits of PA on reducing depressive symptoms in persons with T2DM, suggesting active engagement in PA for effective diabetes management. However, guidelines for objective measurements and well-designed prospective studies are needed to strengthen the evidence base and rigor for the association and its directionality.
Collapse
Affiliation(s)
- Jusung Lee
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Marcia Ory
- Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas
| | - Hongwei Zhao
- Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas
| | - Margaret Foster
- Medical Sciences Library, Texas A&M University, College Station, Texas
| | - Jane N. Bolin
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
- School of Nursing, Texas A&M University, College Station, Texas
| |
Collapse
|
21
|
Harding KA, Pushpanathan ME, Whitworth SR, Nanthakumar S, Bucks RS, Skinner TC. Depression prevalence in Type 2 diabetes is not related to diabetes-depression symptom overlap but is related to symptom dimensions within patient self-report measures: a meta-analysis. Diabet Med 2019; 36:1600-1611. [PMID: 31532013 DOI: 10.1111/dme.14139] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 01/24/2023]
Abstract
AIM Depression is common in Type 2 diabetes, yet rates vary. Overlap between symptoms of depression and diabetes may account for this variability in depression prevalence rates. We examined to what extent depression prevalence was a function of the proportion of depression-diabetes symptom overlap (items within symptom dimensions) and sample characteristics. METHODS Electronic and hand searching of published and unpublished works identified 147 eligible papers. Of 3656 screened, 147 studies (149 samples, N = 17-229 047, mean sample age 25.4-82.8 years, with 152 prevalence estimates), using 24 validated depression questionnaires were selected. Sample size, publication type, sample type, gender, age, BMI, HbA1c , depression questionnaire and prevalence rates were extracted. RESULTS Prevalence rates ranged from 1.8% to 88% (mean = 28.30%) and were higher in younger samples, samples with higher mean HbA1c and clinic samples. Diabetes-depression symptom overlap did not affect prevalence. A higher proportion of anhedonia, cognition, cognitive, negative affect and sleep disturbance symptoms, and a lower proportion of somatic symptoms were consistently associated with higher depression prevalence. CONCLUSIONS The lack of an overall effect of diabetes-depression symptom overlap might suggest that assessment of depression in Type 2 diabetes is generally not confounded by co-occuring symptoms. However, questionnaires with proportionally more or fewer items measuring other symptom categories were associated with higher estimates of depression prevalence. Depression measures that focus on the cardinal symptoms of depression (e.g. negative affect and cognition), limiting symptoms associated with increasing diabetes symptomatology (e.g. sleep disturbance, cognitive) may most accurately diagnose depression.
Collapse
Affiliation(s)
- K A Harding
- VA Puget Sound Healthcare System, Seattle, WA, USA
| | - M E Pushpanathan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - S R Whitworth
- Australian Government Department of Health, Canberra, Australia
| | - S Nanthakumar
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - R S Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - T C Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
22
|
Doroodgar M, Doroodgar M, Tofangchiha S. Evaluation of Relation between HbA1c Level with Cognitive Disorders and Depression in Type 2 Diabetes Mellitus Patients. Open Access Maced J Med Sci 2019; 7:2462-2466. [PMID: 31666848 PMCID: PMC6814457 DOI: 10.3889/oamjms.2019.658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND: The role of HbA1c level in cognition decline and depression in type 2 diabetic patients is reported in some studies. AIM: We evaluated the possible significant relationship between HbA1c level and cognition decline and depression in type 2 diabetic patients. MATERIAL AND METHODS: This descriptive-analytic study was performed on 512 patients with a different HbA1c level and ages range. All subjects were administered a structured clinical interview. Cognitive functions and depressive disorders were assessed through the Mini-Mental Status Exam (MMSE) and Patient Health Questionnaire-9 (PHQ-9) respectively. Chi-square test was used for relationships between variables. RESULTS: HbA1c mean in all patients was 7.58%. MMSE score mean in total was 27.28. 83.3% of patients had a depressive disorder, and 8.59% of patients had an MMSE score < 24. There was no significant relationship between HbA1c level and cognitive problems, but there was a significant relationship between recent memory declines with the level of HbA1c (P = 0.03). Also, there was no significant relationship between attention-deficit with HbA1c level. CONCLUSION: Our finding provides that even though there is no significant difference between HbA1c level and cognitive problems and depression, recent memory state in these patients are more affected than the normal population and these patients have a worse state of depressive disorders.
Collapse
Affiliation(s)
- Masoud Doroodgar
- Department of Internal Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Moein Doroodgar
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahnaz Tofangchiha
- AJA Cancer Epidemiology Research and Treatment Center (AJA-CERTC), AJA University of Medical Sciences, Tehran, Iran
| |
Collapse
|
23
|
Nicolau J, Simó R, Conchillo C, Sanchís P, Blanco J, Romerosa JM, Fortuny R, Bonet A, Masmiquel L. Differences in the cluster of depressive symptoms between subjects with type 2 diabetes and individuals with a major depressive disorder and without diabetes. J Endocrinol Invest 2019; 42:881-888. [PMID: 30788770 DOI: 10.1007/s40618-019-01020-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depressive disorder encompasses a wide spectrum of somatic and psychological symptoms. It is not known whether there are differences regarding the cluster of depressive symptomatology between subjects with depression with and without T2DM. PURPOSE To explore whether the cluster of depression that prevails among depressive subjects with T2DM differs from individuals with depression, but without T2DM. METHODS 87 T2DM patients with a pathological Beck Depression Inventory test (BDI) were compared with 50 age- and gender-matched individuals with a major depressive disorder. All 21 items expressed in the BDI were compared between the two groups. RESULTS The score obtained after administering the BDI was comparable between patients with T2DM and significant depressive symptoms and the control group (18.8 ± 2.7 vs 18.9 ± 3.4; p = 0.9). Subjects with T2DM had higher scores compared with the control group in the following items: sadness (1.4 ± 0.9 vs 0.9 ± 0.9; p = 0.011), difficulty in concentration (1.3 ± 0.8 vs 0.8 ± 0.8; p = 0.01), indecisiveness (1.1 ± 0.8 vs 0.5 ± 0.9; p = 0.012), worries about their health (1.3 ± 0.9 vs 0.6 ± 0.9; p < 0.0001), fatigue (1.2 ± 0.6 vs 0.8 ± 0.7; p = 0.003) and loss of sexual appetite (2.7 ± 0.6 vs 1.2 ± 1.3; p = 0.0001). Suicidal ideation was significantly lower among subjects with T2DM compared with the control group (0.1 ± 0.3 vs 0.6 ± 0.8; p = 0.0001). CONCLUSIONS Subjects with T2DM and a positive screening for depression presented a different cluster of depression compared with depressed subjects without T2DM, with a predominance of somatic-biological depressive symptoms rather than psychological-cognitive cluster and negative emotions, such as suicidal ideation.
Collapse
Affiliation(s)
- J Nicolau
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain.
| | - R Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Barcelona, Spain
| | - C Conchillo
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - P Sanchís
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - J Blanco
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - J M Romerosa
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - R Fortuny
- Hormonal Laboratory Department, Hospital Son Llàtzer, Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - A Bonet
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - L Masmiquel
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| |
Collapse
|
24
|
Khoo K, Man REK, Rees G, Gupta P, Lamoureux EL, Fenwick EK. The relationship between diabetic retinopathy and psychosocial functioning: a systematic review. Qual Life Res 2019; 28:2017-2039. [PMID: 30879245 DOI: 10.1007/s11136-019-02165-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Previous work has reported a link between diabetic retinopathy/diabetic macular edema (DR/DME) and psychosocial functioning, although the extent and direction of the association remains uncertain. OBJECTIVE To determine the relationship between DR/DME and psychosocial functioning, the latter an umbrella term used to capture the emotional and social aspects of functioning which may include, for example, depression; depressive disorder; anxiety; vision-specific distress; diabetes-specific distress and emotional and social well-being. EVIDENCE REVIEW PubMed, Embase, Medline and the Cochrane Central register were systematically searched for relevant interventional and observational quantitative studies using standardised criteria. Studies with DR/DME and psychosocial functioning as exposures or outcomes were accepted. Study quality was evaluated using the modified Newcastle-Ottawa scale for observational studies, and the modified Down's and Black checklist for interventional studies. FINDINGS Of 1827 titles initially identified, 42 were included in the systematic review. They comprised of four interventions (one RCT, three non-RCTs) and 38 observational studies (33 cross sectional, five prospective). In studies with DR/DME as the exposure (n = 28), its severity and related vision impairment were consistently associated with poor psychosocial outcomes, mostly higher incidence of depression and depressive symptoms. Baseline depression and depressive symptoms were also associated with greater DR incidence and progression of DR. Medical intervention strategies showed significant improvement in psychosocial outcomes in patients with DR, such as significant improvements in mental health domain scores of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ 25). CONCLUSION AND RELEVANCE Severity of DR, DME and associated vision loss are significantly associated with poor psychosocial outcomes. Aspects of depression and its symptoms show a bi-directional association, with increased incidence and progression of DR significant in those with baseline depression or depressive symptoms. Based on these findings, we propose two areas that may benefit from targeted interventions: (1) Prevention of development of poor psychological outcomes by preventing and delaying progression of DR/DME; and (2) Improved detection and management of poor psychological functioning by improving screening tools and multidisciplinary care for patients. Subsequent longitudinal studies can further help establish the underlying relationship between the two measures.
Collapse
Affiliation(s)
- Krystal Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Gwyn Rees
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Preeti Gupta
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Ecosse L Lamoureux
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.
- Duke-National University of Singapore Medical School, Singapore, Singapore.
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia.
| | - Eva K Fenwick
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| |
Collapse
|
25
|
Khaledi M, Haghighatdoost F, Feizi A, Aminorroaya A. The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol 2019; 56:631-650. [PMID: 30903433 DOI: 10.1007/s00592-019-01295-9] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/02/2019] [Indexed: 02/06/2023]
Abstract
AIMS Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies. METHODS MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11". RESULTS In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%). CONCLUSION Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.
Collapse
Affiliation(s)
- Mohammad Khaledi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
26
|
Graham EA, Thomson KH, Bambra CL. The association between diabetes and depressive symptoms varies by quality of diabetes care across Europe. Eur J Public Health 2019; 28:872-878. [PMID: 29617999 PMCID: PMC6148969 DOI: 10.1093/eurpub/cky050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Depressive symptoms are more common in adults with diabetes and may arise from the physical and psychosocial burden of disease. Better quality of diabetes care may be associated with a reduced disease burden and fewer depressive symptoms. Methods This cross-sectional study included 34 420 participants from 19 countries in the European Social Survey Round 7 (2014-2015). Countries were grouped into quartiles based on their quality of diabetes care as measured in the Euro Diabetes Index 2014. Individual-level depressive symptoms were measured using the 8-item Center for Epidemiologic Studies-Depression Scale. Negative binomial regression was used to compare the number of depressive symptoms between adults with and without diabetes in each quartile of diabetes care quality. Analyses included adjustment for covariates and survey weights. Results In countries with the highest quality of diabetes care, having diabetes was associated with only a 3% relative increase in depressive symptoms (95% CI 1.00-1.05). In countries in the second, third and fourth (lowest) quartiles of diabetes care quality, having diabetes was associated with a 13% (95% CI 1.08-1.17), 13% (1.08-1.19) and 22% (1.14-1.31) relative increase in depressive symptoms, respectively. Conclusion The association between diabetes and depressive symptoms appears stronger in European countries with lower quality of diabetes care. Potential pathways for this association include the financial aspects of diabetes care, access to services and differential exposure to the social determinants of heath. Further research is needed to unpack these mechanisms and improve the quality of life of people with diabetes across Europe.
Collapse
Affiliation(s)
- Eva A Graham
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Katie H Thomson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare L Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
27
|
Stoop C, Pouwer F, Pop V, Den Oudsten B, Nefs G. Psychosocial health care needs of people with type 2 diabetes in primary care: Views of patients and health care providers. J Adv Nurs 2019; 75:1702-1712. [PMID: 30883846 PMCID: PMC6850404 DOI: 10.1111/jan.13996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/22/2018] [Accepted: 02/18/2019] [Indexed: 01/28/2023]
Abstract
Aims This study examined (a) psychosocial health care needs of people with type 2 diabetes from the perspective of patients and diabetes healthcare providers in primary care, in terms of topics, attention in diabetes care and preferences and (b) factors associated with a positive attitude towards specialized psychosocial health care. Design Qualitative focus group study. Methods Using purposive sampling, participants were selected from general practices. In 2012–2013, three focus groups were conducted in people with type 2 diabetes (N = 20) and three with healthcare providers (N = 18). Results Opinions differed considerably on whether there was a need for psychosocial health care. Topics focused mainly on diabetes‐specific issues ranging from a need for additional diabetes education to attention and support in regular diabetes care. However, not all healthcare providers felt competent enough to address psychosocial problems. Some participants reported a need for specialized psychosocial help. A positive attitude towards specialized psychosocial health care appeared to be influenced by care setting (e.g., in the primary care practice or ‘outside’ mental health care), care accessibility, proactive discussion of psychosocial issues with and referral by healthcare providers and previous experiences with psychosocial health care. Conclusion Although only few participants expressed a need for specialized psychosocial care, attention for psychosocial well‐being in regular diabetes care was generally appreciated. Impact People with type 2 diabetes generally felt psychosocial care could be provided as part of regular diabetes care. Suggestions for healthcare providers to meet psychosocial health care needs include training and discussion tools.
Collapse
Affiliation(s)
- Corinne Stoop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,PoZoB, Veldhoven, The Netherlands
| | - François Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia
| | - Victor Pop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Brenda Den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| |
Collapse
|
28
|
Rauwerda NL, Tovote KA, Peeters ACTM, Sanderman R, Emmelkamp PMG, Schroevers MJ, Fleer J. WHO-5 and BDI-II are acceptable screening instruments for depression in people with diabetes. Diabet Med 2018; 35:1678-1685. [PMID: 30019352 DOI: 10.1111/dme.13779] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/30/2022]
Abstract
AIMS To investigate the acceptability of two questionnaires, the five item WHO Well-being Index (WHO-5) and the Beck Depression Inventory II (BDI-II), which differ in length and focus, by comparing three screening groups: (1) WHO-5, (2) BDI-II and (3) WHO-5 and BDI-II. METHODS A total of 699 individuals with diabetes were approached to participate in the study, of whom 95 completed the WHO-5, 254 completed the BDI-II and 350 completed both the WHO-5 and the BDI-II questionnaires. Five facets of acceptability were compared, including objective aspects (response rate and completion level) and subjective aspects (appreciation, agreeableness and accuracy of the screening questionnaire). Data were analysed using logistic regression analysis and (multivariate) analysis of covariance. RESULTS The overall response rate was 65% (453 out of 699). No differences between the three groups were found with respect to the response rate (WHO-5: 66%; BDI-II: 63%; WHO-5 and BDI-II: 66%; P ≥ 0.19) and completion level (WHO-5: 99.5%; BDI-II: 97.8%; WHO-5 and BDI-II: 98.7%; P=0.45). The three groups did differ significantly in their scores on two of the three subjective indicators (P<0.03), i.e. appreciation (P=0.002) and agreeableness (P=0.035), with those completing only the WHO-5 reporting greater appreciation and agreeableness. CONCLUSIONS A brief well-being questionnaire, such as the WHO-5, results in greater appreciation of mood screening and appreciation of completing the questionnaire, but this does not result in a better response rate and higher questionnaire completion. Given these results, either or both questionnaires can be used to screen for depressive symptoms in people with diabetes in clinical practice.
Collapse
Affiliation(s)
- N L Rauwerda
- Department of Medical Psychology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - K A Tovote
- Department of Health Psychology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A C T M Peeters
- Department of Internal Medicine, Hospital Rivierenland, Tiel, The Netherlands
| | - R Sanderman
- Department of Health Psychology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - P M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam and Netherlands Institute for Advanced Study, Amsterdam, The Netherlands
| | - M J Schroevers
- Department of Health Psychology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J Fleer
- Department of Health Psychology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
29
|
Kampling H, Mittag O, Herpertz S, Baumeister H, Kulzer B, Petrak F. Can trajectories of glycemic control be predicted by depression, anxiety, or diabetes-related distress in a prospective cohort of adults with newly diagnosed type 1 diabetes? Results of a five-year follow-up from the German multicenter diabetes cohort study (GMDC-Study). Diabetes Res Clin Pract 2018; 141:106-117. [PMID: 29698712 DOI: 10.1016/j.diabres.2018.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 01/30/2023]
Abstract
AIMS The longitudinal association between glycemic control with depression, anxiety or diabetes-related distress in type 1 diabetes is poorly understood. Therefore, we examined long-term trajectories of HbA1c in a new-onset cohort of adults with type 1 diabetes, and analyzed associations with depression, anxiety, and diabetes-related distress. METHODS We included 313 newly diagnosed adults with type 1 diabetes in a prospective multicenter cohort study. Depression, anxiety, and diabetes-related distress were assessed starting with the diabetes diagnosis and at five annual surveys. HbA1c-measurements started with the one-year follow-up. HbA1c trajectories were analyzed applying Growth mixture modeling, while prediction of membership in the trajectories classes was analyzed using multiple regression, and one-way ANOVA/Chi2 to identify differences between classes. RESULTS Average HbA1c increased constantly: follow-up at 1-year 6.5% (48 mmol/mol), 2-years 6.9% (52 mmol/mol), 3-years 7.1% (54 mmol/mol), 4-years 7.1% (54 mmol/mol), and 5-years 7.4% (57 mmol/mol). HbA1c trajectories included one 'good control' and three 'poor control' (52% of patients) classes. At the five-year follow-up, mean HbA1c was 6.3% (45 mmol/mol) in the 'good control' class, and ranging from 7.9% (63 mmol/mol) to 9.0% (75 mmol/mol) in the three 'poor control' classes. Classes were neither predicable, nor differentiated by depression, anxiety, or diabetes-related distress. CONCLUSIONS We identified distinct trajectories of glycemic control. Depression and anxiety were highly prevalent but they neither predicted 'poor'/'good' glycemic control trajectories nor were they associated with glycemic control at any assessment point.
Collapse
Affiliation(s)
- Hanna Kampling
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, D-79115 Freiburg, Germany.
| | - Oskar Mittag
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, D-79115 Freiburg, Germany.
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Alexandrinenstrasse 1-3, D-44791 Bochum, Germany.
| | - Harald Baumeister
- University of Ulm, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Albert-Einstein-Allee 47, D-89069 Ulm, Germany.
| | - Bernd Kulzer
- Diabetes Center Mergentheim, Klotzbücher Str. 12, D-97980 Bad Mergentheim, Germany; Research Institute of the Diabetes Academy Mergentheim, Klotzbücher Str. 12, D-97980 Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, D-96047 Bamberg, Germany.
| | - Frank Petrak
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Alexandrinenstrasse 1-3, D-44791 Bochum, Germany; Center for Psychotherapy Wiesbaden, Sonnenberger Str. 20, D-65193 Wiesbaden, Germany.
| |
Collapse
|
30
|
Efe YS, Erdem E. A Comparison of Aggression and Self-injury Among Type 1 Diabetic and Healthy Adolescents: A Sample From Turkey. Arch Psychiatr Nurs 2018; 32:174-179. [PMID: 29579509 DOI: 10.1016/j.apnu.2017.10.012] [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: 10/30/2016] [Revised: 09/28/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescents tend to have risky behaviors like aggression and self-injury due to the age period characteristics. The risk of aggression and self-injury may increase in adolescents with the addition of chronic diseases. OBJECTIVES This study was conducted descriptively to determine and compare the aggression and self-injury in those with type 1 diabetes mellitus (T1DM) and healthy counterparts. METHODS The study sample consisted of 60 adolescents with T1DM followed up in the child endocrinology polyclinic of a university hospital and 319 healthy counterparts, 15-18 aged, at 9th-12th grade at high school. In the study, the permission of the institution, Ethical Committee, the parent and adolescent consent, the data were collected using a questionnaire form, Aggression Questionnaire (AQ) and Inventory of Statements About Self-injury (ISAS). The descriptive statistics, Shapiro-Wilk, Mann-Whitney U, Student t, Chi-square, Spearman correlation tests were used for analyzing data. RESULTS The mean scores of AQ all subscales and the total scale of healthy adolescents were higher than adolescents with T1DM (p<0.05). Mean ISAS scores of adolescents with T1DM were higher than the healthy ones (p>0.05). The mean scores of autonomic function, social function and ISAS were positively moderately correlated with the mean scores of total aggression in both healthy and diabetic adolescents (p<0.05). CONCLUSIONS Considering the age period characteristics, training about anger-stress management and effective communication skill to adolescents and their parents may be recommended by health professionals.
Collapse
Affiliation(s)
- Yagmur Sezer Efe
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Emine Erdem
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| |
Collapse
|
31
|
The Prevalence of Depression among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis, 2018. DEPRESSION RESEARCH AND TREATMENT 2018; 2018:6135460. [PMID: 29951313 PMCID: PMC5989296 DOI: 10.1155/2018/6135460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/28/2018] [Accepted: 04/12/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. Depression is one of the major important public health problems that is often comorbid with diabetes. Despite the huge effect of comorbid depression and diabetes, the overall pooled prevalence of depression among diabetic patients in the country level remains unknown. Therefore, the objective of this systematic review and meta-analysis is to estimate the pooled prevalence of depression among patients with diabetes mellitus in Ethiopia. METHOD Data extraction was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, Embase, and PsycINFO. All statistical analyses were done using STATA version 11 software using random effects model. The pooled prevalence was presented in forest plots. RESULTS A total of 9 studies with 2944 participants were included in this meta-analysis and the overall pooled estimated prevalence of depression among diabetic patients in Ethiopia was 39.73% (95% CI (28.02%, 51.45%)). According to subgroup analysis the estimated prevalence of depression in Addis Ababa was 52.9% (95% CI: 36.93%, 68.88%) and in Oromia region was 45.49% (95% CI: 41.94, 49.03%). CONCLUSION The analysis revealed that the overall prevalence of comorbid depression among diabetic patients in Ethiopia was high. Therefore, Ministry of Health should design multisectorial approach and context specific interventions that address this comorbid depression in this specific group as well as general population.
Collapse
|
32
|
Chowdhury SH, Karim MN, Selim S, Ahmed F, Azad AK, Maksud SA, Rahaman MFU, Uddin MF, Chowdhury MAJ. Risk of depression among Bangladeshi type 2 diabetic patients. Diabetes Metab Syndr 2017; 11 Suppl 2:S1009-S1012. [PMID: 28736257 DOI: 10.1016/j.dsx.2017.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to examine the strength and consistency of the relationship between depression and diabetes in Bangladeshi population. METHODS The study was conducted at the medicine department of Bangabandhu Shiekh Mujib Medical University (BSMMU) during May 2012 to May 2013. Equal number of type 2 diabetes mellitus (T2DM) patients and non-diabetic subjects (patient attendants) were recruited from outpatient department matching for age (±2 years) and gender. Demographic and anthropometric data were collected from all the subjects. Depression was assessed using, Hospital Anxiety and Depression Scale (HADS) questionnaire. A subject with a score above 8 was considered as depressive. Baseline characteristics of diabetic and non-diabetic participants were compared using chi square test. Multivariable logistic regression was performed to assess the association between diabetes and depression adjusting for all plausible confounders in the model. RESULTS 24.8% non-diabetic and 56.2% diabetic subjects were found to have depression. Statistically significant difference was found in income, waist-to-hip ratio between diabetic and non-diabetic subjects (P<0.001). Diabetic patients show 7-fold greater odds of having depression in comparison to their non-diabetic counterpart [OR 7.0, 95% CI (3.4, 14.3)]. Female gender appeared as significant predictor of depression [OR 4.3, 95% CI (2.1, 8.9)]. CONCLUSIONS In Bangladeshi population, people with diabetes are 7 times more likely to have co-existing depression in comparison to non-diabetic subjects. Further studies are required to establish the nature of the relationship between depression and T2DM.
Collapse
Affiliation(s)
| | - M N Karim
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Australia.
| | - S Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - F Ahmed
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - A K Azad
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - S A Maksud
- Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - M F U Rahaman
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - M F Uddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - M A J Chowdhury
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| |
Collapse
|
33
|
Pan S, Liu ZW, Shi S, Ma X, Song WQ, Guan GC, Zhang Y, Zhu SM, Liu FQ, Liu B, Tang ZG, Wang JK, Lv Y. Hamilton rating scale for depression-24 (HAM-D 24) as a novel predictor for diabetic microvascular complications in type 2 diabetes mellitus patients. Psychiatry Res 2017; 258:177-183. [PMID: 28774662 DOI: 10.1016/j.psychres.2017.07.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022]
Abstract
The study was designed to investigate whether the hamilton rating scale for depression (24-items) (HAM-D24) can be used to predict the diabetic microvascular complications in type 2 diabetes mellitus (T2DM) patients. 288 hospitalized patients with T2DM were enrolled. Their diabetic microvascular complications including diabetic nephropathy, diabetic retinopathy, diabetic peripheral neuropathy and diabetic foot as well as demographic, clinical data, blood samples and echocardiography were documented. All the enrolled patients received HAM-D24 evaluation. The HAM-D24 score and incidence of depression in T2DM patients with each diabetic microvascular complication were significantly higher than those in T2DM patients without each diabetic microvascular complication. After the adjustment of use of insulin and hypoglycemic drug, duration of T2DM, mean platelet volume, creatinine, albumin, fasting glucose, glycosylated hemoglobin type A1C, left ventricular ejection fraction, respectively, HAM-D24 score was still significantly associated with diabetic microvascular complications (OR = 1.188-1.281, all P < 0.001). The AUC of HAM-D24 score for the prediction of diabetic microvascular complication was 0.832 (0.761-0.902). 15 points of HAM-D24 score was considered as the optimal cutoff with the sensitivity of 0.778 and specificity of 0.785. In summary, HAM-D24 score may be used as a novel predictor of diabetic microvascular complications in T2DM patients.
Collapse
Affiliation(s)
- Shuo Pan
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Zhong-Wei Liu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Shuang Shi
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Xun Ma
- Department of Emergency Medicine, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Wen-Qian Song
- Department of Internal Medicine, University Hospital of Northwest University, Xi'an, Shaanxi, People's Republic of China
| | - Gong-Chang Guan
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Yong Zhang
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Shun-Ming Zhu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Fu-Qiang Liu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Bo Liu
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Zhi-Guo Tang
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Jun-Kui Wang
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China.
| | - Ying Lv
- First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China.
| |
Collapse
|
34
|
Wang J, Wu X, Lai W, Long E, Zhang X, Li W, Zhu Y, Chen C, Zhong X, Liu Z, Wang D, Lin H. Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open 2017; 7:e017173. [PMID: 28838903 PMCID: PMC5640125 DOI: 10.1136/bmjopen-2017-017173] [Citation(s) in RCA: 237] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Depression and depressive symptoms are common mental disorders that have a considerable effect on patients' health-related quality of life and satisfaction with medical care, but the prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties. DESIGN Systematic review and meta-analysis. DATA SOURCES AND ELIGIBILITY CRITERIA The PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2 tests and the I2 statistic. The study protocol has been registered with PROSPERO under number CRD42017054738. RESULTS Eighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ 2 =25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%). CONCLUSION Our study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial heterogeneity between studies was not fully explained by the variables examined.
Collapse
Affiliation(s)
- Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Weiyi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Erping Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xiaojian Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Dongni Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| |
Collapse
|
35
|
Hall KK, Tambekou J, Penn L, Camara A, Balde NM, Sobngwi E. Association between depression, glycaemic control and the prevalence of diabetic retinopathy in a diabetic population in Cameroon. S Afr J Psychiatr 2017; 23:983. [PMID: 30263178 PMCID: PMC6138139 DOI: 10.4102/sajpsychiatry.v23i0.983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/30/2017] [Indexed: 12/03/2022] Open
Abstract
Purpose The prevalence of diabetes mellitus is increasing especially in low- and middle-income countries in which 75% of the world’s diabetic population reside. The macro- and microvascular complications of diabetes such as diabetic retinopathy are also set to increase in these populations. The relationship between depression and glycaemic control has been established in high-income countries, but evidence from low- and middle-income countries is scarce. This research aimed to determine an association between depression and glycaemic control and record the prevalence of diabetic retinopathy in a diabetic population in Cameroon. Methods Analysis of cross-sectional data from the ‘Improving access to HbA1c measurements in sub-Saharan Africa’ study was used. Primary data were collected from six diabetic care facilities in Yaoundé, Cameroon. Participants were aged ≥ 18 years with at least a 6-month history of diabetes. Depression was assessed using the Centre for Epidemiological Studies Depression Scale (CES-D). A CES-D score ≥ 16 was used to identify the presence of clinically significant depressive symptoms. Data on glycaemic control were measured using HbA1c measurements at baseline. The presence of diabetic retinopathy was established through ophthalmoscopy and angiography using the Early Treatment Diabetic Retinopathy Study classification. Results A total of 261 participants were included in the study, and information on depressive symptoms at baseline (CES-D score) were available for 240 participants. The results of the data analysis found that 60% of the study participants had clinically significant depressive symptoms (CES-D > 16). A weak non-significant positive correlation was found between CES-D score and HbA1c level (p = 0.46, r = 0.05) using the Pearson’s correlation co-efficient. Gender and attendance to a patient support group were significantly associated with the presence of clinically significant depressive symptoms. Poor glycaemic control (HbA1c > 7%) was found in 72.8% of the population. Educational level and insulin use were significantly associated with glycaemic control. The prevalence of diabetic retinopathy was 27.2% (23.4% non-proliferative, 2.5% pre-proliferative and 3.2% proliferative), and the prevalence of diabetic maculopathy was 10.0%. Conclusion The study found that a large proportion of diabetic patients may be experiencing depressive symptoms for which they are currently not receiving treatment or support. We also found a large proportion to have poor glycaemic control that is known to worsen the vascular complications of diabetes. In light of the increasing epidemic of type 2 diabetes in sub-Saharan Africa, it is important that the recognition of depressive symptoms becomes integrated into future healthcare policies in the nations of sub-Saharan Africa. This research suggests that individuals experiencing depressive symptoms may be more likely to engage in patient support groups. These groups can be beneficial in providing patients with diabetes valuable information, which could lead to better glycaemic control.
Collapse
Affiliation(s)
- Kirsty K Hall
- Institute of Health and Society, Newcastle University, United Kingdom
| | | | - Linda Penn
- Institute of Health and Society, Newcastle University, United Kingdom
| | - Alioune Camara
- Department of Endocrinology, University Hospital, Guinea
| | - Naby M Balde
- Department of Endocrinology, University Hospital, Guinea
| | - Eugene Sobngwi
- Institute of Health and Society, Newcastle University, United Kingdom
| |
Collapse
|
36
|
Pouwer F. Fatigue in type 1 diabetes: an understudied problem. Lancet Diabetes Endocrinol 2017; 5:409-410. [PMID: 28462868 DOI: 10.1016/s2213-8587(17)30137-7] [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: 03/14/2017] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| |
Collapse
|
37
|
Naskar S, Victor R, Nath K. Depression in diabetes mellitus-A comprehensive systematic review of literature from an Indian perspective. Asian J Psychiatr 2017; 27:85-100. [PMID: 28558904 DOI: 10.1016/j.ajp.2017.02.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 02/18/2017] [Accepted: 02/18/2017] [Indexed: 12/18/2022]
Abstract
UNLABELLED Diabetes and depression are rapidly growing chronic health conditions that have significant negative impact upon the physical, psychological, social and occupational functioning, quality of life and often leads to socio-economic burden. Presence of both these comorbid diseases results in various short term and long term complications and increases the mortality as compared to those with depression or diabetes alone. OBJECTIVES Systematic review of the epidemiological data, risk factors and relationship between depression and glycaemic control among the Indian studies. METHODS We searched Pubmed, Pubmed Central, Google Scholar and Directory of Open Access Journal (DOAJ) databases to identify relevant Indian studies. RESULTS Substantial variation in the prevalence of depression in people with diabetes was found across the 41 selected studies; according to this review the range is 2% to 84% (T1DM - 2-7%; T2DM - 8%-84%). Correlates of depression in diabetic patients are advancing age, female gender, low literacy rate, burden of being from a lower socioeconomic status, rural domicile, marriage and duration of diabetes of >2years, diabetes related complications and poor glycaemic control. Sedentary life without adequate physical activities, lack of self-care are often the factors that precipitates depression in a T2DM patient and vice versa. CONCLUSION According to this review, among Indian population there is a significant association between depression and diabetes.
Collapse
Affiliation(s)
- Subrata Naskar
- Department of Neuropsychiatry, Institute of Neurosciences, Kolkata, West Bengal, India.
| | - Robin Victor
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Kamal Nath
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| |
Collapse
|
38
|
Stoop CH, Nefs G, Pop VJ, Pouwer F. Screening for and subsequent participation in a trial for depression and anxiety in people with type 2 diabetes treated in primary care: Who do we reach? Prim Care Diabetes 2017; 11:273-280. [PMID: 28330680 DOI: 10.1016/j.pcd.2017.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/26/2017] [Indexed: 01/28/2023]
Abstract
AIMS This study investigated (factors related to) (a) the response to a screening procedure for depression and anxiety in people with type 2 diabetes in primary care, and (b) participation in a subsequent randomised controlled trial targeting depressive or anxiety symptoms. METHODS People with type 2 diabetes (n=1837) received a screening questionnaire assessing depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7). Eligible persons who scored above the cut-off score (PHQ-9≥7 or GAD-7≥8) were offered to participate in the trial. RESULTS In total, 798 people (43%) returned the screening questionnaire. Non-responders were more often female (53% vs 44%, p<0.001), had higher LDL cholesterol levels (Cohen's d=0.17, p=0.001) and a higher albumin/creatinine ratio (Cohen's d=0.08, p=0.01). In total, 130 people (18%) reported elevated depressive or anxiety symptoms. Twenty-seven persons agreed to participate in the trial. Factors related to participation were a high education level, a higher level of diabetes distress and a history of psychological problems. CONCLUSIONS Using screening as recruitment resulted in a small number of participants in a treatment trial for anxiety and depression. Research is needed to investigate whether screening is also followed by a low uptake of treatment in primary care outside a RCT setting.
Collapse
Affiliation(s)
- Corinne H Stoop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands; PoZoB, PO Box 312, 5500 AH Veldhoven, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
| | - Victor J Pop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - François Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| |
Collapse
|
39
|
Economic Utility: Combinatorial Pharmacogenomics and Medication Cost Savings for Mental Health Care in a Primary Care Setting. Clin Ther 2017; 39:592-602.e1. [DOI: 10.1016/j.clinthera.2017.01.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/20/2022]
|
40
|
|
41
|
Prinz N, Ebner S, Grünerbel A, Henkelüdecke U, Hermanns N, Hummel M, Schäfer C, Wagner C, Weiland J, Welp R, Holl RW. Female sex, young age, northern German residence, hypoglycemia and disabling diabetes complications are associated with depressed mood in the WHO-5 questionnaire - A multicenter DPV study among 17,563 adult patients with type 2 diabetes. J Affect Disord 2017; 208:384-391. [PMID: 27810722 DOI: 10.1016/j.jad.2016.08.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/14/2016] [Accepted: 08/28/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Like other mental illnesses, depression is a culturally sensitive topic. Hence, findings cannot be transferred between countries. We investigated the frequency of depressed mood and its association with diabetes-related factors in a large type 2 diabetes (T2D) cohort from real-life care in Germany. METHODS 17,563 adults (median [IQR]: 64.5[55.9-71.1] years) from the multicenter diabetes follow-up registry, DPV (diabetes prospective follow-up), were investigated. All had completed the WHO-5 questionnaire, a screening tool for depression. Logistic regression was applied to study the association of demographic and diabetes-related factors with depressed mood (SAS 9.4). P<0.05 was considered significant. RESULTS Using a WHO-5 cut-off of <13, 27.4% of patients were at risk for depressed mood. A clinical depression diagnosis was recognized in 8.4%. Female sex (OR: 1.5[95%-CI: 1.4-1.6]), young age (1.2[1.1-1.4]), longer diabetes duration (1.2[1.1-1.3]), and living in Northern Germany (1.3[1.2-1.4]) were each associated with increased odds for depressed mood. After adjusting for these confounders, worse glycemic control (1.4[1.3-1.5]), insulin use (1.3[1.2-1.4]), myocardial infarction (1.3[1.2-1.5]), stroke (1.8[1.5-2.0]), retinopathy (1.4[1.3-1.6]), renal failure (1.4[1.2-1.8]), diabetic foot syndrome (1.3[1.2-1.4]), severe hypoglycemia (1.5[1.2-1.9]), two or more inpatient admissions (2.1[1.8-2.4]), and longer duration of hospital stay (1-<14 days: 1.3[1.2-2.3]; >14 days: 2.1[1.9-2.3]) were related to depressed mood. LIMITATION Due to the cross-sectional design, no causality can be drawn. CONCLUSIONS In T2D, depressed mood is not uncommon. However, in routine care a clinical depression might be missed and regular screening is advisable. Besides the well-known associations with depressed mood, northern German residence and mainly life-compromising diabetes comorbidities were identified as related factors.
Collapse
Affiliation(s)
- Nicole Prinz
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Stefan Ebner
- Medical Campus III, Clinic for Internal Medicine 2 - Nephrology, Endocrinology/Diabetes, Rheumatology and Gastroenterology/Hepatology, Kepler University Hospital, Linz, Austria
| | - Arthur Grünerbel
- Specialized Practice for Diabetes and Nutritional Medicine, Munich, Germany
| | - Uwe Henkelüdecke
- Internal Medicine, Hospital Malteser St. Johannes-Stift, Duisburg, Germany
| | | | | | - Claus Schäfer
- Internal Medicine, Hospital Neumarkt, Neumarkt, Germany
| | | | - Jörg Weiland
- Internal Medicine, Hospital Bad Reichenhall, Bad Reichenhall, Germany
| | - Reinhard Welp
- Internal Medicine, Knappschafts-Krankenhaus, Bottrop, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| |
Collapse
|
42
|
Schmidt CB, Potter van Loon BJ, Torensma B, Snoek FJ, Honig A. Ethnic Minorities with Diabetes Differ in Depressive and Anxiety Symptoms and Diabetes-Distress. J Diabetes Res 2017; 2017:1204237. [PMID: 28373992 PMCID: PMC5360952 DOI: 10.1155/2017/1204237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/20/2017] [Accepted: 02/19/2017] [Indexed: 01/14/2023] Open
Abstract
Objective. To determine the association between ethnicity, diabetes-distress, and depressive and anxiety symptoms in adult outpatients with diabetes. Research Design and Methods. Diabetes-distress (Problem Areas in Diabetes Scale, PAID5), depressive and anxiety symptoms (Extended Kessler-10, EK10), and quality of life (Short-Form 12, SF12) were assessed in an ethnic diverse diabetes outpatient population of a teaching hospital in Amsterdam. Descent of one's parents and self-classified ethnicity were obtained to define ethnicity. HbA1c, clinical data, and socioeconomic status were derived from the medical charts. Based on established cut-offs for PAID5- and EK10-scores, emotional distress was dichotomized for the purpose of logistic regression analyses. Results. Of 1007 consecutive patients approached, 575 participated. Forty-nine percent were of non-Dutch ethnicity and 24.7% had type 1 diabetes. Diabetes-distress was reported by 12.5% of the native Dutch patients and by 22.0%, 34.5%, and 42.6% of the Surinamese, Turkish, and Moroccan patients, respectively. Prevalence of depressive symptoms was 9.4% in native Dutch patients and 20.4%, 34.5%, and 27.3% in the other groups mentioned. Diabetes-distress and Moroccan origin were significantly associated (OR = 3.60, p < .01) as well as depressive symptoms and Turkish origin (OR = 4.23, p = .04). Conclusions. Different ethnic minorities with diabetes vary in their vulnerability for emotional distress, warranting clinical attention. Future research should elucidate explanatory factors and opportunities for tailored interventions.
Collapse
Affiliation(s)
- Charlotte B. Schmidt
- Department of Psychiatry, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- *Charlotte B. Schmidt:
| | | | - Bart Torensma
- Department of Epidemiology and Biostatistics, Onze Lieve Vrouwe Gasthuis OLVG, Amsterdam, Netherlands
| | - Frank J. Snoek
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Medical Psychology, Academic Medical Centre (AMC), Amsterdam, Netherlands
- Department of Medical Psychology, VU University Medical Centre (VUMC), Amsterdam, Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands
- Department of Psychiatry, VU Medical Centre (VUmc), Amsterdam, Netherlands
| |
Collapse
|
43
|
Kampling H, Petrak F, Farin E, Kulzer B, Herpertz S, Mittag O. Trajectories of depression in adults with newly diagnosed type 1 diabetes: results from the German Multicenter Diabetes Cohort Study. Diabetologia 2017; 60:60-68. [PMID: 27787619 DOI: 10.1007/s00125-016-4123-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/31/2016] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS There is a paucity of longitudinal data on type 1 diabetes and depression, especially in adults. The present study prospectively analysed trajectories of depressive symptoms in adults during the first 5 years of living with type 1 diabetes. We aimed to identify distinct trajectories of depressive symptoms and to examine how they affect diabetes outcome. METHODS We reanalysed data from a prospective multicentre observational cohort study including 313 adults with newly diagnosed type 1 diabetes. At baseline and in annual postal surveys over 5 consecutive years, we gathered patient characteristics and behavioural and psychosocial data (e.g. Symptom Checklist-90-R [SCL-90-R]). Medical data (e.g. HbA1c levels) was obtained from the treating physicians. We applied growth mixture modelling (GMM) to identify distinct trajectories of depression over time. RESULTS Five years after diagnosis, 7.8% (n = 20) of patients were moderately depressed and 10.2% (n = 26) were severely depressed. GMM statistics identified three possible models of trajectories (class 1, 'no depressive symptoms'; class 2, 'worsening depressive symptoms that improve after 2 years'; class 3, 'worsening depressive symptoms'). Severity of depression symptoms at baseline (subscale of the SCL-90-R questionnaire) significantly predicted membership of classes 2 and 3 vs class 1. After 5 years, higher HbA1c values were detected in class 3 patients (mean = 8.2%, 66 mmol/mol) compared with class 1 and class 2 (both: mean = 7.2%, 55 mmol/mol). CONCLUSIONS/INTERPRETATION We identified distinct trajectories of depressive symptoms that are also relevant for diabetes outcome. Patients with worsening depressive symptoms over time exhibited poor glycaemic control after the first 5 years of living with diabetes. They also exhibited a reduced quality of life and increased diabetes-related distress.
Collapse
Affiliation(s)
- Hanna Kampling
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 49, 79106, Freiburg, Germany.
| | - Frank Petrak
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Bochum, Germany
- Center for Psychotherapy Wiesbaden, Wiesbaden, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 49, 79106, Freiburg, Germany
| | - Bernd Kulzer
- Diabetes Center Mergentheim, Germany; Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Bochum, Germany
| | - Oskar Mittag
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 49, 79106, Freiburg, Germany
| |
Collapse
|
44
|
Comorbidity of depression and diabetes: an application of biopsychosocial model. Int J Ment Health Syst 2016; 10:74. [PMID: 27980612 PMCID: PMC5135819 DOI: 10.1186/s13033-016-0106-2] [Citation(s) in RCA: 14] [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: 06/22/2016] [Accepted: 11/25/2016] [Indexed: 02/06/2023] Open
Abstract
Background Type 2 diabetes (T2D) is one of the most psychologically demanding chronic medical illness in adult. Comorbidity between diabetes and depression is quite common, but most studies were based on developed country sample. Limited data exists to document biopsychosocial predictors of depressive symptoms in Ethiopian patients. Therefore, the aim of the study was to describe the association of depressive symptoms and T2D and explore the potential underlying associated biopsychosocial risk factors. Methods Institution based cross-sectional study was conducted on 276 patient with T2D at diabetic clinic, Black Lion General Specialized Hospital in Ethiopia. Patients were selected using systematic random sampling technique. Depressive symptoms score, which constructed from a validated nine-item Patient Health Questionnaire (PHQ-9), was an outcome variable. Finally, significant associated factors were identified using multiple linear regression analysis with backward elimination procedure. Statistical Package for Social Science (SPSS) version 22.0 (IBM SPSS Corp.) was used to perform all analysis. Results Total of 264 patient data was analyzed with 95.7% response rate. Patients mean (SD) current age and age at diagnosis was 55.9 (10.9) and 43.9 (10.9) years, respectively. Patients waist circumference (mean ± SD) was 98.9 ± 11.1 cm. The average PHQ-9 score was 4.9 (SD 4.1) and fasting blood glucose was 166.4 (SD 73.2). Marital status (divorced), occupation (housewife), diabetic complication (nephropathy), negative life event in the last six months, and poor social support significantly associated with increased mean PHQ-9 score after adjustment for covariates. Whereas not fearing diabetic-related complication and death significantly lower mean PHQ-9 score. Conclusion Biopsychosocial variables including marital status, negative life event in the last 6 months, occupation, diabetic complication, and poor social support significantly increase average depressive symptoms score. Evidence-based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0106-2) contains supplementary material, which is available to authorized users.
Collapse
|
45
|
Wang RH, Hsu HC, Kao CC, Yang YM, Lee YJ, Shin SJ. Associations of changes in psychosocial factors and their interactions with diabetes distress in patients with type 2 diabetes: a longitudinal study. J Adv Nurs 2016; 73:1137-1146. [PMID: 27862194 DOI: 10.1111/jan.13201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 11/26/2022]
Abstract
AIM To assess the associations of changes in self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment and their interactions with changes in diabetes distress in patients with type 2 diabetes mellitus. BACKGROUND Many patients with type 2 diabetes mellitus experience diabetes distress. Few longitudinal studies have investigated the associations of changes in various psychosocial factors with changes in diabetes distress in patients with type 2 diabetes mellitus. DESIGN This study adopted a longitudinal design. Data were collected at baseline and 12 months later. METHODS Overall, 304 patients with type 2 diabetes were recruited from four hospitals in southern Taiwan by convenience sampling. A self-report questionnaire and medical record were used to collect demographic data, clinical indicators, self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment, and diabetes distress. Data were collected from February 2014-March 2015. RESULTS/FINDINGS An increase in resilience or diabetes self-efficacy significantly associated with a decrease in diabetes distress, whereas an increase in patient empowerment significantly associated with an increase in diabetes distress. The interactions between increase in patient empowerment and increase in self-management behaviours significantly associated with decrease in diabetes distress. CONCLUSION Nurses could endeavour to improve the diabetes self-efficacy and resilience to reducing diabetes distress. Arbitrarily empowering patients may increase diabetes distress. Increasing self-care management behaviours and patient empowerment might need to be simultaneously addressed to reduce the diabetes distress in patients with type 2 diabetes.
Collapse
Affiliation(s)
- Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Taiwan
| | - Hui-Chun Hsu
- Department of Diabetes Management, Lee's Endocrinology Clinic, Pingtung, Taiwan
| | - Chia-Chan Kao
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
| | - Yung-Mei Yang
- College of Nursing, Kaohsiung Medical University, Taiwan
| | | | - Shyi-Jang Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
| |
Collapse
|
46
|
D'Amato C, Morganti R, Greco C, Di Gennaro F, Cacciotti L, Longo S, Mataluni G, Lauro D, Marfia GA, Spallone V. Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities. Diab Vasc Dis Res 2016; 13:418-428. [PMID: 27334483 DOI: 10.1177/1479164116653240] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To investigate the independent effect on depression of painless diabetic polyneuropathy, painful diabetic polyneuropathy, and general and diabetes-related comorbidities. METHODS In 181 patients, the presence of painless diabetic polyneuropathy, painful diabetic polyneuropathy, comorbidities and depression was assessed using the Michigan Neuropathy Screening Instrument Questionnaire, the Michigan Diabetic Neuropathy Score, nerve conduction studies, the Douleur Neuropathique en 4 Questions, the Charlson Comorbidity Index and the Beck Depression Inventory-II. RESULTS In all, 46 patients met the criteria of confirmed painless diabetic polyneuropathy and 25 of painful diabetic polyneuropathy. Beck Depression Inventory-II scores indicative of mild-moderate-severe depression were reached in 36 patients (19.7%). In a multiple logistic regression analysis (including age, sex, body mass index, being unemployed, duration, haemoglobin A1c, insulin treatment, systolic blood pressure, nephropathy, retinopathy, Charlson Comorbidity Index and painful diabetic polyneuropathy), female sex (odds ratio: 5.9, p = 0.005) and painful diabetic polyneuropathy (odds ratio: 4.6, p = 0.038) were the only independent predictors of depression. Multiple regression analysis, including Douleur Neuropathique en 4 Questions and Michigan Diabetic Neuropathy Score instead of painful diabetic polyneuropathy, showed that Douleur Neuropathique en 4 Questions, in addition to female sex, was a significant predictor of depressive symptoms severity (p =0.005). CONCLUSION Painful diabetic polyneuropathy is a greater determinant of depression than other diabetes-related complications and comorbidities. Painful symptoms enhance depression severity more than objective insensitivity.
Collapse
Affiliation(s)
- Cinzia D'Amato
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Morganti
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carla Greco
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Federica Di Gennaro
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Laura Cacciotti
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Susanna Longo
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgia Mataluni
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Lauro
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Girolama A Marfia
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Vincenza Spallone
- Endocrinology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
47
|
Sun N, Lou P, Shang Y, Zhang P, Wang J, Chang G, Shi C. Prevalence and determinants of depressive and anxiety symptoms in adults with type 2 diabetes in China: a cross-sectional study. BMJ Open 2016; 6:e012540. [PMID: 27531739 PMCID: PMC5013513 DOI: 10.1136/bmjopen-2016-012540] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To evaluate the prevalence and determinants of anxiety and depression and to assess their impact on glycaemic control in participants with type 2 diabetes mellitus. DESIGN A cross-sectional study. SETTING Community-based investigation in Xuzhou, China. PARTICIPANTS 893 Chinese men and women aged 18-84 years who fulfilled the inclusion criteria. METHODS People with type 2 diabetes completed the Pittsburgh Sleep Quality Index and the Zung Self-Rating Anxiety and Depression Scales. Demographic and physiological characteristics were recorded. Multiple logistic regression was used to evaluate the combined effect of factors associated with anxiety and depression and to assess the effects of anxiety and depression on glycaemic control. RESULTS The prevalence of depressive symptoms and anxiety symptoms was 56.1% and 43.6%, respectively. Multivariate logistic regression analysis indicated that anxiety symptoms were associated with being woman, low income, chronic disease, depressive symptoms and poor sleep quality. Depressive symptoms were associated with being woman, older age, low education level, being single, diabetes complications, anxiety symptoms and poor sleep quality. Glycaemic control was not related to anxiety symptoms (OR=1.31, 95% CIs 0.94 to 1.67) or depressive symptoms (OR=1.23, 95% CI 0.85 to 1.63). A combination of depressive symptoms and anxiety symptoms was associated with poor glycaemic control (relative excess risk due to interaction: 4.93, 95% CI 2.09 to 7.87; attributable proportion due to interaction: 0.27, 95% CI 0.12 to 0.45). CONCLUSIONS There was a high prevalence of depressive and anxiety symptoms in this Chinese sample of participants, although depression and anxiety were not singly associated with glycaemic control. However, a combination of depressive and anxiety symptoms was negatively correlated with glycaemic control in participants with type 2 diabetes.
Collapse
Affiliation(s)
- Nianquan Sun
- Department of Endocrinology, Xuzhou Third People's Hospital, Xuzhou, China
| | - Peian Lou
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Yan Shang
- Department of Endocrinology, Xuzhou Third People's Hospital, Xuzhou, China
| | - Pan Zhang
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Jian Wang
- Department of Endocrinology, Xuzhou Third People's Hospital, Xuzhou, China
| | - Guiqiu Chang
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, The School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Chunlei Shi
- Department of Non-communicable Disease Control, Xuzhou Center for Disease Control and Prevention, The School of Public Health, Xuzhou Medical University, Xuzhou, China
| |
Collapse
|
48
|
Bartoli F, Carrà G, Crocamo C, Carretta D, La Tegola D, Tabacchi T, Gamba P, Clerici M. Association between depression and neuropathy in people with type 2 diabetes: a meta-analysis. Int J Geriatr Psychiatry 2016; 31:829-36. [PMID: 26729627 DOI: 10.1002/gps.4397] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/20/2015] [Accepted: 11/05/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Depression and neuropathy are frequent complications of type 2 diabetes. The current meta-analysis aimed to estimate the association between depression and neuropathy in subjects with type 2 diabetes. METHODS We systematically searched electronic databases for articles published up to February 2015, providing data on the association between depression and neuropathy in individuals with type 2 diabetes. No language restrictions were applied. The meta-analysis generated random-effect odds ratios with 95% confidence intervals (95% CI). Risk of publication bias and heterogeneity were estimated using the Egger test and I(2) index, respectively. Leave-one-out analysis was performed. Data were analysed using stata. RESULTS Thirteen studies were included in the meta-analysis. Data on the association between depression and neuropathy were available for 3898 individuals with type 2 diabetes. Pooled analysis showed an association between depression and neuropathy, with an odds ratio of 2.01 (95% CI: 1.60-2.54; p < 0.001). There was no risk of publication bias (p = 0.064), and heterogeneity was moderate (I(2) = 44.5%). Leave-one-out analysis confirmed consistency of the findings. The association appeared partly influenced by age, because studies selecting older people (sample mean age > 65 years) showed a slightly higher estimate for the association. CONCLUSIONS We found an association between depression and neuropathy among people with type 2 diabetes. Because of the cross-sectional nature of included studies, the relationship between these two conditions might be bidirectional. Further research exploring factors that might moderate or mediate this association is needed. Targeted interventions for comorbid depression and neuropathy should be implemented in clinical practice. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| | - Giuseppe Carrà
- Division of Psychiatry (Formerly Mental Health Sciences), University College London, London, UK
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| | - Daniele Carretta
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| | - Davide La Tegola
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| | - Tommaso Tabacchi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| | - Pierluigi Gamba
- Diabetes Unit, Division of Clinical Medicine, San Gerardo Hospital, Monza (MB), Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| |
Collapse
|
49
|
Mocan AS, Iancu SS, Duma L, Mureseanu C, Baban AS. Depression in romanian patients with type 2 diabetes: prevalence and risk factors. ACTA ACUST UNITED AC 2016; 89:371-7. [PMID: 27547056 PMCID: PMC4990432 DOI: 10.15386/cjmed-641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/29/2016] [Indexed: 01/21/2023]
Abstract
Background and aims Co-existing major depression was found to have a negative impact on the diabetes outcome and the quality of life. The aim of the present study was to assess the prevalence of depressive symptoms in Romanian diabetes patients and to identify the risk factors associated with depression. Methods A total of 144 type 2 diabetes patients were included in the study. Five models of presumed predictors were used to assess the risk factors for depressive symptoms, using hierarchical regression analysis. Together with demographics, disease, lifestyle predictors, previous depressive symptoms and diabetes distress were taken into account. Results In our sample the prevalence of depression was 12.6%. Main risk factors for depressive symptoms were previous depressive symptoms which were associated with depression in both Model 4 (β=0.297, p=0.013) and Model 5 (β=0.239, p=0.017) and diabetes distress in Model 5 (β=0.540, p≤0.001). Employment (β =−0.276, p=0.029) and increased number of diabetes complications (β=0.236, p=0.017) became significant when diabetes distress was added to the analysis. Conclusions The overall prevalence of depressive symptoms was found to be in range with the prevalence identified in the literature. Previous depression and diabetes distress were both independently associated with depression, confirming the bidirectional relationship between depression and diabetes distress. Due to the consequences for daily living, screening for diabetes distress and depression should be done in primary care units both by physicians and trained nurses.
Collapse
Affiliation(s)
- Andreia S Mocan
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital Cluj, Romania; Department of Psychology and Educational Sciences, Babes-Bolyai University, Cluj, Romania
| | - Silvia S Iancu
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital Cluj, Romania
| | - Livia Duma
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital Cluj, Romania
| | - Camelia Mureseanu
- Department of Psychology and Educational Sciences, Babes-Bolyai University, Cluj, Romania
| | - Adriana S Baban
- Department of Psychology and Educational Sciences, Babes-Bolyai University, Cluj, Romania
| |
Collapse
|
50
|
Habtewold TD, Alemu SM, Haile YG. Sociodemographic, clinical, and psychosocial factors associated with depression among type 2 diabetic outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMC Psychiatry 2016; 16:103. [PMID: 27083154 PMCID: PMC4833927 DOI: 10.1186/s12888-016-0809-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/08/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Depression is a common comorbidity among patients with type 2 diabetes. There are several reports supporting a bidirectional association between depression and type 2 diabetes. However, there is limited data from non-western countries. Therefore, the aim of this study was to assess the sociodemographic, clinical, and psychosocial factors associated with co-morbid depression among type 2 diabetic outpatients presenting to Black Lion General Specialized Hospital, Addis Ababa, Ethiopia. METHODS This institution based cross-sectional study design was conducted on a random sample of 276 type 2 diabetic outpatients. Type 2 diabetes patients were evaluated for depression by administering a validated nine-item Patient Health Questionnaire (PHQ-9). Risk factors for depression among type 2 diabetes patients were identified using multiple logistic regression analysis. RESULT In total, 264 study participants were interviewed with a response rate of 95.6%. The prevalence of depression was 44.7%. In the multivariate analysis, the statistically significant risk factors for depression were monthly family income ≤ 650 (p-value = 0.056; OR = 2.0; 95% CI = 1.01, 4.2), presence of ≥3 diabetic complications (p-value = 0.03; OR = 3.3; 95% CI = 1.1, 10.0), diabetic nephropathy (p-value = 0.01; OR = 2.9; 95% CI = 1.2, 6.7), negative life events (p-value = 0.01; OR = 2.4; 95% CI = 1.2, 4.5), and poor social support (p-value = 0.001; OR = 2.7; 95% CI = 1.5, 5.0). CONCLUSION This study demonstrated that depression is a common co-morbid health problem with a prevalence rate of 44.7%. The presence of diabetic complications, low monthly family income, diabetic nephropathy, negative life event, and poor social support were the statistically significant risk factors associated with depression. We presume that the burden of mental health especially depression is high in the population with type 2 diabetes mellitus co-morbidity. Therefore, specific attention is needed to diagnose early and treat promptly.
Collapse
Affiliation(s)
- Tesfa Dejenie Habtewold
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, P.O. BOX: 445, Ethiopia.
| | - Sisay Mulugeta Alemu
- International Medical Corps, Mental Health and Psychosocial Support Program, Dollo Ado Refugee Camp, Ethiopia
| | | |
Collapse
|