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Hawkins J, Sengupta S, Kloss KA, Schwenzer C, Smith FN, Jones LM, Mitchell J, Nwankwo R, Piatt GA. Applying the theoretical domains framework to identify determinants to mental healthcare use among older African Americans with type 2 diabetes: a qualitative study. BMJ Open 2024; 14:e073689. [PMID: 39353695 PMCID: PMC11448234 DOI: 10.1136/bmjopen-2023-073689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/26/2024] [Indexed: 10/04/2024] Open
Abstract
OBJECTIVES There is a paucity of research focused on enhancing access to mental healthcare for older African Americans with type 2 diabetes (T2D), who may be at risk for or living with comorbid depression. This study aims to identify barriers and facilitators to mental healthcare utilisation among this population, guided by the theoretical domains framework (TDF). DESIGN This qualitative study involved 30 interviews with older African American adults diagnosed with T2D. The interview questions were aligned with TDF domains to capture participant perspectives on barriers and facilitators to mental healthcare use. SETTING Interviews were conducted via telephone by a licensed clinician trained in social work. Each session lasted 60-90 min and was transcribed and analysed. PARTICIPANTS The study included 30 African American adults (15 males and 15 females), aged 60 and above, living in an urban area in the Midwest. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the identification of themes from participant responses, analysed using thematic content techniques and categorised into TDF constructs. Demographic data served as the secondary outcome. RESULTS Nine key themes were identified, categorised under major TDF domains and constructs. Significant barriers included (1) systemic racism ('knowledge'), (2) normalisation of depressive symptoms ('beliefs about consequences'), (3) perceived stigma ('beliefs about consequences') and 4) costs of medications and healthcare ('environmental context and resources'). Facilitators to seeking mental healthcare included (1) empowerment ('beliefs about capabilities'), (2) perceived benefits of mental health exams ('beliefs about consequences'), (3) positive provider experiences ('reinforcement'), (4) recognition of depressive symptoms as a motivator ('goals') and (5) support networks ('social influences'). CONCLUSION AND IMPLICATIONS Key findings highlight that fostering positive patient-provider relationships and enhancing self-recognition of depressive symptoms can significantly encourage mental healthcare utilisation among older African Americans with T2D. These findings suggest that future interventions should focus on strengthening these relationships and improving self-awareness to better mental health outcomes.
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Affiliation(s)
- Jaclynn Hawkins
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Srijani Sengupta
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Katherine A Kloss
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Claudia Schwenzer
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Fonda N Smith
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Lenette M Jones
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Jamie Mitchell
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Robin Nwankwo
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Mohamed NA, Mohamud RYH, Hilowle FH, Mohamed YA, Mohamed HN. The Prevalence and Determinants of Anxiety and Depressive Symptoms in Patients with Type II Diabetes Mellitus in Mogadishu, Somalia: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2024; 17:3419-3432. [PMID: 39295644 PMCID: PMC11410038 DOI: 10.2147/dmso.s479583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/31/2024] [Indexed: 09/21/2024] Open
Abstract
Purpose This study aims to determine the prevalence of depression, anxiety, and stress among TIIDM patients in Mogadishu, Somalia, and identify predicting factors, as there is limited research on these disorders in Somalia. Methods A hospital-based cross-sectional study was conducted on adult patients with TIIDM from November 2023 to January 2024 at Erdogan Hospital, in the capital city of Somalia. A total of 360 participants were recruited using the systematic sampling technique. Data was collected using questionnaires on sociodemographic, clinical and behavioral characteristics. The depression, anxiety, and stress scale (DASS-21) questionnaire was used to assess symptoms of depression, anxiety, and stress. Bivariate and multivariate logistic regression analyses were performed to identify variables predicted by the outcome variables. Results Out of the 360 participants included in this study, 44.7%, 55.0%, and 30.3% had depression, anxiety, and stress symptoms, respectively. A lack of regular exercise (AOR = 1.79; 95% CI: 1.14-2.79) and an illness duration of 4-7 years (AOR = 1.94; 95% CI: 1.16-3.23) were statistically associated with depression. Being female (AOR = 2.07; 95% CI: 1.31-3.28), having ≥9 children (AOR = 1.94; 95% CI: 1.07-3.53), and a lack of regular exercise (AOR = 1.57; 95% CI: 1.01-2.45) were statistically associated with anxiety. A lack of regular exercise (AOR = 2.07; 95% CI: 1.31-3.28), having DM complications (AOR = 2.14; 95% CI: 1.01-4.54), an illness duration of 4-7 years (AOR = 2.22; 95% CI: 1.25-3.94), and DM management non-compliance (AOR = 2.74; 95% CI: 1.20-6.26) were statistically associated with stress. Conclusions This study found that TIIDM patients had moderately high rates of depression, anxiety, and stress symptoms, with a lack of physical activity associated with increased odds of depression, anxiety, and stress symptoms. Healthcare workers should screen for psychological symptoms, provide interventions, monitor sedentary patients, and encourage adherence to treatment and physical exercise to reduce mental health burden.
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Affiliation(s)
- Nur Adam Mohamed
- Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Department of Psychiatry and Behavioral Sciences, Mogadishu, Somalia
| | - Rahma Yusuf Haji Mohamud
- Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Department of Nursing, Mogadishu, Somalia
| | - Fadumo Hussein Hilowle
- Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Department of Nursing, Mogadishu, Somalia
| | - Yusuf Abdirisak Mohamed
- Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Department of Psychiatry and Behavioral Sciences, Mogadishu, Somalia
- Lecturer, Faculty of Medicine and Surgery, Somali National University, Mogadishu, Somalia
| | - Hawa Nuradin Mohamed
- Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Department of Internal Medicine, Mogadishu, Somalia
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Merkel L, Teufel F, Malta DC, Theilmann M, Marcus ME, Flood D, Geldsetzer P, Manne-Goehler J, Petrak F, Vollmer S, Davies J. The Association Between Depressive Symptoms, Access to Diabetes Care, and Glycemic Control in Five Middle-Income Countries. Diabetes Care 2024; 47:1449-1456. [PMID: 38917276 PMCID: PMC11272970 DOI: 10.2337/dc23-1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 05/18/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE The relationship between depression, diabetes, and access to diabetes care is established in high-income countries (HICs) but not in middle-income countries (MICs), where contexts and health systems differ and may impact this relationship. In this study, we investigate access to diabetes care for individuals with and without depressive symptoms in MICs. RESEARCH DESIGN AND METHODS We analyzed pooled data from nationally representative household surveys across Brazil, Chile, China, Indonesia, and Mexico. Validated survey tools Center for Epidemiologic Studies Depression Scale Revised, Composite International Diagnostic Interview, Short Form, and Patient Health Questionnaire identified participants with depressive symptoms. Diabetes, defined per World Health Organization Package of Essential Noncommunicable Disease Interventions guidelines, included self-reported medication use and biochemical data. The primary focus was on tracking diabetes care progression through the stages of diagnosis, treatment, and glycemic control. Descriptive and multivariable logistic regression analyses, accounting for gender, age, education, and BMI, examined diabetes prevalence and care continuum progression. RESULTS The pooled sample included 18,301 individuals aged 50 years and above; 3,309 (18.1%) had diabetes, and 3,934 (21.5%) exhibited depressive symptoms. Diabetes prevalence was insignificantly higher among those with depressive symptoms (28.9%) compared with those without (23.8%, P = 0.071). Co-occurrence of diabetes and depression was associated with increased odds of diabetes detection (odds ratio [OR] 1.398, P < 0.001) and treatment (OR 1.344, P < 0.001), but not with higher odds of glycemic control (OR 0.913, P = 0.377). CONCLUSIONS In MICs, individuals aged 50 years and older with diabetes and depression showed heightened diabetes identification and treatment probabilities, unlike patterns seen in HICs. This underscores the unique interplay of these conditions in different income settings.
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Affiliation(s)
- Lena Merkel
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Institute for Global and Area Studies, Hamburg, Germany
| | - Felix Teufel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Deborah Carvalho Malta
- Emory Global Diabetes Research Center of the Woodruff Health Sciences Center and Emory University, Atlanta, GA
| | - Michaela Theilmann
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Brigham and Women’s Hospital, Boston, MA
| | - Maja-Emilia Marcus
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Brigham and Women’s Hospital, Boston, MA
| | | | - Pascal Geldsetzer
- University of Michigan, Ann Arbor, MI
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA
- Chan Zuckerberg Biohub – San Francisco, San Francisco, CA
| | - Jennifer Manne-Goehler
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Brigham and Women’s Hospital, Boston, MA
| | - Frank Petrak
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
- Center for Psychotherapy Wiesbaden MVZ GmbH, Wiesbaden, Germany
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
- Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Al-Jabi SW. Emerging global interest: Unraveling the link between diabetes mellitus and depression. World J Psychiatry 2024; 14:1127-1139. [PMID: 39050204 PMCID: PMC11262933 DOI: 10.5498/wjp.v14.i7.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/03/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Studies have shown a strong bidirectional association between diabetes and depression, with diabetes increasing the risk of developing depression and vice versa. Depression among patients with diabetes is associated with poor glycemic control, complications, and poor self-care. AIM To explore the present state of research globally concerning diabetes and depression, to aid understanding the current research landscape and identify potential future areas of research. METHODS A bibliometric approach was used, utilizing the Scopus database to gather pertinent research articles released from 2004 to 2023. Analyses encompassed publication patterns, significant contributors, research focal points, prevalent themes, and the most influential articles, aimed at discerning emerging research subjects. RESULTS A total of 3229 publications that met the search criteria were identified. A significant increase in the number of publications related to diabetes and depression has been observed in the past two decades. The most productive nation was the USA (n = 1015; 31.43%), followed by China (n = 325; 10.07%), the UK (n = 236; 7.31%), and Germany (n = 218; 6.75%). Three principal themes in research on depression and diabetes were delineated by the analysis. First, the exploration of the elevated prevalence and etiology of this comorbidity; second, the focus on interventions, particularly randomized controlled trials, aimed at enhancing diabetes management among individuals with depression; and finally, the investigation of the involved risk factors and biological mechanisms underlying this bidirectional relationship. CONCLUSION There has been a recent surge of interest in the relationship between diabetes and depression. This could aid researchers to identify areas lacking in the literature and shape future research.
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Affiliation(s)
- Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine
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Sokoty L, Eshaghi M, Farezi M, Mirshafiyi P, Darabian S. Relationship between sleep quality and depression in people with type 2 diabetes. J Diabetes Metab Disord 2024; 23:765-772. [PMID: 38932818 PMCID: PMC11196463 DOI: 10.1007/s40200-023-01349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/08/2023] [Indexed: 06/28/2024]
Abstract
Background sleep quality disorder is both a risk factor for diabetics and a symptom of depression. This study aimed to determine the relationship between sleep quality and depression in people with type 2 diabetes in Delijan city in 2022. Methods The present study was a descriptive-analytical study conducted on 245 people with Type 2 Diabetes Mellitus(T2DM). The data were collected from health centers and homes, diabetes clinics in the city of Delijan. The sampling method in this study was Convenienc. Inclusion criteria include people over 30 years old, people with a history of diabetes for more than six months and and people with no known mental disorders. Data collection tools included the Pittsburgh Sleep Quality Index (PSQI), the Beck questionnaire, clinical information about diabetes(FBS, %HbA1c level and duration of diabetes), and a checklist of demographic information. SPSS 23 software was used for data analysis. Data were analyzed using independent t-tests, Chi-square, ANOVA and logistic regression. A significance level of P < 0.05 was considered significant. Results The mean (SD) age of the participants was 57.58 (10.58) years. Regarding gender, 162 subjects (66.1%) were female. A statistically significant relationship was observed between the quality of sleep in people with type 2 diabetes with gender, education, Family history T2DM, age, and between depression with gender and FBG. a statistically significant relationship was observed between sleep quality and depression. Also, according to the logistic regression, sleep quality (dependent variable) showed a significant relationship with depression, age, sex, and education. Conclusion According to the results, there is a significant relationship between sleep quality and depression In people with T2DM, so it can be used in periodic care of diabetic people to screen for depression, which could improve their sleep quality to some extent.
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Affiliation(s)
- Leily Sokoty
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Morteza Eshaghi
- Departman of clinical laboratory, school of medicine, Arak University of medical sciences, Arak, Iran
| | - Meysam Farezi
- Department of Public Health, school of Health, Alborz University of Medical Sciences, Alborz, Iran
| | - Pary Mirshafiyi
- Department of Non-Communicable Diseases, Vice-Chancellor of Health, Arak University of Medical Sciences, Arak, Iran
| | - Samad Darabian
- Department of Epidemiology, school of Health, Arak University of medical sciences, Arak, Iran
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Cai J, Zhang S, Wu R, Huang J. Association between depression and diabetes mellitus and the impact of their comorbidity on mortality: Evidence from a nationally representative study. J Affect Disord 2024; 354:11-18. [PMID: 38447915 DOI: 10.1016/j.jad.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/16/2024] [Accepted: 03/03/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Depression and diabetes mellitus (DM) are major chronic noncommunicable diseases that impair one's mental and physical well-being and impose substantial burdens on the health system. Depressed individuals have an increased risk of impaired blood glucose, weight gain and dyslipidemia which could induce poorer long-term survival. METHODS 37,040 individuals from the National Health and Nutrition Examination Survey (NHANES) were included. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9) and classified by the total scores as no (0-4), mild (5-9), moderate (10-14), and severe (15-27). DM was determined based on self-reported medical history, clinical test results, and medication use. Logistic and Cox regression were the main statistical models. All analyses were based on weighted data from complex sampling. RESULTS The prevalence of DM was higher in depressed than non-depressed individuals (21.26 % vs. 13.75 %). The adjusted odds ratio (OR) (95 % CI) of comorbid DM increased with depression severity, from 1.00 (reference) for no depression, to 1.22 (1.09,1.36) for mild, 1.62 (1.37,1.92) for moderate, and 1.52(1.28,1.82) for severe depression. Comorbidity of DM and depression significantly associated with a higher risk of all-cause mortality, with a hazard ratio (HR) (95 % CI) = 2.09 (1.64,2.66). LIMITATIONS Dynamic demographic and metabolic data were not available. CONCLUSION Depression is associated with a higher risk of DM, which may be related to biological, socioeconomic, and medication-related factors. Comorbidity of the two worsens long-term survival. Therefore, blood glucose management and prevention of DM should be emphasized in depressed patients.
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Affiliation(s)
- Jingda Cai
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Songyan Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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Safiri S, Mousavi SE, Nejadghaderi SA, Noori M, Sullman MJM, Kolahi AA, Shekarriz-Foumani R. The burden of major depressive disorder in the Middle East and North Africa region, 1990-2019. Acta Neuropsychiatr 2024; 36:139-152. [PMID: 37690795 DOI: 10.1017/neu.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the leading causes of disability. We aimed to report the MDD-attributable prevalence, incidence and years lived with disability (YLDs) in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex and socio-demographic index (SDI). METHODS Publicly available data on the burden of MDD were retrieved from the Global Burden of Disease (GBD) study 2019 for the 21 countries in MENA. The counts and age-standardised rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals. RESULTS In 2019, MDD had an age-standardised point prevalence of 3322.1 and an incidence rate of 4921.7 per 100,000 population in MENA. Furthermore, there were 4.1 million YLDs in 2019. However, there were no substantial changes in the MDD burden over the period 1990-2019. In 2019, Palestine had the highest burden of MDD. The highest prevalence, incidence and YLDs attributable to MDD were found in the 35-39 age group. In 2019, the YLD rate in MENA was higher than the global rate for almost all age groups. Furthermore, there was a broadly negative association between the YLD rate and SDI. CONCLUSION The study highlights the need to prevent the disorder using a multidisciplinary approach and for the provision of cost-effective treatments for those affected, in order to increase their quality of life.
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Affiliation(s)
- Saeid Safiri
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ehsan Mousavi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shekarriz-Foumani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Szabo G, Szigeti F J, Sipos M, Varbiro S, Gonda X. Adherence to dietary recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Sci Rep 2024; 14:12544. [PMID: 38822094 PMCID: PMC11143238 DOI: 10.1038/s41598-024-63343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/28/2024] [Indexed: 06/02/2024] Open
Abstract
Affective temperaments have been shown to robustly affect infertility treatment success. However, identification of possible mediating factors through which they exert their influence is still lacking. A growing number of results suggest that adherence to recommended treatments may be such a mediator, on the one hand, because affective temperaments are known to influence adherence and, on the other hand, because non-adherence negatively influences the treatment outcome. Recommended treatment of infertility involves, beyond medications, dietary and lifestyle changes. The aim of this retrospective cohort study was to evaluate whether adherence to physician-prescribed diet and physical activity recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Among 308 women who underwent infertility treatment in an Assisted Reproduction Center, affective temperaments, adherence to diet, adherence to physical exercise, and infertility treatment success (clinical pregnancy) were assessed besides detailed medical history and demographic parameters. Associations between affective temperaments, adherence to diet and recommended physical activity, and assisted reproduction outcomes were analyzed using generalized linear models and causal mediation analysis. Adherence to physical activity didn't have an effect, but diet adherence increased the odds of infertility treatment success by 130% suggesting its role as a potential mediator. Based on causal mediation analysis, higher depressive and anxious temperament scores were directly associated with 63% and 45% lower odds of achieving clinical pregnancy, respectively, with effects not mediated by diet adherence. Higher irritable temperament scores indirectly decreased the odds of achieving clinical pregnancy by 14%, mediated by diet adherence; while higher cyclothymic temperament scores decreased the odds of achieving clinical pregnancy both directly by 51% and indirectly, mediated by diet adherence by 11%. Our results suggest that diet adherence mediates the mechanism by which irritable and cyclothymic affective temperaments influence IVF treatment success. Since adherence is a modifiable risk factor of infertility treatment success, screening for affective temperaments may help to identify potentially high-risk non-adherent patient groups and offer patient-tailored treatment, which may help increase the chances of a successful pregnancy and live birth in women undergoing IVF treatment.
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Affiliation(s)
- Georgina Szabo
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Judit Szigeti F
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Miklos Sipos
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Varbiro
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Gyulai Pal utca 2, Budapest, 1085, Hungary.
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Nagyvárad tér 4., Budapest, 1085, Hungary.
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Aungle P, Langer E. The borderline effect for diabetes: when no difference makes a difference. Front Psychol 2024; 15:1333248. [PMID: 38765836 PMCID: PMC11099830 DOI: 10.3389/fpsyg.2024.1333248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/01/2024] [Indexed: 05/22/2024] Open
Abstract
We hypothesized that people at the borderline of being labeled as "prediabetic" based on A1c blood test results, who initially face equivalent risks of developing diabetes but who are labeled differently, would be more likely to develop diabetes when labeled as "prediabetic" as a result of the label. Study 1 served to establish the psychological effect of the prediabetes label: we surveyed 260 participants on Amazon Mechanical Turk to test whether risk perception significantly increased when comparing A1c test results that differed by 0.1% and led to different diagnostic labels (5.6 and 5.7%) but did not significantly increase when comparing those that differed by 0.1% but received the same label (5.5%/5.6 and 5.7%/5.8%). Study 2 explored whether labels are associated with different rates of developing diabetes when the initial difference in A1c results suggests equivalent risk. Using data from 8,096 patients, we compared patients whose initial A1c results differed by 0.1% and found those who received results labeled as prediabetic (A1c of 5.7%) were significantly more likely to develop diabetes than patients whose initial results were labeled as normal (5.6%). In contrast, patients whose initial results differed by 0.1% but who received the same "normal" label (5.5 and 5.6%) were equally likely to develop diabetes. These preliminary results suggest that diagnostic labels may become self-fulfilling, especially when the underlying pathology of patients receiving different labels does not meaningfully differ.
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Affiliation(s)
- Peter Aungle
- Department of Psychology, Harvard University, Cambridge, MA, United States
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Wang L, Ding H, Deng Y, Huang J, Lao X, Wong MCS. Associations of obesity indices change with cardiovascular outcomes: a dose-response meta-analysis. Int J Obes (Lond) 2024; 48:635-645. [PMID: 38336864 DOI: 10.1038/s41366-024-01485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Little is known about the degrees and shapes of associations of changes in obesity indices with cardiovascular disease (CVD) and mortality risks. We aimed to conduct a dose-response meta-analysis for the associations of changes in weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio, and waist-to-height ratio with CVD events, CVD-specific deaths, and all-cause mortality. METHODS We searched MEDLINE via OvidSP, Embase via OvidSP, Web of Science, CINAHL, and Scopus for articles published before January 8th, 2023. Dose-response relationships were modeled using the one-stage mixed-effects meta-analysis. Random-effects models were used to pool the relative risk (RR) and 95% confidence interval (CI). RESULTS We included 122 articles. Weight change was negatively associated with deaths from CVD and any cause, while WC change elevated CVD-specific mortality. Non-linear relationships also confirmed the adverse effects of increased WC on CVD-specific mortality. Additionally, gains of 5 kg in weight and 1 kg/m2 in BMI or more were associated with elevated CVD events, especially among young adults and individuals without CVD. Conversely, reductions of 5 kg in weight and 1 kg/m2 in BMI or more were associated with higher CVD-specific and all-cause deaths than increased counterparts, particularly among old adults and individuals with CVD. Similar non-linear relationships between relative changes in weight and BMI and deaths from CVD and any cause were observed. CONCLUSIONS The effects of changes in weight and BMI on CVD outcomes were affected by age and cardiovascular health. Tailored weight management and avoidance of increased WC should be recommended.
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Affiliation(s)
- Lyu Wang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hanyue Ding
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunyang Deng
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiangqian Lao
- Department of Biomedical Science, City University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China.
- School of Public Health, Peking University, Beijing, China.
- Centre for Health Education and Health Promotion, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China.
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11
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Jeffery A, Walters K, Wong ICK, Osborn D, Hayes JF. Antidepressant treatment and mortality in people with comorbid depression and type 2 diabetes: UK electronic health record study. BJPsych Open 2024; 10:e79. [PMID: 38606433 PMCID: PMC11060070 DOI: 10.1192/bjo.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Depression is associated with higher rates of premature mortality in people with physical comorbidities, such as type 2 diabetes. Conceptually, the successful treatment of depression in people with type 2 diabetes could prevent premature mortality. AIMS To investigate the association between antidepressant prescribing and the rates of all-cause and cause-specific (endocrine, cardiovascular, respiratory, cancer, unnatural) mortality in individuals with comorbid depression and type 2 diabetes. METHOD Using UK primary care records between years 2000 and 2018, we completed a nested case-control study in a cohort of people with comorbid depression and type 2 diabetes who were starting oral antidiabetic treatment for the first time. We used incident density sampling to identify cases who died and matched controls who remained alive after the same number of days observation. We estimated incidence rate ratios for the association between antidepressant prescribing and mortality, adjusting for demographic characteristics, comorbidities, medication use and health behaviours. RESULTS We included 5222 cases with a recorded date of death, and 18 675 controls, observed for a median of 7 years. Increased rates of all-cause mortality were associated with any antidepressant prescribing during the observation period (incidence rate ratio 2.77, 95% CI 2.48-3.10). These results were consistent across all causes of mortality that we investigated. CONCLUSIONS Antidepressant prescribing was highly associated with higher rates of mortality. However, we suspect that this is not a direct causal effect, but that antidepressant treatment is a marker of more severe and unsuccessfully treated depression.
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Affiliation(s)
- Annie Jeffery
- Epidemiology and Applied Clinical Research Department, Division of Psychiatry, University College London, UK
| | - Kate Walters
- Department of Primary Care & Population Health, Institute of Epidemiology & Health Care, University College London, UK
| | - Ian C. K. Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, UK; and Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - David Osborn
- Epidemiology and Applied Clinical Research Department, Division of Psychiatry, University College London, UK
| | - Joseph F. Hayes
- Epidemiology and Applied Clinical Research Department, Division of Psychiatry, University College London, UK
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12
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Hoogendoorn CJ, Krause-Steinrauf H, Uschner D, Wen H, Presley CA, Legowski EA, Naik AD, Golden SH, Arends VL, Brown-Friday J, Krakoff JA, Suratt CE, Waltje AH, Cherrington AL, Gonzalez JS. Emotional Distress Predicts Reduced Type 2 Diabetes Treatment Adherence in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:629-637. [PMID: 38227900 PMCID: PMC10973907 DOI: 10.2337/dc23-1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/18/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE We examined longitudinal associations between emotional distress (specifically, depressive symptoms and diabetes distress) and medication adherence in Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), a large randomized controlled trial comparing four glucose-lowering medications added to metformin in adults with relatively recent-onset type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS The Emotional Distress Substudy assessed medication adherence, depressive symptoms, and diabetes distress in 1,739 GRADE participants via self-completed questionnaires administered biannually up to 3 years. We examined baseline depressive symptoms and diabetes distress as predictors of medication adherence over 36 months. Bidirectional visit-to-visit relationships were also examined. Treatment satisfaction, beliefs about medication, diabetes care self-efficacy, and perceived control over diabetes were evaluated as mediators of longitudinal associations. RESULTS At baseline, mean ± SD age of participants (56% of whom were White, 17% Hispanic/Latino, 18% Black, and 66% male) was 58.0 ± 10.2 years, diabetes duration 4.2 ± 2.8 years, HbA1c 7.5% ± 0.5%, and medication adherence 89.9% ± 11.1%. Higher baseline depressive symptoms and diabetes distress were independently associated with lower adherence over 36 months (P < 0.001). Higher depressive symptoms and diabetes distress at one visit predicted lower adherence at the subsequent 6-month visit (P < 0.0001) but not vice versa. Treatment assignment did not moderate relationships. Patient-reported concerns about diabetes medications mediated the largest percentage (11.9%-15.5%) of the longitudinal link between emotional distress and adherence. CONCLUSIONS Depressive symptoms and diabetes distress both predict lower adherence to glucose-lowering medications over time among adults with T2DM. Addressing emotional distress and concerns about anticipated negative effects of taking these treatments may be important to support diabetes treatment adherence.
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Affiliation(s)
- Claire J. Hoogendoorn
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Heidi Krause-Steinrauf
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Diane Uschner
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Hui Wen
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Caroline A. Presley
- General Internal and Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL
| | - Elizabeth A. Legowski
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Aanand D. Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
- University of Texas Health Science Center (UTHealth) School of Public Health, Houston, TX
- Consortium on Aging, University of Texas Health Science Center (UTHealth), Houston, TX
| | - Sherita Hill Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Valerie L. Arends
- Advanced Research and Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Janet Brown-Friday
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Jonathan A. Krakoff
- Obesity and Diabetes Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Colleen E. Suratt
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | | | - Andrea L. Cherrington
- General Internal and Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL
| | - Jeffrey S. Gonzalez
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY
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13
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Davis TME, Tan E, Davis WA. Prevalence and prognostic significance of cardiac autonomic neuropathy in community-based people with type 2 diabetes: the Fremantle Diabetes Study Phase II. Cardiovasc Diabetol 2024; 23:102. [PMID: 38500197 PMCID: PMC10949593 DOI: 10.1186/s12933-024-02185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND There is a paucity of contemporary data on the prevalence and prognostic significance of cardiac autonomic neuropathy (CAN) from community-based cohorts with type 2 diabetes assessed using gold standard methods. The aim of this study was to assess these aspects of CAN in the longitudinal observational Fremantle Diabetes Study Phase II (FDS2). METHODS FDS2 participants were screened at baseline using standardised cardiovascular reflex tests (CARTs) of heart rate variation during deep breathing, Valsalva manoeuvre and standing. CAN (no/possible/definite) was assessed from the number of abnormal CARTs. Multinomial regression identified independent associates of CAN status. Cox proportional hazards modelling determined independent baseline predictors of incident heart failure (HF) and ischaemic heart disease (IHD), and all-cause mortality. RESULTS Of 1254 participants assessed for CAN, 86 (6.9%) were outside CART age reference ranges and valid CART data were unavailable for 338 (27.0%). Of the remaining 830 (mean age 62.3 years, 55.3% males, median diabetes duration 7.3 years), 51.0%, 33.7% and 15.3% had no, possible or definite CAN, respectively. Independent associates of definite CAN (longer diabetes duration, higher body mass index and resting pulse rate, antidepressant and antihypertensive therapies, albuminuria, distal sensory polyneuropathy, prior HF) were consistent with those reported previously. In Kaplan-Meier analysis, definite CAN was associated with a lower likelihood of incident IHD and HF versus no/possible CAN (P < 0.001) and there was a graded increase in all-cause mortality risk from no CAN to possible and definite CAN (P < 0.001). When CAN category was added to the most parsimonious models, it was not a significant independent predictor of IHD (P ≥ 0.851) or HF (P ≥ 0.342). Possible CAN (hazard ratio (95% CI) 1.47 (1.01, 2.14), P = 0.046) and definite CAN (2.42 (1.60, 3.67), P < 0.001) increased the risk of all-cause mortality versus no CAN. CONCLUSIONS Routine screening for CAN in type 2 diabetes has limited clinical but some prognostic value.
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Affiliation(s)
- Timothy M E Davis
- Medical School, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia.
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Murdoch, WA, Australia.
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, VIC, Australia.
| | - Eva Tan
- Medical School, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
| | - Wendy A Davis
- Medical School, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, VIC, Australia
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14
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Pouwer F, Perrin B, Lavender A, Najafi B, Ismail K, Vileikyte L. The quest for wellness: How to optimise self-care strategies for diabetic foot management? Diabetes Metab Res Rev 2024; 40:e3751. [PMID: 38041482 DOI: 10.1002/dmrr.3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023]
Abstract
Diabetic foot ulceration (DFU) is common and highly recurrent, negatively impacting the individuals' quality of life. The 2023 guidelines of the International Working Group on the Diabetic Foot emphasise that adherence to foot self-care recommendations is one of the most important factors in DFU prevention. These guidelines also briefly mention that depression and other psychosocial problems can hamper treatment and ulcer healing. Moreover, a new clinical question was added on psychological interventions for ulcer prevention, although the evidence regarding the role of psychological and social factors is still limited. To help the field progress, this narrative overview discusses how a stronger focus on psychological factors by both researchers and clinicians could improve the care for people at high DFU risk. The review starts with a testimony of a person living with DFU, explaining that for him, the absence of shared decision-making has been a key barrier to successful foot self-care implementation. Intervention studies that address patient-reported barriers are still scarce, and are therefore urgently needed. Furthermore, the key elements of psychological interventions found to be successful in managing diabetes are yet to be implemented in DFU risk management. Importantly, research evidence indicates that commonly advocated foot self-care recommendations may be insufficient in preventing DFU recurrence, whereas digital technology appears to effectively reduce recurrent DFU. More research is therefore needed to identify determinants of patient acceptance of digital technology.
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Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense (SDCO), Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Byron Perrin
- La Trobe Rural Health School, La Trobe University - Bendigo Campus, Bendigo, Victoria, Australia
| | | | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London, Weston Education Centre, London, UK
| | - Loretta Vileikyte
- Diabetes Centre, Manchester Royal Infirmary, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
- Department of Endocrinology and Dermatology, University of Miami, Miami, Florida, USA
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15
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Schmitt A, Beran M, Geraets A, Iversen MM, Nefs G, Nouwen A, Pouwer F, Huber JW, Schram MT. Associations between HbA1c Reduction and Change in Depressive Symptoms following Glucose-lowering Treatment in Adults: A Systematic Review of Intervention Studies. Curr Diabetes Rev 2024; 20:e020623217607. [PMID: 37278034 DOI: 10.2174/1573399820666230602124223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Hyperglycemia constitutes a likely pathway linking diabetes and depressive symptoms; lowering glycemic levels may help reduce diabetes-comorbid depressive symptoms. Since randomized controlled trials can help understand temporal associations, we systematically reviewed the evidence regarding the potential association of hemoglobin HbA1c lowering interventions with depressive symptoms. METHODS PubMed, PsycINFO, CINAHL, and EMBASE databases were searched for randomized controlled trials evaluating HbA1c-lowering interventions and including assessment of depressive symptoms published between 01/2000-09/2020. Study quality was evaluated using the Cochrane Risk of Bias tool. PROSPERO registration: CRD42020215541. RESULTS We retrieved 1,642 studies of which twelve met our inclusion criteria. Nine studies had high and three unclear risks of bias. Baseline depressive symptom scores suggest elevated depressive symptoms in five studies. Baseline HbA1c was <8.0% (<64 mmol/mol) in two, 8.0-9.0% (64-75 mmol/mol) in eight, and ≥10.0% (≥86 mmol/mol) in two studies. Five studies found greater HbA1c reduction in the treatment group; three of these found greater depressive symptom reduction in the treatment group. Of four studies analyzing whether the change in HbA1c was associated with the change in depressive symptoms, none found a significant association. The main limitation of these studies was relatively low levels of depressive symptoms at baseline, limiting the ability to show a lowering in depressive symptoms after HbA1c reduction. CONCLUSIONS We found insufficient available data to estimate the association between HbA1c reduction and depressive symptom change following glucose-lowering treatment. Our findings point to an important gap in the diabetes treatment literature. Future clinical trials testing interventions to improve glycemic outcomes might consider measuring depressive symptoms as an outcome to enable analyses of this association.
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Affiliation(s)
- Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Johann-Hammer- Straße 24, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Magdalena Beran
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Anouk Geraets
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marjolein M Iversen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 27, 6525 EZ Nijmegen, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 Diabetes, Blaak 6, 3011 TA Rotterdam, The Netherlands
| | - Arie Nouwen
- Department of Psychology, Middlesex University London, The Burroughs, London NW4 4BT, United Kingdom
- School of Health, Wellbeing and Social Care, The Open University, Walton Hall, Milton Keynes MK7 6AA, United Kingdom
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Steno Diabetes Center Odense (SDCO), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jörg W Huber
- School of Sport and Health Sciences, University of Brighton, Westlain House, Brighton BN1 9PH, United Kingdom
| | - Miranda T Schram
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Center, Professor Debyelaan 25, 6229HX Maastricht, The Netherlands
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16
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Buchanan AL, Kotecha R. Thinking Clearly: A Preventative Cognitive Health Visit Integrated in Primary Care. J Prim Care Community Health 2024; 15:21501319241273290. [PMID: 39143809 PMCID: PMC11327965 DOI: 10.1177/21501319241273290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE The pandemic contributed to increased mental and cognitive health concerns as well as reduced utilization of preventive and treatment focused care. Deferred care can contribute to negative clinical outcomes, including increased acuity of mental and cognitive health concerns that benefit from early intervention. A new visit type was launched with the aim of reaching patients who may need care and supporting early identification of cognitive and mental health issues. METHODS We developed the Healthy Mind visit, a preventative visit administered by Primary Care Providers (PCPs) within outpatient clinics. The Healthy Mind visit included use of a pre-visit mental health screener as well as a brief computerized cognitive assessment. The clinical interaction focused on identifying mental and cognitive health concerns and developing a plan for wellness. Outcomes data collection occurred over nearly 2.5 years and focused on analyzing booking patterns, depression screening and follow-up, and clinical outcomes such as health confidence and post-visit motivation. RESULTS The visit was effective in supporting depression screening and follow-up with 29.6% of those participating in a Healthy Mind visit receiving a PHQ-9, and 82.5% of patients with elevated PHQ-9 scores attending a subsequent visit with their PCP. Improvements in health confidence and high patient reported motivation post-visit represent other notable clinical outcomes. The visit also promoted care utilization, with 73.5% of patients who attended a Healthy Mind visit being new to the practice or those who had not attended an appointment in the past 6 months. CONCLUSIONS The Healthy Mind visit, with a focus on mental and cognitive health, was successful in reaching patients who may not have otherwise sought care and supported positive clinical outcomes including early identification and treatment of depression and increased health confidence. RECOMMENDATIONS These findings reflect the importance of developing innovative programs to connect patients with care, especially those who may have deferred care due to a variety of factors. Focusing on mental and cognitive health with the use of innovative tools such as a computerized assessment, can drive patient interest in care offerings and support positive clinical outcomes.
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Pouwer F, Mizokami-Stout K, Reeves ND, Pop-Busui R, Tesfaye S, Boulton AJM, Vileikyte L. Psychosocial Care for People With Diabetic Neuropathy: Time for Action. Diabetes Care 2024; 47:17-25. [PMID: 38117989 DOI: 10.2337/dci23-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/23/2023] [Indexed: 12/22/2023]
Abstract
Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.
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Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
- Lieutenant Colonel Charles S. Kettles Veteran Affairs Medical Center, Ann Arbor, MI
| | - Neil D Reeves
- Department of Life Sciences, Faculty of Science and Engineering, Manchester, U.K
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Andrew J M Boulton
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
| | - Loretta Vileikyte
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
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Wijk I, Amsberg S, Johansson UB, Livheim F, Toft E, Anderbro T. Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: a randomised controlled trial. BMJ Open 2023; 13:e072061. [PMID: 38101850 PMCID: PMC10729111 DOI: 10.1136/bmjopen-2023-072061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To evaluate the impact of an Acceptance and Commitment Therapy (ACT) programme, tailored for people living with type 1 diabetes, on glycated haemoglobin (HbA1c), self-management and psychosocial factors among individuals with HbA1c>60 mmol/mol compared with treatment as usual (TAU). SETTING An endocrinologic clinic in Sweden. PARTICIPANTS In this randomised controlled trial, 81 individuals with type 1 diabetes, aged 18-70 years with HbA1c>60 mmol/mol, were randomly assigned to either an ACT group intervention or TAU. Exclusion criteria were: unable to speak Swedish, untreated or severe psychiatric disease, cortisone treatment, untreated thyroid disease and newly started insulin pump therapy. At the 2-year follow-up, HbA1c was measured in 26 individuals. INTERVENTION The ACT programme comprised seven 2-hour sessions held over 14 weeks and focused on acceptance of stressful thoughts and emotions, and to promote value-based committed action. OUTCOMES The primary outcome was HbA1c, and the secondary outcomes were measures of depression, anxiety, general stress, fear of hypoglycaemia, diabetes distress, self-care activities, psychological flexibility (general and related to diabetes) and quality of life. The primary endpoint was HbA1c 2 years after the intervention programme. Linear mixed models were used to test for an interaction effect between measurement time and group. RESULTS Likelihood ratio test of nested models demonstrated no statistically significant interaction effect (χ2=0.49, p=0.485) between measurement time and group regarding HbA1c. However, a statistically significant interaction effect (likelihood ratio test χ2=12.63, p<0.001) was observed with improved scores on The Acceptance and Action Questionnaire in the intervention group after 1 and 2 years. CONCLUSIONS No statistically significant difference was found between the groups regarding the primary outcome measure, HbA1c. However, the ACT programme showed a persistent beneficial impact on psychological flexibility in the intervention group. The dropout rate was higher than expected, which may indicate a challenge in this type of study. TRIAL REGISTRATION NUMBER NCT02914496.
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Affiliation(s)
- Ingrid Wijk
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Susanne Amsberg
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Livheim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Toft
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Therese Anderbro
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
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19
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Vadeo B, Shetty S, Nalini M. Prevalence of depression among clients with diabetes and hypertension in selected hospital at Mangaluru, India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:404. [PMID: 38333166 PMCID: PMC10852190 DOI: 10.4103/jehp.jehp_973_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/03/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Non-communicable diseases are lifestyle diseases that are increasing throughout the world. They are responsible for 71% of death worldwide, among which 16 million people die prematurely or before reaching the age of 70 years. Among the non-communicable diseases, diabetes and hypertension are the most common. The study aimed to find the prevalence of depression among diabetes and hypertensive clients. MATERIALS AND METHODS A descriptive cross-sectional study was conducted among 370 subjects diagnosed with diabetes mellitus, hypertension, and both in Justice K.S Hegde Charitable Hospital at Mangaluru. A purposive sampling technique was adopted to select the subjects. Patient health questionnaire-9 (PHQ-9) was used to find the depressive symptoms among the client. The statistical analysis was conducted using SPSS version 20 (Armonk, NY: IBM Corp.); descriptive (frequency and percentage) and inferential (one-way analysis of variance (ANOVA)) statistics were used to interpret the data. RESULTS Out of 370 subjects, 41% had no depression, and most 59% had mild to severe levels of depression. Among clients diagnosed with diabetes mellitus (n = 139), the majority (63%) had mild to severe depression. Similarly, of subjects diagnosed with hypertension, 51% had no depression, and 49% had mild to severe depression. In addition, among subjects diagnosed with both diabetes mellitus and hypertension (n = 99), 67% had mild to severe depression. CONCLUSIONS The study shows that many diabetes and hypertensive patients attending the outpatient departments of the hospital experience depression. So, it is crucial to identify the depressive symptoms early and take appropriate measures to prevent complications.
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Affiliation(s)
- Bizo Vadeo
- Department of Mental Health Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka, India
| | - Sukesh Shetty
- Department of Mental Health Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka, India
| | - M Nalini
- Department of Mental Health Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka, India
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Carr KD, Weiner SP, Vasquez C, Schmidt AM. Involvement of the Receptor for Advanced Glycation End Products (RAGE) in high fat-high sugar diet-induced anhedonia in rats. Physiol Behav 2023; 271:114337. [PMID: 37625475 PMCID: PMC10592025 DOI: 10.1016/j.physbeh.2023.114337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
Clinical and basic science investigation indicates a link between insulin resistance and anhedonia. Previous results of this laboratory point to impaired nucleus accumbens (NAc) insulin signaling as an underpinning of diet-induced anhedonia, based on use of a glucose lick microstructure assay. The present study evaluated whether advanced glycation end products (AGEs) and their receptor (RAGE), known to mediate obesogenic diet-induced inflammation and pathological metabolic conditions, are involved in this behavioral change. Six weeks maintenance of male and female rats on a high fat-high sugar liquid diet (chocolate Ensure) increased body weight gain, and markedly increased circulating insulin and leptin, but induced anhedonia (decreased first minute lick rate and lick burst size) in males only. In these subjects, anhedonia correlated with plasma concentrations of insulin. Although the diet did not alter plasma or NAc AGEs, or the expression of RAGE in the NAc, marginally significant correlations were seen between anhedonia and plasma content of several AGEs and NAc RAGE. Importantly, a small molecule RAGE antagonist, RAGE229, administered twice daily by oral gavage, prevented diet-induced anhedonia. This beneficial effect was associated with improved adipose function, reflected in the adiponectin/leptin ratio, and increased pCREB/total CREB in the NAc, and a shift in the pCREB correlation with pThr34-DARPP-32 from near-zero to strongly positive, such that both phospho-proteins correlated with the rescued hedonic response. This set of findings suggests that the receptor/signaling pathway and cell type underlying the RAGE229-mediated increase in pCREB may mediate anhedonia and its prevention. The possible role of adipose tissue as a locus of diet-induced RAGE signaling, and source of circulating factors that target NAc to modify hedonic reactivity are discussed.
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Affiliation(s)
- Kenneth D Carr
- Departments of Psychiatry, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, United States; Departments of Biochemistry and Molecular Pharmacology, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, United States.
| | - Sydney P Weiner
- Departments of Psychiatry, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, United States
| | - Carolina Vasquez
- Departments of Psychiatry, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, United States; Departments of Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, United States
| | - Ann Marie Schmidt
- Departments of Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, 435 East 30th Street, New York, NY 10016, United States
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21
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Liu YT, Wu WH, Tseng WT, Lin HC, Wu MS, Chen PF, Wu IC. Lower HbA1C of glycemic control is associated with higher risk of depressive symptoms in elderly with type 2 diabetes mellitus-A Nationwide Community-based study. J Psychosom Res 2023; 174:111492. [PMID: 37708592 DOI: 10.1016/j.jpsychores.2023.111492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We investigated the correlation between glycemic control status and depressive symptoms in type 2 diabetes elderly. METHODS A total of 1527 participants with type 2 diabetes aged 55 years and older from the Healthy Aging Longitudinal Study in Taiwan study were included in this cross-sectional study. The Center for Epidemiologic Studies Depression Scale (CESD) (20 items) score of ≥16 was indicative of depressive symptoms. The participants were divided into HbA1c ≥ 6.5% and < 6.5% representing the glycemic control. Multiple logistic regression (MLR) and Generalized linear model (GLM) were used. RESULTS The MLR analysis showed that the low HbA1c group had significant two-fold increased odds of depressive symptoms compared to the high HbA1c group (OR 1.89, 95% CI 1.17-3.05). The risk of depressive symptoms was lower among males (OR 0.49, 95% CI 0.30-0.80) and those with higher BMI (OR 0.93, 95% CI 0.86-1.00); whereas the risk was higher among those who lived alone (OR 2.37, 95% CI 1.31-4.27) and with ADL disability (OR 3.01, 95% CI 1.85-4.89). The GLM showed that the dimension of depressive affect reached statistical significance with lower HbA1c. CONCLUSION This nationwide community-based study shows that depressive symptoms are associated with lower HbA1C, reminding us that more attention should be paid to the presence of depressive symptoms in those with lower HbA1C. Further research is needed to clarify the causal relationship.
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Affiliation(s)
- Yen-Tze Liu
- Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Big Data Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Wan-Hui Wu
- Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Ting Tseng
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Hsien-Chih Lin
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ming-Shiang Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
| | - Pei-Fen Chen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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McCready RG, Gilley KR, Kusumo LE, Hall GM, Vichaya EG. Chronic Stress Exacerbates Hyperglycemia-Induced Affective Symptoms in Male Mice. Neuroimmunomodulation 2023; 30:302-314. [PMID: 37852199 PMCID: PMC10641805 DOI: 10.1159/000534669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Among chronically ill populations, affective disorders remain underdiagnosed and undertreated. A high degree of comorbidity exists between diabetes and affective disorders, particularly depression and anxiety. The mechanisms underlying stress-induced affective dysregulation are likely distinct from those induced by diabetes. A direct comparison between stress- and hyperglycemia-induced affective dysregulation could provide insight into distinct mechanistic targets for depression/anxiety associated with these different conditions. METHODS To this end, the present study used male C57BL/6J mice to compare the independent and combined behavioral and neuroinflammatory effects of two models: (1) unpredictable chronic mild stress and (2) pharmacologically induced hyperglycemia. RESULTS Streptozotocin-induced hyperglycemia was associated with a set of behavioral changes reflective of the neurovegetative symptoms of depression (i.e., reduced open field activity, reduced grooming, increased immobility in the forced swim task, and decreased marble burying), increased hippocampal Bdnf and Tnf expression, and elevations in frontal cortex Il1b expression. Our chronic stress protocol produced alterations in anxiety-like behavior and decreased frontal cortex Il1b expression. DISCUSSION While the combination of chronic stress and hyperglycemia produced limited additive effects, their combination exacerbated total symptom burden. Overall, the data indicate that stress and hyperglycemia induce different symptom profiles via distinct mechanisms.
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Affiliation(s)
- Riley G McCready
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Kayla R Gilley
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Laura E Kusumo
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Grace M Hall
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Elisabeth G Vichaya
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
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Pedersen FN, Stokholm L, Andersen N, Andresen J, Bek T, Hajari JN, Heegaard S, Højlund K, Kawasaki R, Möller S, Laugesen CS, Schielke KC, Thykjær AS, Peto T, Pouwer F, Grauslund J. Longitudinal bidirectional associations between diabetic retinopathy and diagnosed depression: Results from a Danish nationwide registry-based cohort study. J Diabetes Complications 2023; 37:108589. [PMID: 37657405 DOI: 10.1016/j.jdiacomp.2023.108589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/31/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Diabetic retinopathy (DR) is a feared complication and a leading course of visual impairment, but the connection between DR and depression including the direction has never been studied in a nationwide cohort. We aimed to assess, whether the associations between DR and diagnosed depression are bidirectional. METHODS We performed a national register-based cohort study of individuals with type 2 diabetes, who attended diabetic eye screening between January 2013 and June 2022. Level of DR was extracted from the Danish Registry of Diabetic Retinopathy. The severity of DR was assessed according to the International Clinical Diabetic Retinopathy severity scale. Diagnosed depression was ascertained by physician diagnostic codes of unipolar depression (F32), recurrent depression (F33) or dysthymia (F34.1) from the Danish National Patient Register. We estimated presence of diagnosed depression according to DR level at index date and risk of diagnosed depression during follow-up using multivariable logistic and Cox regression, respectively. Secondly, we assessed whether diagnosed depression at index date could predict incident DR. RESULTS We included 240,893 individuals with type 2 diabetes with baseline rates of diagnosed depression ranging from 5.2 to 6.0 % for DR level 1-4. At index date, individuals with type 2 diabetes and DR were less likely to have a history of diagnosed depression (multivariable adjusted OR, 0.77 [95 % CI 0.73-0.82]). In 226,523 individuals with type 2 diabetes followed for 1,159,755 person-years, 1.7 % developed at least one episode of diagnosed depression. In a model adjusted for age and sex, individuals with DR at index date had an increased risk of incident diagnosed depression compared to those without DR (HR 1.25 [95 % CI 1.16-1.36]). Adjusting for marital status, use of glucose-, lipid- and blood pressure lowering medication, HbA1c, diabetic neuropathy and Charlson comorbidity index waived the above risk (multivariable adjusted HR 1.02 [95 % CI 0.93-1.12]). Furthermore a previous history of diagnosed depression was not associated with increased risk of incident DR (multivariable adjusted HR 0.89 [95 % CI 0.77-1.03]). CONCLUSION In this nationwide cohort study, individuals with DR at first screening were 23 % less likely to have a history of depression, but our data did not support a bidirectional association between DR and depression. Selection bias may have occurred as diagnosed depression is a known barrier for attending DR-screening.
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Affiliation(s)
- Frederik N Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN - Open Patient data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Javad N Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN - Open Patient data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Caroline S Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Katja C Schielke
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne S Thykjær
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland, United Kingdom
| | - Frans Pouwer
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Ulambayar B, Ghanem AS, Kovács N, Trefán L, Móré M, Nagy AC. Cardiovascular disease and risk factors in adults with diabetes mellitus in Hungary: a population-based study. Front Endocrinol (Lausanne) 2023; 14:1263365. [PMID: 37780630 PMCID: PMC10538629 DOI: 10.3389/fendo.2023.1263365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Diabetes mellitus (DM) and cardiovascular disease (CVD) such as acute myocardial infarction, stroke, and coronary artery disease are highly prevalent conditions that are responsible for significant morbidity and mortality, particularly in Hungary. The conditions are attributed to identical risk factors, and individuals with DM are primarily susceptible to cardiovascular complications, which are the leading causes of death and disability in patients with DM. The objective of this study was to estimate the prevalence of CVD in individuals with DM and to investigate the association between potential risk factors and the presence of CVD among individuals with DM in a population-based sample. Methods The study was based on data from three waves of the European Health Interview Surveys (EHIS) conducted in Hungary in 2009, 2014, and 2019. Results The prevalence of CVD among patients with DM decreased during the study period and that socioeconomic factors, cardiometabolic risk factors including high blood pressure and high cholesterol, and depression are major contributors to CVD burden in patients with DM in Hungary. Discussion Our findings suggest the importance of regular check-up for hypertension and hypercholesterolemia, better focus on socioeconomic status, as well as ongoing monitoring of mental health among patients with diabetes. Further research is needed to understand the potential causes behind the observed decrease in CVD prevalence.
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Affiliation(s)
- Battamir Ulambayar
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Amr Sayed Ghanem
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Trefán
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Marianna Móré
- Institute of Social and Sociological Sciences, Faculty of Health Sciences, University of Debrecen, Nyíregyháza, Hungary
| | - Attila Csaba Nagy
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
- Coordinating Centre for Epidemiology, University of Debrecen, Debrecen, Hungary
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25
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Tusa N, Kautiainen H, Elfving P, Sinikallio S, Mäntyselkä P. Depressive symptoms decrease health-related quality of life of patients with coronary artery disease and diabetes: a 12-month follow up study in primary care. Scand J Prim Health Care 2023; 41:276-286. [PMID: 37455531 PMCID: PMC10478631 DOI: 10.1080/02813432.2023.2233995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is a multidimensional patient-related outcome. Less is known about the role of depressive symptoms on HRQoL in chronic diseases. This follow-up study analyzed depressive symptoms' association with HRQoL change measured with 15D in patients with chronic diseases. DESIGN AND SETTING A total of 587 patients from the Siilinjärvi Health Center, Finland were followed up due to the treatment of hypertension (HA), coronary artery disease (CAD) or diabetes (DM). Depressive symptoms were based on Beck Depression Inventory (BDI) (BDI ≥10 =depressive symptoms). HRQoL was assessed at the baseline and after 12 months. RESULTS There were 244 patients with HA (mean age 70 years, 59% women); 103 patients (72 years, 38%) with CAD and 240 with DM (67 years, 52%). The change from baseline to the 12-month follow-up in 15D was significantly different between patients without and with depressive symptoms in CAD (p < 0.001) and DM (p = 0.024). In CAD with depressive symptoms, the change was -0.064 (95% CI: -0.094 to -0.035) and in DM -0.018 (95% CI: -0.037 to 0.001). In the 15 HRQoL dimensions of 15D, a depressive symptoms-related decrease was found in three dimensions with HA, in 9 with CAD and in 7 with DM. As a function of the BDI at baseline, the 15D score decreased significantly among patients with CAD and DM. CONCLUSIONS Depressive symptoms impact negatively on future HRQoL among primary care patients with coronary artery disease and diabetes emphasizing that mood should be acknowledged in their care and follow-up. TRIAL REGISTRATION Clinical Trials registration number: NCT02992431, registered December 14th 2016.
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Affiliation(s)
- Nina Tusa
- Wellbeing services county of North Savo, Educational services, Finland
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
- Siilinjärvi Health Center, Siilinjärvi, Finland
| | | | - Pia Elfving
- Department of Medicine, Kuopio University Hospital, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
- Clinical Research and Trials Centre, Kuopio University Hospital, Kuopio, Finland
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26
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Laird E, Herring MP, Carson BP, Woods CB, Walsh C, Kenny RA, Rasmussen CL. Physical activity for depression among the chronically Ill: Results from older diabetics in the Irish longitudinal study on ageing. Psychiatry Res 2023; 326:115274. [PMID: 37270867 DOI: 10.1016/j.psychres.2023.115274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
Among chronically-ill older adults, the benefits of moderate-to-vigorous physical activity (MVPA) are established. Comorbid depressive symptoms and Major Depression are prevalent among the chronically-ill, but how different doses of MVPA may protect against depression remains understudied. Thus, using 10 years of data from The Irish Longitudinal Study on Ageing, we quantified longitudinal associations between MVPA doses and depressive symptoms and Major Depression among chronically-ill older adults living with type 2 diabetes (T2DM). Continuous MVPA (MET.min.week-1), three dose and five dose MVPA categories were examined. Depressive symptoms and Major Depression were measured using the center for Epidemiological Studies Depression and the Composite International Diagnostic Interview for Major Depressive Episode. Negative binomial regression and logistic models, adjusted for covariates, quantified associations across time. Among the 2,262 participants, those adhering to the WHO guidelines of 600-<1,200 MET.min.week-1 had 28% lower odds of Major Depression compared to those not achieving the guidelines (OR: 0.72; 95%CI: 0.53-0.98). For depressive symptoms, a higher MVPA dose was required with a 13% (IRR: 0.87; 95%CI: 0.82-0.93) lower rate of symptoms among those exceeding recommendations (1200-<2,400 MET.min.week-1). Interventions should focus on enhancing achievability of and compliance with these MVPA doses among the chronically-ill, including T2DM, to protect against depression.
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Affiliation(s)
- Eamon Laird
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland; The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland.
| | - Matthew P Herring
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland; The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland
| | - Brian P Carson
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - Catherine B Woods
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - Cathal Walsh
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland
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27
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Holloway EE, Gray S, Halliday J, Harrap B, Hines C, Skinner TC, Speight J, Hendrieckx C. Feasibility and acceptability of 'low-intensity mental health support via a telehealth-enabled network' for adults with type 1 and type 2 diabetes: the LISTEN pilot study. Pilot Feasibility Stud 2023; 9:133. [PMID: 37501203 PMCID: PMC10373371 DOI: 10.1186/s40814-023-01367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND This study examined the feasibility and acceptability of the low-intensity mental health support via telehealth-enabled network (LISTEN) intervention, for adults with diabetes, facilitated by diabetes health professionals (HPs). METHODS LISTEN training. Three HPs participated in three half-day online workshops and applied their learnings during training cases (maximum four). Competency was assessed with a validated tool and achieved 'satisfactory' ratings for three consecutive sessions. LISTEN pilot. A single-group, pre-post study (up to four LISTEN sessions) with online assessments at baseline, post-intervention, and 4-week follow-up. Eligible participants were adults with type 1 or type 2 diabetes, with diabetes distress, but excluded if they had moderate/severe depressive and/or anxiety symptoms. Feasibility was assessed via recruitment and session completion rates. Acceptability was assessed with post-intervention self-report data. Changes in diabetes distress and general emotional well-being from baseline (T1) were explored at post-intervention (T2) and at 4-week follow-up (T3). RESULTS Two HPs achieved competency (median training case sessions required: 7) and progressed to deliver LISTEN in the pilot study. In the pilot, N = 16 adults (Med [IQR] age: 60 [37-73] years; 13 women) with diabetes participated (median sessions per participant: 2). Twelve participants (75%) completed the post-intervention assessment (T2): 92% endorsed the number of sessions offered as 'just right', 75% felt comfortable talking with the HP, and 67% were satisfied with LISTEN. Perceived limitations were the structured format and narrow scope of problems addressed. Diabetes distress scores were lower post-intervention. CONCLUSIONS This pilot demonstrates the feasibility of training HPs to deliver LISTEN, and the acceptability and potential benefits of LISTEN for adults with diabetes. The findings highlight adaptations that may enhance the delivery of, and satisfaction with, LISTEN that will be tested in a hybrid type 1 effectiveness-implementation trial.
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Affiliation(s)
- Edith E Holloway
- School of Psychology, Deakin University, Geelong, VIC, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia.
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.
| | - Shikha Gray
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Jennifer Halliday
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Benjamin Harrap
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, VIC, Australia
| | | | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- La Trobe Rural Health School, La Trobe University, Flora Hill, VIC, Australia
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
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28
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Feng Z, Tong WK, Zhang X, Tang Z. Prevalence of depression and association with all-cause and cardiovascular mortality among individuals with type 2 diabetes: a cohort study based on NHANES 2005-2018 data. BMC Psychiatry 2023; 23:490. [PMID: 37430235 DOI: 10.1186/s12888-023-04999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Individuals with diabetes have increased risk of depression, but there are limited nationally representative studies on this topic. We aimed to investigate the prevalence and predictors of depression, as well as its impact on all-cause and cardiovascular mortality in adults with type 2 diabetes (T2DM) using a prospective cohort study and a representative sample of the U.S. POPULATION METHODS We analyzed National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018 and linked it with the most recent publicly available National Death Index (NDI) data. Individuals aged 20 years or old who had depression measurements were included. Depression was defined as a Patient Health Questionnaire (PHQ-9) score ≥ 10, and categorized into moderate (10-14 points) and moderately severe to severe (≥ 15 points). Cox proportional hazard models were used to estimate the association between depression and mortality. RESULTS Among 5695 participants with T2DM, 11.6% had depression. Depression was associated with female gender, younger age, overweight, lower education, being unmarried, smoking, and a history of coronary heart disease and stroke. During a mean follow-up period of 78.2 months, 1161 all-cause deaths occurred. Total depression and moderately severe to severe depression significantly increased all-cause mortality (adjusted hazard ratio [aHR] 1.36, 95% CI [1.09-1.70]; 1.67 [1.19-2.34]) and non-cardiovascular mortality (aHR 1.36, 95% CI [1.04-1.78]; 1.78, 95% CI [1.20-2.64]), but not cardiovascular mortality. Subgroup analysis showed a significant association between total depression and all-cause mortality in males (aHR 1.46, 95% CI [1.08-1.98]) and those aged 60 years or older (aHR 1.35, 95% CI [1.02-1.78]). Any severity of depression was not significantly associated with cardiovascular mortality in age- or gender- stratified subgroups. CONCLUSIONS In a nationally representative sample of U.S. adults with T2DM, approximately 10% experienced depression. Depression did not significantly associate with cardiovascular mortality. However, comorbid depression in T2DM patients increased the risk of all-cause and non-cardiovascular mortality. The impact of depression on mortality varied across subgroups. Therefore, healthcare providers should consider incorporating depression screening and management into routine care, especially for subgroups with specific risk factors, due to the increased risk of all-cause mortality in T2DM patients with depression.
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Affiliation(s)
- Zhen Feng
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, 826 Zhangheng Rd, Shanghai, 201203, China
- Department of Pharmacy, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, 221002, China
| | - Wai Kei Tong
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, 826 Zhangheng Rd, Shanghai, 201203, China
| | - Xinyue Zhang
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, 826 Zhangheng Rd, Shanghai, 201203, China
| | - Zhijia Tang
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, 826 Zhangheng Rd, Shanghai, 201203, China.
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Ahmed A, Zeng G, Azhar M, Wang F, Wang J, Fan B, Liu X, Jiang D, Wang Q. Combination of Shengmai San and Radix puerariae ameliorates depression-like symptoms in diabetic rats at the nexus of PI3K/BDNF/SYN protein expression. Animal Model Exp Med 2023; 6:211-220. [PMID: 37317044 PMCID: PMC10272924 DOI: 10.1002/ame2.12333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/03/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Hyperglycemia is a characteristic feature of diabetes that often results in neuropsychological complications such as depression. Diabetic individuals are more vulnerable to experience depression compared to the normal population. Thus, novel treatment approaches are required to reduce depressive symptoms among diabetic individuals. Traditional Chinese medicines (TCMs) such as Shengmai San (SMS) and Radix puerariae (R) are usually widely used to treat ailments such as neurological complications since ancient time. METHODS In this study, SMS was combined with R to prepare an R-SMS formulation and screened for their antidepressant activity in diabetic rats. The antidepressant potential of the prepared combination was evaluated behaviorally using open field test, novelty-induced hypophagia, and forced swim test in diabetic rats with biochemical and protein expression (PI3K, BDNF [brain-derived neurotrophic factor], and SYN [presynaptic vesicle protein]) analysis. RESULTS Diabetic rats (streptozotocin, 45 mg/kg) showed elevated fasting blood glucose (FBG) >12 mM with depressive symptoms throughout the study. Treatment with R-SMS (0.5, 1.5, and 4.5 g/kg) significantly reverted depressive symptoms in diabetic rats as evinced by significantly (p < 0.05) reduced immobility time with an increased tendency to eat food in a novel environment. Treatment with R-SMS also significantly increased the protein expression of PI3K, BDNF, and SYN protein, which play a crucial role in depression. CONCLUSION This study showed that R-SMS formulation antagonized depressive symptoms in diabetic rats; thus, this formulation might be studied further to develop as an antidepressant.
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Affiliation(s)
- Ayaz Ahmed
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological SciencesUniversity of KarachiKarachiPakistan
| | - Guirong Zeng
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
- Institute of Drug Discovery TechnologyNingbo UniversityNingboChina
- Research Center for Pharmacodynamic, Material Basis and Mechanism of ActionCollege of Pharmacy, Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Mudassar Azhar
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological SciencesUniversity of KarachiKarachiPakistan
| | - Fengzhong Wang
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
| | - Jingru Wang
- Research Center for Pharmacodynamic, Material Basis and Mechanism of ActionCollege of Pharmacy, Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Bei Fan
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
| | - Xinmin Liu
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological SciencesUniversity of KarachiKarachiPakistan
- Institute of Drug Discovery TechnologyNingbo UniversityNingboChina
| | - Dejiang Jiang
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
| | - Qiong Wang
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
- Sino‐Portugal TCM International Cooperation CenterThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhouChina
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30
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Safari M, Asadi A, Aryaeian N, Huseini HF, Shidfar F, Jazayeri S, Malek M, Hosseini AF, Hamidi Z. The effects of melissa officinalis on depression and anxiety in type 2 diabetes patients with depression: a randomized double-blinded placebo-controlled clinical trial. BMC Complement Med Ther 2023; 23:140. [PMID: 37131158 PMCID: PMC10152712 DOI: 10.1186/s12906-023-03978-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/26/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Depression is more common in diabetic patients, with a 1.5-fold increased risk of death.Melissa officinalis (M. officinalis) have anti-diabetic and anti-depression activities. The study aimed to determine the efficacy of M. officinalis extract on depression, anxiety, and sleep quality in patients with type 2 diabetes with depressive symptoms. METHODS In this double-blind clinical trial, 60 volunteer patients (age range 20-65 years) with type 2 diabetes mellitus with symptoms of depression were randomized into the intervention (received 700 mg/day hydroalcoholic extract; n = 30) or control group (received 700 mg/day toasted flour; n = 30). Dietary intake, physical activity, anthropometric indices, FBS (Fasting blood sugar), hs-CRP(High-sensitivity C-reactiveprotein), depression, anxiety, and sleep quality were determined at the beginning and end of the study. Depression and anxiety were assessed by Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI), respectively; sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). RESULTS Sixty participants received M. officinalis extract or placebo, of which 44 patients completed the 12-week double-blind clinical trial. After 12-week the mean change of depression and anxiety scores were statistically significant between the two groups (p < 0.001 and p = 0.04, respectively), but no significant differences were observed in FBS, hs-CRP, anthropometric indices, sleep quality, and blood pressure.In the intervention group, there was a significant decrease in depression and anxiety severity(p < 0.001 and p = 0.01, respectively) at the end of the study compared to the baseline. TRIAL REGISTRATION All protocols in this study were followed in accordance with the Helsinki Declaration (1989 revision). Ethical approval for this study was obtained from the Iran University of Medical Sciences Ethics committee (IR.IUMS.FMD.REC 1396.9413468004; research.iums.ac.ir). The study was registered at the Iranian Registry of Clinical Trials (IRCT201709239472N16); Registration date: 09/10/2017.
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Affiliation(s)
- Mostafa Safari
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
| | - Akbar Asadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
| | - Naheed Aryaeian
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran.
| | - Hasan Fallah Huseini
- Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, 30Th Km of Karaj-Qazvin Freeway, ACECR Research Complex, Karaj, 3365166571, Iran
| | - Farzad Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
| | - Shima Jazayeri
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
| | - Mojtaba Malek
- Institute of Endocrinology & Metabolism, Firoozeh Alley, Vali-asrSq, Tehran, Iran
| | - Agha Fateme Hosseini
- Department of Statistics, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, Tehran, Iran
| | - Zahra Hamidi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
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31
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Safari M, Asadi A, Aryaeian N, Huseini HF, Shidfar F, Jazayeri S, Malek M, Hosseini AF, Hamidi Z. The effects of melissa officinalis on depression and anxiety in type 2 diabetes patients with depression: a randomized double-blinded placebo-controlled clinical trial. BMC Complement Med Ther 2023; 23:140. [PMID: 37131158 DOI: 10.1186/s12906-023-03978-x.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/26/2023] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Depression is more common in diabetic patients, with a 1.5-fold increased risk of death.Melissa officinalis (M. officinalis) have anti-diabetic and anti-depression activities. The study aimed to determine the efficacy of M. officinalis extract on depression, anxiety, and sleep quality in patients with type 2 diabetes with depressive symptoms. METHODS In this double-blind clinical trial, 60 volunteer patients (age range 20-65 years) with type 2 diabetes mellitus with symptoms of depression were randomized into the intervention (received 700 mg/day hydroalcoholic extract; n = 30) or control group (received 700 mg/day toasted flour; n = 30). Dietary intake, physical activity, anthropometric indices, FBS (Fasting blood sugar), hs-CRP(High-sensitivity C-reactiveprotein), depression, anxiety, and sleep quality were determined at the beginning and end of the study. Depression and anxiety were assessed by Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI), respectively; sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). RESULTS Sixty participants received M. officinalis extract or placebo, of which 44 patients completed the 12-week double-blind clinical trial. After 12-week the mean change of depression and anxiety scores were statistically significant between the two groups (p < 0.001 and p = 0.04, respectively), but no significant differences were observed in FBS, hs-CRP, anthropometric indices, sleep quality, and blood pressure.In the intervention group, there was a significant decrease in depression and anxiety severity(p < 0.001 and p = 0.01, respectively) at the end of the study compared to the baseline. TRIAL REGISTRATION All protocols in this study were followed in accordance with the Helsinki Declaration (1989 revision). Ethical approval for this study was obtained from the Iran University of Medical Sciences Ethics committee (IR.IUMS.FMD.REC 1396.9413468004; research.iums.ac.ir). The study was registered at the Iranian Registry of Clinical Trials (IRCT201709239472N16); Registration date: 09/10/2017.
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Affiliation(s)
- Mostafa Safari
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
| | - Akbar Asadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
| | - Naheed Aryaeian
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran.
| | - Hasan Fallah Huseini
- Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, 30Th Km of Karaj-Qazvin Freeway, ACECR Research Complex, Karaj, 3365166571, Iran
| | - Farzad Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
| | - Shima Jazayeri
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
| | - Mojtaba Malek
- Institute of Endocrinology & Metabolism, Firoozeh Alley, Vali-asrSq, Tehran, Iran
| | - Agha Fateme Hosseini
- Department of Statistics, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, Tehran, Iran
| | - Zahra Hamidi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemmat Broadway, 14155-6171, Tehran, 1449614535, Iran
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Suvada K, Ali MK, Chwastiak L, Poongothai S, Emmert-Fees KMF, Anjana RM, Sagar R, Shankar R, Sridhar GR, Kasuri M, Sosale AR, Sosale B, Rao D, Tandon N, Narayan KMV, Mohan V, Patel SA. Long-term Effects of a Collaborative Care Model on Metabolic Outcomes and Depressive Symptoms: 36-Month Outcomes from the INDEPENDENT Intervention. J Gen Intern Med 2023; 38:1623-1630. [PMID: 36596908 PMCID: PMC10212897 DOI: 10.1007/s11606-022-07958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/15/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Collaborative care (CC) is a multicomponent team-based approach to providing mental health care with systematic integration into outpatient medical settings. The 12-month INDEPENDENT CC intervention improved joint disease control measures in patients with both depression and diabetes at 12 and 24 months following randomization. OBJECTIVE This study investigated the durability of intervention effects on patient outcomes at 36 months following randomization. PARTICIPANTS Adult patients with poorly controlled T2D and depression in India randomized to CC or usual care. DESIGN Post hoc analyses of between-group differences in patient outcomes at 36 months post-randomization (N = 331) and maintenance of outcomes from 12 to 36 months (N = 314). MAIN MEASURES We evaluated combined risk factor improvement since baseline, defined as ≥ 50.0% reduction in Symptom Checklist Depression Scale (SCL-20) scores along with reduction of at least 0.5 percentage point hemoglobin A1C, 5 mmHg systolic blood pressure, or 10 mg/dL low-density lipoprotein cholesterol. Improvements in single risk factors were also examined. KEY RESULTS There were no between-group differences in improvements since baseline in multiple or single risk factors at 36 months. Patients in the CC group with improved outcomes at 12 months were more likely to maintain a ≥ 50.0% reduction since baseline in SCL-20 scores (CC [54.9%] vs. UC [40.9%]; RR: 1.27 [95% CI: 1.04, 1.56]) and 0.5 percentage point reduction since baseline in hemoglobin A1C (CC [31.9%] vs. UC [19.5%]; RR: 1.64 [95% CI: 1.11, 2.41]) at 36 months. CONCLUSIONS While improvements since baseline in patient outcomes did not differ between the collaborative care and usual care groups at 36 months, patients who received CC were more likely to maintain improvements in depressive symptoms and glucose levels at 36 months if they had achieved these improvements at the end of active intervention. TRIAL REGISTRATION NUMBER NCT02022111.
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Affiliation(s)
- Kara Suvada
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | - Mohammed K Ali
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Subramani Poongothai
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Karl M F Emmert-Fees
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Radha Shankar
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Madhu Kasuri
- Diabetes Care and Research Center, Diacon Hospital, Bangalore, India
| | - Aravind R Sosale
- Diabetes Care and Research Center, Diacon Hospital, Bangalore, India
| | - Bhavana Sosale
- Diabetes Care and Research Center, Diacon Hospital, Bangalore, India
| | - Deepa Rao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Delhi, India
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Shivani A Patel
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Zavala GA, Jennings HM, Afaq S, Alam A, Ahmed N, Aslam F, Arsh A, Coales K, Ekers D, Nabi M, Naz A, Shakur N, Siddiqi N, Wright JM, Kellar I. Effectiveness and implementation of psychological interventions for depression in people with non-communicable diseases in South Asia: Systematic review and meta-analysis. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2023; 52:260-284. [PMID: 38013979 PMCID: PMC10461698 DOI: 10.1080/00207411.2023.2202431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
We evaluate the effectiveness of psychological interventions for depression in people with NCDs in South Asia and explore the individual, organizational, and policy-level barriers and facilitators for the implementation and scaling up of these interventions. Eight databases (and local web pages) were searched in May 2022. We conducted random effects models to evaluate the pooled effect of psychological interventions on depression in people with NCDs. We extracted the individual, organizational, and policy level barriers and facilitators. We found five randomized control trials, nine qualitative studies, and 35 policy documents that fitted the inclusion criteria. The pooled standardized mean difference in depression comparing psychological interventions with usual care was -2.31 (95% CI, -4.16 to -0.45; p = .015, I2 = 96.0%). We found barriers and facilitators to intervention delivery, mental health appears in the policy agenda in Bangladesh and Pakistan. However, there is a lack of policies relating to training in mental health for NCD health providers and a lack of integration of mental health care with NCD care. All of the psychological interventions reported to be effective in treating depression in this population. There are important delivery and policy barriers to the implementation and scaling up of psychological interventions for people with NCDs.
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Affiliation(s)
- Gerardo A. Zavala
- Department of Health Sciences, University of York, York, United Kingdom
| | - Hannah Maria Jennings
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Saima Afaq
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Ashraful Alam
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Faiza Aslam
- Institute of Psychiatry (IoP), Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Aatik Arsh
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Karen Coales
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Ekers
- Department of Health Sciences, University of York, York, United Kingdom
- Tees Esk and Wear Valleys NHS FT, York, United Kingdom
| | | | - Anum Naz
- Institute of Psychiatry (IoP), Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Judy M. Wright
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
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Rozanski A, Blumenthal JA, Hinderliter AL, Cole S, Lavie C. Cardiology and lifestyle medicine. Prog Cardiovasc Dis 2023; 77:4-13. [PMID: 37059409 DOI: 10.1016/j.pcad.2023.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/09/2023] [Indexed: 04/16/2023]
Abstract
Poor lifestyle habits, such as physical inactivity and poor diets, are highly prevalent within society and even more so among patients with chronic disease. The need to stem poor lifestyle habits has led to the development of a new field of Lifestyle Medicine, whose mission is to prevent, treat, and even reverse chronic diseases through lifestyle interventions. Three fields within Cardiology relate to this mission: Cardiac Rehabilitation, Preventive Cardiology, and Behavioral Cardiology. Each of these three fields have contributed substantially to the reduction of cardiovascular disease (CVD) morbidity and mortality. The historic contributions of these three cardiac fields are reviewed as well as the challenges each of these fields has faced in optimizing the application of lifestyle medicine practices. A shared agenda between Cardiology and the American College of Lifestyle Medicine could further the utilization of behavioral interventions. This review suggests seven steps that could be shared by these organizations and other medical societies. First, there is a need to develop and promulgate the assessment of lifestyle factors as "vital signs" during patient visits. Second, developing a strong partnership between the fields of Cardiology and Physiatry could improve important aspects of cardiac care, including a potential redesign of cardiac stress testing. Third, behavioral evaluations should be optimized at patients' entrée points into medical care since these may be considered "windows of opportunity". Fourth, there is a need to broaden cardiac rehabilitation into inexpensive programs and make this program eligible for patients with risk factors but no known CVD. Fifth, lifestyle medicine education should be integrated into the core competencies for relevant specialties. Sixth, there is a need for inter-societal advocacy to promote lifestyle medicine practices. Seventh, the well-being effects of healthy lifestyle behaviors, such as their impact on one's sense of vitality, should be emphasized.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Steven Cole
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States of America; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Carl Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA, United States of America
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Rozanski A. The pursuit of health: A vitality based perspective. Prog Cardiovasc Dis 2023; 77:14-24. [PMID: 37037404 DOI: 10.1016/j.pcad.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Abstract
The larger number of adults who enter their senior years with a high burden of chronic diseases has led to new metrics designed to promote health pro-activity, such as the calculation of one's "healthspan". These efforts call for re-evaluation as to what is meant by "health". A large body of epidemiologic and clinical investigation identifies that good health is shaped by specific health behaviors (aerobic exercise, resistance training, sleep, and good diet quality) and four psychological determinants (positive emotions, positive mindsets, purposeful living, and social connectivity). In common, each of these determinants produce "vitality", which can be defined as having the pleasing sensation of feeling energetic. Having a strong sense of vitality produces a sense of agency, provides resilience, and serves as a leading indicator of good health. Importantly, vitality can be assessed as a single item "vital sign" in clinical practice and can be promoted by recommending simple steps to patients, such as suggesting that they initiate walking or other aerobic activities. Because health habits and psychological determinants of health are inter-related, such simple steps can initiate a "virtuous cycle" of health improvement. An emphasis on vitality can also encourage patients to become more cognizant of their level of energy and manage it through health-promoting behaviors rather than quick fix behaviors. Finally, vitality assessment and prescription can promote more successful aging. In sum, an updated and more clinically useful definition of health recognizes that it is a dynamic entity that is influenced at any time by one's engagement in physical and psychological practices that promote health. Accordingly, an updated definition of health is proposed: good health is characterized by physical and psychological well-being and is associated with vitality.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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Mpango RS, Ssembajjwe W, Rukundo GZ, Birungi C, Kalungi A, Gadow KD, Patel V, Nyirenda M, Kinyanda E. Physical and psychiatric comorbidities among patients with severe mental illness as seen in Uganda. Eur Arch Psychiatry Clin Neurosci 2023; 273:613-625. [PMID: 36002543 PMCID: PMC9950291 DOI: 10.1007/s00406-022-01478-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
While psychiatric and physical comorbidities in severe mental illness (SMI) have been associated with increased mortality and poor clinical outcomes, problem has received little attention in low- and middle-income countries (LMICs). This study established the prevalence of psychiatric (schizophrenia, bipolar affective disorder, and recurrent major depressive disorder) and physical (HIV/AIDS, syphilis, hypertension and obesity) comorbidities and associated factors among 1201 out-patients with SMI (schizophrenia, depression and bipolar affective disorder) attending care at two hospitals in Uganda. Participants completed an assessment battery including structured, standardised and locally translated instruments. SMIs were established using the MINI International Neuropsychiatric Interview version 7.2. We used logistic regression to determine the association between physical and psychiatric comorbidities and potential risk factors. Bipolar affective disorder was the most prevalent (66.4%) psychiatric diagnoses followed by schizophrenia (26.6%) and recurrent major depressive disorder (7.0%). Prevalence of psychiatric comorbidity was 9.1%, while physical disorder comorbidity was 42.6%. Specific comorbid physical disorders were hypertension (27.1%), obesity (13.8%), HIV/AIDS (8.2%) and syphilis (4.8%). Potentially modifiable factors independently significantly associated with psychiatric and physical comorbidities were: use of alcohol for both syphilis and hypertension comorbidities; and use of a mood stabilisers and khat in comorbidity with obesity. Only psychiatric comorbidity was positively associated with the negative outcomes of suicidality and risky sexual behaviour. The healthcare models for psychiatric care in LMICs such as Uganda should be optimised to address the high burden of psychiatric and physical comorbidities.
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Affiliation(s)
- Richard Stephen Mpango
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda.
- Senior Wellcome Trust Fellowship, Entebbe, Uganda.
- Brown School, Washington University, in St. Louis, St. Louis, MO, 63130, USA.
- Department of Mental Health, Soroti School of Health Sciences, Soroti University, P. O. Box 211, Soroti, Uganda.
- Butabika National Psychiatric Hospital, Kampala, Uganda.
| | - Wilber Ssembajjwe
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda
- Senior Wellcome Trust Fellowship, Entebbe, Uganda
- Statistical Section, MRC/UVRI and LSHTM Uganda Research Unit, P. O. Box 49, Entebbe, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Carol Birungi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Allan Kalungi
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda
- Senior Wellcome Trust Fellowship, Entebbe, Uganda
| | - Kenneth D Gadow
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Massachusetts, USA
| | - Moffat Nyirenda
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda
- Senior Wellcome Trust Fellowship, Entebbe, Uganda
- Global Non-Communicable Diseases (NCD) Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Eugene Kinyanda
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda
- Senior Wellcome Trust Fellowship, Entebbe, Uganda
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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Rasalam R, Abdo S, Deed G, O'Brien R, Overland J. Early type 2 diabetes treatment intensification with glucagon-like peptide-1 receptor agonists in primary care: An Australian perspective on guidelines and the global evidence. Diabetes Obes Metab 2023; 25:901-915. [PMID: 36541153 DOI: 10.1111/dom.14953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/03/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Early and intensive management of type 2 diabetes has been shown to delay disease progression, reduce the risk of cardiorenal complications and prolong time to treatment failure. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are being increasingly recognized for their potential in early disease management, with recent guideline updates recommending second-line use of this injectable drug class alongside oral glucose-lowering drugs. GLP-1RAs target at least six of the eight core defects implicated in the pathogenesis of type 2 diabetes and offer significant glycaemic and weight-related improvements over other second-line agents in head-to-head trials. In addition, placebo-controlled clinical trials have shown cardiovascular protection with GLP-1RA use. Even so, this therapeutic class is underused in primary care, largely owing to clinical inertia and patient-related barriers to early intensification with GLP-1RAs. Fortunately, clinicians can overcome barriers to treatment acceptance through patient education and training, and management of treatment expectations. In this review we comment on global and Australian guideline updates and evidence in support of early intensification with this therapeutic class, and provide clinicians with practical advice for GLP-1RA use in primary care.
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Affiliation(s)
- Roy Rasalam
- College of Medicine, James Cook University, Townsville, Queensland, Australia
| | - Sarah Abdo
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Gary Deed
- Monash University, Melbourne, Victoria, Australia
- HealthcarePlus Medical, Carindale, Queensland, Australia
| | - Richard O'Brien
- Austin Clinical School, University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Jane Overland
- Total Diabetes Care, Sydney, New South Wales, Australia
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Maimaitituerxun R, Chen W, Xiang J, Kaminga AC, Wu XY, Chen L, Yang J, Liu A, Dai W. Prevalence of comorbid depression and associated factors among hospitalized patients with type 2 diabetes mellitus in Hunan, China. BMC Psychiatry 2023; 23:158. [PMID: 36918821 PMCID: PMC10012793 DOI: 10.1186/s12888-023-04657-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Depression and diabetes are major health challenges, with heavy economic social burden, and comorbid depression in diabetes could lead to a wide range of poor health outcomes. Although many descriptive studies have highlighted the prevalence of comorbid depression and its associated factors, the situation in Hunan, China, remains unclear. Therefore, this study aimed to identify the prevalence of comorbid depression and associated factors among hospitalized type 2 diabetes mellitus (T2DM) patients in Hunan, China. METHODS This cross-sectional study involved 496 patients with T2DM who were referred to the endocrinology inpatient department of Xiangya Hospital affiliated to Central South University, Hunan. Participants' data on socio-demographic status, lifestyle factors, T2DM-related characteristics, and social support were collected. Depression was evaluated using the Hospital Anxiety and Depression Scale-depression subscale. All statistical analyses were conducted using the R software version 4.2.1. RESULTS The prevalence of comorbid depression among hospitalized T2DM patients in Hunan was 27.22% (95% Confidence Interval [CI]: 23.3-31.1%). Individuals with depression differed significantly from those without depression in age, educational level, per capita monthly household income, current work status, current smoking status, current drinking status, regular physical activity, duration of diabetes, hypertension, chronic kidney disease, stroke, fatty liver, diabetic nephropathy, diabetic retinopathy, insulin use, HbA1c, and social support. A multivariable logistic regression model showed that insulin users (adjusted OR = 1.86, 95% CI: 1.02-3.42) had a higher risk of depression, while those with regular physical activity (adjusted OR = 0.48, 95% CI: 0.30-0.77) or greater social support (adjusted OR = 0.20, 95% CI: 0.11-0.34) had a lower risk of depression. The area under the curve of the receiver operator characteristic based on this model was 0.741 with a sensitivity of 0.785 and specificity of 0.615. CONCLUSIONS Depression was moderately prevalent among hospitalized T2DM patients in Hunan, China. Insulin treatment strategies, regular physical activity, and social support were significantly independently associated with depression, and the multivariable model based on these three factors demonstrated good predictivity, which could be applied in clinical practice.
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Affiliation(s)
- Rehanguli Maimaitituerxun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Wenhang Chen
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingsha Xiang
- Human Resource Department, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Atipatsa C Kaminga
- Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi
| | - Xin Yin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Letao Chen
- Infection Control Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianzhou Yang
- Department of Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China.
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Brieler JA, Salas J, Keegan-Garrett E, Scherrer JF. Achievement of glycemic control and antidepressant medication use in comorbid depression and type 2 diabetes. J Affect Disord 2023; 324:1-7. [PMID: 36566931 DOI: 10.1016/j.jad.2022.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 11/22/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Existing studies designed to determine if depression treatment in patients with type 2 diabetes (T2D) is associated with improved glycemic control have produced inconsistent results. The present study investigated the link between acute phase antidepressant medication treatment and achievement of glycemic control in patients with T2D using nationally distributed electronic health record data. METHODS A retrospective cohort study (n = 7332) was conducted using nationally distributed Optum® de-identified electronic health record data from 2010 to 2018. Eligible patients were 18-64 years old and had T2D, depression, and poor glycemic control. Antidepressant medication treatment was categorized into acute phase treatment (≥12 weeks), less than acute phase (<12 weeks) or no treatment. Glycemic control was defined as HbA1c < 7.0 % (53 mmol/mol). Propensity scores (PS) and inverse probability of treatment weighting (IPTW) controlled for confounding. Extended Cox models measured the association between duration of antidepressant medication treatment and glycemic control at 0 to 36 months, 36 to 72 months and ≥72 months. RESULTS After controlling for confounding, compared to no treatment, acute phase treatment was significantly associated with achieving glycemic control within 36 months (HR 1.17, 95 % CI 1.02-1.34). No association was observed beyond 36 months. There was no association between acute vs. less than acute phase treatment and glycemic control. LIMITATIONS We were unable to measure decreased depression severity which could contribute to glycemic control. CONCLUSIONS For patients with T2D and hyperglycemia, acute phase antidepressant medication may enable glycemic control. Further research is needed to establish mechanisms for this association.
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Affiliation(s)
- Jay A Brieler
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Elizabeth Keegan-Garrett
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 S Grand Blvd, St. Louis, MO 63104, USA
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Witkow S, Liberty IF, Goloub I, Kaminsky M, Otto O, Rabia Y, Boehm IH, Golan R. Simplifying carb counting: A randomized controlled study - Feasibility and efficacy of an individualized, simple, patient-centred carb counting tool. Endocrinol Diabetes Metab 2023; 6:e411. [PMID: 36750449 PMCID: PMC10000617 DOI: 10.1002/edm2.411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION The purpose of this study was to introduce and test a simple, individualized carbohydrate counting tool designed for persons with Type 1 Diabetes Mellitus (T1DM) in order to determine whether the tool improved A1C levels for participants with age, education or language barriers. METHODS In a randomized controlled trial, 85 participants were offered six diabetes instructional sessions free of charge over a six-month period. Forty-one received guidance using the regular carbohydrate counting (RCC) method. Forty-four received guidance using an individualized 'Simple Carb Counting' (SCC), involving two customized tables prepared for participants. RESULTS The simple, individualized SCC tool for carbohydrate counting was non-inferior to the standard method of RCC. The SCC tool was more effective among participants aged 40 and older, while no differences were found when comparing participants by education level. Irrespective of intervention group, all participants improved their A1C level (9.9% = 13.2 mmol/L vs 8.6% = 11.1 mmol/L, p = .001). A greater improvement in A1C level was seen in newly diagnosed participants (-6.1 vs -0.7, p = .005, -3.4 vs 0.9, p = .032) in both the RCC and SCC groups. All participants expressed improved emotional level per their PAID5 questionnaires (Problem Areas in Diabetes Scale-PAID), (10.6 (±5.7) vs 9.5 (±5.7), p = .023), with women reporting greater improvement than men. CONCLUSIONS SCC is a simple, individualized, feasible, low-tech tool for carbohydrate counting, which promotes and enables accurate insulin dosing in people with T1DM. It was found more effective among participants aged 40 and older. Additional studies are needed to corroborate these findings.
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Affiliation(s)
- Shulamit Witkow
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
| | - Idit F. Liberty
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
- Ben‐Gurion University of the NegevBeer ShevaIsrael
| | - Irina Goloub
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
| | - Malka Kaminsky
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
| | - Olga Otto
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
- Clalit HMO of the NegevBeer ShevaIsrael
| | - YonesAbu Rabia
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
- Clalit HMO of the NegevBeer ShevaIsrael
| | | | - Rachel Golan
- Ben‐Gurion University of the NegevBeer ShevaIsrael
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Forma F, Liberman JN, Rui P, Ruetsch C. Adherence to augmentation therapy for the treatment of major depressive disorder. Expert Rev Pharmacoecon Outcomes Res 2023; 23:327-335. [PMID: 36697398 DOI: 10.1080/14737167.2023.2167712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Inadequate response to antidepressant medication is common. Often, adjunctive pharmacotherapy or psychotherapy is recommended. OBJECTIVE To measure adherence to adjunctive pharmacotherapy and psychotherapy among individuals with major depressive disorder (MDD). METHODS Retrospective cohort study of individuals with MDD on antidepressant monotherapy who added adjunctive pharmacotherapy and/or psychotherapy. Medication adherence was measured by proportion of days covered (PDC) with optimal adherence defined as PDC≥0.80 and psychotherapy adherence defined by count of visits (optimal 8+ visits). Factors associated with optimal adherence were assessed by logistic regression. RESULTS Among 218,192 individuals with adjunctive therapy, 185,349 added pharmacotherapy and 32,843 added psychotherapy. In the subsequent 12 months, 36.2% and 54.9% achieved optimal adherence to adjunctive pharmacotherapy and psychotherapy, respectively. Adherence to adjunctive pharmacotherapy was associated with adding psychotherapy, index antidepressant adherence, medical comorbidities, and MDD severity codes. Adherence to adjunctive psychotherapy was associated with adding another medication, previous psychiatry visit and psychiatric comorbidities. CONCLUSION Adjunctive psychotherapy appears under-utilized and adherence to adjunctive therapy was low. Low adherence to adjunctive therapy reinforces challenges in managing MDD. That a second adjunctive therapy enhanced adherence to the initial adjunctive therapy indicates an opportunity to explore alternative adjunctive therapies.
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Affiliation(s)
- Felicia Forma
- Health Economics, Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | | | - Pinyao Rui
- Health Analytics, LLC, Clarksville, MD, USA
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Saqib K, Qureshi AS, Butt ZA. COVID-19, Mental Health, and Chronic Illnesses: A Syndemic Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3262. [PMID: 36833955 PMCID: PMC9962717 DOI: 10.3390/ijerph20043262] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic is an epidemiological and psychological crisis; what it does to the body is quite well known by now, and more research is underway, but the syndemic impact of COVID-19 and mental health on underlying chronic illnesses among the general population is not completely understood. METHODS We carried out a literature review to identify the potential impact of COVID-19 and related mental health issues on underlying comorbidities that could affect the overall health of the population. RESULTS Many available studies have highlighted the impact of COVID-19 on mental health only, but how complex their interaction is in patients with comorbidities and COVID-19, the absolute risks, and how they connect with the interrelated risks in the general population, remain unknown. The COVID-19 pandemic can be recognized as a syndemic due to; synergistic interactions among different diseases and other health conditions, increasing overall illness burden, emergence, spread, and interactions between infectious zoonotic diseases leading to new infectious zoonotic diseases; this is together with social and health interactions leading to increased risks in vulnerable populations and exacerbating clustering of multiple diseases. CONCLUSION There is a need to develop evidence to support appropriate and effective interventions for the overall improvement of health and psychosocial wellbeing of at-risk populations during this pandemic. The syndemic framework is an important framework that can be used to investigate and examine the potential benefits and impact of codesigning COVID-19/non-communicable diseases (NCDs)/mental health programming services which can tackle these epidemics concurrently.
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Affiliation(s)
- Kiran Saqib
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Afaf Saqib Qureshi
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Zahid Ahmad Butt
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Dragioti E, Radua J, Solmi M, Gosling CJ, Oliver D, Lascialfari F, Ahmed M, Cortese S, Estradé A, Arrondo G, Gouva M, Fornaro M, Batiridou A, Dimou K, Tsartsalis D, Carvalho AF, Shin JI, Berk M, Stringhini S, Correll CU, Fusar-Poli P. Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction. World Psychiatry 2023; 22:86-104. [PMID: 36640414 PMCID: PMC9840513 DOI: 10.1002/wps.21068] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 01/15/2023] Open
Abstract
Empirical evidence indicates a significant bidirectional association between mental disorders and physical diseases, but the prospective impact of men-tal disorders on clinical outcomes of physical diseases has not been comprehensively outlined. In this PRISMA- and COSMOS-E-compliant umbrella review, we searched PubMed, PsycINFO, Embase, and Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, up to March 15, 2022, to identify systematic reviews with meta-analysis that examined the prospective association between any mental disorder and clinical outcomes of physical diseases. Primary outcomes were disease-specific mortality and all-cause mortality. Secondary outcomes were disease-specific incidence, functioning and/or disability, symptom severity, quality of life, recurrence or progression, major cardiac events, and treatment-related outcomes. Additional inclusion criteria were further applied to primary studies. Random effect models were employed, along with I2 statistic, 95% prediction intervals, small-study effects test, excess significance bias test, and risk of bias (ROBIS) assessment. Associations were classified into five credibility classes of evidence (I to IV and non-significant) according to established criteria, complemented by sensitivity and subgroup analyses to examine the robustness of the main analysis. Statistical analysis was performed using a new package for conducting umbrella reviews (https://metaumbrella.org). Population attributable fraction (PAF) and generalized impact fraction (GIF) were then calculated for class I-III associations. Forty-seven systematic reviews with meta-analysis, encompassing 251 non-overlapping primary studies and reporting 74 associations, were included (68% were at low risk of bias at the ROBIS assessment). Altogether, 43 primary outcomes (disease-specific mortality: n=17; all-cause mortality: n=26) and 31 secondary outcomes were investigated. Although 72% of associations were statistically significant (p<0.05), only two showed convincing (class I) evidence: that between depressive disorders and all-cause mortality in patients with heart failure (hazard ratio, HR=1.44, 95% CI: 1.26-1.65), and that between schizophrenia and cardiovascular mortality in patients with cardiovascular diseases (risk ratio, RR=1.54, 95% CI: 1.36-1.75). Six associations showed highly suggestive (class II) evidence: those between depressive disorders and all-cause mortality in patients with diabetes mellitus (HR=2.84, 95% CI: 2.00-4.03) and with kidney failure (HR=1.41, 95% CI: 1.31-1.51); that between depressive disorders and major cardiac events in patients with myocardial infarction (odds ratio, OR=1.52, 95% CI: 1.36-1.70); that between depressive disorders and dementia in patients with diabetes mellitus (HR=2.11, 95% CI: 1.77-2.52); that between alcohol use disorder and decompensated liver cirrhosis in patients with hepatitis C (RR=3.15, 95% CI: 2.87-3.46); and that between schizophrenia and cancer mortality in patients with cancer (standardized mean ratio, SMR=1.74, 95% CI: 1.41-2.15). Sensitivity/subgroup analyses confirmed these results. The largest PAFs were 30.56% (95% CI: 27.67-33.49) for alcohol use disorder and decompensated liver cirrhosis in patients with hepatitis C, 26.81% (95% CI: 16.61-37.67) for depressive disorders and all-cause mortality in patients with diabetes mellitus, 13.68% (95% CI: 9.87-17.58) for depressive disorders and major cardiac events in patients with myocardial infarction, 11.99% (95% CI: 8.29-15.84) for schizophrenia and cardiovascular mortality in patients with cardiovascular diseases, and 11.59% (95% CI: 9.09-14.14) for depressive disorders and all-cause mortality in patients with kidney failure. The GIFs confirmed the preventive capacity of these associations. This umbrella review demonstrates that mental disorders increase the risk of a poor clinical outcome in several physical diseases. Prevention targeting mental disorders - particularly alcohol use disorders, depressive disorders, and schizophrenia - can reduce the incidence of adverse clinical outcomes in people with physical diseases. These findings can inform clinical practice and trans-speciality preventive approaches cutting across psychiatric and somatic medicine.
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Affiliation(s)
- Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families and Health Professionals, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Imaging of Mood- and Anxiety-Related Disorders Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, University of Barcelona, Barcelona, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Corentin J Gosling
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- DysCo Lab, Paris Nanterre University, Nanterre, France
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Boulogne-Billancourt, France
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Filippo Lascialfari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Muhammad Ahmed
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, and Solent NHS Trust, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gonzalo Arrondo
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Mary Gouva
- Research Laboratory Psychology of Patients, Families and Health Professionals, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Agapi Batiridou
- Research Laboratory Psychology of Patients, Families and Health Professionals, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina Dimou
- Research Laboratory Psychology of Patients, Families and Health Professionals, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Andre F Carvalho
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Severance Children's Hospital, Seoul, South Korea
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Silvia Stringhini
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- University Centre for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
- Department of Health and Community Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
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Melamed OC, Kalia S, Moineddin R, Greiver M, Kloiber S, Mulsant BH, Selby P, O'Neill BG. Factors Associated With Initiation of Antidepressant Medication in Adults With Type 1 and Type 2 Diabetes: A Primary Care Retrospective Cohort Study in Ontario, Canada. Can J Diabetes 2023; 47:11-18. [PMID: 35933314 DOI: 10.1016/j.jcjd.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/08/2022] [Accepted: 05/23/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Depression in patients with diabetes mellitus is common and associated with poorer outcomes. This study aims to identify demographic, socioeconomic and medical factors associated with the initiation of antidepressant medication after a diagnosis of diabetes in adult patients without a previous prescription for antidepressants. We also examined frequency of primary care visits in the year after antidepressant initiation compared with the year before treatment began. METHODS This was a retrospective cohort study using routinely collected electronic medical record data spanning January 2011 to December 2019 from the University of Toronto Practice-based Research Network (UTOPIAN) Data Safe Haven. Our primary outcome was a first prescription for an antidepressant in patients with diabetes. We used a mixed-effects logistic regression model to identify sociodemographic and medical factors associated with this event. RESULTS Among 22,750 patients with diabetes mellitus, 3,055 patients (13.4%) began taking an antidepressant medication. Increased odds of antidepressant initiation were observed in younger patients (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39 to 2.26), females (OR, 1.60; 95% CI, 1.46 to 1.7), those receiving insulin treatment (OR, 1.59; 95% CI, 1.43 to 1.78) and cases of polypharmacy (OR, 3.67; 95% CI, 3.29 to 4.11). There was an increase in the mean number of primary care visits from 4.6 to 5.9 per year after antidepressant initiation. CONCLUSIONS In patients with diabetes, age, sex and medical characteristics were associated with the initiation of antidepressants. These patients accessed primary care more frequently. Screening and prevention of depression, particularly in these subgroups, could reduce its personal and systemic burdens.
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Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Sumeet Kalia
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Braden G O'Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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Rodzlan Hasani WS, Muhamad NA, Maamor NH, Hanis TM, Xin Wee C, Abu Hassan MR, Abdul Karim Z, Musa KI. Premature mortality and years of potential life lost from cardiovascular diseases: Protocol of a systematic review and meta-analysis. PLoS One 2023; 18:e0284052. [PMID: 37134125 PMCID: PMC10155956 DOI: 10.1371/journal.pone.0284052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/03/2023] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Despite the burden of cardiovascular disease (CVD) continuing to increase globally, no comprehensive meta-analyses have been conducted quantifying premature CVD mortality. This paper reports the protocol for a systematic review and meta-analysis to derive updated estimates of premature CVD mortality. METHODS AND EXPECTED OUTPUTS This review will include the studies that reported premature CVD mortality based on standard premature mortality indicators, including years of life lost (YLL), age standardized mortality rate (ASMR) or standardised mortality ratio (SMR). PUBMED, Scopus, Web of Science (WoS), CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) will be used as the literature databases. The study selection as well as the evaluation of the quality of the included articles will be done independently by two reviewers. Pooled estimates of YLL, ASMR, and SMR will be computed by applying random-effects meta-analysis. Heterogeneity among selected studies will be assessed using the I2 statistic and Q statistic with associated p-values. A funnel plot analysis and Egger's test will be conducted to assess the potential impact of publication bias. Depending on data availability, we propose to conduct subgroup analyses by sex, geographic location, main CVD types, and study time. Reporting of our findings will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. CONCLUSION Our meta-analysis will provide a comprehensive synthesis of the available evidence on premature CVD mortality, which is a major public health concern worldwide. The results of this meta-analysis will have important implications for clinical practice and public health policy, providing insights into strategies to prevent and manage premature CVD mortality. TRIAL REGISTRATION Systematic review registration: PROSPERO CRD42021288415. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288415.
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Affiliation(s)
- Wan Shakira Rodzlan Hasani
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Nor Asiah Muhamad
- Sector for Evidence-based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Nur Hasnah Maamor
- Sector for Evidence-based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Tengku Muhammad Hanis
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Chen Xin Wee
- Faculty of Medicine, Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | | | - Zulkarnain Abdul Karim
- Office of The Manager, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Huber J, Smeikal M, Saely CH, Stingl H, Clodi M, Lechleitner M, Fasching P. [Geriatric aspects for the management of diabetes mellitus (Update 2023)]. Wien Klin Wochenschr 2023; 135:307-318. [PMID: 37101051 PMCID: PMC10133361 DOI: 10.1007/s00508-022-02124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 04/28/2023]
Abstract
There is a high prevalence of diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly diabetic patients according to current scientific evidence.
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Affiliation(s)
- Joakim Huber
- Abteilung für Innere Medizin mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Landstraßer Hauptstraße 4a, 1030 Wien, Österreich
| | - Michael Smeikal
- Abteilung für Innere Medizin mit allgemeiner Geriatrie und Palliativmedizin, Haus der Barmherzigkeit, Wien, Österreich
| | - Christoph H. Saely
- Abteilung für Innere Medizin und Kardiologie/VIVIT-Institut, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Harald Stingl
- Interne Abteilung, Landesklinikum Melk, Melk, Österreich
| | - Martin Clodi
- ICMR—Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz (JKU Linz), 4040 Linz, Österreich
| | - Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl – Natters, Hochzirl, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring der Stadt Wien, Wien, Österreich
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Hong JY, Kim YJ, Bae S, Kim MK. Associations of daily diet-related greenhouse gas emissions with the incidence and mortality of chronic diseases: a systematic review and meta-analysis of epidemiological studies. Epidemiol Health 2022; 45:e2023011. [PMID: 36596731 PMCID: PMC10581893 DOI: 10.4178/epih.e2023011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/30/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Although the entire process extending from food production to dietary consumption makes a large contribution to total greenhouse gas (GHG) emissions, little and inconsistent evidence exists on the epidemiological associations of daily diet-related GHG emissions with chronic disease risk or all-cause mortality. This systematic review and meta-analysis explored the observational epidemiological relationship between daily diet-related GHG emissions and health outcomes, including the risk of chronic diseases and all-cause mortality. METHODS Original articles published in English until May 2022 were identified by searching PubMed, Ovid-Embase, Web of Science, CINAHL, and Google Scholar. The extracted data were pooled using both fixed-effects and random-effects meta-analyses and presented as hazard and risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS In total, 7 cohort studies (21 study arms) were included for qualitative synthesis and meta-analysis. The GHG emissions of dietary consumption showed a significant positive association with the risk of chronic disease incidence and mortality in both fixed-effects and random-effects models (fixed: RR, 1.04; 95% CI, 1.03 to 1.05; random: RR, 1.04; 95% CI, 1.02 to 1.06). This positive association was robust regardless of how daily diet-related GHG emissions were grouped. More strongly animal- based diets showed higher GHG emissions. However, there were only a few studies on specific chronic diseases, and the subgroup analysis showed insignificant results. There was no evidence of publication bias among the studies (Egger test: p=0.79). CONCLUSIONS A higher GHG-emission diet was found to be associated with a greater risk of all-cause mortality.
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Affiliation(s)
- Jee Yeon Hong
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Young Jun Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Sanghyuk Bae
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Kyung Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
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Hermanns N, Ehrmann D, Shapira A, Kulzer B, Schmitt A, Laffel L. Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes. Diabetologia 2022; 65:1883-1894. [PMID: 35380233 PMCID: PMC9522821 DOI: 10.1007/s00125-022-05685-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
Monitoring of glucose plays an essential role in the management of diabetes. However, to fully understand and meaningfully interpret glucose levels, additional information on context is necessary. Important contextual factors include data on behaviours such as eating, exercise, medication-taking and sleep, as well as data on mental health aspects such as stress, affect, diabetes distress and depressive symptoms. This narrative review provides an overview of the current state and future directions of precision monitoring in diabetes. Precision monitoring of glucose has made great progress over the last 5 years with the emergence of continuous glucose monitoring (CGM), automated analysis of new glucose variables and visualisation of CGM data via the ambulatory glucose profile. Interestingly, there has been little progress in the identification of subgroups of people with diabetes based on their glycaemic profile. The integration of behavioural and mental health data could enrich such identification of subgroups to stimulate precision medicine. There are a handful of studies that have used innovative methodology such as ecological momentary assessment to monitor behaviour and mental health in people's everyday life. These studies indicate the importance of the interplay between behaviour, mental health and glucose. However, automated integration and intelligent interpretation of these data sources are currently not available. Automated integration of behaviour, mental health and glucose could lead to the identification of certain subgroups that, for example, show a strong association between mental health and glucose in contrast to subgroups that show independence of mental health and glucose. This could inform precision diagnostics and precision therapeutics. We identified just-in-time adaptive interventions as a potential means by which precision monitoring could lead to precision therapeutics. Just-in-time adaptive interventions consist of micro-interventions that are triggered in people's everyday lives when a certain problem is identified using monitored behaviour, mental health and glucose variables. Thus, these micro-interventions are responsive to real-life circumstances and are adaptive to the specific needs of an individual with diabetes. We conclude that, with current developments in big data analysis, there is a huge potential for precision monitoring in diabetes.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Amit Shapira
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Lori Laffel
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
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49
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Benaran I, McKay G, Llano A. Sertraline. PRACTICAL DIABETES 2022. [DOI: 10.1002/pdi.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Sirirak T, Sangsupawanich P, Wongpakaran N, Srisintorn W. The Geriatric Depression Scale Predicts Glycemic Control in Older Adult with Type 2 Diabetes Mellitus: A Longitudinal Study. Healthcare (Basel) 2022; 10:healthcare10101990. [PMID: 36292437 PMCID: PMC9601955 DOI: 10.3390/healthcare10101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
The presence of comorbid depression and diabetes is associated with worse glycemic control, higher complication and greater mortality risk than expected by each condition alone. The association between various levels of severity of depressive symptoms and glycemic control over time among type 2 diabetic older patients was unclear. This study aimed to investigate a longitudinal association between depression and HbA1c among type 2 diabetic older patients. Type 2 diabetes patients aged 60 years and above with normal cognition were recruited from the outpatient department from 1 June 2020 to 1 July 2021. The Thai Geriatric Depression Scale (TGDS) and HbA1c were assessed at five time points (baseline and every 12 weeks) for 1 year. A linear mixed effect model was used. Of the 161 enrolled participants, 146 completed the study. At baseline, 14% were susceptible to depression or having depression (TGDS score 6 and above), and there was a significant correlation between HbA1c and depression (r = 0.26, p ≤ 0.01). The longitudinal analysis indicated that TGDS was a significant predictor of HbA1c in the next visit, and the relationship was J-shaped. A TGDS below 5 was associated with decreasing HbA1c in the next visit, but the association became positive at a TGDS score at 5 or higher. The presence of significant symptoms of depression was associated with glycemic control in the next 3-month interval OPD visit event, although major depressive disorder has not yet been established.
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Affiliation(s)
- Thanitha Sirirak
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pasuree Sangsupawanich
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Correspondence: ; Tel.: +66-(81)-5404777
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wisarut Srisintorn
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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