The Association of Depression and the Cardiovascular Risk Factors of Blood Pressure, HbA1c, and Body Mass Index among Patients with Diabetes: Results from the Translating Research into Action for Diabetes Study

The design and rationale of a multicenter real-world trial: The Southeastern Collaboration to Improve Blood Pressure Control in the US Black Belt - Addressing the Triple Threat

BACKGROUND

Impoverished African Americans (AA) with hypertension face poor health outcomes.

PURPOSE

To conduct a cluster-randomized trial testing two interventions, alone and in combination, to improve blood pressure (BP) control in AA with persistently uncontrolled hypertension.

METHODS

We engaged primary care practices serving rural Alabama and North Carolina residents, and in each practice we recruited approximately 25 AA adults with persistently uncontrolled hypertension (mean systolic BP >140 mmHg over the year prior to enrollment plus enrollment day BP assessed by research assistants ≥140/90 mmHg). Practices were randomized to peer coaching (PC), practice facilitation (PF), both PC and PF (PC + PF), or enhanced usual care (EUC). Coaches met with participants from PC and PC + PF practices weekly for 8 weeks then monthly over one year, discussing lifestyle changes, medication adherence, home monitoring, and communication with the healthcare team. Facilitators met with PF and PC + PF practices monthly to implement ≥1 quality improvement intervention in each of four domains. Data were collected at 0, 6, and 12 months.

RESULTS

We recruited 69 practices and 1596 participants; 18 practices (408 participants) were randomized to EUC, 16 (384 participants) to PF, 19 (424 participants) to PC, and 16 (380 participants) to PC + PF. Participants had mean age 57 years, 61% were women, and 56% reported annual income <$20,000.

LIMITATIONS

The PF intervention acts at the practice level, possibly missing intervention effects in trial participants. Neither PC nor PF currently has established clinical reimbursement mechanisms.

CONCLUSIONS

This trial will fill evidence gaps regarding practice-level vs. patient-level interventions for rural impoverished AA with uncontrolled hypertension.

The relationship between the joint effect of C-reactive protein and glycated hemoglobin with the risk of depressive symptoms among middle-aged and older adults: Findings from the China health and retirement longitudinal study

OBJECTIVES

The present study aimed to explore the relationship between the joint effect of C-reactive protein and glycated hemoglobin with the risk of depressive symptoms among middle-aged and older adults.

METHODS

A total of 5985 participants aged 45 years or older from the China Health and Retirement longitudinal study 2011 and 2015 were included in this study. Participants were divided into 4 groups according to C-reactive protein and glycated hemoglobin. Multivariate logistic regression model was used to explore the associations between C-reactive protein and glycated hemoglobin and new-onset depression.

RESULTS

During the follow-up period, 1001(16.73%) participants experienced depressive symptoms. Compared to participants with low C-reactive protein and low glycated hemoglobin, individuals with C-reactive protein and glycated hemoglobin both high levels have a higher risk to suffer from depressive symptoms with corresponding multivariable adjusted odds ratio (OR = 1.17, 95% CI: 1.01-1.36). Adding C-reactive protein and glycated hemoglobin simultaneously to conventional risk model significantly improved risk reclassification for depressive symptoms. The statistically significant interaction with joint effects of C-reactive protein and glycated hemoglobin on depressive symptoms was only found in different sex (P-interaction = 0.006) or age (P-interaction = 0.004) groups. Sensitivity analysis yields similar results.

CONCLUSIONS

Higher levels of C-reactive protein and glycated hemoglobin jointly increased the risk of depressive symptoms among Chinese middle-aged and older adults. Using the combination indicator of C-reactive protein and glycated hemoglobin could better identify individuals at risk of depressive symptoms.

Mental Health Status of Adults with Cardiovascular or Metabolic Diseases by Gender

This study aimed to compare mental health in people with cardiovascular or metabolic diseases and the general adult population in each gender. Cardiovascular and metabolic diseases affect mental health, and the prognosis and incidence rates of these diseases differ by age. To date, studies comparing mental health in adults with cardiovascular or metabolic diseases by gender and with the general population have been insufficient. This work is a cross-sectional study. Data from 9828 men and 13,389 women aged 19 years or older from the Korea National Health and Nutrition Examination Survey V and VI (2010–2013) were used. Men and women with cardiovascular diseases showed high risks of stress, depression, and suicidal ideation. Men with metabolic diseases had worse mental health in relation to depression and suicidal ideation, and women with metabolic diseases in relation to stress and depression, indicating a need for intervention and management of mental health by gender for these individuals. There is a need to develop a clear perception and understanding, both among practitioners and the general population, of mental health issues associated with having cardiovascular or metabolic diseases. Active, specific health improvement and training programmes considering gender differences are necessary.

Pharmacotherapeutic strategies for managing comorbid depression and diabetes

Introduction: The increasing prevalence of comorbid depression and diabetes exerts a heavy burden on global health. Co-occurrence of depression and diabetes is common, affecting 14% to 35.8% of patients with diabetes, leading to a higher mortality and morbidity rate, more micro- and macro-vascular diseases and more cognitive decline. Areas covered: In this paper, the authors address various areas from epidemiology, the association between depression and diabetes, treatment strategies and future directions based on the currently available literature to provide novel insight into the pharmacotherapeutic management of comorbid depression and diabetes. Expert opinion: Pharmacotherapy can help patients with comorbid depression and diabetes by relieving depressive symptoms and improving glycemic control. When combined with psychological therapy, as a collaborative care effort, pharmacological therapy based on selective serotonin reuptake inhibitors (SSRIs) is recommended for comorbid depression with diabetes. Furthermore, studies with larger sample sizes that can help to define different subtypes of diabetes and severity of depression are needed so that clinicians can draw up a precise and applicable management guidelines for the personalized therapy of these diseases.

Childhood trauma, pubertal timing, and cardiovascular risk in adulthood

OBJECTIVE

An association between childhood trauma and adult health outcomes has been widely reported, but little is known about the developmental pathways through which childhood trauma influences adult cardiovascular disease (CVD).

METHOD

Hypotheses were tested with a sample of 405 African Americans from the Family and Community Health Study (FACHS). Path modeling was used to test our theoretical model.

RESULTS

Replicating prior research, exposure to childhood trauma was associated positively with increases in symptoms of CVD risk across young adulthood even after controlling for a variety of health-related and health behavior covariates. Further, the association of childhood trauma with CVD risk was mediated by early pubertal maturation. There were no gender differences in the magnitude of this effect.

CONCLUSION

Our findings support an evolutionary-development perspective (Belsky & Shalev, 2016) suggesting that early adverse life experiences lead to early biologically embedded changes reflected in early physical maturation and that these early changes predict later negative adult health outcomes. The results imply that early pubertal maturation is a precursor to vulnerability to long term health problems. From an intervention standpoint, identifying such developmental pathways may help inform future health-promoting interventions. (PsycINFO Database Record

Prevalence and prevention of cardiovascular disease and diabetes mellitus

Noncommunicable diseases (NCDs) have become important causes of mortality on a global scale. According to the report of World Health Organization (WHO), NCDs killed 38 million people (out of 56 million deaths that occurred worldwide) during 2012. Cardiovascular diseases accounted for most NCD deaths (17.5 million NCD deaths), followed by cancers (8.2 million NCD deaths), respiratory diseases (4.0 million NCD deaths) and diabetes mellitus (1.5 million NCD deaths). Globally, the leading cause of death is cardiovascular diseases; their prevalence is incessantly progressing in both developed and developing nations. Diabetic patients with insulin resistance are even at a greater risk of cardiovascular disease. Obesity, high cholesterol, hypertriglyceridemia and elevated blood pressure are mainly considered as major risk factors for diabetic patients afflicted with cardiovascular disease. The present review sheds light on the global incidence of cardiovascular disease and diabetes mellitus. Additionally, measures to be taken to reduce the global encumbrance of cardiovascular disease and diabetes mellitus are highlighted.

The association between diabetes and depression: a very disabling condition

Rates of depression are significantly increased in diabetic patients, and even more in the elderly. About 20-30% of patients with diabetes suffer from clinically relevant depressive disorders, 10% of which being affected by the major depression disorder. Moreover, people with depression seem to be more prone to develop an associated diabetes mellitus, and depression can worsen glycemic control in diabetes, with higher risk to develop complications and adverse outcomes, whereas improving depressive symptoms is generally associated with a better glycemic control. Thus, the coexistence of depression and diabetes has a negative impact on both lifestyle and quality of life, with a reduction of physical activity and an increase in the request for medical care and prescriptions, possibly increasing the healthcare costs and the susceptibility to further diseases. These negative aspects are particularly evident in the elderly, with further decrease in the mobility, worsening of disability, frailty, geriatric syndromes and increased mortality. Healthcare providers should be aware of the possible coexistence of depression and diabetes and of the related consequences, to better manage the patients affected by these two pathological conditions.

Mind and body: how the health of the body impacts on neuropsychiatry

It has long been established in traditional forms of medicine and in anecdotal knowledge that the health of the body and the mind are inextricably linked. Strong and continually developing evidence now suggests a link between disorders which involve Hypothalamic-Pituitary-Adrenal axis (HPA) dysregulation and the risk of developing psychiatric disease. For instance, adverse or excessive responses to stressful experiences are built into the diagnostic criteria for several psychiatric disorders, including depression and anxiety disorders. Interestingly, peripheral disorders such as metabolic disorders and cardiovascular diseases are also associated with HPA changes. Furthermore, many other systemic disorders associated with a higher incidence of psychiatric disease involve a significant inflammatory component. In fact, inflammatory and endocrine pathways seem to interact in both the periphery and the central nervous system (CNS) to potentiate states of psychiatric dysfunction. This review synthesizes clinical and animal data looking at interactions between peripheral and central factors, developing an understanding at the molecular and cellular level of how processes in the entire body can impact on mental state and psychiatric health.