Depression, anxiety, and associated factors in patients with diabetes: evidence from the anxiety, depression, and personality traits in diabetes mellitus (ADAPT-DM) study

Study protocol on the efficacy of exergames-acceptance and commitment therapy program for the treatment of major depressive disorder: comparison with acceptance and commitment therapy alone and treatment-as-usual in a multicentre randomised controlled trial

BACKGROUND

The prevalence of major depressive disorder (MDD) is on the rise globally, and the use of antidepressant medications for its treatment does not usually result in full remission. However, the combination of physical exercise and psychotherapy for the treatment of MDD increase the rate of full remission among patients. This three-armed, parallel-group, double-blinded randomised controlled trial (RCT) aims to assess and compare the effects between the combination of exergame and acceptance and commitment therapy (e-ACT) programme, ACT only and treatment-as-usual (TAU) control groups on the severity of depression and anxiety symptoms, the degree of experiential avoidance and quality of life (QoL) and the serum levels of depression biomarkers (such as brain-derived neurotrophic factor, C-reactive protein and vascular endothelial growth factor) among patients with MDD across three time points.

METHODS AND ANALYSIS

This RCT will recruit 126 patients with MDD who will be randomised using stratified permuted block randomisation into three groups, which are the combined e-ACT programme, ACT-only and TAU control groups in a 1:1:1 allocation ratio. The participants in the e-ACT and ACT-only intervention groups will undergo once a week intervention sessions for 8 weeks. Assessments will be carried out through three time points, such as the pre-intervention assessment (t0), assessment immediately after completion of the intervention at 8 weeks (t1) and assessment at 24 weeks after completion of the intervention (t2). During each assessment, the primary outcome to be assessed includes the severity of depression symptoms, while the secondary outcomes to be assessed are the severity of anxiety symptoms, experiential avoidance, QoL and depression biomarkers.

ETHICS AND DISSEMINATION

Approval of this study was obtained from the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/PP/23050420). The findings of the study will be published in academic peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05812001 (ClinicalTrials.gov). Registered on 12 April 2023.

Association of Long-Term HbA1c Variability with Anxiety and Depression in Patients with Type 2 Diabetes: A Cross-Sectional Retrospective Study

Purpose

To explore the relationship between long-term glycemic variability and anxiety and depression in patients with type 2 diabetes.

Participants and Methods

A cohort comprising 214 individuals diagnosed with type 2 diabetes participated in this study. Comprehensive demographic and laboratory information was gathered for them. The evaluation of anxiety relied on the 7-item Generalized Anxiety Disorder Scale (GAD-7), while depression was assessed utilizing the 9-item Health Questionnaire (PHQ-9). Based on the presence or absence of anxiety and depression, participants were categorized into either the mood disorder or control groups. Subsequently, univariate and stepwise multiple binary logistic regression analyses were conducted to investigate the potential correlations between factors and the presence of anxiety and depression.

Results

The prevalence of anxiety disorders is 23%, and depression is 32%. The prevalence of smoking, diabetic autonomic neuropathy, stroke, and osteoporosis in the mood disorder group was significantly higher than that in the control group (P < 0.05), the glycated hemoglobin A1c variability score (HVS), mean hemoglobin A1c value, total cholesterol, urinary albumin/creatinine and systemic immune-inflammatory index (SII) were significantly higher in the control group (P < 0.05). The level of high-density lipoprotein in the mood disorder group was significantly lower than the control group (P < 0.05). In stepwise multiple binary logistic regression analyses, the main factors associated with anxiety were depression (P < 0.001, OR=117.581) and gender (P < 0.001, OR=9.466), and the main factors related to depression included anxiety (P < 0.001, OR=49.424), smoking (P=0.042, OR=2.728), HVS (P=0.004, OR=8.664), and SII (P=0.014, OR=1.002).

Conclusion

Persistent fluctuations in blood glucose levels have been linked to anxiety and depression. Consequently, maintaining an optimal level of glycemic control and minimizing fluctuations becomes imperative in the comprehensive management of diabetes.

Prevalence of Anxiety and Associated Factors Among Inpatients with Type 2 Diabetes Mellitus in China: A Cross-Sectional Study

This study aimed to investigate the prevalence of anxiety and its associated factors among inpatients with type 2 diabetes mellitus (T2DM) in China. This study was a cross-sectional study. Inpatients with T2DM admitted to the Endocrinology Department of Xiangya Hospital, Central South University in Hunan Province of China from March 2021 to December 2021 were consecutively included in this study. Participants were interviewed to obtain the data on socio-demographic characteristics, lifestyle characteristics, T2DM-related information, and social support. Anxiety was measured using the Hospital Anxiety and Depression Scale-anxiety subscale by experienced physicians. Multivariable logistic regression analysis was used to estimate the independent contribution of each independent variable to anxiety. A total of 496 inpatients with T2DM were included in this study. The prevalence of anxiety was 21.8% (95% confidence interval [CI]: 18.1%-25.4%). The results of multivariable logistic regression analysis indicated that age of at least 60 (adjusted odd ratio [aOR] = 1.79, 95% CI: 1.04-3.08), and having diabetes specific complications (aOR = 4.78, 95% CI: 1.02-22.44) were risk factors for anxiety, and an educational level of high school or above (aOR = 0.55, 95% CI: 0.31-0.99), regular physical activity (aOR = 0.36, 95% CI: 0.22-0.58), and high social support (aOR = 0.30, 95% CI: 0.17-0.53) were protective factors for anxiety. A predictive model based on these five variables showed good performance (area under the curve = 0.80). Almost one in five inpatients with T2DM suffered from anxiety in China. Age, educational level, regular physical activity, diabetes specific complications, and social support were independently associated with anxiety.

The status of stigma in patients with type 2 diabetes mellitus and its association with medication adherence and quality of life in China: A cross-sectional study

Type 2 diabetes mellitus (T2DM) is a chronic, lifelong disease that can negatively affect patients' mental health and quality of life (QoL). A notable proportion of patients with T2DM worldwide have experienced stigma through instances of discrimination, unfair social treatment and lack of promotion opportunities. Stigma refers to the negative emotional experience of people with illness, often mixed with self-stigmatization. Stigma remains an obstacle to patients' self-management, its association with patients with T2DM on medication adherence and QoL in China are unknown. Therefore, the objective of the study was to analyze the status of stigma in patients with T2DM and its association with medication adherence and QoL in China. A cross-sectional, observational study among 346 inpatients with T2DM in 2 tertiary-level hospitals in Chengdu, China, was conducted using a general data questionnaire, Chinese version type 2 diabetes stigma scale (DSAS-2), Morisky medication adherence scale (MMAS-8) and diabetic QoL specificity scale by convenient sampling method from January to August 2020. The total score and scores for the 3 dimensions of stigma, treated differently, blame and judgment, and self-stigma, were 54.30 ± 12.22, 16.57 ± 4.06, 20.92 ± 4.42, 16.82 ± 4.78, respectively. The scores for medication adherence and QoL were 5.43 ± 1.8 and 73.24 ± 9.38. Pearson correlation analysis showed that the total score of stigma and the scores of each dimension were negatively weak-correlated with the score of medication adherence (r = -0.158 to -0.121, P < .05), and positively moderate-correlated with the score of QoL (R = 0.073 to 0.614, P < .05). Stigma of patients with T2DM was negatively associated with medication adherence, and negatively associated with QoL, namely, the stronger the stigma, the worse the medication adherence and QoL. The results of the hierarchical regression analysis revealed that stigma independently explained 8.8% of the variation in medication adherence and 9.4% to 38.8% of the variation in QoL. The stigma of patients with T2DM was at a moderate degree and negatively correlated with medication adherence and QoL, it is necessary to pay more attention to relieve stigma and negative emotions timely, in order to improve patients' mental health and QoL.

Intra-gastrically administration of Stevia and particularly Nano-Stevia reversed the hyperglycemia, anxiety, and memory impairment in streptozotocin-induced diabetic rats

Type II diabetes mellitus is a group of metabolic disorders considered chronic hyperglycemia resulting from deficits in insulin secretion or insulin function. This disease usually links with various psychological problems such as anxiety and cognitive dysfunctions. Stevia (Stevia rebaudiana Bertoni) is a natural and healthy substitute sweetener for sugar and artificial sweeteners. It has become essential for human diets and food manufacturers. The aim of this research was to investigate the effects of Stevia and Nano-stevia on the regulation of anxiety and memory processes in male diabetic rats. The elevated plus-maze (EPM) test-retest procedure was used to assess anxiety and memory in male diabetic rats. The findings exhibited that induction of diabetes caused a distorted cellular arrangement in the liver tissue of male rats. On the other hand, intra-gastrically administration of Stevia (1 ml/kg) and nano-Stevia (1 ml/kg) indicated a normal appearance in the liver tissue of male diabetic rats. Moreover, induction of diabetes caused the augmentation of blood glucose, reduction in time spent in%open-arm time (%OAT) on the test day, and enhancement of%OAT on the retest day. Therefore, induction of diabetes in rats produced hyperglycemia, anxiogenic effect, and memory impairment and these responses were reversed by drug treatment. Furthermore, intra-gastrically application of Stevia (1 ml/kg) and nano-Stevia (1 ml/kg) reversed the hyperglycemia, anxiogenic effect, and memory impairment in male diabetic rats. Interestingly, Nano-Stevia exhibited the highest significant response rather than Stevia. In conclusion, the results of this research suggested the beneficial properties of Stevia and particularly Nano-Stevia on inducing anti-diabetic effects, anxiolytic behavior, as well as memory improvement in male diabetic rats.

Associations of different types of child maltreatment and diabetes in adulthood - the mediating effect of personality functioning: Findings from a population-based representative German sample

PURPOSE

This study aimed to examine the role of personality functioning in the association between various types of child maltreatment (CM) (sexual, physical, and emotional abuse as well as physical and emotional neglect) and diabetes in adulthood.

METHODS

Analyses are based on representative data of the German population (N = 5,041) from 2016 to 2019. Self-report questionnaires assessed diagnosis of diabetes, child maltreatment (CTQ), personality functioning (OPD-SQS), and symptoms of depression/anxiety (PHQ-4). Odd ratios were calculated to examine the association between CM and diabetes, and mediation analyses including PHQ-4 as covariate were conducted to examine the role of personality functioning.

RESULTS

All CM types significantly elevated the odds of having diabetes in adulthood. Personality functioning mediated the association between abuse and diabetes (sexual: b = 0.012, 95% CI [.002, 0.022], P_M = 25.0%, physical: b = 0.009, 95% CI [.001, 0.017], P_M = 12.0%, and emotional: b = 0.013, 95% CI [.002, 0.024], P_M = 59.8%), but not between neglect and diabetes.

CONCLUSIONS

CM is associated with an increased risk of diabetes, with personality functioning being a relevant mediator for CM abuse types. Hence, by focusing on CM prevention and considering impaired personality functioning in diabetes treatment, diabetes self-management and health behavior could be improved.

Evaluation of oral health-related quality of life and its association with mental health status of patients with type 2 diabetes mellitus in the post-COVID-19 pandemic era: A study from Central Saudi Arabia

Background and objectives

The association between oral and mental health is reciprocal, in which poor oral health may lead to several mental health issues, especially among patients with diabetes. The present study evaluated oral health-related quality of life (OHRQOL) and its association with mental health conditions among patients with type 2 diabetes mellitus (T2DM) in central Saudi Arabia.

Methods

The Arabic version of the Oral Health Impact Profile-14 (OHIP-14) questionnaire and the Depression, Anxiety, and Stress Scale-21 Items (DASS-21) were used to assess the OHRQOL and mental health status of patients with diabetes. We utilized logistic regression analysis to identify the predictors of poor OHRQOL, and Spearman's correlation test to identify any correlations between OHIP-14 and overall DASS-21 scores, as well as each subscale.

Results

Of the 677 patients included in the present study, 52.7% had a poor OHRQOL, which was significantly higher (positive association) among patients with a longer duration of diabetes (adjusted odds ratio [AOR] = 3.31; 95% confidence interval [CI] = 1.96-4.17) and those who did not periodically monitor their oral health (AOR = 2.85; 95% CI = 1.76-3.89). Some forms (mild, moderate, severe, or extremely severe) of depression, anxiety, and stress were observed in 59.7, 71.1, and 67.1% of the participants, respectively. Furthermore, we found that the total OHRQOL scores had a significant positive association with depression (AOR = 2.32, 95% CI = 1.34-3.71, p = 0.001), anxiety (AOR = 1.81, 95% CI = 1.22-2.79, p = 0.003), and stress (AOR = 1.43, 95% CI = 1.14-2.19, p = 0.026).

Conclusion

The results of the present study suggest the importance of appropriate and targeted health education programs for T2DM patients to ensure periodic dental examinations and oral health. Additionally, we recommend counseling sessions for all T2DM patients with trained healthcare providers to improve their mental health status during follow-up visits at outpatient diabetes care centers.

Does awareness of diabetic status increase risk of depressive or anxious symptoms? Findings from the China Multi-Ethnic cohort (CMEC) study

INTRODUCTION

People with diabetes mellitus (DM) have increased risk of depressive symptoms (DS) or anxious symptoms (AS). This study explores whether awareness of DM will contribute to prevalence of DS or AS.

METHODS

The baseline data including 81,717 adults from Southwest China was analyzed. DS and AS were assessed using PHQ-2 and GAD-2. Exposures were defined as 1) having self-reported physician diagnosis of diabetes (self-reported DM), 2) no prior diagnosis of diabetes but meeting diagnostic criteria (newly diagnosed DM), 3) having self-reported physician diagnosis or meeting criteria of non-diabetic diseases (non-diabetic patients), 4) healthy participants. Generalized linear mixed models were used to assess impact of presence and awareness of DM on DS or AS, adjusting for regional and individual related factors.

RESULTS

The prevalence of DS in self-reported DM, newly diagnosed DM, non-diabetic patient and healthy participants was 7.08 %, 4.30 %, 5.37 % and 3.17 %. The prevalence of AS was 7.80 %, 5.77 %, 6.37 % and 3.91 %. After adjusting for related factors, compared with healthy participants, self-reported DM and non-diabetic patients were associated with DS [AOR_{DS, self-reported} = 1.443(1.218,1.710), AOR_{DS, nondiabetic patients} = 1.265(1.143,1.400)], while the association between newly diagnosed DM and DS was not statistically significant. The associations between self-reported DM, newly diagnosed DM, non-diabetic patients and AS were all statistically significant.

LIMITATIONS

DS and AS were assessed through self-report and may suffer recall or information bias.

CONCLUSIONS

The association between awareness of diabetes and DS/AS suggests to pay attention to distinguish between self-reported and newly diagnosed DM and screening for DS and AS in diabetic population.

Hardiness moderates the effects of COVID-19 stress on anxiety and depression

The COVID-19 pandemic has led to sharp increases in mental health problems around the world, most notably in anxiety and depression. The present study examines hardiness and age as potential protective factors against the mental health effects of COVID-related stress. A sample of Canadians balanced across age and gender, completed an online survey including measures of COVID related stressors, hardiness, depression, and anxiety, along with age, gender, and other demographics. Conditional PROCESS analysis showed that COVID stressors led to significant increases in anxiety and depression. Hardiness moderated these relations, with those high in hardiness showing less anxiety and depression. Age was negatively related to anxiety and depression, with highest levels observed among the younger respondents. At the same time, a moderating effect of age was found with respect to depression, with older people showing sharper increases in depression as COVID-related stress goes up. Gender was not a significant factor in any of these relations, meaning that the results apply equally well to both women and men. This study provides evidence that younger people who are also low in hardiness are most vulnerable to developing anxiety and depression while under COVID stress, and so would likely benefit from preventive intervention strategies. While anxiety and depression symptoms are highest among the young, older age groups appear more vulnerable to increasing rates of depression symptoms related to COVID stress. Clinicians and practitioners should thus be especially vigilant for COVID related increases in depression among older people, and those low in psychological hardiness.

A bidirectional relationship between diabetes mellitus and anxiety: A systematic review and meta-analysis

BACKGROUND

Due to the existence of inconsistencies in the evidence regarding the direction and extent of association between diabetes and anxiety disorders, the anxiety-diabetes comorbidity remains an issue of debate.

AIM

To estimate the proportion and risk of diabetes among individuals with anxiety disorder and vice versa.

METHODS

A systematic review was conducted using studies retrieved from databases and grey literature, with the last database search being conducted on April 15, 2021. The methodological rigor of studies was assessed using the National Institute of Health quality assessment tool. Prevalence and effect size (ES) estimates were pooled using a random effect model. Heterogeneity was assessed using the Higgins' I² statistical test, and subgroup analysis conducted.

RESULTS

We included 68 studies presenting data from 2,128,029 participants. The prevalence of anxiety disorders in diabetic patients was 28% (95% CI: 26%, 31%); however, subgroup analysis showed significant differences based on type of anxiety assessment scales, study location, and type of diabetes. The prevalence of diabetes among patients with anxiety disorders was 12% (95% CI: 9%, 16%). Patients with anxiety disorders were found to have a 19% higher risk of diabetes (pooled effect size (ES) = 1.19, 95% CI: 1.13, 1.26). Diabetic patients were found to have a 41% higher risk of developing anxiety disorders (ES = 1.41, 95% CI: 1.19, 1.62).

CONCLUSIONS

There is a higher risk of anxiety disorders in patients with diabetes mellitus and vice versa. It is recommended to screen diabetic patients for anxiety at initial diagnosis and follow-up visits. Similarly, patients with anxiety disorders should have regular screening for diabetes.

REVIEW REGISTRATION

PROSPERO registration number CRD42021252475.

Microglia activation and inflammation in hippocampus attenuates memory and mood functions during experimentally induced diabetes in rat

Incidence of cognitive and emotional alterations are reportedly two times more in diabetic patients than in non-diabetic population with hitherto unexplained causation and mechanism. Purview of the hippocampus functional diversity sanctions the accessibility and the necessity to investigate the regional neuro-immunological aspects of neurodegeneration and related functional alterations following diabetes. We examined the possible involvement of microglia activation, macrophage response, oxidative stress and inflammatory stature in both ventral and dorsal hippocampus of rats rendered diabetic by a single injection of streptozotocin (STZ; 45 mg/ kg body weight; intraperitoneal). Cognitive and behavioural alterations were studied using open field test (locomotor activity), elevated plus maze (anxiety), Barnes maze (spatial cognition) and T maze (working memory) at 2nd, 4th, 6th, 8th, 10th and 12th week post diabetic confirmation. Oxidative stress was investigated via measuring the level of lipid peroxidation biochemically. Scenario of microglia activation, macrophage response and inflammation was gauged using qualitative and quantitative analysis. Pronounced macrophage expression and activation directed microglia phenotypic switching was prominent in both ventral and dorsal hippocampus indicating the impact of oxidative stress following diabetes in hippocampus. The resultant inflammatory response was also progressive and persistent in both ventral and dorsal hippocampus parallel to the altered cognitive, locomotor ability and anxiety behaviour in diabetic rats. Conclusively, present data not only comprehends the microglia, macrophage physiology and related immune response in functionally different hippocampal regions associated cognitive and behavioural deficits, but also offers a suggestive region-specific cellular mechanism pathway for developing an imminent therapeutic approach during particular diabetes deficits.

Compulsive Study Behaviors Are Associated with Eating Disorders and Have Independent Negative Effects on Well-Being: A Structural Equation Model Study among Young Musicians

Compulsive overworking and eating disorders (EDs) show considerable similarities in terms of risk factors (e.g., rigid perfectionism), clinical manifestation (e.g., excessive controlling behaviors), and consequences (e.g., physical exhaustion and depression). This study aimed to examine the hypotheses that compulsive study behaviors (conceptualized as study addiction) are related to EDs and that they have independent negative effects on well-being among young musicians, who constitute a highly vulnerable population for these types of problematic behaviors. The relatively high prevalence of study addiction and its pronounced negative relationship with psychosocial functioning make it a pending challenge for sustainable education. A total of 255 students from various music academies in Poland took part in the study. The Bergen Study Addiction Scale, assessing compulsive studying (conceptualized as addictive behavior), the Eating Attitude Test-26 (EAT-26), the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, and the quality-of-life measure were used. A structural equation model was investigated. Study addiction was positively related to the general factor of EDs and the social pressure component. Both problematic behaviors showed negative and independent effects on the well-being of young musicians. EDs may be 8 to 16 times more prevalent among the students of music academies who are addicted to studying than among the general population. About 80% of those students showing all seven symptoms of study addiction exhibited at least mild depression, while more than half had clinically significant levels of depression. Almost 90% had clinically significant levels of anxiety. Without addressing co-occurring study addiction and eating disorders, including their commonalities and idiosyncrasies, their prevention and treatment cannot be effective and it will substantially affect the sustainability of education and work.

Biopsychosocial and Nutritional Factors of Depression among Type 2 Diabetes Mellitus Patients: A Systematic Review

The rising prevalence of depression among Type 2 Diabetes Mellitus (T2DM) patients has triggered an alarming situation, and further actions need to be taken by health care professionals and policymakers to curb the issue. There is a lack of evidence review in terms of the biopsychosocial and nutritional factors that are related to depression among T2DM. Hence, this review aimed to identify available evidence on the biopsychosocial and nutritional factors associated with depression among T2DM patients based on the existing literature. Articles were systematically searched from four databases, namely PubMed, Scopus, Web of Science, and EBSCOHost. The approach for the identification of the final articles followed PRISMA guidelines. The selected full-text articles were published between 2017 and 2021 in the English language, and included studies focused on depression among T2DM patients. Using AXIS tools, the eligible articles were evaluated to assess the quality of studies. A total of 19 studies were included in the review, and information related to research questions and associated factors was extracted. Biological, psychological, social, and nutritional factors were shown to be linked with depression among T2DM patients. Future studies need to considered using the biopsychosocial model and incorporating nutritional factors to manage the issues of depression among T2DM patients.

Depression in Diabetic Patients: What Is the Link With Eating Disorders? Results of a Study in a Representative Sample of Patients With Type 1 Diabetes

BACKGROUND AND PURPOSE

Comorbidity between diabetes and depression, and diabetes and eating disorders (ED) conveys significant diagnostic, clinical and therapeutic implications. The present study was conducted on a sample of adult outpatients affected by Type 1 Diabetes (T1DM) to assess lifetime prevalence of ED; current prevalence of depression and Disturbed Eating Behaviors (DEB) and their impact on glycemic control. We hypothesized that patients with depression would have higher rates of lifetime ED and current DEB. We hypothesized a significant and independent association between DEB and the prevalence of depression.

MATERIALS AND METHODS

The study was carried out using a cross-sectional design in a sample of 172 diabetic patients with T1DM aged from 17 to 55 years. Lifetime prevalence of ED according to DSM-5 criteria was assessed by means of the Module H modified of the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). The following questionnaires were used: Beck Depression Inventory-IA version (BDI-IA) and Diabetes Eating Problems Survey-Revised (DEPS-R), to assess respectively the current presence of depression and DEB. Socio-demographic, clinical, and laboratory data were also collected.

RESULTS

High rates of depression (35.5%) and DEB (19.2%) were observed in our sample of 172 adult outpatients with T1DM. Lifetime history of ED was present in 20.9% of the sample and was more frequently diagnosed in patients with current depression (34.4% vs. 13.9%, p = 0.002). Higher levels of DEB at DEPS-R significantly increased the odds of depression (adjOR: 1.09; 95% CI: 1.03-1.15; p = 0.003). The presence of DEB was associated with poor glycemic control. On the other hand, no association was found between depression and metabolic compensation.

CONCLUSION

Adult patients with T1DM and depression should be screened for ED and DEB. Treating DEB could positively impact both mood and glycemic control in this population. Further studies should be carried out on a larger patient population using a longitudinal design and an accurate method of evaluation to explore the complex relationship between diabetes, depression, ED, and DEB. Future research should investigate treatment strategies for DEB in T1DM patients and their impact on both psychopathological and metabolic outcomes.

Brain Expression, Physiological Regulation and Role in Motivation and Associative Learning of Peroxisome Proliferator-activated Receptor γ

Like other members of the superfamily of nuclear receptors, the peroxisome proliferator-activated receptor γ (PPARγ), is a ligand-activated transcription factor known for its insulin-sensitizing actions in the periphery. Despite only sparse evidence for PPARγ in the CNS, many reports suggest direct PPARγ-mediated actions in the brain. This study aimed to (i) map PPARγ expression in rodent brain areas, involved in the regulation of cognitive, motivational, and emotional functions, (ii) examine the regulation of central PPARγ by physiological variables (age, sex, obesity); (iii) chemotypically identify PPARγ-expressing cells in the frontal cortex (FC) and hippocampus (HP); (iv) study whether activation of PPARγ by pioglitazone (Pio) in FC and HP cells can induce target gene expression; and (v) demonstrate the impact of activated PPARγ on learning behavior and motivation. Immunoreactive PPARγ was detectable in specific sub-nuclei/subfields of the FC, HP, nucleus accumbens, amygdala, hypothalamus, thalamus, and granular layers of the cerebellum. PPARγ protein levels were upregulated during aging and in high fat diet-induced obesity. PPARγ mRNA expression was upregulated in the amygdala of females (but not males) that were made obese. Neural precursor cells, mature neurons, and astrocytes in primary FC and HP cultures were shown to express PPARγ. Pioglitazone dose-dependently upregulated PPARγ target genes in manner that was specific to the origin (FC or HP) of the cultures. Lastly, administration of Pio impaired motivation and associative learning. Collectively, we provide evidence for the presence of regulatable PPARγ in the brain and demonstrate their participation the regulation of key behaviors.

Depression and anxiety in patients with diabetes in a Moroccan region

AIMS

To estimate prevalence of anxiety and depression in patients with diabetes mellitus and identify their determinants.

METHODS

A cross-sectional study was conducted at Hassan II University-Hospital of Fes in 2019-2020. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariate analysis by logistic regression was used to determine factors associated with depression and anxiety, adjusting for confounding factors. All statistical analyses were conducted using EPIINFO7.

RESULTS

A total of 243 diabetics were included in the study. The average age of the participants was 48.07±14.25 years, 58% were females and 72% were diagnosed with diabetes type II. The prevalence of depressive symptoms and anxiety symptoms was (18, 1%, CI_95%=(13-23)) and (29.6%, CI_95%=(24-35)), respectively. The prevalence of depression and anxiety was higher among women than man and increases with increasing duration of the disease. In multivariate analysis, illiterates (OR=3.19, CI_95%=(1.46-6.98)), those with depression (OR=3.61, CI_95%=(1.78-7.32)), and type 1 diabetics (OR=3.22, CI_95%=(1.44-7.21)) are a higher risk of developing anxiety. Depression was associated with older age (OR=2, 65, CI_95%=(1, 14-6, 14)), use of insulin (OR=3.77 CI_95%=(1.50-9.44)) and anxiety symptoms (OR=4, 27, CI_95%=(2, 05-8, 91)).

CONCLUSION

High prevalence of depressive and anxiety symptoms in diabetics suggests consideration of psychological aspect in implementation of diabetes managing program.

Quality assessment of a consultation-liaison psychiatry service

BACKGROUND

Consultation-Liaison Psychiatry (CLP) provides services for patients with medical-psychiatric comorbidity at the general hospital. Referral satisfaction is considered as one of the most important outcome measures of CLP interventions. Our aim was to assess the levels of satisfaction with the CLP service amongst medical staff at a university hospital in Denmark.

METHODS

Medical staff answered an online survey regarding their experience with different aspects of inpatient and outpatient CLP services.

RESULTS

There were 152 responses from 16 medical units, with a survey return rate above 85%. Measured on a 5-point Likert scale, there was a median rating of 4 in response to questions regarding communication and organizational aspects, a median rating of 5 in response to questions regarding overall evaluation of the CLP service on both inpatient and outpatient questionnaire. The questions regarding treatment quality were rated with a median of 4 on the inpatient questionnaire and 2 of the outpatient questionnaire items, and with a median of 5 on 2 outpatient items. Physicians´ evaluations were statistically more positive than nurses´. As a group, respondents already employed before the CLP unit was established and those who used the CLP services more were statistically significantly more satisfied then respondents employed after the establishment of the CLP unit and those who used the CLP service less.

CONCLUSION

The CLP services were positively appreciated and considered to be valuable among medical hospital staff. We believe that Consultation-Liaison Psychiatry deserves further help to implement and expand its services in general hospital settings. In addition, our results underline the feasibility of surveys as quality measures of clinical care.

Investigating the Factors Affecting Depression By Using Structural Equation Modeling

The objective of the research was to study the factors affecting depression in general population. Materials and Methods. A total of 1,291 individuals at the age of 15-68 years participated in this cross-sectional study. The Demographic Information Form, the Beck Depression Inventory for Primary Care and the Generalized Anxiety Disorder Scale were used as data collection tools. The data obtained were evaluated in the SPSS 23 package program. Missing data were validated for extreme values, and, then, tested for normality and homogeneity. Testing for the research model was implemented by structural equation modeling using the AMOS program. Results. The following goodness-of-fit values were determined for the revised model predicting the factors influencing depression: χ2 = 535.62, χ2/df = 4.74, the normed fit index = 0.95, the Tucker-Lewis index = 0.95, the comparative fit index = 0.96, the goodness-of-fit index = 0.95, the adjusted goodness-of-fit index = 0.94, the root-mean-square error of approximation = 0.05, the root mean square residual = 0.12, which were within acceptable limits. According to our model, the generalized anxiety disorder-7 (t = 15.923; p < 0.001), gender (t = -5.866; p < 0.001), age (t = -8.193; p < 0.001) and marital status (t = -6.107; p < 0.001) had a significant effect on depression. However, there was no significant relationship between depression score and educational status, place of residence, family type, and smoking. Conclusions. In this model of our study, generalized anxiety disorder was found to have the greatest effect on depression, followed by age, marital status, and gender, respectively.

Depression and anxiety in the Malaysian urban population and their association with demographic characteristics, quality of life, and the emergence of the COVID-19 pandemic

The prevalence of depression and anxiety has been shown to be higher in the urban population compared with the rural population. The present study investigated the prevalence of depression symptoms, anxiety symptoms, and depression with comorbid anxiety symptoms and their associated factors in a random sample drawn from several urban communities in Malaysia. This study also determined the association between the emergence of the COVID-19 pandemic and depression symptoms, anxiety symptoms, and depression with comorbid anxiety symptoms. We recruited 326 participants, who were administered a sociodemographic characteristics questionnaire; the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to assess the presence or absence of depression symptoms, anxiety symptoms, and depression with comorbid anxiety symptoms; and the World Health Organization Quality of Life-BREF (WHOQoL-BREF) to assess their QoL. The following prevalence values were obtained among the participants: depression symptoms, 23.9%; anxiety symptoms, 41.7%; and depression with comorbid anxiety symptoms, 19.9%. Those assessed after the declaration of COVID-19 as a global pandemic showed increased odds of depressive symptoms (adjusted OR = 2.99, 95% CI = 1.41–6.35, p = 0.006) and depressive with comorbid anxiety symptoms (adjusted OR = 3.19, 95% CI = 1.37–7.45, p = 0.005), while the presence of comorbid stress increased the odds of depressive symptoms (adjusted OR = 16.00, 95% CI = 7.84–32.63, p < 0.001), anxiety symptoms (adjusted OR = 19.72, 95% CI = 9.75–39.89, p < 0.001), and depressive with comorbid anxiety symptoms (adjusted OR = 40.44, 95% CI = 15.90–102.87, p < 0.001). Higher psychological QoL reduced the odds of depressive symptoms (adjusted OR = 0.83, 95% CI = 0.69–0.99, p = 0.032) and depressive with comorbid anxiety symptoms (adjusted OR = 0.82, 95% CI = 0.68–0.98, p = 0.041), whereas higher physical health QoL (adjusted OR = 0.85, 95% CI = 0.75–0.97, p = 0.021) and social relationship QoL (adjusted OR = 0.70, 95% CI = 0.55–0.90, p = 0.009) reduced the odds of anxiety symptoms. Based on our findings, we recommended several measures to curb psychological complications among the urban population, particularly as the battle to contain COVID-19 is ongoing.

Induction of anxiolytic, antidepressant and analgesic effects by Shiff base of (E)-3-(1H-imidazol-4-yl)-2-((2-oxoindolin-3-ylidene)amino)propanoic acid derivatives in diabetic rats

Diabetes mellitus is a metabolic disorder with several psychological problems such as anxiety, depression, and pain sense. This study aimed to evaluate the effect of Schiff base on the modulation of anxiety, depression, and pain behaviors in diabetic rats. Anxiety, depression, and pain behaviors were evaluated by elevated plus maze (EPM), forced swim test (FST), and hot-plate test, respectively. The results indicated that induction of diabetes decreased time spent in open arms (OAT) in the EPM whereas injection of insulin (1 ml/kg), glibenclamide (5 mg/kg), and Schiff base II (100 mg/kg) increased OAT in the EPM. So, induction of diabetes in rats caused an anxiogenic effect that this effect reversed by drug treatment. Interestingly, co-treatment of insulin and glibenclamide along with an ineffective dose of Schiff base II potentiated anxiolytic behavior in diabetic rats. Furthermore, induction of diabetes increased immobility time in the FST but administration of insulin (1 ml/kg), glibenclamide (5 mg/kg), and Schiff base II (25, 50, and 100 mg/kg) decreased immobility time in the FST which indicated depressant effect in diabetic rats without drug-treatment and antidepressant effect in diabetic rats with drug-treatment. Additionally, induction of diabetes decreased latency in the hot-plate test while injection of insulin (1 ml/kg), glibenclamide (5 mg/kg), Schiff base I (50 mg/kg), and Schiff base II (25, 50, and 100 mg/kg) enhanced latency in the hot-plate test which revealed hyperalgesic effect in diabetic rats without drug-treatment and analgesic effect in diabetic rats with drug-treatment. Consequently, induction of diabetes-induced anxiogenic, depressant, and hyperalgesia effects that administration of insulin, glibenclamide, Schiff bases I, and II reversed these effects.