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Sayadi AR, Seyed Bagheri SH, Khodadadi A, Jafari Torababadi R. The effect of mindfulness-based stress reduction (MBSR) training on serum cortisol levels, depression, stress, and anxiety in type 2 diabetic older adults during the COVID-19 outbreak. J Med Life 2022; 15:1493-1501. [PMID: 36762327 PMCID: PMC9884344 DOI: 10.25122/jml-2021-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/28/2022] [Indexed: 02/11/2023] Open
Abstract
Old age is rapidly increasing and is linked to with chronic diseases, especially diabetes. Diabetes is associated with increased anxiety, stress, and depression and, in turn, can increase cortisol secretion. To this end, the present research studied the impact of mindfulness-based stress reduction (MBSR) training on serum cortisol levels, depression, anxiety, and stress in type 2 diabetic (T2DM) older adults during the COVID-19 epidemic. The participants in this interventional work were 56 older adult patients with type 2 diabetes chosen through systematic random sampling and then randomly divided into control and intervention groups containing equal members. In the intervention group, the participants attended eight mindfulness-based stress reduction (MBSR) training sessions. The subjects in the control group received no intervention. Since four patients left the study, only data for 52 patients were collected using the Depression Anxiety Stress Scale (DASS-21) and a demographic and disease information questionnaire. Data were examined with SPSS18 software using the Kolmogorov-Smirnov test, chi-square test, Fisher test, independent samples t-test, and two-way ANOVA; the significance was p<0.05. Statistically significant differences were observed between the mean scores of anxiety, stress, depression, and cortisol levels in the intervention group (p<0.00001) before, directly after, and three months after the intervention. However, no statistically significant difference was observed in the mentioned variables in the control group. The mindfulness-based stress reduction (MBSR) intervention can improve anxiety, depression, stress, and cortisol levels in older adults suffering from T2DM.
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Affiliation(s)
- Ahmad Reza Sayadi
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran,Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Seyed Hamid Seyed Bagheri
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran,Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Khodadadi
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran,Department of Medical Surgical Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Reza Jafari Torababadi
- Department of Geriatric Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran,Corresponding Author: Reza Jafari Torababadi, Department of Geriatric Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. E-mail:
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Cárdenas L, Cabezas MDC, Muñoz A, Proaño JL, Miño C, Aguirre N. Prevalence and risk factors of depression, anxiety, and stress in an Ecuadorian outpatient population with type II diabetes mellitus: A cross-sectional study (STROBE). Medicine (Baltimore) 2022; 101:e30697. [PMID: 36181107 PMCID: PMC9524958 DOI: 10.1097/md.0000000000030697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Type II diabetes mellitus (DM2) is a worldwide disease with an important economic and health impact. Currently, depression, anxiety and stress are common disorders among diabetic populations but their respective prevalence may well be underestimated. So far, Latin American countries have only reported limited information about the impact of mental diseases on DM2 outpatients. The objective of this study was to evaluate the prevalence and risk factors related to depression, anxiety, and stress among ambulatory DM2 populations from two third-level hospitals in Quito, Ecuador. A cross-sectional study based on a random sample was carried out in two hospitals. Patients were evaluated by the 21-item Depression, Anxiety and Stress Scale (DASS-21). In addition, a validated survey was used to grade socioeconomic, demographic, clinical, and comorbidity variables. Descriptive statistics and multiple logistic regression were used to analyze the data. Statistical analysis was performed by SPSS (version 22.0). STROBE guidelines were used for reporting this trial. A total of 208 adult patients with DM2 were included (women 58%; men 42%). The prevalence of depression, anxiety and stress was 31.7% (95% CI, 25.5-38.5%), 33.7% (95% CI, 27.3-40.5%), and 25.0% (95% CI, 19.3-31.5%), respectively. Male gender was associated with a decreased risk for depression (OR 0.39 [95% CI, 0.18-0.81]; P = .01), anxiety (OR 0.31 [95% CI, 0.16-0.65]; P = .002), and stress (OR 0.35 [95% CI, 0.15-0.77]; P = .009). A higher level of education was associated with low risk for depression (OR 0.23 [95% CI, 0.11-0.46]; P < .001), anxiety (OR 0.47 [95% CI, 0.25-0.90]; P = .02), and stress (OR 0.24 [95% CI, 0.12-0.49]; P = .001). In contrast, patients with DM2 complications were more likely to have depression (OR 2.96 [95% CI, 1.32-6.63]; P = .008) and anxiety (OR 2.56 [95% CI, 1.20-5.48]; P = .01). Finally, an income higher than the basic salary reduced the risk of depression alone (OR 0.39 [95% CI, 0.16-0.91]; P = .03). In conclusion, a high prevalence rate of depression, anxiety, and stress was found in the DM2 outpatient population. Thus, more tailored care surveillance for DM2 patients is needed considering the bio-psycho-social environment to provide an integral health management.
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Affiliation(s)
- Luisa Cárdenas
- School of Medicine, Pontifical Catholic University of Ecuador, Ave 12 de Octubre 170143, Quito, Ecuador
| | - María del Carmen Cabezas
- School of Medicine, Pontifical Catholic University of Ecuador, Ave 12 de Octubre 170143, Quito, Ecuador
| | - Angie Muñoz
- School of Medicine, Pontifical Catholic University of Ecuador, Ave 12 de Octubre 170143, Quito, Ecuador
| | - José Luis Proaño
- School of Medicine, Pontifical Catholic University of Ecuador, Ave 12 de Octubre 170143, Quito, Ecuador
| | - Camila Miño
- School of Medicine, Pontifical Catholic University of Ecuador, Ave 12 de Octubre 170143, Quito, Ecuador
| | - Nicole Aguirre
- School of Medicine, Pontifical Catholic University of Ecuador, Ave 12 de Octubre 170143, Quito, Ecuador
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Patrascu R, Albai A, Braha A, Gaita L, Lazar S, Potre O, Timar B. Factors Influencing the Desirability, Acceptability, and Adherence of Patients with Diabetes to Telemedicine. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58080997. [PMID: 35893112 PMCID: PMC9331825 DOI: 10.3390/medicina58080997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Telemedicine solutions have proven their value and efficacy in augmenting diabetes care. In addition to the availability of tools needed to implement telemedicine solutions for patients with diabetes, the patients’ desirability, acceptance, and adherence represent major burdens in implementing them. The main aim of this research is to evaluate which factors are influencing the desirability, acceptance, and adherence of patients with diabetes to telemedicine interventions in diabetes care. Materials and Methods: QTelemeDiab, a previously validated instrument for assessing patients’ desirability, acceptance, and adherence to telemedicine in diabetes care, was used on 114 enrolled patients with diabetes mellitus, in parallel with demographic, socio-economic, disease history, and psychometric data from all patients. Results: Left-skewed score distributions were observed for the QTelemeDiab total score (median = 166; skewness = −1.738), as well as all its components, thus denoting a high desirability, acceptance, and adherence towards telemedicine use. The presence of severe depression was associated with significant decreases in the QTelemeDiab score (148 vs. 167; p < 0.001), as well as on the desirability sub-score (101 vs. 115; p < 0.001) and adherence sub-score (30 vs. 35; p < 0.001). The presence of severe anxiety was associated with significant decreases in QTelemeDiab score (150 vs. 166), as well as the desirability sub-score (104 vs. 114; p = 0.008) and adherence sub-score (30 vs. 34; p = 0.012). Conclusions: There is a high desirability, acceptance, and adherence to the use of telemedicine interventions in patients with diabetes, both in special and in normal epidemiological settings. The presence of severe anxiety decreases the patient’s desirability, acceptance, and adherence, while the presence of severe depression decreases the patient’s desirability and adherence to the use of telemedicine interventions in diabetes care.
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Affiliation(s)
- Raul Patrascu
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania; (A.B.); (L.G.); (B.T.)
| | - Alin Albai
- “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania; (A.B.); (L.G.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Correspondence: ; Tel.: +40-7214-35829
| | - Adina Braha
- “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania; (A.B.); (L.G.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Laura Gaita
- “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania; (A.B.); (L.G.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Sandra Lazar
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Ovidiu Potre
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Bogdan Timar
- “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania; (A.B.); (L.G.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Magee MF, Kaltman SI, Mete M, Nassar CM. A Prospective, Non-randomized Feasibility and Preliminary Efficacy Study of a Telemedicine-Enabled Co-management Intervention for Adults With Type 2 Diabetes and Moderate Anxiety and/or Depression. Sci Diabetes Self Manag Care 2021; 47:144-152. [PMID: 34078174 DOI: 10.1177/0145721721996305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The primary aim of this pilot study was to examine the feasibility of codelivering a mental health intervention with an evidence-based type 2 diabetes (T2DM) boot camp care management program. The preliminary impact of participation on symptom scores for depression and anxiety and A1C was also examined. METHODS This was a 12-week, non-randomized pilot intervention conducted with a convenience sample of adults with uncontrolled T2DM and moderate depression and/or anxiety at an urban teaching hospital. Co-management intervention delivery was via in-person and telehealth visits. Participants were assessed at baseline and 90 days. RESULTS Participants (n = 18) were African American, majority female (83%), and age 50.7 ± 13.4 years. Significant improvements in mental health outcomes were demonstrated, as measured by a reduction in Patient Health Questionnaire - 9 scores of 2.4 ± 2.9 (P = .01) and in Generalized Anxiety Disorder - 7 scores of 2.3 ± 1.9 (P = .001). The pre-post intervention mean A1C improved by 3.4 ± 2.1 units from 12% ± 1.4% to 8.5% ± 1.7% (P < .001). CONCLUSION The data generated in this pilot support the feasibility of delivering a diabetes and mental health co-management intervention using a combination of in-person and telemedicine visits to engage adults with T2DM and coexisting moderate depression and/or anxiety. Further research is warranted.
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Affiliation(s)
- Michelle F Magee
- MedStar Diabetes Institute, Washington, DC.,Department of Medicine, Georgetown University School of Medicine, Washington, DC.,MedStar Health Research Institute, Hyattsville, Maryland
| | | | - Mihriye Mete
- Department of Psychiatry, Georgetown University, Washington, DC
| | - Carine M Nassar
- MedStar Diabetes Institute, Washington, DC.,MedStar Health Research Institute, Hyattsville, Maryland
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Şahin S, Haliloğlu Ö, Polat Korkmaz Ö, Durcan E, Rekalı Şahin H, Yumuk VD, Damcı T, İlkova HM, Oşar Siva Z. Does treatment with sodium-glucose co-transporter-2 inhibitors have an effect on sleep quality, quality of life, and anxiety levels in people with Type 2 diabetes mellitus? Turk J Med Sci 2020; 51:735-742. [PMID: 33356033 PMCID: PMC8203126 DOI: 10.3906/sag-2008-37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/26/2020] [Indexed: 01/10/2023] Open
Abstract
Background/aim To evaluate the impact of treatment with sodium-glucose co-transporter-2 (SGLT2) Inhibitors on quality of life (QoL), sleep quality (SQ), and anxiety levels in patients with Type 2 diabetes mellitus (T2DM). Materials and methods Ninety-seven patients with type 2 diabetes admitted to tertiary care hospital diabetes clinic were included. Fifty patients were randomized to receive SGLT2 inhibitors in addition to baseline treatment (Group A), 47 subjects continued with their baseline treatment or were added other medications as needed (Group B). Thirty healthy controls (HC) were recruited (Group C). All groups were subjected to the Turkish version of Short Form-36 (SF-36), Pittsburgh Sleep Quality (PSQ), and Beck Anxiety Inventory (BAI) scales both at baseline and final visit. Results Physical function, emotional role limitation, vitality, mental health, pain, general health perception scores of SF-36 were significantly improved in Group A, at the end of the follow-up period. There was no significant change in terms of PSQ, BAI scores, and hypoglycaemia documented in all groups. The intervention-related change in HbA1c level, body weight, and body mass index were significantly higher in Group A. Conclusion The QoL was improved in people with diabetes who were taking SGLT2 inhibitors. This may be explained by weight loss observed in participants.
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Affiliation(s)
- Serdar Şahin
- Department of Internal Medicine, Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Özlem Haliloğlu
- Department of Internal Medicine, Taksim Training and Research Hospital, İstanbul, Turkey
| | - Özge Polat Korkmaz
- Department of Internal Medicine, Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Emre Durcan
- Department of Internal Medicine, Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Hümeyra Rekalı Şahin
- Department of Internal Medicine, Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Volkan Demirhan Yumuk
- Department of Internal Medicine, Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Taner Damcı
- Department of Internal Medicine, Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Hasan Mahmut İlkova
- Department of Internal Medicine, Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Zeynep Oşar Siva
- Department of Internal Medicine, Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey
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Mendes R, Martins S, Fernandes L. Adherence to Medication, Physical Activity and Diet in Older Adults With Diabetes: Its Association With Cognition, Anxiety and Depression. J Clin Med Res 2019; 11:583-592. [PMID: 31413770 PMCID: PMC6681861 DOI: 10.14740/jocmr3894] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/20/2019] [Indexed: 01/13/2023] Open
Abstract
Background Adherence to medication, physical activity (PA) and diet in diabetes mellitus (DM) patients is crucial for its good management, avoiding acute and chronic complications. There are several risk factors associated with non-adherence, including cognitive impairment, depression and anxiety. Nevertheless, studies on therapeutic adherence in older patients with DM are scarce. In this context, the present study aimed to analyze whether adherence to medication, PA and diet are associated with cognitive impairment, anxiety and depression. It also aimed to identity predictors of medication non-adherence. Methods A cross-sectional study of older patients (≥ 65 years old) with DM was carried out in the Outpatient Department of Internal Medicine Service of CHUSJ-Porto, Portugal. Those unable to communicate were excluded. Cognition (mini-mental state examination), anxiety and depression (hospital anxiety and depression scale) were assessed. Adherence to medication, PA and diet was measured, based on self-reporting patient/family, questionnaires, physician clinical opinion, hemoglobin test and pharmacy records. Patient groups were compared, using the Mann-Whitney or the Kruskal-Wallis test for continuous variables and the Chi-square test for paired categorical variables (significance level of 0.05). The odds ratio (OR) was calculated to identify independent predictors of non-adherence to medication. Results The final sample (n = 94) had a mean age of 75.2 years (standard deviation: 6.7) and mostly were female (53.2%), married (63.8%) and with a low education level (61.7%). Also, 22.3% with cognitive impairment, 16% with depression and 23.4% with anxiety were found. Patients non-adherent to medication had higher depression (P = 0.048) and anxiety (P = 0.010), compared to adherents/partial adherents. Patients non-adherent to PA showed higher anxiety (P = 0.035) and depression (P = 0.004), compared to adherents. Non-adherents to PA had more cognitive impairment than adherents (26.3% vs. 0%; P = 0.034). Patients who had insulin prescribed presented a higher risk of non-adherence to medication (OR: 4.041, 95% confidence interval (CI): 1.404 - 11.628; P = 0.010). Also, the risk of non-adherence to medication is higher by an increase of one unit in anxiety (OR: 1.252, 95% CI: 1.046 - 1.499; P = 0.014). Conclusions Higher anxiety and depression were associated with non-adherence to medication and to PA. Insulin prescribed and high anxiety scores were predictors of medication non-adherence. This study appears to contribute to the knowledge about the influence of cognitive and psychological factors in therapeutic adherence in these older diabetic patients.
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Affiliation(s)
- Rosa Mendes
- Department of Internal Medicine, Centro Hospitalar Universitario S. Joao (CHUSJ), Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal
| | - Sonia Martins
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Portugal
| | - Lia Fernandes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Portugal.,Clinic of Psychiatry and Mental Health, Centro Hospitalar Universitario S. Joao (CHUSJ), Porto, Portugal
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Sayın S, Sayın S, Bursalı B, Bilen İpek H. Tip 2 diyabet hastalarında anksiyete ve depresyon riski ve ilişkili faktörler. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.463589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Khan P, Qayyum N, Malik F, Khan T, Khan M, Tahir A. Incidence of Anxiety and Depression Among Patients with Type 2 Diabetes and the Predicting Factors. Cureus 2019; 11:e4254. [PMID: 31131177 PMCID: PMC6516618 DOI: 10.7759/cureus.4254] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction Diabetes mellitus (DM) is a chronic, progressive metabolic illness which is commonly complicated by coexistence of depression and anxiety. This study aimed to assess the prevalence of anxiety and depression among diabetic patients and the factors predicting this coexistence. Methods It was a cross-sectional, observational study which included patients of type 2 DM admitted in the hospital due to diabetes-related condition - diabetic foot infections/ulcers, hyperosmotic hyperglycaemic state (HHS), and hypoglycaemic coma/seizure. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Data was entered and analysed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Results Mean anxiety score of the participants was 10.88 ± 4.075 and mean depression score was 11.82 ± 4.049. There were 72 (50.7%) patients who had anxiety and 70 (49.2%) patients who had depression. Higher scores of anxiety and depression were statistically significant in female gender, older participants, individuals with longer duration of diabetes, those taking non-insulin treatment, and individuals with painful neuropathy, nephropathy, and foot ulcers. Conclusion The incidence of depression and anxiety among hospitalized patients of diabetes mellitus is high. The coexistence of these two chronic debilitating illnesses is worsening the overall quality of life. It is very important to diagnose and manage anxiety and depression in patients with type 2 DM to ensure higher quality of life and life expectancy.
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Affiliation(s)
- Paeenda Khan
- Miscellaneous, Jinnah Sindh Medical University, Karachi, PAK
| | - Neyha Qayyum
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Farina Malik
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Tooba Khan
- Miscellaneous, Jinnah Sindh Medical University, Karachi, PAK
| | - Maaz Khan
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Amber Tahir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Al-Mohaimeed AA. Prevalence and factors associated with anxiety and depression among type 2 diabetes in Qassim: A descriptive cross-sectional study. J Taibah Univ Med Sci 2017; 12:430-436. [PMID: 31435275 PMCID: PMC6694910 DOI: 10.1016/j.jtumed.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/12/2017] [Accepted: 04/16/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To assess the prevalence of anxiety and depression and to identify their associated risk factors among people with type 2 diabetes mellitus. METHODS A cross-sectional, single-centre study that included 300 adults with type 2 diabetes mellitus was conducted at The Diabetic Center of King Saud Hospital in the Qassim region. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was conducted to evaluate the combined effect of various factors associated with anxiety and depression, adjusting for confounding variables. RESULTS Overall, 43.6% (95% CI: 37.9-49.3%) and 34.8% (95% CI: 29-40%) of the participants experienced anxiety and depression, respectively. Anxiety was more common among patients who had poor social support (OR 5.35, P 0.001). Anxiety was less common among retired people (OR 0.36, P 0.048) and those having diabetes for more than ten years (OR 0.39, P 0.006). In contrast, depression was more common among patients who had received moderate (OR 2.47, P 0.031) or low social support (OR 6.62, P 0.000) but less common among those having diabetes for more than ten years (OR 0.44, P 0.022). CONCLUSION This study showed that the prevalence of anxiety and depression is high among adults with type 2 diabetes mellitus. These results should alert clinicians to identify and treat anxiety and depression as part of multidisciplinary diabetes care. Larger community-based studies are needed to identify the magnitude of these problems and their related factors.
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AlBekairy A, AbuRuz S, Alsabani B, Alshehri A, Aldebasi T, Alkatheri A, Almodaimegh H. Exploring Factors Associated with Depression and Anxiety among Hospitalized Patients with Type 2 Diabetes Mellitus. Med Princ Pract 2017; 26:547-553. [PMID: 29131123 PMCID: PMC5848470 DOI: 10.1159/000484929] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/02/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aims of the current study were to determine the prevalence and severity of anxiety and depression, and to explore associated factors among hospitalized patients with type 2 diabetes mellitus. SUBJECTS AND METHODS All patients with type 2 diabetes (160 patients) who were admitted to the Internal Medicine Wards of the King Abdulaziz Medical City, Riyadh, Saudi Arabia, from January to August 2015 were asked to participate, and 158 patients agreed to do so. A self-administered questionnaire consisting of 2 parts was used. The first part was on sociodemographic information, and the second part was a validated screening tool for assessing depression and anxiety. The severity of anxiety and depression was classified as normal, mild, moderate, and severe. Logistic regression was carried out to identify variables that were independently associated with anxiety and depression. RESULTS Using the screening tool, 85 (53.8%) and 80 (50.6%) study patients were identified as patients who suffered from depression and anxiety, respectively. The severity of distress was moderate/severe in 36 (42.4%) patients with depression and 41 (51.3%) patients with anxiety. The factors independently associated with the risk for anxiety in hospitalized patients with diabetes were physical inactivity and staying 8 days or longer in the hospital. On the other hand, factors that were independently associated with the risk for depression were older age, low income, and nephropathy. CONCLUSION The majority of hospitalized patients with diabetes developed moderate/severe anxiety or depression, or both, during hospitalization. Hence, screening for anxiety and depression in high-risk hospitalized diabetic patients is recommended during hospitalization.
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Affiliation(s)
- Abdulkareem AlBekairy
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Salah AbuRuz
- College of Pharmacy, Al Ain University of Science and Technology, Al Ain, United Arab Emirates
- College of Pharmacy, University of Jordan, Amman, Jordan
- *Salah AbuRuz, College of Pharmacy, Al Ain University of Science and Technology, Albaladya Street, 124th Street, PO Box 64141, Al Ain (United Arab Emirates), E-Mail
| | - Bandar Alsabani
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulmajeed Alshehri
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Tariq Aldebasi
- Division of Ophthalmology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulmalik Alkatheri
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hind Almodaimegh
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Iversen MM, Nefs G, Tell GS, Espehaug B, Midthjell K, Graue M, Pouwer F. Anxiety and Depressive Symptoms as Predictors of All-Cause Mortality among People with Insulin-Naïve Type 2 Diabetes: 17-Year Follow-Up of the Second Nord-Trøndelag Health Survey (HUNT2), Norway. PLoS One 2016; 11:e0160861. [PMID: 27537359 PMCID: PMC4990320 DOI: 10.1371/journal.pone.0160861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/26/2016] [Indexed: 11/18/2022] Open
Abstract
AIM To examine whether elevated anxiety and/or depressive symptoms are related to all-cause mortality in people with Type 2 diabetes, not using insulin. METHODS 948 participants in the community-wide Nord-Trøndelag Health Survey conducted during 1995-97 completed the Hospital Anxiety and Depression Scale with subscales of anxiety (HADS-A) and depression (HADS-D). Elevated symptoms were defined as HADS-A or HADS-D ≥8. Participants with type 2 diabetes, not using insulin, were followed until November 21, 2012 or death. Cox regression analyses were used to estimate associations between baseline elevated anxiety symptoms, elevated depressive symptoms and mortality, adjusting for sociodemographic factors, HbA1c, cardiovascular disease and microvascular complications. RESULTS At baseline, 8% (n = 77/948) reported elevated anxiety symptoms, 9% (n = 87/948) elevated depressive symptoms and 10% (n = 93/948) reported both. After a mean follow-up of 12 years (SD 5.1, range 0-17), 541 participants (57%) had died. Participants with elevated anxiety symptoms only had a decreased mortality risk (unadjusted HR 0.66, 95% CI 0.46-0.96). Adjustment for HbA1c attenuated this relation (HR 0.73, 95% CI 0.50-1.07). Those with elevated depression symptoms alone had an increased mortality risk (fully adjusted model HR 1.39, 95% CI 1.05-1.84). Having both elevated anxiety and depressive symptoms was not associated with increased mortality risk (adjusted HR 1.30, 95% CI 0.96-1.74). CONCLUSIONS Elevated depressive symptoms were associated with excess mortality risk in people with Type 2 diabetes not using insulin. No significant association with mortality was found among people with elevated anxiety symptoms. Having both elevated anxiety and depressive symptoms was not associated with mortality. The hypothesis that elevated levels of anxiety symptoms leads to behavior that counteracts the adverse health effects of Type 2 diabetes needs further investigation.
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Affiliation(s)
- Marjolein M. Iversen
- Department of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
- * E-mail:
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Birgitte Espehaug
- Department of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
| | - Kristian Midthjell
- Department of Community Medicine and General Practice, Norwegian University of Science and Technology, HUNT Research Centre, Levanger, Norway
| | - Marit Graue
- Department of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
| | - Frans Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
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The Prevalence and Specificity of Depression Diagnosis in a Clinic-Based Population of Adults With Type 2 Diabetes Mellitus. PSYCHOSOMATICS 2016; 58:28-37. [PMID: 27692654 DOI: 10.1016/j.psym.2016.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the crude prevalence of minor depressive disorder (MinD) in a clinic-based population of adults with type 2 diabetes. METHODS We screened a clinical sample of 702 adults with type 2 diabetes for depressive symptoms using the Patient Health Questionnaire-2 and performed a structured diagnostic psychiatric interview on 52 screen-positive and a convenience sample of 51 screen-negative individuals. Depressive disorder diagnoses were made using Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) Text Revised criteria and categorized as MinD, major depressive disorder (MDD), or no depressive disorder. We estimated prevalence of MinD and MDD and derived 95% CIs. RESULTS The crude prevalence of current, past, and current or past MinD was 4.3% (95% CI: 0.9-9.2%), 9.6% (95% CI: 3.9-15.9%), and 13.9% (95% CI: 7.7-21.2%), respectively. The crude prevalence of current, past, and current or past MDD was slightly higher-5.0% (95% CI: 1.9-9.4%), 12.0% (95% CI: 6.1-19.5%), and 17.0% (95% CI: 10.1-24.8%), respectively. There was a high prevalence of coexisting anxiety disorders in individuals with MinD (42.2%) and MDD (8.1%). Hemoglobin A1c levels were not significantly different in individuals with MinD or MDD compared to those without a depressive disorder. CONCLUSIONS MinD is comparably prevalent to MDD in patients with type 2 diabetes; both disorders are associated with concomitant anxiety disorders. MinD is not included in the DSM-5; however, our data support continuing to examine patients with chronic medical conditions for MinD.
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Bensbaa S, Agerd L, Boujraf S, Araab C, Aalouane R, Rammouz I, Ajdi F. Clinical assessment of depression and type 2 diabetes in Morocco: Economical and social components. J Neurosci Rural Pract 2014; 5:250-3. [PMID: 25002763 PMCID: PMC4078608 DOI: 10.4103/0976-3147.133576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The global prevalence of diabetes is increasing worldwide. In Morocco, diabetes and depression are major public health problems, requiring improvement in their care. Diabetes and depression are associated with morbidity and early mortality. This association contributes to raising the risk of the complications that occur, while causing higher suffering to patients, as also an increased cost toward healthcare. Aim: This study aims to assess the prevalence of depression in patients with type 2 diabetes (T2D), and identify the main risk factors for depression in this category of diabetic patients. Patients and Methods: Type 2 diabetic patients and older than 18 years of age were recruited. The exclusion criteria included being type 1 diabetic, pregnant woman, hospitalized patients, a history of neurological disorders, such as, stroke, infectious episidodes, and history of psychiatric disorders. The individual patient data was collected through individual and confidential interviews lasting 30 minutes, at the end of the diabetology consultation, by the same diabetologist, trained to use the psychometric scales that were needed. The Moroccan–Arabic version of the Beck diagnostic scale of depression was used. Patients assessed with depressive disorders were reviewed in a specialized psychiatric consultation. The statistical analysis was achieved by using SPSS package (version 17). We retained a threshold P value of 0.05. Settings and Design: A cross-sectional study was conducted that included adults with type 2 diabetes. The depression diagnosis was performed using the Arabic version of the Beck Depression scale. Statistical Analysis: We included 142 patients with type 2 diabetes, with an average age of 56.26 years. The prevalence of depression was 33.1%. The risk factors recognized for depression were, lack of social security, hypertension, and a history of type 2 diabetes of more than five years. Results and Conclusions: In this study, we have focused on the frequent association of ‘Type 2 diabetes and depression’ and the risk of mutual aggravation of both pathologies that might require multidisciplinary healthcare, as well as, improvement in the risk factors of depression through improved access to healthcare, with the extension of social security. The stability of the healthcare personnel involved in the treatment of both chronic diseases, including diabetes and hypertension screening, should also be considered for better management of psychiatric complications.
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Affiliation(s)
- Salma Bensbaa
- Departments of Endocrinology, Diabetology and Nutrition, Fez, Morocco
| | - Loubna Agerd
- Departments of Endocrinology, Diabetology and Nutrition, Fez, Morocco
| | - Saïd Boujraf
- Clinical Neuroscience Laboratory, University of Fez, Fez, Morocco ; Department of Biophysics and Clinical MRI Methods, University of Fez, Fez, Morocco
| | - Chadya Araab
- Clinical Neuroscience Laboratory, University of Fez, Fez, Morocco ; Department of Psychiatry, University Hospital of Fez, Fez, Morocco
| | - Rachid Aalouane
- Clinical Neuroscience Laboratory, University of Fez, Fez, Morocco ; Department of Psychiatry, University Hospital of Fez, Fez, Morocco
| | - Ismail Rammouz
- Clinical Neuroscience Laboratory, University of Fez, Fez, Morocco ; Department of Psychiatry, University Hospital of Fez, Fez, Morocco
| | - Farida Ajdi
- Departments of Endocrinology, Diabetology and Nutrition, Fez, Morocco
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