Health professionals' detection of depression and anxiety in their patients with diabetes: The influence of patient, illness and psychological factors

Diabetic neuropathy: A NRF2 disease?

The transcription factor nuclear factor erythroid 2-related factor 2 (NRF2) has multifarious action with its target genes having redox-regulating functions and being involved in inflammation control, proteostasis, autophagy, and metabolic pathways. Therefore, the genes controlled by NRF2 are involved in the pathogenesis of myriad diseases, such as cardiovascular diseases, metabolic syndrome, neurodegenerative diseases, autoimmune disorders, and cancer. Amidst this large array of diseases, diabetic neuropathy (DN) occurs in half of patients diagnosed with diabetes and appears as an injury inflicted upon peripheral and autonomic nervous systems. As a complex effector factor, NRF2 has entered the spotlight during the search of new biomarkers and/or new therapy targets in DN. Due to the growing attention for NRF2 as a modulating factor in several diseases, including DN, this paper aims to update the recently discovered regulatory pathways of NRF2 in oxidative stress, inflammation and immunity. It presents the animal models that further facilitated the human studies in regard to NRF2 modulation and the possibilities of using NRF2 as DN biomarker and/or as target therapy.

Prevalence and associated factors of depression and anxiety among Chinese diabetic retinopathy patients: A cross-sectional study

The purposes of this study were to evaluate the mental health among patients with diabetic retinopathy (DR) and to explore its' influencing factors. A cross-sectional survey was conducted in Liaoning Province, China. A total of 200 patients volunteered to participate in the survey. Psycho-social variables included stress, self-efficacy, resilience, and social support. logistic regression analysis was used to explore the effect of psycho-social factors on depression and anxiety in DR patients. The prevalence of depression and anxiety was 25% and 13.5% among DR patients. Regression analysis showed that social support had a significant protective effect on depression (95%CI 0.931-0.997) and anxiety (95%CI 0.900-0.995). Stress had a significant acceleration of depression (95%CI 1.055-1.253) and anxiety (95%CI 1.120-1.457). Family history of diabetes (95%CI 1.856-18.057) and other chronic diseases (95%CI 1.485-12.508) were risk factors for anxiety. The high prevalence of depression (25.0%) and anxiety (13.5%) among DR patients should receive more attention in Chinese medical settings. Stress, social support, family history of diabetes and other chronic diseases seemed to be crucial in relation to depressive symptoms. Efficient interventions such as improving social support and decreasing stress with patients should be considered by health administrators aiming at alleviating depressive and anxiety among Chinese DR patients.

Brief Cognitive Behavioral Therapy for Patients with Comorbid Depression and Type 2 Diabetes in an Urban Primary Care Facility: Randomized Controlled Trial

Background: The relation between depression and diabetes is bidirectional and both can lead to morbidity and mortality. Despite the success of Cognitive Behavioral Therapy (CBT) in managing psychiatric comorbidities, research on its use in the treatment of comorbid diabetes and depression is limited and with varying results. The aim of the study is to assess the efficacy of CBT on depressed patients with type 2 diabetes. Methods: This randomized controlled trial was conducted at an urban primary healthcare center in Egypt from February 2019 to March 2020 and included 80 participants. Key inclusion criteria were uncontrolled type 2 diabetes (T2D) (HbA1c >7.5%) and depression symptoms diagnosed by Beck’s Depression Index. Participants were assessed for all battery of instruments. Subsequently, participants were randomized to control and treatment groups. The treatment group received four CBT sessions. Both groups received a thirty-minute structured diabetes education and their usual diabetes treatment. Three months later, all participants were reassessed for depression and diabetes compliance and all labs were performed post intervention. Both the primary (the difference in HbA1c pre-post intervention) and secondary outcomes (the change in depressive symptoms assessed) were analyzed using ANCOVA.  Results: Both groups were matching at baseline. Post intervention, the CBT group revealed a significant reduction in depressive symptoms while adjusting for Beck Depression Index (BDI) pre-intervention [F (1, 74) = 7.074, p = 0.010]. Moreover, HBA1c was improved significantly when controlling for pre-intervention BDI scores and BMI [F (1,73) = 4.27, p = 0.042] compared to the control group. Conclusions: The CBT program was both inexpensive and easily accessible. It could fit very well in primary care settings. The results indicated CBT intervention was effective in improving diabetes control and depression. However, a larger-scale study to test its effect on a larger scale population and its long-term impact is recommended.

Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1)

People with type 1 diabetes (T1D) are more likely to have depression than the general population and their prognosis is worse. Unfortunately, the characteristics of persons with T1D lead to inadequate screening for depression in this population. To aid in the detection of depression in this population, this study was undertaken to develop a depressive symptoms assessment instrument specific to patients with T1D and to examine its psychometric properties. A total of 207 people with T1D participated in this study. The reliability of the new scale was assessed using Cronbach’s alpha and the Spearman-Brown split-half coefficient. The Depression Inventory for type 1 Diabetes (DID-1), composed of 45 items on a Likert scale (1–7), shows high internal and temporal consistency, as well as adequate concurrent, convergent and discriminant validity. Factor analysis identified 7 factors (Symptoms of depression, Diminished interest, Hopelessness and dissatisfaction, Guilt, Fear, frustration and irritability, Defenselessness, and Interference in daily life) that explained 61.612% of the total variability. The cut-off score for diagnosis was set at 155 points. It was concluded that the DID-1 scale is a reliable, valid and useful tool for the assessment of depressive symptoms, eliminating the bias of other nonspecific diabetes scales.

Implementation of a Mental Health Screening Program in a Pediatric Tertiary Care Setting

We evaluated the acceptability and usefulness of brief mental health screening during pediatric subspecialty clinic visits. Patients (8-17 years) and parents (of patients 5-17 years) in pediatric allergy, immunology, and hematology clinics completed the PROMIS (Patient-Reported Outcomes Measurement Information System) Pediatric Profile. Medical providers reviewed results and interpretations to guide discussion of mental health during visits. Almost all providers (96%) reported discussing mental health during visits but fewer parents (60%) said this discussion occurred. All parents who reported that mental health discussions occurred liked that this happened. Some parents (25%) who said no mental health discussion occurred wished it had. Most parents strongly agreed that screening completion was easy and appropriate. Most providers (79%) believed the screening was useful and 87% reported using screening results to guide discussion. Brief electronic mental health screening in pediatric subspecialty clinics is feasible, useful in guiding discussion, and viewed favorably by providers and parents of children with chronic illnesses.

Agreement between a single-item measure of anxiety and depression and the Hospital Anxiety and Depression Scale: A cross-sectional study

Anxiety and depression can be heightened among individuals living with chronic diseases. Identifying these individuals is necessary for ensuring they are provided with adequate support. Traditional tools such as clinical interviews or symptom checklists are not always feasible to implement in practice. Robust single-item questions may be a useful alternative. This study aimed to measure agreement, sensitivity, specificity, positive predictive value and negative predictive value of a single-item question about anxiety and depression compared to the widely used Hospital Anxiety and Depression Scale (HADS). A cross-sectional survey of 2,811 people with cancer attending 19 treatment centres in Australia. Patients were approached in the waiting room prior to an outpatient clinic appointment and invited to complete a pen and paper survey. Participants completed the HADS as well as 2 single-items asking if they have felt anxious or depressed in the last week. The single-items for anxiety and depression each demonstrated moderate levels of sensitivity (0.78 for anxiety; 0.63 for depression) and specificity (0.75 for anxiety; 0.84 for depression) against the relevant HADS subscale. Positive predictive values were moderate (0.53 for anxiety and 0.52 for depression) while negative predictive values were high for both single-item questions (0.90 for anxiety and 0.89 for depression). The single-item measures of anxiety and depression may be useful to rule out individuals who do not require further psychological assessment or intervention for anxiety and depression. Further research is needed to explore whether these findings generalise to other chronic diseases.

Depression and anxiety disorders in people with diabetes

Introduction: As the global number of diabetes and the burden of depression together with other mental disorders increases, there is a need for better understanding of the connection between these diseases. In patients with diabetes, mental disorders are more common than in the general population, especially anxiety disorders and depression, which are often difficult to detect by health professionals.

Material and methods: Using the keywords searched in the international bibliographic databases: Embase, Medline, Science Direct, Web of Science. We analyzed clinical trials published in English and international journals

Results: Patients with diabetes are exposed to serious physical and mental complications. The occurence of depression and psychiatric disorders among people with diabetes was twice as frequent as in the general population. There are also studies showing a higher risk of suicide among people with diabetes. In addition, patients with both diseases, diabetes and depression, had an increased risk of cardiovascular complications and increased mortality and higher costs of health care. Diabetic patients have increased incidence of anxiety disorders in relation to non-diabetic patients by 20%.

Conclusion: Further researches and integration of medical and psychological treatment are needed. Cooperation between psychiatrists and diabetologists can reduce mental and physical harm in patients with diabetes.

PRELIMINARY INSIGHTS IN OXYTOCIN ASSOCIATION WITH THE ONSET OF DIABETIC NEUROPATHY

Diabetes is one of the most prevalent chronic disorders, associating numerous somatic and behavioral modifications. Oxytocin has been widely studied for its involvement in social behavior and psychiatric disorders. This pilot study presents a series of 3 patients with type 1 diabetes and diabetic neuropathy in which the values of plasma oxytocin, neurotensin, β-endorphins, α-MSH, substance P and orexin A were measured in comparison to 3 healthy controls with matching ages. In the diabetic patients group, there was a strong negative correlation between the value of plasma glucose and oxytocin (r=-0.99, p=0.04), respectively neurotensin (r=-0.99, p=0.03). These values did not correlate in the control group. The results suggest that oxytocin, in conjunction with neurotensin, could be investigated as a potential early detection marker of diabetic neuropathy and, to our knowledge, this is the first report focusing on plasma oxytocin levels in patients with diabetic neuropathy.

Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or rheumatoid arthritis

We studied emotional health in patients with diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) aged 18–65 years, at the time of diagnosis and after 24 months. Predictors for depression or anxiety according to the Hospital Anxiety and Depression scale after 2 years were assessed by logistic regression, with psychosocial factors and coping as dependent factors. There were many similarities between patients with diabetes mellitus or rheumatoid arthritis. Having children at home, low score on the Sense of Coherence scale, and high score on the coping strategy “protest” were important risk factors for depression and anxiety after 2 years.

Internet-delivered cognitive behaviour therapy for depression in people with diabetes: study protocol for a randomised controlled trial

INTRODUCTION

Depression substantially contributes to the personal burden and healthcare costs of living with diabetes mellitus (DM). Comorbid depression and DM are associated with poorer quality of life, poorer self-management and glycemic control, increased risk for DM complications and higher mortality rates, and higher health service utilization. Depression remains under-recognized and undertreated in people with DM, which may, in part, result from barriers associated with accessing face-to-face treatment. This study will examine the efficacy of an internet-based cognitive behaviour therapy programme for major depressive disorder (iCBT-MDD) in people with DM.

METHODS AND ANALYSIS

A CONSORT 2010 compliant, registered randomised controlled trial of the intervention (iCBT-MDD) versus a treatment as usual control group will be conducted. The study will include 100 adults aged 18 years and over with a diagnosis of type 1 or type 2 DM and self-reported symptoms that satisfy MDD which will enable us to detect a statistically significant difference with a group effect size of 0.6 at a power of 80% and significance level of p=0.05. Participants will be randomised to receive the iCBT-MDD programme immediately, or to wait 10 weeks before accessing the programme. Primary outcomes will be self-reported depression severity, DM-related distress, and glycemic control (glycosylated hemoglobin). Secondary outcomes will be general distress and disability, generalized anxiety, lifestyle behaviours, somatization, eating habits, alcohol use, and acceptability of the iCBT programme to participants, and practicality for clinicians. Data will be analyzed with linear mixed models for each outcome measure.

ETHICS AND DISSEMINATION

The Human Research Ethics Committee of St Vincent's Hospital Australia have given ethics approval (HREC/13/SVH/291). Results will be disseminated via peer-reviewed publication and social media channels of Australian Diabetes Consumer Representative Bodies.

TRIAL REGISTRATION NUMBER

The trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12613001198718).