Diabetes mellitus e depressão: uma revisão sistemática

Occurrence of depression and assessment of functional capacity in patients with vascular diseases admitted to a Vascular Surgery Service

Background

Vascular diseases are associated with significant sequelae and clinical repercussions for the lives of affected patients, which are more serious among the elderly. The consequences of vascular disease, such as limb loss, chronic pain, prolonged hospitalization, and polypharmacy, reduce these patients' autonomy and independence, influencing their wellbeing and quality of life.

Objectives

To determine the prevalence of depression and assess functional capacity in patients with vascular diseases admitted to a Vascular Surgery Service.

Methods

This is a descriptive, cross-sectional study, carried out at the Vascular Surgery Service of a tertiary hospital with a non-random sample of patients selected consecutively. The geriatric depression scale short form (GDS-15) was used to assess depression and the Katz scale was used for functional assessment.

Results

The prevalence of depression in these patients was 60.6%. Associations were observed between depression and consultation with a family doctor in the last 12 months, alcoholism, claudication, diabetes, and individuals who had had an amputation. Individuals' Katz index functional capacity scores were significantly associated with sociodemographic variables, conditions related to vascular disease, and hospitalization.

Conclusions

There was a high prevalence of depression in patients with vascular diseases admitted to a vascular surgery service and important reductions in functional capacity in some groups, such as individuals with low educational levels, those who had chronic pain in the lower limbs, patients with diabetes, and those who had had an amputation.

Health profile and medication adherence of diabetic patients in the Portuguese population

AIMS

To understand the psychological and behavioural impact of type 2 diabetes in the Portuguese Primary Care setting.

METHODS

Observational, cross-sectional study of a convenience sample of portuguese people diagnosed with type 2 diabetes mellitus. The Diabetes Health Profile (DHP-18) and the Four Item Morisky Medication Adherence Scale (MMAS-4) were applied, as well as socio-demographic and disease-related questions.

RESULTS

In a n=110 patient sample, lower education level showed a negative impact on the Psychological Distress dimension (p=0,013). In the Barriers to activity dimension, significant differences were found between different age groups (p=0,033) - a better health profile was observed in the 40-59 years group and also between gender (p=0,039) - greater impact in female subjects. Disinhibited Eating dimension wasn't associated with any of the studied variables. However, all the groups showed worse results in this domain. No associations were found between DHP and medication adherence. Worse medication adherence is more common when there is a prevailing notion of lack of control of diabetes.

DISCUSSION AND CONCLUSION

Using DHP, a larger negative impact related to type 2 diabetes mellitus is found in those with lower educational level, female and younger (20-39 years) or older (60-79 years) subjects. Broader information strategies aimed at improving the quality of life of diabetic patients is necessary, particularly those related to nutrition.

The impact of diabetes mellitus on quality of life - differences between genders

OBJECTIVE

To determine whether there are gender differences in the impact of the disease in the quality of life of individuals with Diabetes Mellitus type 2.

METHODS

The sample consisted of 192 individuals distributed in equal numbers by gender. Data were collected between the months of August 2013 to May 2014, by sociodemographic and clinical questionnaires and instruments for assessing quality of life (PAID) and adherence to treatment.

RESULTS

The age of the patients ranged from 30 to 80 years old with a mean of 61 years of age (± 11). B-PAID scores were higher in men except in issues related to social support, but the differences were not statistically significant; 51.7% of the patients with good adherence to treatment were women and 48.3% were men.

CONCLUSIONS

The perception of the impact of diabetes in the quality of life of individuals in the present study, measured by the B-PAID instrument, showed that the highest scores predominate in men, that is, they have a higher degree of emotional distress than women. In the group with good adherence to treatment, there is a greater number of individuals with higher PAID scores, especially in men. In the group with poor adherence to treatment, the number of individuals with a high degree of emotional distress was similar in both sexes. This research was approved by the Research Ethics Committee of UNIFESP, through Plataforma Brasil (Protocol number 103,384).

Tradução e adaptação do "Diabetes Distress Scale - DDS" na cultura brasileira

OBJETIVO: Traduzir e adaptar o Diabetes Distress Scale para a cultura brasileira. MÉTODOS: o processo seguiu as normas internacionais para adaptação de um instrumento: tradução, retrotradução e avaliação por um grupo de juízes e pré-teste. RESULTADOS: as etapas de tradução e retrotradução foram realizadas com sucesso, e a avaliação da versão síntese pelo comitê de juízes resultou em alteração de itens, assegurando as equivalências entre a versão original e a traduzida. Durante o pré-teste, foram realizadas reformulações de alguns itens, tornando-os mais claros e de fácil compreensão. CONCLUSÃO: a versão brasileira do Diabetes Distress Scale encontrou resultados satisfatórios em relação ao processo de tradução e adaptação cultural.

What is the effectiveness of the use of polyunsaturated fatty acid omega-3 in the treatment of depression?

This systematic review aims to identify the effect of polyunsaturated fatty acid omega-3 on depressive disorder. A bibliographical search was conducted in the databases SciELO, PubMed and ISIWEB. The keywords used were: "depression" and "omega-3 fatty acids", "depression" and "omega-3 polyunsaturated fatty acid", "depression" and "n-3 fatty acids". A total of 19 studies were identified: four double-blind randomized studies, four cohorts, two cross-sectional lines and nine case-controls. Only five studies presented dropout of less than 30% and controlled for the most important confounding variables. Of the evaluated studies, 13 showed a significant positive association between omega-3 and depression, while six studies did not show a relationship between the referred variables. Therefore, future studies with similar methodology would aid in determining the precise effect of omega-3 on depressive disorders.

[Depressive symptoms and quality of life in type 2 diabetic patients with diabetic distal polyneuropathy]

OBJECTIVE

To investigate the impact of depressive symptoms and neuropathic pain in the quality of life (QL) of diabetic patients with diabetic distal polyneuropathy (DDP).

METHODS

Two hundred and four patients with type 2 diabetes mellitus were evaluated. The diagnosis of DDP was achieved using the Neuropathy Disability Score and Neuropathy Symptom Score questionnaires. The severity of neuropathic pain was assessed by means of a Visual Analogue Scale (VAS); the severity of depression, by means of the Beck Depression Inventory (BDI); and QL was assessed by means of the World Health Organization Quality of Life Instrument-bref (WHOQOLbref).

RESULTS

Patients with DDP presented significant higher scores in BDI (12.6 +/- 7.2 versus 9.9 +/- 7.3; p = 0.018) and in VAS (5.0 +/- 2.4 versus 2.6 +/- 2.9; p < 0.001). They also presented significant lower scores in the physical (52.8 +/- 15.5 versus 59.2 +/- 17.0; p = 0.027) and environmental domains (56.6 +/- 12.3 versus 59.6 +/- 13.6; p = 0,045).

CONCLUSIONS

Diabetic patients with DDP presented a worse QL in the physical and environmental domains of the WHOQOL-bref, probably due to more depressive symptoms and the severity of pain.

Correlação entre Inventário de Depressão de Beck e cortisol urinário em diabéticos tipo 2

OBJETIVO: Verificar a correlação entre o cortisol urinário e o Inventário de Depressão de Beck em diabéticos do tipo 2. MÉTODOS: O cortisol urinário foi avaliado em uma amostra composta por 40 pacientes da Liga de Controle de Diabetes da Disciplina de Endocrinologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e para a avaliação dos sintomas de depressão foi aplicado o Inventário de Depressão de Beck. RESULTADOS: Alta confiabilidade para o Inventário de Depressão de Beck(Alfa de Cronbach=0,920)e correlação significativa foi observada entre cortisol urinário e Inventário de Depressão de Beck(Spearman,r=0.523,p<0.001). CONCLUSÕES: Houve correlação entre cortisol urinário e Inventário de Depressão de Beck, demonstrando que estes indicadores são confiáveis na detecção de sintomas de depressão em diabéticos do tipo 2.

Distribuição de transtornos alimentares em indivíduos com diabetes melito do tipo 1 e do tipo 2: descrição de dois casos

A presença de alterações do comportamento alimentar parece estar aumentada no diabetes melito (DM). Entretanto, a distribuição das diversas categorias de transtornos alimentares tende a se distinguir de acordo com a fisiopatologia do diabetes. O objetivo dessa apresentação é discutir dois casos distintos de ocorrência de transtornos alimentares no DM do tipo 1 (DM1) e no DM do tipo 2 (DM2). A paciente A é do sexo feminino, tem 19 anos e apresenta DM1 desde os 13 anos. Evidenciava sintomas depressivos proeminentes e, há 2 anos, passou a apresentar episódios de compulsão alimentar seguidos de vômitos auto-induzidos e omissão das doses de insulina com o objetivo de evitar ganho de peso. Em função desse comportamento, apresentou diversas internações associadas a uma piora do controle glicêmico. Após o uso de fluoxetina, houve remissão da psicopatologia alimentar e melhora do controle do DM. A paciente B possui 42 anos e é portadora do DM2 há 6 anos. Apresenta obesidade grau II e vinha exibindo, antes mesmo do diagnóstico do DM2, episódios de compulsão alimentar na ausência de comportamentos compensatórios, que prejudicavam o controle metabólico do diabetes. Foi iniciada fluoxetina até a dose de 60 mg/dia, com remissão do descontrole alimentar, perda ponderal e redução da hemoglobina glicosilada. A incidência de transtornos alimentares no DM1 estaria associada com um aumento da preocupação com a forma corporal e a possibilidade da omissão do uso da insulina como comportamento compensatório. No DM2, a obesidade seria um dos fatores associados ao desenvolvimento da psicopatologia alimentar.

Increased waist circumference is associated with an increased prevalence of mood disorders and depressive symptoms in obese women

OBJECTIVE

There is growing evidence suggesting that obese patients may be more prone to develop certain psychiatric diseases, especially mood disorders. However, no studies have already determined which indicator of fat distribution best explains these comorbidities. The aim of this study is to investigate which anthropometric indicator of overweight (i.e. body mass index [BMI], waist circumference [WC] or waist/hip ratio [WHR]) best correlates with the presence of current mood disorders and the severity of depressive symptoms in obese women.

METHODS

Two hundred seventeen (217) obese women (BMI> or =30 kg/m2) between 18 and 75 years old were selected to participate in the study. All participants had anthropometrical data registered. The diagnosis of current mood disorders was assessed according to the Portuguese version of the Structured Clinical Interview for DSM-IV [SCID]. The severity of depressive symptoms was assessed using the Beck Depression Inventory (BDI).

RESULTS

A statistically significant association was found between BDI scores and BMI (r=0.16; p=0.018) and WC (r=0.20; p=0.004), but not WHR (r=0.10; p=0.15) or any socio-demographic variable. An increased prevalence of mood disorders was observed in the fourth quartile of WC, but not BMI or WHR, in comparison with the first and the second ones (p<0.05).

DISCUSSION

In conclusion, obesity, per se, seems to be an independent variable associated with the severity of depressive symptoms and the prevalence of current mood disorders in obese women. Waist circumference, and not BMI or WHR, seems to be the anthropometric indicator of overweight and fat distribution that best explains these findings.

Transtornos psiquiátricos em pacientes diabéticos tipo 2 em distrito docente assistencial de Rio Branco - Acre

INTRODUÇÃO: Estudos têm estabelecido maior prevalência de transtornos psiquiátricos em diabéticos. OBJETIVO: Descrever as características sócio-demográficas e comparar a freqüência daqueles na população diabética e nos indivíduos não-diabéticos. MÉTODO: Estudo de corte transversal, com grupo de comparação. Oitenta e quatro pacientes diabéticos foram comparados a igual número de pacientes não-diabéticos agrupados quanto ao gênero, idade e residência. Aplicou-se questionário-padrão e a avaliação psiquiátrica foi realizada através do Mini Internacional Neuropsychiatric Interview. RESULTADOS: Transtorno de ansiedade generalizada foi freqüente tanto entre os diabéticos (73,8%) quanto os não-diabeticos (65,5%). Transtornos fóbico-ansiosos representaram 42,8% entre os diabéticos e 31,5% nos não-diabéticos. Transtornos do humor foram de 53,5% no grupo de diabéticos e 29,1% entre os não-diabéticos. Somente as categorias risco de suicídio (p=0,03) e episódio hipomaníaco passado (p=0,006) foram as que tiveram significância estatística para os diabéticos. CONCLUSÃO: Os transtornos de ansiedade e de humor foram os mais encontrados, predominando entre os diabéticos.

Prevalence of eating disorders and psychiatric comorbidity in a clinical sample of type 2 diabetes mellitus patients

BACKGROUND

A few studies have shown high rates of eating disorders and psychiatric morbidity in patients with type 2 diabetes mellitus.

OBJECTIVE

Disturbed eating behavior and psychiatric comorbidity in a sample of T2DM patients.

METHODS

Seventy type 2 diabetes mellitus patients between 40 and 65 years of age (mean, 52.9 +/- 6.8) from a diabetes outpatient clinic were sequentially evaluated. The Structured Clinical Interview for DSM-IV, Binge Eating Scale and Beck Depression Inventory were used to assess eating disorders and other psychiatric comorbidity. In addition to the descriptive analysis of the data, we compared groups divided based on the presence of obesity (evaluated by the body mass index) or an eating disorder.

RESULTS

Twenty percent of the sample displayed an eating disorder. Binge eating disorder was the predominant eating disorder diagnosis (10%). Overall, the group of obese patients with type 2 diabetes mellitus presented rates of psychiatric comorbidity comparable to those seen in their nonobese counterparts. However, the presence of an eating disorder was associated with a significant increase in the frequency of anxiety disorders (57.1% x 28.6%; p = 0.044).

CONCLUSIONS

In our study sample, the occurrence of eating disorders was increased compared to rates observed in the general population, with the predominance of binge eating disorder. The presence of an eating disorder in type 2 diabetes mellitus patients was associated with higher rates of anxiety disorders.