Indicators of self-rated health in the Canadian population with diabetes

Exploring factors associated with self-rated health in individuals with diabetes and its impact on quality of life: Evidence from the Survey of Health, Ageing, and Retirement in Europe

BACKGROUND

Self-rated health (SRH), a measure of self-reported general health, is a robust predictor of morbidity and mortality in various populations, including people with diabetes. Diabetes is negatively associated with SRH and quality of life (QoL). Little is known about how people with diabetes rate their health and which aspects influence the rating. Also, the predictive value of SRH on future QoL has not yet been evaluated.

METHODS

We analyzed data from 46 592 participants of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using linear regression, we aimed to determine which sociodemographic, socioeconomic, medical, social, mental, and health behavior factors determine SRH in people with diabetes. In addition, we analyzed the predictive value of SRH on future QoL using the generalized estimating equations procedure.

RESULTS

We determined that country, current job situation, hospitalization, pain, polypharmacy, memory, eyesight, activities of daily living, number of chronic diseases, and depression are all linked to SRH. Together these variables explained 38% of the SRH's variance, whereas depression, pain, and memory had the greatest influence on SRH of people with diabetes. We also found that SRH independently predicted future QoL, supported by a regression coefficient of β = -1.261 (Wald chi-square test, χ2 = 22.097, df = 1, p < .05).

CONCLUSIONS

As SRH is linked to future QoL, we conclude that incorporating SRH assessment into medical evaluations can help health care professionals gaining a more comprehensive understanding of an individual's health trajectory and supporting patients to enhance their QoL.

Self-rated health and its determinants in patients with hypertension in Isfahan in 2019

BACKGROUND AND OBJECTIVES

Self-rated health (SRH) serves as an assessment of contentment regarding one's social, mental, and physical well-being and has been linked to both cardiovascular mortality and morbidity. Nonetheless, the relationship between SRH and medical outcomes in individuals with hypertension unsettled. This research endeavors to pinpoint the determinants that affect SRH in Iranian patients with hypertension.

MATERIALS AND METHODS

This cross-sectional study took place in Isfahan, Iran, from November 2018 to August 2019 and involved 886 patients with essential HTN. The data collection methods included a checklist for demographic information and risk factors, blood pressure measurements (systolic and diastolic), the Persian version of the 8-Item Morisky Medication Adherence scale, and a self-rated health questionnaire recommended by the World Health Organization. Independent sample T-test and chi squared test were used for comparison of variables between two groups of SRH. Additionally, multivariable logistic regression was used to analyze the factors influencing self-rated health status.

RESULTS

Among 886 participants (mean age 57.8 ± 8.8 years, 71.9% women), 89.62% reported good SRH. Comorbid conditions were significantly associated with poorer SRH (p < 0.05). Notably, higher education (odd ratio (OR) = 1.88, 95% confidence interval (CI) = 1.13-3.11, p = 0.015) and increased income (OR = 4.34, 95% CI = 1.43-13.18, p = 0.010) were identified as positive determinants of good SRH.

CONCLUSION

We concluded that socioeconomic factors (education and income) and comorbid conditions (diabetes, hyperlipidemia, and pulmonary diseases) are risk factors for poor SRH among hypertensive patients. These findings could help planning of health enhancement initiative.

Urban-rural disparities in the prevalence and trends of depressive symptoms among Chinese elderly and their associated factors

BACKGROUND

This study aimed to examine urban-rural disparities in the prevalence and trends of depressive symptoms (DS) among Chinese elderly and associated factors.

METHODS

A total of 8025, 7808, and 4887 respondents aged 60 years and above were selected from the China Family Panel Studies (CFPS) in 2016, 2018, and 2020, respectively. DS was assessed using a short version of Center for Epidemiologic Studies Depression Scale (CES-D). Twenty-two associated factors from six categories were included in random forest (RF) models. All urban-rural comparisons were conducted based on good model performance.

RESULTS

The DS prevalence among all rural elderly was significantly higher than corresponding urban elderly. This disparity continued to widen among younger elderly, while it continued to narrow among older elderly. The top 10 common leading factors were sleep quality, self-rated health, life satisfaction, memory ability, child relationship, IADL disability, marital status, educational level, and gender. Urban-rural disparities in sleep quality, interpersonal trust, and child relationship continued to widen, while disparities in multimorbidity, hospitalization status, and frequency of family dinner continued to narrow.

LIMITATION

This study may exist recall bias and lacks causal explanation.

CONCLUSIONS

Significant and continuing disparities in the DS prevalence were observed between urban and rural elderly in China, showing opposite trends in younger and older elderly. The top 10 leading associated factors for DS were nearly consistent across urban and rural elderly, with sleep quality having strongest contribution. Urban-rural disparities in associated factors also showed different trends. This study provides a reference for mental health promotion among Chinese elderly.

Sleep Duration, Sleep Quality, and Insomnia in Association With Self-Rated Health: A Systematic Review and Meta-Analysis

Background and Objective This study undertook a systematic review and meta-analysis of the relationship between sleep duration, sleep quality, and insomnia in association with self-rated health.Methods Studies that had examined the relationship between sleep duration, sleep quality, and insomnia with self-rated health were eligible. PubMed and Scopus were the two main databases for searching for studies related to this meta-analysis. The Google Scholar database as a source of gray literature was also searched by hand. This search was from the beginning of the formation of databases until the end of January 2022, and the search language was limited to articles published in English. The Effective Public Health Practice Project Quality Assessment Tool was used to assess the quality of studies. For this meta-analysis, odds ratio and 95% confidence interval were extracted or calculated. The pool of studies was processed by the random effects method.Results Twenty-six studies were included in this meta-analysis. Sleep duration of ≤ 8 hours per day (h/d) (odds ratio = 1.58 and 95% confidence interval = [1.41–1.77]) and sleep duration of > 8 h/d (odds ratio = 1.32 and 95% confidence interval = [1.17–1.50]) are associated with poor self-rated health. Poor sleep quality and insomnia are associated with poor self-rated health. Conclusions Sleep problems have a negative effect on self-rated health, and therefore, effective interventions can help improve sleep.

People with Diabetes Have Poorer Self-Rated Health (SRH) and Diabetes Moderates the Association between Age and SRH

Diabetes is a severe chronic condition that is related to decreased physical functioning. Recently, there has been growing interest in understanding how a brief report on health such as self-rated health (SRH) could be used to track changes in health status and service needs in people with diabetes. The current research aims to investigate how SRH is affected by diabetes and how diabetes could moderate the association between age and SRH. By analyzing data from 47,507 participants, with 2869 of them clinically diagnosed with diabetes, the current study found that people with diabetes had significantly poorer SRH than people without diabetes after controlling for demographic covariates (t(2868) = -45.73, p < 0.001, 95% C.I. (-0.92, -0.85), Cohen's d = -0.85). In addition, diabetes was a significant moderator of the relationship between age and SRH (b = 0.01, p < 0.001, 95% C.I. (0.01, 0.01)). Specifically, age was more strongly related to SRH in people without diabetes (b = -0.015, p < 0.001, 95% C.I. (-0.016, -0.015)) than in people with diabetes (b = -0.007, p < 0.001, 95% C.I. (-0.010, -0.004)). Health professionals should aim to improve SRH in people with diabetes given that SRH is related to various outcomes.

Event History Analysis of Factors Affecting Survival of Older Adults in Taiwan

(1) Background: Due to rapidly increasing average age of Taiwan's population, it is very important to analyze the factors affecting the survival of older adults. (2) Methods: In this study, the 1989 Taiwan Longitudinal Study on Aging, which lasted 22 years and consisted of seven surveys, was used. Furthermore, Cox and Aalen's time-dependent frailty models were used to analyze factors that affect the survival of older adults. (3) Results: Based on past literature, we selected 15 important factors that were closely associated with the survival of older adults and constructed six models based on these factors. The study results showed that, in addition to background characteristics, physical and mental conditions, activities of daily living (ADL), physical performance, and self-rated health had a huge association with the survival of older adults. (4) Conclusions: We selected ten variables (age, gender, population, education level, ADL status, physical performance, self-rated health, smoking, chewing betel nut, and the presence of a spouse), and their combinations were used to generate reduced models, which could be considered as important markers that affect and predict the survival of older adults.

The Mediating Role of Healthy Lifestyle Behaviours on the Association between Perceived Stress and Self-Rated Health in People with Non-Communicable Disease

Perceived stress can affect people's lifestyle behaviours and self-rated health. A balanced, healthy lifestyle can alleviate experiences of stress. For clinicians to use evidence-based and theory-based knowledge in health dialogues with people with non-communicable diseases, and in order to develop more effective behavioural counselling, more knowledge is needed. Hence, this study aimed to examine the mediating role of sedentary behaviour, daily physical activity, physical exercise, and dietary habits on the association between perceived stress and self-rated health in people with or without one to four self-reported non-communicable diseases (myocardial infarction, stroke, hypertension, diabetes). The study used a cross-sectional design. Responses from in total 10,583 individuals were collected in 2016 and 2019 by a self-report questionnaire. A series of simple and multiple regression analyses were conducted to examine the mediating effects of healthy lifestyle behaviours on the association between perceived stress and self-rated health. The results show that the investigated healthy lifestyle behaviours partly mediated the association between perceived stress and self-rated health in people with no diagnosis, and in people with one or two diagnoses. It can be concluded that healthy lifestyle behaviours could probably be targeted in relation to the number of noncommunicable diseases that the individuals have.

Predicting depression among rural and urban disabled elderly in China using a random forest classifier

With global aging, the number of elderly with physical disabilities is also increasing. Compared with the ordinary elderly, the elderly who lose their independence are more likely to have the symptoms of depression. Reducing depression may help to alleviate the disability process of those who find themselves in the disabled stages. Therefore, the purpose of this study is to explore the predictive effects of demographic characteristics, health behavior, health status, family relations, social relations, and subjective attitude on depression in rural and urban disabled elderly to improve early depression symptom recognition.A total of 1460 older adults aged 60 and disabled were selected from China Family Panel Studies (CFPS). Depression was assessed according to The Center for Epidemiologic Studies Depression Scale (CES-D). This paper used the random forest classifier to predict the depression of the disabled elderly from six aspects: demographic characteristics, health status, health behavior, family relationship, and social relationship. The prediction model was established based on 70% of the training set and 30% of the test set. The depression rate of rural disabled elderly was 57.67%, and that of urban disabled elderly was 44.59%. The mean values of the 10-k cross-validated results were 0.71 in rural areas and 0.70 in urban areas. AUC:0.71, specificity: 65.3%, sensitivity: 80.6% for rural disabled elderly with depression; AUC:0.78, specificity: 78.1%, sensitivity: 64.2% for urban disabled elderly with depression, respectively. There are apparent differences in the top ten predictors between rural and urban disabled elderly. The common predictors were self-rated health, changing in perceived health, disease or accidence experience within the past 2 weeks, life satisfaction, trusting people, BMI, and having trust in the future. Non-common predictors were chronic diseases, neighborly relations, total medical expenses within 1 year, community emotion, sleep duration, and family per capita income. Using random forest data to predict the depression of the disabled elderly may lead to early detection of depression.

Patients in general practice share a common pattern of symptoms that is partly independent of the diagnosis

OBJECTIVE

To describe self-reported symptoms among patients in general practice and to explore the relationships between symptoms experienced by patients and diagnoses given by general practitioners.

DESIGN

Doctor-patient questionnaires focusing on patients' self-reported symptoms during the past 7 days and the doctors' diagnoses.

SETTING

General practices in urban and suburban areas in Southeast Norway.

SUBJECTS

Forty-seven general practitioners who included 866 patients aged ≥18 years on a random day in practice.

RESULTS

The most frequently reported symptoms were tiredness (46%), lower back pain (43%), neck pain (41%), headache (39%), shoulder pain (36%), and sleep problems (35%). Women had a significantly higher prevalence than men for 16 of 38 symptoms (p < 0.05). The mean number of symptoms was 7.5 (range, 0-32; women, 8.1; men, 6.5, p < 0.05). Regression analysis showed that patients who received a social security grant had 59% more symptoms than those who were employed and that people with asthenia and depression/anxiety had 44% and 23% more symptoms, respectively than those with all other diagnoses. The patterns of symptoms reported showed similar patterns across the five most prevalent diagnoses.

CONCLUSIONS

Patients in general practice report a number of symptoms and share a common pattern of symptoms, which appear to be partly independent of the diagnoses given. These findings suggest that symptoms are not necessarily an indication of disease.KEY POINTSPatients consulting general practitioners have a high number of self-reported symptoms.The most frequent symptoms are tiredness, lower back pain, neck pain, headache, shoulder pain, and sleep problems.Patients diagnosed with asthenia and depression/anxiety report the highest number of symptoms.Selected diagnoses show similar patterns in symptom distribution.Symptoms are not necessarily an indication of disease.

Predictors of Subjective Cognitive Decline Among People With Diabetes: Data From the Behavioral Risk Factor Surveillance System

PURPOSE

The purpose of this study was to examine the prevalence of subjective cognitive decline (SCD) and SCD-related functional limitations among people with diabetes and to identify socioeconomic and comorbidity risk factors associated with SCD.

METHODS

This study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) with background variables (race, gender, education, and age), health-related factors (self-rated health, BMI, insurance, and comorbid conditions), and health behaviors (smoking, exercise, alcohol consumption) entered simultaneously to estimate logistic regression models of SCD.

RESULTS

Within the sample (n = 5263 adults with diabetes), 48% were age ≥65 years; 50% were male; 55% were non-Hispanic White; and of the 15% who reported having SCD, 57% had functional limitations. Increased odds of reporting SCD were observed among individuals who were Hispanic (odds ratio [OR] = 2.21, P < .001), male (OR = 1.47, P < .01), depressed (OR = 3.85, P < .001), or had arthritis (OR = 1.43, P < .03). Participants with better self-rated health had a reduced likelihood of SCD (OR = 0.51, P < .001).

CONCLUSIONS

Health care providers should assess high-risk patients for self-rated cognitive dysfunction and offer early interventions.

Physical Exercise, Social Interaction, Access to Care, and Community Service: Mediators in the Relationship Between Socioeconomic Status and Health Among Older Patients With Diabetes

The differences in socioeconomic status (SES) will cause a disparity in the health of the elderly. Taking diabetes as an example, previous studies have focused on risk factors of diabetes, while the relationship and mechanism between SES, multi-faceted factors, and the health of older patients with diabetes are not well-understood. This study aims to investigate the association between SES and health in older patients with diabetes and the interrelated mediators between them. Based on the data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018, structural equation modeling (SEM) was used to test whether physical exercise, social interaction, access to care, and community service mediated the effect of SES on the health in older patients with diabetes. We found support for the model in which SES predicted the health in older patients with diabetes (comparative fit index = 0.910, incremental fit index = 0.911, goodness-of-fit index = 0.982, adjusted goodness-of-fit index = 0.959, standardized root mean square residual = 0.037, and root mean square error of approximation = 0.061). The total indirect effect of SES on the health accounted for 55.52% of the total effect. Results indicated that physical exercise (β = 0.108, p < 0.01), social interaction (β = 0.253, p < 0.001), and community service (β = 0.111, p < 0.001) had significant positive effects on the health of older patients with diabetes. SES was positively associated with physical exercise (β = 0.417, p < 0.001) and community service (β = 0.126, p < 0.01). Although no direct effect of SES on the health was found, SES mediated the positive effect in their relationship by physical exercise (indirect effect = 0.045, p < 0.01), and community service (indirect effect = 0.014, p < 0.05). This study showed the health disparities of older patients with diabetes were influenced by individual-level (physical exercise, social interaction) and environmental-level (community service). It suggests that a lack of physical exercise and health-related community service may impair the health of older patients with diabetes with low SES, which recommends individuals' positive actions and environmental supports for promoting health of regarding population.

Factors Related to Diabetes Mellitus in the Middle-Aged and Over in Taiwan

Study Objective: to investigate the factors related to diabetes mellitus in the middle-aged and over in Taiwan. Method: data from seven surveys (in 1989–2011) from the “Taiwan Longitudinal Study on Aging” (TLSA), among cohort B (above the age 60 in 1989), cohort A (aged 50–66 in 1996), and cohort C (aged 50–66 in 2003), were analyzed by the interval-censored Cox model. Results: in the early aging stage (aged 60–64), diabetes mellitus prevalence among the same age appeared the lowest in cohort B, followed by cohort A; cohort C reveals the highest than the young generation. Moreover, suffering from hypertension and kidney diseases are closely related to diabetes mellitus, with the diabetes mellitus suffering hazard ratio of 2.53 (95%: 2.35, 2.73) and 1.26 (95%: 1.11, 1.44) times, respectively. For people with fair and poor self-rated health, the risk of suffering from diabetes mellitus is 1.16 (95%: 1.07, 1.27) and 1.50 (95%: 1.35, 1.67) times compared to people with good self-rated health, respectively. Conclusions: in this study, it is considered that an advanced interval censoring model analysis could more accurately grasp the characteristics of factors in people who are middle-aged and over suffering from diabetes mellitus in Taiwan.

Association between self-rated health and physical performance in middle-aged and older women from Northeast Brazil

Background

Self-rated Health (SRH) is regarded as a simple and valid measure of a person’s health status, given its association to adverse health outcomes, including low physical performance in older populations. However, studies investigating these associations in low- and middle-income settings are scarce, especially for middle-aged populations. Understanding the validity of SRH in relation to objective health measures in low-income populations could assist in decision making about health policy and strategies, especially in under-resourced settings.

Objective

Assess the relationship between SRH and physical performance measures in middle-aged and older women in a low-income setting of Brazil.

Methods

This is a cross-sectional study of 571 middle-aged (40–59 years old) and older (60–80 years old) women living in Parnamirim and Santa Cruz in the Northeast region of Brazil. Participants reported their health status and were allocated to the “SRH good” or “SRH poor” groups. The physical performance evaluation included: handgrip strength, one-legged balance with eyes open and closed and chair stand test. The relationship between SRH and physical performance for middle-aged and older women was assessed by quantile regression (modeling medians) adjusted for potential confounders (age, socioeconomic variables, body mass index, menopause status, age at first birth, parity, chronic conditions and physical activity).

Results

Middle-aged women from the “SRH good” group presented better physical performance with 1.75 kgf stronger handgrip strength (95% CI [0.47–3.02]; p = 0.004), 1.31 s longer balance with eyes closed ([0.00–2.61]; p = 0.030), and they were 0.56 s faster in the chair stand test ([0.18–0.94]; p = 0.009) than those who reported “SRH poor”. No association was found for balance with eyes open. For older women, there was no evidence of associations between physical performance and SRH.

Conclusion

This study showed that SRH is significantly associated with objective measures of physical performance in a sample of low-income middle-aged women. SRH can be an important tool to indicate the need for further evaluation of physical performance among middle-aged women and can be particularly useful for low-income communities.

Self-Perceived Health, Objective Health, and Quality of Life among People Aged 50 and Over: Interrelationship among Health Indicators in Italy, Spain, and Greece

It is well known that self-perceived health (SPH), even if it is a subjective health indicator, is significantly associated with objective health and quality of life (QoL) in the general population. Whether it can be considered an indicator of cognitive functioning and quality of life in the elderly is still an open issue. This study used a data-driven approach to investigate the interrelationship among SPH, non-communicable diseases (NCDs), QoL, and cognitive functioning to answer this question. The study sample included information about 12,831 people living in Italy, Spain, and Greece, extracted from the Survey on Health, Aging, and Retirement in Europe, in the year 2015. The additive Bayesian networks methodology was used to identify the best directed acyclic graphs (DAG) for SPH, QoL, and NCDs. Results were given as posterior estimates of generalized linear models (GLM) coefficients, with 95% credibility intervals. Good SPH was associated with a decreasing number of chronic diseases in Italy (coeff = −0.52, 95%CI: [−0.59, −0.44]), Spain (coeff = −0.53, 95%CI: [−0.60, −0.46]) and Greece (coeff = −0.57, 95%CI: [−0.64, −0.50]). Age and Body Mass Index were determinants of NCDs in all countries. QoL of elderly was associated with SPH in Italy (coeff = 0.12, 95%CI: [0.10, 0.14]), Spain (coeff = 0.16, 95%CI: [0.15, 0.18]), and Greece (coeff = 0.18, 95%CI: [0.16, 0.20]). The number of NCDs was higher for people who were not employed in Spain (coeff = 0.45, 95%CI: [0.37, 0.53]) and was decreasing for a unitary increase in years of education in Greece (coeff = −0.12, 95%CI: [−0.14, −0.09]). As a general rule, the framework of the interrelationship among NCDs, SPH, and QoL was similar for Italy, Spain, and Greece. The connections found among indicators could be proposed to identify strategies for health promotion and healthy aging among people aged 50 and above, which are viable in general and at a country level. Reinforcing strategies targeted at some health indicators could have relevant effects on other related indicators.

Men with impaired glucose tolerance have lower self-rated health than men with impaired fasting glucose

AIM

Previous studies have shown that individuals with impaired glucose tolerance (IGT) have lower self-rated health than normoglycaemic individuals. The aim of this study was to examine differences in self-rated health between individuals with IGT and those with impaired fasting glucose (IFG) and to consider the potentially mediating effect of physical activity.

METHODS

In 2002-2005, a total of 2816 individuals were randomly selected for a population-based study in Sweden. All participants performed an oral glucose tolerance test (OGTT). Fasting venous blood samples were drawn, and questionnaires concerning lifestyles were completed. Self-rated health (SRH) and leisure time physical activity (LTPA) were reported on a five-graded and four-graded scale, respectively. A total of 213 individuals with IGT and 129 with IFG were detected.

RESULTS

IGT, but not IFG, was associated with low self-rated health. The difference in self-rated health was seen particularly in men when adjusted for age and BMI (OR = 2.13, CI: 1.13-4.02, p = 0.020). The results became insignificant when including physical activity in the model (OR = 1.8, CI: 0.91-3.58, p = 0.094).

CONCLUSION

The low self-rated health adds further weight to the risk profile in men with IGT and stresses the importance of early detection and lifestyle interventions.

Self-rated Health Among Saudi Women: Association with Morbidity, Lifestyle, and Psychosocial Factors

Self-rated health (SRH) is an essential global measure of general health and quality of life, and a predictor of the mortality and morbidity of populations. We assessed the SRH and identified associated factors among women in Riyadh, the capital of Saudi Arabia, using a cross-sectional survey conducted on a sample of women aged 18 years and older. Univariate and multivariate logistic regression analyses were conducted to identify factors that are significantly associated with SRH. Overall, 36.6% (n = 329) of participating women reported poor SRH. Higher body mass index (BMI), physical inactivity, greater number of morbidities, and reporting ill-being/likely depression were significantly associated with poor SRH. The findings from this study suggest that health status, lifestyle factors, and psychosocial conditions are associated with SRH in this population. Focusing on these factors suggests a turning point for public health policies and interventions to improve the health and quality of life of this group of women.

Self-rated health and the risk of incident type 2 diabetes mellitus: A cohort study

We aimed to evaluate the association between self-rated health (SRH) and the risk of incident type 2 diabetes mellitus (T2D). This cohort study consisted of 250,805 Korean men and women without T2D at baseline. SRH was assessed at baseline with a self-administered structured questionnaire. Incident T2D was defined as fasting serum glucose ≥126 mg/dL, HbA1C ≥6.5%, or use of medication for T2D during follow-up. After adjustment for possible confounders including age, center, year of screening exam, smoking status, alcohol intake, physical activity, education level, total calorie intake, body mass index, sleep duration, depressive symptoms, family history of diabetes, history of hypertension, and history of cardiovascular disease, the multivariable-adjusted hazard ratios (95% confidence intervals) for incident T2D comparing good, fair, and poor or very poor SRH to very good SRH were 1.20 (0.98-1.48), 1.63 (1.33-1.98), and 1.83 (1.47-2.27), respectively. These associations were consistently observed in clinically relevant subgroups. Fair or poorer SRH was independently and positively associated with the development of T2D in a large-scale cohort study of apparently healthy Korean adults, indicating that SRH is a predictor of metabolic health. Physicians involved in diabetes screening and management should routinely consider SRH when evaluating T2D risk as well as overall health.

Health related outcomes among people with type 2 diabetes by country of birth: Result from the 45 and Up Study

BACKGROUND

Ethnic variation in the occurrence of type 2 diabetes, complications, mortality, and health behaviours has been reported. The current research examined patterns of health-related outcomes by country of birth in people with diabetes aged 45years and over in New South Wales, Australia.

METHODS

This study was based on the baseline data of 266,848 participants aged 45years and over from "The Sax Institute's 45 and Up Study" (2006-2009), NSW; Australia's most populous state. Health-related factors including self-rated overall health, Quality of Life (QoL), eyesight, subjective memory complaint, hearing loss, psychological distress and functional limitation were examined according to country of birth among 23,112 people with type 2 diabetes. Logistic regression modelling was used to compare the odds of poor outcomes between Australian-born and overseas-born participants, adjusting for potential confounding and mediating variables. Both age-sex and fully adjusted odds ratios (aORs) are reported.

RESULTS

Nearly half of the people with diabetes in the sample reported hearing loss and high levels of functional limitations, a third reported poor overall health. Compared to people with diabetes born in Australia, people born in South East Europe, North Africa, the Middle East had significantly greater odds of poor outcomes across the majority of examined health-related factors, with the largest odds observed in the elevated level of psychological distress outcome (aOR=3.4 in North African and the Middle East group). Higher aORs of poor overall health, QoL, memory problems and poor eyesight, and lower aORs for hearing loss, were also found among those born in the Asian countries.

CONCLUSIONS

The results demonstrated significant ethnic disparity in the prevalence of health-related outcomes. These findings provide important context for the formulation of culturally sensitive secondary prevention strategies.

The associations between objective and subjective health among older adults with type 2 diabetes: The moderating role of personality

BACKGROUND

Objective and subjective health are two powerful constructs which predict morbidity and mortality across a range of conditions including Type 2 Diabetes (T2D). Studies, however, suggest that these two constructs do not necessarily correlate, as some people with poor objective health perceive their health as good, while other people with good objective health perceive their health as poor. We seek to examine the role of personality as a moderator of the associations between objective and subjective health among older adults with T2D, who are likely to experience poor objective and subjective health due to their chronic medical condition.

METHODS

Cross-sectional study of 368 individuals with T2D (72 ± 4 years, 42% women), participating in the Israel Diabetes and Cognitive Decline Study. Personality was conceptualized using the five-factor model (agreeableness, conscientiousness, extraversion, neuroticism, openness). Objective health was operationalized by T2D-related clinical status, cognitive function, and motor ability. Subjective health was assessed using a single self-report question. Hayes' process macro was used for the moderation analyses.

RESULTS

The objective-subjective health associations were stronger among individuals with increased neuroticism (proportion of days covered: p = 0.02; cognitive function: p = 0.003; hand grip: p = 0.02; 3-m walk: p = 0.04) as well as decreased openness (cognitive status: p = 0.04) and agreeableness (3-m walk: p = 0.02).

DISCUSSION

Personality traits, and specifically neuroticism, can modify the associations between objective and subjective health in older adults with T2D. Findings contribute to the understanding of health as a multidimensional construct that encompasses medical and psychological aspects, especially among older adults with a chronic illness.

Drug utilization and factors associated with polypharmacy in individuals with diabetes mellitus in Minas Gerais, Brazil

The objective of this study was to evaluate the use of drugs and the factors associated with polypharmacy in patients with diabetes mellitus (DM) in Minas Gerais. Descriptive analysis of drugs in use and logistic regression to estimate the association between socio-demographic and clinical characteristics with polypharmacy were performed. Of the 2619 respondents, 56.5% were in polypharmacy. Drugs for DM, agent in renin-angiotensin system, and diuretics are the most frequently used. Factors such as age, comorbidities and increased access to health services were associated with polypharmacy. It was observed high prevalence of polypharmacy, which requires a suitable care and better quality of drug use in this population.

Regional differences and determinants of self-rated health in a lower middle income rural Society of China

Objective

Self-rated health represents a reliable and important health measure related to general health and quality of life. This study aimed to identify the differences of health states of rural residents in a lower middle income setting in China and its associated factors.

Methods

A descriptive study of a stratified random sample of 3870 individuals was conducted in rural Anhui during 2015. We investigated the influence of five independent variables: individual demographic characteristics, family factors, social capital traits, physical health conditions and healthy lifestyle habits of participants who self-related their health as good. A chi-square test and ordinal logistic regression analyses were used to identify the relationship of these variables and self-rated health.

Results

The study found that respondents who negatively rated their health often were female, elderly, poor, lived alone, had low levels of education, inadequate social support, poor physical health, used healthcare services and lived in the lower economic regions. We found no significant correlations between self-rated health and employment, marital status, medical insurance, or exercise frequency. Surprisingly, smoking and drinking also seemed to be unrelated to poor self-reported health.

Conclusion

Health differences based on region were apparent in rural China. We highlighted the possible impacts of income, age, physical health, education, advanced age, and social support on health. The results from this study could inform the delivery of appropriate health and social healthcare interventions to promote rural residents’ health and quality of life.

Self-rated health is prospectively associated with uptake of screening for the early detection of colorectal cancer, not vice versa

Self-rated health (SRH) is a consistent predictor of mortality and other health outcomes. One of the mechanisms hypothesized to explain its validity as a predictor is that SRH affects the adoption of health behaviors. The present study examined the prospective association between SRH and performance of a recommended colorectal cancer (CRC) screening test. One thousand four hundred and seventy-six men and women aged 50-74 years, eligible for CRC screening, who had undergone the test a year before were interviewed 1-2 weeks (long interview, before testing) or 2 months (short interview, after testing) following the mailing of a test kit. Test performance was ascertained using an HMO's computerized data set. Respondents in the long interview group who rated their health as 'higher than others' performed the screening test 2 months following the invitation more than those who rated their health as similar to or lower than that of others (65.4, 61.6, and 49.1%, respectively, χ=8.02, P=0.018). At the same time, these respondents perceived the risk of CRC as significantly lower than that of those who rated their health as comparable with or lower than that of others. In a multivariate logistic regression of CRC screening behavior that included demographic and perceptual variables, age, intentions, and SRH were found to be significant predictors. Among respondents in the short interview, who tested before the interview, there was no significant association between SRH and behavior. SRH prospectively predicts uptake of CRC screening better than other perceptual variables, after accounting for demographic variables.

Lifestyle Behaviors, Subjective Health, and Quality of Life Among Chinese Men Living With Type 2 Diabetes

The aim of the present study was to investigate the association between self-reported health (SRH) and quality of life (QoL) with five lifestyle-related behaviors including tobacco smoking, drinking alcohol, physical activity status, consumption of fruits, and consumption of vegetables among men diagnosed with type 2 diabetes. Participants were 786 Chinese men older than 40 years and living in urban households. Cross-sectional data on self-rated health, associated sociodemographics, and health-related behaviors were collected from the Study on Global AGEing and Health (Wave 1) of World Health Organization. Results of multivariable regression reported significant association with adherence to healthy lifestyle behavior and SRH but not QoL. According to the results, percentage of men who reported being in good SRH was overwhelmingly high (95.9%) compared with good QoL (5%). Adherence to healthy behavior was strongly associated with SRH in both bivariate and multivariate analysis, adjusted odds ratio (95% confidence interval) of good SRH for nonsmokers: 1.276 [1.055, 2.773], nondrinkers:1.351 [1.066, 3.923], taking physical exercise: 1.267 [1.117, 3.109], consuming at least five servings of fruits: 1.238 [1.034, 6.552], and vegetables: 1.365 [1.032, 3.885]. The current findings suggest that abstention from tobacco and alcohol, optimum consumption of fruits and vegetables, regular physical exercise could have marked impact on the health status of diabetic men.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

The development and validation of the AMPREDICT model for predicting mobility outcome after dysvascular lower extremity amputation

OBJECTIVE

The objective of this study was the development of AMPREDICT-Mobility, a tool to predict the probability of independence in either basic or advanced (iBASIC or iADVANCED) mobility 1 year after dysvascular major lower extremity amputation.

METHODS

Two prospective cohort studies during consecutive 4-year periods (2005-2009 and 2010-2014) were conducted at seven medical centers. Multiple demographic and biopsychosocial predictors were collected in the periamputation period among individuals undergoing their first major amputation because of complications of peripheral arterial disease or diabetes. The primary outcomes were iBASIC and iADVANCED mobility, as measured by the Locomotor Capabilities Index. Combined data from both studies were used for model development and internal validation. Backwards stepwise logistic regression was used to develop the final prediction models. The discrimination and calibration of each model were assessed. Internal validity of each model was assessed with bootstrap sampling.

RESULTS

Twelve-month follow-up was reached by 157 of 200 (79%) participants. Among these, 54 (34%) did not achieve iBASIC mobility, 103 (66%) achieved at least iBASIC mobility, and 51 (32%) also achieved iADVANCED mobility. Predictive factors associated with reduced odds of achieving iBASIC mobility were increasing age, chronic obstructive pulmonary disease, dialysis, diabetes, prior history of treatment for depression or anxiety, and very poor to fair self-rated health. Those who were white, were married, and had at least a high-school degree had a higher probability of achieving iBASIC mobility. The odds of achieving iBASIC mobility increased with increasing body mass index up to 30 kg/m² and decreased with increasing body mass index thereafter. The prediction model of iADVANCED mobility included the same predictors with the exception of diabetes, chronic obstructive pulmonary disease, and education level. Both models showed strong discrimination with C statistics of 0.85 and 0.82, respectively. The mean difference in predicted probabilities for those who did and did not achieve iBASIC and iADVANCED mobility was 33% and 29%, respectively. Tests for calibration and observed vs predicted plots suggested good fit for both models; however, the precision of the estimates of the predicted probabilities was modest. Internal validation through bootstrapping demonstrated some overoptimism of the original model development, with the optimism-adjusted C statistic for iBASIC and iADVANCED mobility being 0.74 and 0.71, respectively, and the discrimination slope 19% and 16%, respectively.

CONCLUSIONS

AMPREDICT-Mobility is a user-friendly prediction tool that can inform the patient undergoing a dysvascular amputation and the patient's provider about the probability of independence in either basic or advanced mobility at each major lower extremity amputation level.

Self-rated health as a predictor of outcomes of type 2 diabetes patient education programmes in Denmark

OBJECTIVE

To explore if self-rated health (SRH) can predict differences in outcomes of patient education programmes among patients with type 2 diabetes over time.

STUDY DESIGN

This is an observational cohort study conducted among 83 patients with type 2 diabetes participating in patient education programmes in the Capital Region of Denmark.

METHODS

Questionnaire data were collected by telephone interview at baseline and 2 weeks (77 participants, 93%) and 12 months (66, 80%) after the patient education ended. The seven-scale Health Education Impact Questionnaire (HeiQ) was the primary outcome. The independent variable was SRH, which was dichotomized into optimal or poor SRH. Changes over time were assessed using mean values and standard deviation (SD) at each time point and Cohen effect sizes. Odds ratios and 95% confidence intervals were calculated for the likelihood of having poor SRH for each baseline sociodemographic and health-related variable.

RESULTS

Twelve months after patient education programmes, 60 (72%) patients with optimal SRH at baseline demonstrated increased self-management skills, overall acceptance of chronic illness, positive social interaction with others, and improved emotional well-being. Participants with poor SRH (23, 28%) reported no improvements over time. Not being married (odds ratio [OR] 7.79, P < 0.001), living alone (OR 4.93, P = 0.003), having hypertension (OR 8.00, P = 0.031), and being severely obese (OR 4.07, P = 0.009) were significantly associated with having poor SRH. After adjusting for sex, age and vocational training, marital status (OR 9.35, P < 0.001), cohabitation status (OR = 4.96, P = 0.005) and hypertension (OR 10.9, P = 0.03) remained associated with poor SRH.

CONCLUSIONS

We found a strong association between SRH and outcomes of patient education, as measured by the HeiQ, at 12 months. Only participants with optimal SRH appeared to benefit from patient education. Other patient characteristics may be responsible to explain the observed difference between patients with optimal and poor SRH.

Evaluating lifestyle and health-related characteristics of older adults with co-occurring depressive symptoms and cardiometabolic abnormalities

OBJECTIVE

Comorbid depression and cardiometabolic abnormalities might represent an important subgroup of depression. The aim of the present study was to evaluate lifestyle and health-related characteristics of individuals with both depressive symptoms and cardiometabolic abnormalities.

METHODS

Data were from the English Longitudinal Study of Ageing. The sample was comprised of 5365 adults aged 50-80 years. High depressive symptoms were based on the eight-item Center for Epidemiologic Studies - Depression scale. Cardiometabolic abnormalities were defined as having ≥3 cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, hypertriglyceridemia, and central obesity). Four groups were created based on Center for Epidemiologic Studies - Depression scores and cardiometabolic abnormalities: those with (i) comorbid depressive symptoms and cardiometabolic abnormalities (DCM); (ii) depressive symptoms only (DnoCM); (iii) cardiometabolic abnormalities only; and (iv) neither depressive symptoms nor cardiometabolic abnormalities. Lifestyle and health-related characteristics of the four groups were compared using chi-square tests. A modified Poisson regression analysis was performed to compare the DCM and the DnoCM groups with respect to lifestyle and health-related characteristics.

RESULTS

Those in the DCM group were significantly less physically active (p = 0.003), had poorer self-rated health (p < 0.001), had lower income (p = 0.001), and were more likely to be retired (p < 0.001) than those in the DnoCM group. The pattern of results remained after controlling for other lifestyle and health-related factors.

CONCLUSION

These results provide support for a cardiometabolic subgroup of depression that is associated with physical inactivity, poorer self-rated health, lower income, and retirement. Copyright © 2015 John Wiley & Sons, Ltd.

Determinants of Poor Self-rated Health in Korean Adults With Diabetes

Objectives:

Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes.

Methods:

A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance.

Results:

We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio [OR]_{Frequent stress events}, 5.40; 95% confidence interval [CI], 4.63 to 6.29; OR_{Severe distress}, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants’ medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A_1clevels of 6.5% or more, and comorbidities, were other correlates of poor reported health.

Conclusions:

Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.

Body Mass Index and Poor Self-Rated Health in 49 Low-Income and Middle-Income Countries, By Sex, 2002-2004

This study investigated whether the relationship between body mass index (BMI) and poor self-rated health differed by sex in low-income countries and middle-income countries. We analyzed data from the World Health Survey (2002-2004) on 160,099 participants from 49 low-income and middle-income countries by using random-intercept multilevel logistic regressions. We found a U-shaped relationship between BMI and poor self-rated health among both sexes in both low-income and middle-income countries, but the relationship differed by sex in strength and direction between low-income countries and middle-income countries. Differential perception of body weight and general health might explain some of the observed sex differences.

Self-perceived health versus actual cardiovascular disease risks

AIM

Self-perceived poor health is related to cardiovascular disease (CVD) risk perception, cardiovascular event, hospital readmission, and death from CVD. This study evaluated the associations between self-perceived health and actual CVD risk in South Koreans as well as the influence of sociodemographic and cardiovascular risk factors on self-perceived poor health.

METHODS

This is a secondary data analysis of the 2010 Korea National Health and Nutrition Examination Survey. The sample was 4535 South Koreans aged 30-74 years without CVD. Self-perceived health status was compared with actual cardiovascular risk separately by sex using χ(2) -tests. Logistic regressions were used to identify potential sociodemographic and cardiovascular risk factors of self-perceived poor health.

RESULTS

Self-perceived poor health was related to higher CVD risk but there were substantial gaps between them. Among cardiovascular risk factors, dyslipidemia, obesity, smoking, and a family history of CVD did not affect self-perceived health.

CONCLUSION

Gaps between perceived health and actual CVD risk should be closed to optimize cardiovascular health of South Koreans. Koreans need to increase risk perception to a level commensurate with their actual risk. Healthcare providers should try to provide individuals at increased CVD risk with better information more frequently, especially those who have favorable perceptions of their health but smoke or have elevated cholesterol levels and bodyweight.

Factors associated with a diabetes diagnosis and late diabetes diagnosis for males and females

Aims

To examine the factors associated with diabetes, a late diabetes diagnosis, and whether these factors are different for males and females.

Methods

Cross-sectional study including 7101 individuals aged ≥25 years in Newfoundland and Labrador, Canada (466 with diabetes; 332 diagnosed late). Logistic regression analysis was used to determine the factors associated with a diabetes diagnosis and late diabetes diagnosis.

Results

For males, overweight/obesity (HR, 1.35; 95% CI, 1.06-1.72) was positively associated with diabetes while being a regular/occasional drinker (HR, 0.53; 95% CI, 0.32-0.88) was inversely associated with diabetes. Living in a rural area (HR, 1.47; 95% CI, 1.01-2.15), receiving social assistance (HR, 2.80; 95% CI, 1.52-5.15), having poor self perceived health (HR, 2.06; 95% CI, 1.32-3.21), and considering most days stressful (HR, 1.45; 95% CI, 1.01-2.10) were positively associated with diabetes for females. No factors were significantly associated with a late diabetes diagnosis for males. Having a low education (OR, 0.33; 95% CI, 0.11-0.99) was inversely associated with a late diabetes diagnosis for females.

Conclusions

Different factors are associated with diabetes for males and females. Disadvantaged females appear to be at the greatest risk. The factors associated with a late diabetes diagnosis were also different for males and females. Females with lower education levels are diagnosed with diabetes earlier than females with higher education levels. Certain risk factors appear to impact males and females differently and more research is needed on how males and females develop diabetes and when they are diagnosed.

Association of depression and anxiety symptoms with functional disability and disability days in a community sample with type 2 diabetes

BACKGROUND

There is a well-documented association between depression and disability in people with diabetes. However, less is known about the possible association of co-occurring anxiety on these associations.

OBJECTIVE

The objective of this study was to assess the association of elevated anxiety or depression symptoms or both with functional disability and frequent disability days in a community sample with type 2 diabetes.

METHODS

The participants were 1999 people with diabetes who completed the baseline portion of the Evaluation of Diabetes Treatment study. Functional disability was assessed using the World Health Organization Disability Assessment Schedule II. Frequent disability days were assessed using a cutoff score ≥14 on a question assessing functional disability in the past month from the Healthy Days Core Module. Depression and anxiety were assessed with the Patient Health Questionnaire and General Anxiety Questionnaire with cutoff scores ≥10 applied to create groups. Additional questions examined diabetes complications, chronic conditions, and sociodemographic characteristics.

RESULTS

Fully adjusted logistic regression analyses demonstrated an increased likelihood of reporting functional disability for all groups with high anxiety or depressive symptoms or both. Groups with high depressive symptoms with and without high anxiety symptoms were also more likely to report frequent disability days.

CONCLUSIONS

Results indicate that elevated anxiety and depression symptoms are important factors associated with increased functional disability and frequent disability days in people with diabetes.

Recurrent subthreshold depression in type 2 diabetes: an important risk factor for poor health outcomes

OBJECTIVE To evaluate the association between recurrent subthreshold depressive episodes and functioning in a prospective community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS A prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n = 1,064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (Patient Health Questionnaire [PHQ]-9). Functioning (World Health Organization Disability Assessment Schedule II [WHODAS-II]) and health-related quality of life (Centers for Disease Control and Prevention [CDC] unhealthy days) at 4- and 5-year follow-up assessments were the outcome measures. RESULTS Nearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/impaired health-related quality of life was nearly three times higher (relative risk = 2.86) for participants with four subthreshold depressive episodes compared with participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/impaired health-related quality of life increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, P < 0.001). CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring, and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.

Assessing health literacy in rural settings: a pilot study in rural areas of Cluj County, Romania

Health literacy improves knowledge and builds skills to help individuals make appropriate decisions regarding their health. Over the past 20 years, several studies have described associations between health literacy and health outcomes. With respect to Romania, evidence is scarce on the level of health literacy, as well as on its determinants. Thus, the objectives of this study were to briefly screen functional health literacy levels in a sample of rural inhabitants, to assess the relationship between health literacy and reported health status, as well as to explore health literacy determinants within this population. Data were collected between September–November 2010, in four villages in Cluj County, Romania, using a cross-sectional survey. The mean age of respondents in the sample was 56 years, with roughly half of respondents being retired. The brief screening of health literacy suggested inadequate to marginal levels within the sample. Significant associations were observed between health literacy score and education, and self-perceived health status, whereas the relationship between health literacy and gender, and the presence of a chronic disease was not statistically significant. Limited health literacy has been shown to be common in people who rated their health as poor, those who attended only middle school, and individuals lacking basic information about their body. In order to minimize the adverse effects of low health literacy on health and health outcomes, efforts should be invested in identifying and addressing the health needs of adults with low and marginal health literacy, especially in underserved areas such as rural and remote settings, where access to health-related information is limited.

The association between self-rated health and impaired glucose tolerance in Swedish adults: a cross-sectional study

OBJECTIVE

To investigate gender differences in the association between self-rated health (SRH) and impaired glucose tolerance (IGT) in subjects unaware of their glucose tolerance.

DESIGN

A cross-sectional population-based study.

SETTING

The two municipalities of Vara and Skövde in south-western Sweden.

SUBJECTS

A total of 2502 participants (1301 women and 1201 men), aged 30-75, were randomly selected from the population.

MAIN OUTCOME MEASURES

IGT was regarded as the outcome measure and SRH as the main risk factor.

RESULTS

The prevalence of IGT was significantly higher in women (11.9%) than in men (10.1%), (p = 0.029), as was the prevalence of low SRH (women: 35.4%; men: 22.1%, p = 0.006). Both men and women with low SRH had a poorer risk factor profile than those with high SRH, and a statistically significant crude association between SRH and IGT was found in both men (OR = 2.8, 95% CI 1.8-4.4) and women (OR = 1.5, 95% CI 1.0-2.2, p = 0.033). However, after controlling for several lifestyle factors and biomedical variables, the association was attenuated and remained statistically significant solely in men (OR = 2.3, 95% CI 1.2-4.3).

CONCLUSION

The gender-specific associations found between SRH and IGT suggest that SRH may be a better indicator of IGT in men than in women. Future studies should evaluate the utility of SRH in comparison with objective health measures as a potential aid to health practitioners when deciding whether to screen for IGT and T2DM.

Self-rated health: a predictor for the three year incidence of major depression in individuals with Type II diabetes

BACKGROUND

To determine whether self-rated health was a predictor for the three year incidence of major depression in people with Type II diabetes.

METHODS

Data was collected as part a population-based telephone survey of adults with diabetes, in Québec, Canada (2008-2011). Adults with Type II diabetes who did not have major depression at baseline were assessed at three follow-up interviews conducted 12, 24 and 36 months after baseline. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Self-rated health status was determined by asking participants to rate their health on a scale from excellent to poor.

RESULTS

The sample consisted of 1265 adults with Type II diabetes who did not have major depression at baseline. 36% of individuals who had developed major depression at follow up rated their health as fair or poor at baseline compared to 14.4% of those who had not developed major depression. Logistic regression analyses indicated fair or poor self-rated health at baseline to be predictive of a twofold increased risk for major depression at follow-up, even after adjusting for socio-demographic characteristics, lifestyle-related behaviors, disability and diabetes characteristics (OR=2.05, 95% CI 1.20-3.48).

LIMITATIONS

We have focused on current depression (last two weeks) and we have used a questionnaire (PHQ-9) rather than a clinical interview for the assessment of depression.

CONCLUSIONS

Self-rated health status might be a predictor for developing major depression in people with diabetes in addition to well established risk factors.