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Huang CJ, Lin CH, Liu TL, Lin PC, Chu CC, Wang JJ, Wei CW, Weng SF. Healthcare Utilization and Its Correlates in Comorbid Type 2 Diabetes Mellitus and Generalized Anxiety Disorder. Psychiatr Q 2024; 95:233-252. [PMID: 38639873 DOI: 10.1007/s11126-024-10072-z] [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] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
This study investigated the healthcare utilization and medical expenditure of type 2 diabetes mellitus (T2DM) patients with generalized anxiety disorder (GAD) and identified the associated factors. The healthcare utilization and expenditure of T2DM patients with (case group) and without (control group) GAD between 2002 and 2013 were examined using the population-based Taiwan National Health Insurance Research Database. Healthcare utilization included outpatient visits and hospitalization; health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, nonpsychiatric healthcare utilization and medical expenditure were distinguished from total healthcare utilization and medical expenditure. The average healthcare utilization, including outpatient visits and hospitalization, was significantly higher for the case group than for the control group (total and nonpsychiatric). The results regarding differences in average outpatient expenditure (total and nonpsychiatric), inpatient expenditure (total and nonpsychiatric), and total expenditure (total and nonpsychiatric) between the case and control groups are inconsistent. Sex, age, income, comorbidities/complications, and the diabetes mellitus complication severity index were significantly associated with outpatient visits, medical expenditure, and hospitalization in the case group (total and nonpsychiatric). Greater knowledge of factors affecting healthcare utilization and expenditure in comorbid individuals may help healthcare providers intervene to improve patient management and possibly reduce the healthcare burden in the future.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pai-Cheng Lin
- Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chun-Wang Wei
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Center for Medical Informatics and Statistics, Office of R&D, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Westall SJ, Narayanan RP, Watmough S, Irving G, Furlong N, McNulty S, Bujawansa S, Hardy K. The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review. Clin Med (Lond) 2022; 22:257-265. [PMID: 38589086 DOI: 10.7861/clinmed.2021-0764] [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: 11/27/2022]
Abstract
BACKGROUND Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. METHODS We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes. Data were analysed thematically with the themes inductively derived from article review. FINDINGS Evidence suggests that presence of cardiovascular disease, hypoglycaemia unawareness, severe hypoglycaemia, limited life expectancy, advanced age, long diabetes duration, frailty, cognitive impairment, disability, extensive comorbidity, diabetes distress and patient preference should inform the setting of glycaemic targets. CONCLUSION The management of people with diabetes is complex. In clinical practice, many patients will have a variety of factors that should be considered when personalising their care. Approaches to personalised care and glycaemic treatment targets should be undertaken as part of a shared decision-making process between physician and patient. Use of electronic records might enable greater efficiency and more widespread use of personalised care plans for people with diabetes.
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Affiliation(s)
- Samuel J Westall
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK and Edge Hill University, Ormskirk, UK.
| | | | | | | | - Niall Furlong
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
| | - Sid McNulty
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
| | - Sumudu Bujawansa
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
| | - Kevin Hardy
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
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Almohammed OA, Alsalem AA, Almangour AA, Alotaibi LH, Al Yami MS, Lai L. Antidepressants and health-related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States. PLoS One 2022; 17:e0265928. [PMID: 35442954 PMCID: PMC9020683 DOI: 10.1371/journal.pone.0265928] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/10/2022] [Indexed: 12/25/2022] Open
Abstract
Background Despite the empirical literature demonstrating the efficacy of antidepressant medications for treatment of depression disorder, these medications’ effect on patients’ overall well-being and health-related quality of life (HRQoL) remains controversial. This study investigates the effect of antidepressant medication use on patient-reported HRQoL for patients who have depression. Methods A comparative cohort, secondary database analysis was conducted using data from the United States’ Medical Expenditures Panel Survey for patients who had depression. HRQoL was measured using the SF-12 and reported as physical and mental component summaries (PCS and MCS). A cohort of patients that used antidepressant medications were compared to a cohort of patients that did not. Univariate and multivariate difference-in-differences (D-I-D) analyses were used to assess the significance of the mean difference of change on the PCS and MCS from baseline to follow-up. Results On average, 17.5 million adults were diagnosed with depression disorder each year during the period 2005–2016. The majority were female (67.9%), a larger proportion of whom received antidepressant medications (60.5% vs. 51.5% of males). Although use of antidepressants was associated with some improvement on the MCS, D-I-D univariate analysis revealed no significant difference between the two cohorts in PCS (–0.35 vs. –0.34, p = 0.9595) or MCS (1.28 vs. 1.13, p = 0.6405). The multivariate D-I-D analyses ensured the robustness of these results. Conclusion The real-world effect of using antidepressant medications does not continue to improve patients’ HRQoL over time. Future studies should not only focus on the short-term effect of pharmacotherapy, it should rather investigate the long-term impact of pharmacological and non-pharmacological interventions on these patients’ HRQoL.
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Affiliation(s)
- Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Abdulaziz A. Alsalem
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A. Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lama H. Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majed S. Al Yami
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Leanne Lai
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, Davie, Florida, United States of America
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Huang CJ, Liu TL, Huang YT, Hsieh HM, Chang CC, Chu CC, Wei CW, Weng SF. Healthcare burden and factors of type 2 diabetes mellitus with Schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:519-529. [PMID: 33860331 DOI: 10.1007/s00406-021-01258-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/30/2021] [Indexed: 02/08/2023]
Abstract
This study investigated healthcare utilization and expenditure for patients with type 2 diabetes mellitus and schizophrenia and associated factors. Healthcare utilization (outpatient visits and hospitalization) and expenditure (outpatient, inpatient, and total medical expenditure) between 2002 and 2013 of patients with T2DM with schizophrenia (case group) and without (control group) were examined using the Taiwan National Health Insurance Research Database. (1) The average total numbers of outpatient visits and hospital admissions of the case group were 35.14 outpatient visits and 1.09 hospital admissions significantly higher than those of the control group in the whole study period (based on every 3-year period). Nonpsychiatric outpatient visits and nonpsychiatric hospital admissions were significantly more numerous for the case group. (2) The total outpatient expenditure, total inpatient expenditure, and total medical expenditure of the case group were NT$65,000, NT$170,000, and NT$235,000 significantly higher than those of the control group, respectively. Nonpsychiatric outpatient expenditure was significantly lower for the case group, but the inpatient and total nonpsychiatric medical expenditure were similar between groups. (3) Patients who were elder of low income, with complications, and high diabetes mellitus complication severity index had higher total numbers of outpatient visits and hospitalizations and medical expenditure. (4) Women had a higher number of outpatient visits but a lower number of hospitalization and medical expenditure. Lower non-psychiatric outpatient expenditure despite more visits indicated non-psychiatrist may not understand schizophrenia patients and cannot communicate well with them, leading to neglect of medical evaluation and treatment that should be carried out.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung, 807, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Huang
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung, 807, Taiwan
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, 442, Section. 2, Shulin Street, South District, Tainan, 702, Taiwan.,Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, 901, Chung Hwa Rd, Yung Kang District, Tainan, 710, Taiwan
| | - Chun-Wang Wei
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Center for Medical Informatics and Statistics, Office of R&D, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Tardif I, Guénette L, Zongo A, Demers É, Lunghi C. Depression and the risk of hospitalization in type 2 diabetes patients: A nested case-control study accounting for non-persistence to antidiabetic treatment. DIABETES & METABOLISM 2022; 48:101334. [PMID: 35231612 DOI: 10.1016/j.diabet.2022.101334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/29/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depression is one of the most common comorbidities of type 2 diabetes. The relationship between these two diseases seems to be bidirectional. Both conditions separately lead to significant morbidity and mortality, including hospitalization. Moreover, depression is associated with non-persistence with antidiabetic drugs. OBJECTIVES To measure the effect of depression on morbidity and particularly on all-cause, diabetes-related, cardiovascular-related and major cardiovascular events-related hospitalization, adjusting for non-persistence to antidiabetic drugs and other confounders. METHODS We performed a nested case-control study within a cohort of type 2 diabetic individuals initiating antidiabetic drugs. Using the health administrative data of the province of Quebec, Canada, we identified all-cause, diabetes-related, cardiovascular-related and major cardiovascular hospitalizations during a maximum follow-up of eight years after the initiation of antidiabetic drug treatment. A density sampling method matched all cases with up to 10 controls by age, sex, and the Elixhauser comorbidity index. The effect of depression on hospitalization was estimated using conditional logistic regressions adjusting for non-persistence to antidiabetic drug treatment and other variables. RESULTS We identified 41,550 all-cause hospitalized cases, of which 34,437 were related to cardiovascular (CV) diseases, 29,584 to diabetes, and 13,867 to major CV events. Depression was diagnosed in 2.51% of all-cause hospitalizations and 1.16% of matched controls. 69.11% of cases and 72.59% of controls were on metformin monotherapy. The majority (71.62% vs 75.02%, respectively) stayed on metformin monotherapy without adding or switching drugs during follow-up. Non-persistence was at similar rates (about 30%) in both groups. In the multivariable analyses, depression was associated with an increased risk for all-cause hospitalizations, with odds ratios (ORs) ranging from 2.21 (95% CI: 2.07-2.37) to 1.32 (95% CI: 1.22-1.44) according to the model adjustment (from the univariate to the fully adhjusted). CONCLUSION Depression increased the risk of all-cause hospitalizations among patients treated for diabetes, even after accounting for non-persistence and other potentially confounding factors. These results stress the impact of depression on diabetic patients' use of health care resources.
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Affiliation(s)
- Isabelle Tardif
- Faculty of Medicine, 1050 avenue de la Médecine, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada
| | - Éric Demers
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada
| | - Carlotta Lunghi
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada; Department of Health Sciences, Université du Québec à Rimouski, 1595 boulevard Alphonse-Desjardins, Lévis, QC, Canada.
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AlOtaibi AA, Almesned M, Alahaideb TM, Almasari SM, Alsuwayt SS. Assessment of diabetes-related distress among type 2 diabetic patients, Riyadh, Saudi Arabia. J Family Med Prim Care 2021; 10:3481-3489. [PMID: 34760777 PMCID: PMC8565154 DOI: 10.4103/jfmpc.jfmpc_488_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/07/2021] [Accepted: 07/12/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the prevalence of diabetes-related distress (DRD) among Type 2 diabetics in the diabetic center of King Salman Hospital, Riyadh, Saudi Arabia. METHODS This was an observational descriptive study conducted between December 2019 and January 2020 among T2DM patients followed up at the diabetic clinics of the Diabetic Center of King Salman Hospital in Riyadh, Saudi Arabia. We used the 17-items Diabetes Distress Scale (DDS17) to measure DRD. RESULTS A total of 399 T2DM patients were included in the study, 58.4% were males. High distress was seen in 40 patients. Multivariate analysis showed that longer duration of diabetes (>15 years), female gender, longer intervals in-between visits (>6 months), and experience of episodes of severe hypoglycemia as the most significant factors related to higher levels of distress. The patients who were diabetics longer than 15 years had an increased risk for high distress by 3.6 times, infrequent clinic visits (longer than 6 months) increased the risk for high distress by 5.3 times×, and patients who experienced severe hypoglycemia had an increased risk for high distress by 5.8 times. CONCLUSION This study showed a high (35.6%) prevalence of moderate to severe DRD. Long-standing diabetes, a longer interval of a clinic visit, and severe hypoglycemia increase the risk for DRD by 3.6, 5.3, and 5.8 folds. Health care providers should focus on reducing DRD and devise ways to increase self-care practices and coping skills.
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Affiliation(s)
- Abdullah Aedh AlOtaibi
- Family Medicine Physicians, Academy of Family Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammed Almesned
- Head Department of Family Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Turki Mohammed Alahaideb
- Family Medicine Physicians, Academy of Family Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saad Mohammed Almasari
- Family Medicine Physicians, Academy of Family Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh Saad Alsuwayt
- Family Medicine Physicians, Academy of Family Medicine, King Saud Medical City, Riyadh, Saudi Arabia
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Mathur D, Anand A, Srivastava V, Patil SS, Singh A, Rajesh SK, Nagendra HR, Nagarathna R. Depression in High-Risk Type 2 Diabetes Adults. Ann Neurosci 2020; 27:204-213. [PMID: 34556961 PMCID: PMC8455004 DOI: 10.1177/0972753121990181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients suffering from diabetes mellitus are two to three times more vulnerable to develop depressive symptomatology. PURPOSE To report the association between depression and high-risk diabetes in India. METHODS A total of 1,606 adults were recruited for the study. A patient health questionnaire was used to determine the depression on the basis of score. A statistical analysis was done using analysis of covariance (ANCOVA) and binary logistic regression to determine the association between diabetes categories and four degrees of depression. RESULTS Out of 1,606 participants, 52.6% were males and 47.4% were females, 56.4% belonged to the urban area and 43.6% to the rural area. However, 19.5% (314) had diabetes; 29.1% of diabetes individuals had minimal depression, 38.7% had mild, 17.2% moderate, 12.0% moderately severe, and 3.1% had severe depression. In the self-reported diabetic participant group (N = 142), there was a significantly higher degree of severe depression (3.3%) in the uncontrolled group (HbA1c >7%) as compared to the well-controlled diabetes group (HbA1c <7%). ANCOVA in gender differences in the uncontrolled diabetes group showed that male gender had significantly (P = -.02) higher mean scores of depression. CONCLUSION This study found that there is a positive association between depression and uncontrolled diabetes in male gender.
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Affiliation(s)
- Deepali Mathur
- Department of Neurology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Akshay Anand
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vinod Srivastava
- College of Health and Behavioral Sciences, Fort Hays State University, Hays, Kansas, USA
| | - Suchitra S. Patil
- Department of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - Amit Singh
- Department of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - SK Rajesh
- Department of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - HR Nagendra
- Department of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - Raghuram Nagarathna
- Department of Arogyadhama, Vivekananda Yoga Anusandhana Samsthana (VYASA), Bengaluru, Karnataka, India
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Akena D, Okello ES, Simoni J, Wagner G. The development and tailoring of a peer support program for patients with diabetes mellitus and depression in a primary health care setting in Central Uganda. BMC Health Serv Res 2020; 20:436. [PMID: 32430046 PMCID: PMC7236139 DOI: 10.1186/s12913-020-05301-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/06/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND About 20-40% of patients with diabetes mellitus (DM) suffer from depressive disorders (DD) during the course of their illness. Despite the high burden of DD among patients with DM, it is rarely identified and adequately treated at the majority of primary health care clinics in sub-Saharan Africa (SSA). The use of peer support to deliver components of mental health care have been suggested in resource constrained SSA, even though its acceptability have not been fully examined. METHODS We conducted qualitative interviews (QI) to assess the perceptions of DM patients with an experience of suffering from a DD about the acceptability of delivering peer support to patients with comorbid DM and DD. We then trained them to deliver peer support to DM patients who were newly diagnosed with DD. We identified challenges and potential barriers to a successful implementation of peer support, and generated solutions to these barriers. RESULTS Participants reported that for one to be a peer, they need to be mature in age, consistently attend the clinics/keep appointments, and not to be suffering from any active physical or co-morbid mental or substance abuse disorder. Participants anticipated that the major barrier to the delivery of peer support would be high attrition rates as a result of the difficulty by DM patients in accessing the health care facility due to financial constraints. A potential solution to this barrier was having peer support sessions coinciding with the return date to hospital. Peers reported that the content of the intervention should mainly be about the fact that DM was a chronic medical condition for which there was need to adhere to lifelong treatment. There was consensus that peer support would be acceptable to the patients. CONCLUSION Our study indicates that a peer support program is an acceptable means of delivering adjunct care to support treatment adherence and management, especially in settings where there are severe staff shortages and psycho-education may not be routinely delivered.
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Affiliation(s)
- Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elialilia S. Okello
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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Kong D, Solomon P, Dong X. Comorbid Depressive Symptoms and Chronic Medical Conditions Among US Chinese Older Adults. J Am Geriatr Soc 2019; 67:S545-S550. [PMID: 31403205 DOI: 10.1111/jgs.15669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/26/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The prevalence and health consequences of comorbid depressive symptoms (DSs) and chronic medical conditions (CMCs) among older ethnic minority populations remain poorly understood. To bridge this gap, the present cross-sectional study examined the prevalence of comorbid DS-CMC and the association between such comorbidity and health services use among US Chinese older adults. DESIGN AND SETTING Data were from the Population Study of Chinese Elderly in Chicago (N = 3157). The relationship between comorbid DS-CMC and health service use (ie, emergency department [ED] visits and hospitalizations) was investigated by stratifying the sample into four groups: (1) neither DSs nor CMCs (ie, heart disease, stroke, cancer, high cholesterol, diabetes, high blood pressure, hip fraction, thyroid, and osteoarthritis); (2) DSs only; (3) CMCs only; and (4) comorbid DS-CMC. Multivariate negative binomial regression models were conducted to determine the relationship between comorbid DS-CMC and health service use. RESULTS Participants were 73 years old on average. The prevalence of comorbid DSs ranged between 0.7% and 4.6% across various CMCs. The odds of DSs were at least twice as high among US Chinese older adults with CMCs than those without the various conditions. Compared with US Chinese older adults with neither DSs nor CMCs, those with comorbid DS-CMC had more ED visits (rate ratio [RR] = 3.32; 95% confidence interval [CI] = 2.03-5.42) and hospitalizations (RR = 3.12; 95% CI = 1.95-4.97). CONCLUSION Recognition and treatment of comorbid DS-CMC warrant increased policy and clinical attention. The findings underscore the potential need to develop effective services targeting DSs among US Chinese older adults with CMCs. J Am Geriatr Soc 67:S545-S550, 2019.
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Affiliation(s)
- Dexia Kong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Phyllis Solomon
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
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Nicolau J, Simó R, Conchillo C, Sanchís P, Blanco J, Romerosa JM, Fortuny R, Bonet A, Masmiquel L. Differences in the cluster of depressive symptoms between subjects with type 2 diabetes and individuals with a major depressive disorder and without diabetes. J Endocrinol Invest 2019; 42:881-888. [PMID: 30788770 DOI: 10.1007/s40618-019-01020-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depressive disorder encompasses a wide spectrum of somatic and psychological symptoms. It is not known whether there are differences regarding the cluster of depressive symptomatology between subjects with depression with and without T2DM. PURPOSE To explore whether the cluster of depression that prevails among depressive subjects with T2DM differs from individuals with depression, but without T2DM. METHODS 87 T2DM patients with a pathological Beck Depression Inventory test (BDI) were compared with 50 age- and gender-matched individuals with a major depressive disorder. All 21 items expressed in the BDI were compared between the two groups. RESULTS The score obtained after administering the BDI was comparable between patients with T2DM and significant depressive symptoms and the control group (18.8 ± 2.7 vs 18.9 ± 3.4; p = 0.9). Subjects with T2DM had higher scores compared with the control group in the following items: sadness (1.4 ± 0.9 vs 0.9 ± 0.9; p = 0.011), difficulty in concentration (1.3 ± 0.8 vs 0.8 ± 0.8; p = 0.01), indecisiveness (1.1 ± 0.8 vs 0.5 ± 0.9; p = 0.012), worries about their health (1.3 ± 0.9 vs 0.6 ± 0.9; p < 0.0001), fatigue (1.2 ± 0.6 vs 0.8 ± 0.7; p = 0.003) and loss of sexual appetite (2.7 ± 0.6 vs 1.2 ± 1.3; p = 0.0001). Suicidal ideation was significantly lower among subjects with T2DM compared with the control group (0.1 ± 0.3 vs 0.6 ± 0.8; p = 0.0001). CONCLUSIONS Subjects with T2DM and a positive screening for depression presented a different cluster of depression compared with depressed subjects without T2DM, with a predominance of somatic-biological depressive symptoms rather than psychological-cognitive cluster and negative emotions, such as suicidal ideation.
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Affiliation(s)
- J Nicolau
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain.
| | - R Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Barcelona, Spain
| | - C Conchillo
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - P Sanchís
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - J Blanco
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - J M Romerosa
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - R Fortuny
- Hormonal Laboratory Department, Hospital Son Llàtzer, Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - A Bonet
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - L Masmiquel
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
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11
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Quiñones AR, Markwardt S, Botoseneanu A. Diabetes-Multimorbidity Combinations and Disability Among Middle-aged and Older Adults. J Gen Intern Med 2019; 34:944-951. [PMID: 30815788 PMCID: PMC6544693 DOI: 10.1007/s11606-019-04896-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/17/2018] [Accepted: 01/24/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Older adults with diabetes rarely have only one chronic disease. As a result, there is a need to re-conceptualize research and clinical practice to address the growing number of older Americans with diabetes and concurrent chronic diseases (diabetes-multimorbidity). OBJECTIVE To identify prevalent multimorbidity combinations and examine their association with poor functional status among a nationally representative sample of middle-aged and older adults with diabetes. DESIGN A prospective cohort study of the 2012-2014 Health and Retirement Study (HRS) data. We identified the most prevalent diabetes-multimorbidity combinations and estimated negative binomial models of diabetes-multimorbidity on prospective disability. PARTICIPANTS Analytic sample included 3841 HRS participants with diabetes, aged 51 years and older. MAIN MEASURES The main outcome measure was the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index (range 0-11; higher index denotes higher disability). The main independent variables were diabetes-multimorbidity combination groups, defined as the co-occurrence of diabetes and at least one of six somatic chronic diseases (hypertension, cardiovascular disease, lung disease, cancer, arthritis, and stroke) and/or two mental chronic conditions (cognitive impairment and high depressive symptoms (CESD score ≥ 4). KEY RESULTS The three most prevalent multimorbidity combinations were, in rank-order diabetes-arthritis-hypertension (n = 694, 18.1%); diabetes-hypertension (n = 481, 12.5%); and diabetes-arthritis-hypertension-heart disease (n = 383, 10%). Diabetes-multimorbidity combinations that included high depressive symptoms or stroke had significantly higher counts of ADL-IADL limitations compared with diabetes-only. In head-to-head comparisons of diabetes-multimorbidity combinations, high depressive symptoms or stroke added to somatic multimorbidity combinations was associated with a higher count of ADL-IADL limitations (diabetes-arthritis-hypertension-high depressive symptoms vs. diabetes-arthritis-hypertension: IRR = 1.95 [1.13, 3.38]; diabetes-arthritis-hypertension-stroke vs. diabetes-arthritis-hypertension: IRR = 2.09 [1.15, 3.82]) even after adjusting for age, gender, education, race/ethnicity, BMI, baseline ADL-IADL, and diabetes duration. Coefficients were robust to further adjustment for diabetes treatment. CONCLUSIONS Depressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.
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Affiliation(s)
- Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA. .,OHSU-PSU School of Public Health, Portland, OR, USA.
| | | | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI, USA.,Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
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12
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Chireh B, Li M, D'Arcy C. Diabetes increases the risk of depression: A systematic review, meta-analysis and estimates of population attributable fractions based on prospective studies. Prev Med Rep 2019; 14:100822. [PMID: 30815337 PMCID: PMC6378921 DOI: 10.1016/j.pmedr.2019.100822] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/25/2019] [Accepted: 02/06/2019] [Indexed: 12/27/2022] Open
Abstract
We aim to examine the relationship between diabetes and depression risk in longitudinal cohort studies and by how much the incidence of depression in a population would be reduced if diabetes was reduced. Medline/PubMed, EMBASE, PsycINFO, and Cochrane Library databases were searched for English-language published literature from January 1990 to December 2017. Longitudinal studies with criteria for depression and self-report doctors' diagnoses or diagnostic blood test measurement of diabetes were assessed. Systematic review with meta-analysis synthesized the results. Study quality, heterogeneity, and publication bias were examined. Pooled odds ratios were calculated using random effects models. Population attributable fractions (PAFs) were used to estimate potential preventive impact. Twenty high-quality articles met inclusion criteria and were analyzed. The pooled odds ratio (OR) between diabetes and depression was 1.33 (95% CI, 1.18-1.51). For the various study types the ORs were as follows: prospective studies (OR 1.34, 95% CI 1.14-1.57); retrospective studies (OR 1.30, 95% CI 1.05-1.62); self-reported diagnosis of diabetes (OR 1.37, 95% CI 1.17-1.60); and diagnostic diabetes blood test (OR 1.25, 95% CI 1.04-1.52). PAFs suggest that over 9.5 million of global depression cases are potentially attributable to diabetes. A 10-25% reduction in diabetes could potentially prevent 930,000 to 2.34 million depression cases worldwide. Our systematic review provides fairly robust evidence to support the hypothesis that diabetes is an independent risk factor for depression while also acknowledging the impact of risk factor reduction, study design and diagnostic measurement of exposure which may inform preventive interventions.
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Affiliation(s)
- Batholomew Chireh
- University of Saskatchewan School of Public Health, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Muzi Li
- The Douglas Hospital Research Centre, 6875 boulevard LaSalle, Montreal H4H 1R3, Canada
| | - Carl D'Arcy
- University of Saskatchewan, Department of Psychiatry and, School of Public Health, 103 Hospital drive, Ellis Hall, Room 107, Saskatoon, SK S7N 0W8, Canada
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13
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Abstract
AIMS Major depressive disorders are highly prevalent in the world population, contribute substantially to the global disease burden and cause high health care expenditures. Information on the economic impact of depression, as provided by cost-of-illness (COI) studies, can support policymakers in the decision-making regarding resource allocation. Although the literature on COI studies of depression has already been reviewed, there is no quantitative estimation of depression excess costs across studies yet. Our aims were to systematically review COI studies of depression with comparison group worldwide and to assess the excess costs of depression in adolescents, adults, elderly, and depression as a comorbidity of a primary somatic disease quantitatively in a meta-analysis. METHODS We followed the PRISMA reporting guidelines. PubMed, PsycINFO, NHS EED, and EconLit were searched without limitations until 27/04/2018. English or German full-text peer-reviewed articles that compared mean costs of depressed and non-depressed study participants from a bottom-up approach were included. We only included studies reporting costs for major depressive disorders. Data were pooled using a random-effects model and heterogeneity was assessed with I2 statistic. The primary outcome was ratio of means (RoM) of costs of depressed v. non-depressed study participants, interpretable as the percentage change in mean costs between the groups. RESULTS We screened 12 760 articles by title/abstract, assessed 393 articles in full-text and included 48 articles. The included studies encompassed in total 55 898 depressed and 674 414 non-depressed study participants. Meta-analysis showed that depression was associated with higher direct costs in adolescents (RoM = 2.79 [1.69-4.59], p < 0.0001, I2 = 87%), in adults (RoM = 2.58 [2.01-3.31], p < 0.0001, I2 = 99%), in elderly (RoM = 1.73 [1.47-2.03], p < 0.0001, I2 = 73%) and in participants with comorbid depression (RoM = 1.39 [1.24-1.55], p < 0.0001, I2 = 42%). In addition, we conducted meta-analyses for inpatient, outpatient, medication and emergency costs and a cost category including all other direct cost categories. Meta-analysis of indirect costs showed that depression was associated with higher costs in adults (RoM = 2.28 [1.75-2.98], p < 0.0001, I2 = 74%). CONCLUSIONS This work is the first to provide a meta-analysis in a global systematic review of COI studies for depression. Depression was associated with higher costs in all age groups and as comorbidity. Pooled RoM was highest in adolescence and decreased with age. In the subgroup with depression as a comorbidity of a primary somatic disease, pooled RoM was lower as compared to the age subgroups. More evidence in COI studies for depression in adolescence and for indirect costs would be desirable.
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14
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Franco P, Gallardo AM, Urtubey X. Web-Based Interventions for Depression in Individuals with Diabetes: Review and Discussion. JMIR Diabetes 2018; 3:e13. [PMID: 30291082 PMCID: PMC6238863 DOI: 10.2196/diabetes.9694] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/01/2018] [Accepted: 06/15/2018] [Indexed: 11/18/2022] Open
Abstract
Background Depression is twice as common in people with diabetes, and this comorbidity worsens the course of both pathologies. In clinical practice guidelines, screening and treatment of depression in patients with diabetes are highly recommended. However, depression is still both underrecognized and undertreated. To find ways to enhance their reach, psychological treatments have taken advantage of benefits of internet and technological devices as delivery formats, providing interventions that require considerably less (or even no) interaction time with therapists. Web-based treatments hold promise for effective interventions at low cost with positive results. Objective The objectives of this review were to describe Web-based interventions for depression in individuals with diabetes and to discuss these studies’ procedures and findings in light of evidence from a wider range of interventions for depression and diabetes. Methods A comprehensive literature search was conducted in PsycINFO and MEDLINE electronic databases. Studies were included when they met the following selection criteria: the study was available in a peer-reviewed journal mainly publishing studies written in either English or Spanish; the studied sample comprised individuals with diabetes; the intervention targeted depression symptomatology; the intervention was accessible via the internet; and the intervention was accessible via the internet with little or no clinician support. Results Overall, 5 research studies were identified in the review. All studies were randomized controlled trials, and most used a wait list as a control; 4 studies reported treatment dropout, rates of which varied from 13% to 42%. Studies supported the notion that the Web-based format is a suitable psychology service delivery option for diabetic individuals with depression (effect size range for completers 0.7-0.89). Interventions varied in their characteristics but most were clinical-assisted, had a cognitive behavioral therapy approach, used diabetes-specific topics, had a weekly modular display, used homework assignments, and had some adherence management strategy. These characteristics are consistent with the intervention features associated with positive results in the literature. Conclusions The analyzed studies’ findings and procedures are discussed in light of evidence drawn from a wider range of reviews on Web-based interventions for depression and diabetes. Consistent with previous research on depression treatment, Web-based interventions for depression among individuals with diabetes have shown positive results. Future research should contribute new evidence as to why these interventions are effective, for whom, and which particular aspects can increase patients’ adherence.
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Affiliation(s)
- Pamela Franco
- Accuhealth, Santiago, Chile.,Department of Psychology, Universidad del Desarrollo, Santiago, Chile
| | - Ana María Gallardo
- Accuhealth, Santiago, Chile.,Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
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15
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Zhu Y, Kim MH, Banerjee S, Deferio J, Alexopoulos GS, Pathak J. Understanding the research landscape of major depressive disorder via literature mining: an entity-level analysis of PubMed data from 1948 to 2017. JAMIA Open 2018; 1:115-121. [PMID: 31984323 PMCID: PMC6951824 DOI: 10.1093/jamiaopen/ooy001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To analyze literature-based data from PubMed to identify diseases and medications that have frequently been studied with major depressive disorder (MDD). Materials and methods Abstracts of 23 799 research articles about MDD that have been published since 1948 till 2017 were analyzed using data and text mining approaches. Methods such as information extraction, frequent pattern mining, regression, and burst detection were used to explore diseases and medications that have been associated with MDD. Results In addition to many mental disorders and antidepressants, we identified several nonmental health diseases and nonpsychotropic medications that have frequently been studied with MDD. Our results suggest that: (1) MDD has been studied with disorders such as Pain, Diabetes Mellitus, Wounds and Injuries, Hypertension, and Cardiovascular Diseases; (2) medications such as Hydrocortisone, Dexamethasone, Ketamine, and Lithium have been studied in terms of their side effects and off-label uses; (3) the relationships between nonmental disorders and MDD have gained increased attention from the scientific community; and (4) the bursts of Diabetes Mellitus and Cardiovascular Diseases explain the psychiatric and/or depression screening recommended by authoritative associations during the periods of the bursts. Discussion and conclusion This study summarized and presented an overview of the previous MDD research in terms of diseases and medications that are highly relevant to MDD. The reported results can potentially facilitate hypothesis generation for future studies. The approaches proposed in the study can be used to better understand the progress and advance of the field.
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Affiliation(s)
- Yongjun Zhu
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA.,Department of Library and Information Science, Sungkyunkwan University, Seoul, South Korea
| | - Min-Hyung Kim
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Samprit Banerjee
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Joseph Deferio
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Jyotishman Pathak
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
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16
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Depression and mild cognitive impairment (MCI) among elderly patients with type 2 diabetes mellitus in Pakistan: possible determinants. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0600-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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17
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Strauss SM, Rosedale MT, Rindskopf DM. Predictors of Depression Among Adult Women With Diabetes in the United States: An Analysis Using National Health and Nutrition Examination Survey Data From 2007 to 2012. DIABETES EDUCATOR 2017; 42:728-738. [PMID: 27831524 DOI: 10.1177/0145721716672339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of the study was to identify the sex-specific characteristics that predict depression among adult women with diabetes. METHODS Data from the 2007-2012 National Health and Nutrition Examination Survey in the United States were used to identify the predictors of depression in a large sample of women ages 20 years and older with diabetes (n = 946). RESULTS When extrapolated to almost 9 million women in the United States ≥ 20 years of age with diabetes, 19.0% had depression. Female-specific significant predictors of depression included younger age (< 65 years old), less than high school graduation, self-rated fair or poor health, inactivity due to poor health, and pain that interferes with usual activities. Marital status and diabetes-related factors (years living with diabetes, use of insulin, parent or sibling with diabetes) were not significant predictors of depression in adult women with diabetes. CONCLUSION When educating and counseling women with diabetes, diabetes educators should be aware that some of the predictors of depression in women with diabetes differ from those of populations that include both sexes. Depression screening, although important for all women with diabetes, should especially be performed among women with female-specific depression predictors.
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Affiliation(s)
- Shiela M Strauss
- New York University, Rory Meyers College of Nursing, New York, New York (Dr Strauss, Dr Rosedale)
| | - Mary T Rosedale
- New York University, Rory Meyers College of Nursing, New York, New York (Dr Strauss, Dr Rosedale)
| | - David M Rindskopf
- City University of New York, Graduate School and University Center, New York, New York (Dr Rindskopf)
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18
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Huang CJ, Hsieh HM, Chiu HC, Wang PW, Lee MH, Li CY, Lin CH. Health Care Utilization and Expenditures of Patients with Diabetes Comorbid with Depression Disorder: A National Population-Based Cohort Study. Psychiatry Investig 2017; 14:770-778. [PMID: 29209380 PMCID: PMC5714718 DOI: 10.4306/pi.2017.14.6.770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/14/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study investigated to compare health care utilization and expenditures between diabetic patients with and without depression in Taiwan. METHODS Health care utilization and expenditure among diabetic patients with and without depression disorder during 2000 and 2004 were examined using Taiwan's population-based National Health Insurance claims database. Health care utilization included outpatient visits and the use of inpatient services, and health expenditures were outpatient, inpatient, and total medical expenditures. Moreover, general estimation equation models were used for analyzing the factors associated with outpatient visits and expenditures. Multiple logistic regression analysis was applied for identifying the factors associated with hospitalization. RESULTS The average annual outpatient visits and annual total medical expenditures in the study period were 44.23-52.20; NT$87,496-133,077 and 30.75-32.92; NT$64,411-80,955 for diabetic patients with and without depression. After adjustment for covariates, our results revealed that gender and complication were associated with out-patient visits. Moreover, the time factor was associated with the total medical expenditure, and residential urbanization and complication factors were associated with hospitalization. CONCLUSION Health care utilization and expenditures for diabetic patients with depression were significantly higher than those without depression. Sex, complications, time, and urbanization are the factors associated with health care utilization and expenditures.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsuan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yi Li
- Division of Secretary, Kaohsiung Medical University Hospital, Kaohsiung Medical, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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19
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Campesi I, Franconi F, Seghieri G, Meloni M. Sex-gender-related therapeutic approaches for cardiovascular complications associated with diabetes. Pharmacol Res 2017; 119:195-207. [PMID: 28189784 DOI: 10.1016/j.phrs.2017.01.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/14/2016] [Accepted: 01/23/2017] [Indexed: 12/14/2022]
Abstract
Diabetes is a chronic disease associated with micro- and macrovascular complications and is a well-established risk factor for cardiovascular disease. Cardiovascular complications associated with diabetes are among the most important causes of death in diabetic patients. Interestingly, several sex-gender differences have been reported to significantly impact in the pathophysiology of diabetes. In particular, sex-gender differences have been reported to affect diabetes epidemiology, risk factors, as well as cardiovascular complications associated with diabetes. This suggests that different therapeutic approaches are needed for managing diabetes-associated cardiovascular complications in men and women. In this review, we will discuss about the sex-gender differences that are known to impact on diabetes, mainly focusing on the cardiovascular complications associated with the disease. We will then discuss the therapeutic approaches for managing diabetes-associated cardiovascular complications and how differences in sex-gender can influence the existing therapeutic approaches.
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Affiliation(s)
- Ilaria Campesi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | - Flavia Franconi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Dipartimento Politiche della Persona, Regione Basilicata, Italy.
| | | | - Marco Meloni
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, UK.
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Abstract
The aim of this study was to investigate healthcare utilization and expenditure for patients with diabetes comorbid with and without mental illnesses in Taiwan. People with diabetes comorbid with and without mental illnesses in 2000 were identified and followed up to 2004 to explore the healthcare utilization and expenditure. Healthcare utilization included outpatient visits and use of hospital inpatient services, and expenditure included outpatient, inpatient and total medical expenditure. General estimation equation models were used to explore the factors associated with outpatient visits and expenditure. To identify the factors associated with hospitalization, multiple logistic regressions were applied. The average number of annual outpatient visits of the patients with mental illnesses ranged from 37.01 to 41.91, and 28.83 to 31.79 times for the patients without mental illnesses from 2000 to 2004. The average annual total expenditure for patients with mental illnesses during this period ranged from NT$77,123-NT$90,790, and NT$60,793- NT$84,984 for those without mental illnesses. After controlling for covariates, the results indicated that gender, age, mental illness and time factor were associated with outpatient visits. Gender, age, and time factor were associated with total expenditure. Age and mental illness were associated with hospitalization in logistic regression. The healthcare utilization and expenditure for patients with mental illnesses was significantly higher than for patients without mental illnesses. The factors associated with healthcare utilization and expenditure included gender, age, mental illness and time trends.
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21
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Gaitonde P, Shaya FT. Relationship between depression, self-care behaviors, and treatment success among older Medicare beneficiaries with type 2 diabetes. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2016. [DOI: 10.1111/jphs.12147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Priyanka Gaitonde
- Department of Pharmaceutical Health Services Research; University of Maryland; School of Pharmacy; Baltimore MD USA
| | - Fadia T. Shaya
- Department of Pharmaceutical Health Services Research; University of Maryland; School of Pharmacy; Baltimore MD USA
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Bhattacharya R, Shen C, Wachholtz AB, Dwibedi N, Sambamoorthi U. Depression treatment decreases healthcare expenditures among working age patients with comorbid conditions and type 2 diabetes mellitus along with newly-diagnosed depression. BMC Psychiatry 2016; 16:247. [PMID: 27431801 PMCID: PMC4950075 DOI: 10.1186/s12888-016-0964-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many studies in the literature on the association between depression treatment and health expenditures. However, there is a knowledge gap in examining this relationship taking into account coexisting chronic conditions among patients with diabetes. We aim to analyze the association between depression treatment and healthcare expenditures among adults with Type 2 Diabetes Mellitus (T2DM) and newly-diagnosed depression, with consideration of coexisting chronic physical conditions. METHODS We used multi-state Medicaid data (2000-2008) and adopted a retrospective longitudinal cohort design. Medical conditions were identified using diagnosis codes (ICD-9-CM and CPT systems). Healthcare expenditures were aggregated for each month for 12 months. Types of coexisting chronic physical conditions were hierarchically grouped into: dominant, concordant, discordant, and both concordant and discordant. Depression treatment categories were as follows: antidepressants or psychotherapy, both antidepressants and psychotherapy, and no treatment. We used linear mixed-effects models on log-transformed expenditures (total and T2DM-related) to examine the relationship between depression treatment and health expenditures. The analyses were conducted on the overall study population and also on subgroups that had coexisting chronic physical conditions. RESULTS Total healthcare expenditures were reduced by treatment with antidepressants (16 % reduction), psychotherapy (22 %), and both therapy types in combination (28 %) compared to no depression treatment. Treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all groups that had a coexisting chronic physical condition. CONCLUSIONS Among adults with T2DM and chronic conditions, treatment with both antidepressants and psychotherapy may result in economic benefits.
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Affiliation(s)
| | - Chan Shen
- />Department of Health Services Research and Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX USA
- />Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1444, Houston, TX 77030 USA
| | - Amy B. Wachholtz
- />Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA USA
| | - Nilanjana Dwibedi
- />Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV USA
| | - Usha Sambamoorthi
- />Department of Social & Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV USA
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Wu J, Davis-Ajami ML, Kevin Lu Z. Impact of Depression on Health and Medical Care Utilization and Expenses in US Adults With Migraine: A Retrospective Cross Sectional Study. Headache 2016; 56:1147-60. [PMID: 27350407 DOI: 10.1111/head.12871] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The association between migraine and depression has been extensively examined and a bidirectional hypothesis of the comorbidity between the 2 diseases has been reported. However, the economic impact of comorbid depression on migraine has not been fully explored. OBJECTIVE The purpose of this study is to determine the impact of depression on medical utilization and health care expenses among subjects reporting migraine. METHODS The Medical Expenditure Panel Survey (MEPS) household component longitudinal data files (2006-2012) identified subjects (≥ 18 years) with migraines. Two groups were created from all eligible subjects with migraine based on whether comorbid depression was reported or not. The major outcome measures were annualized average total and migraine-related health care expenses and medical utilization during a 2-year period. The impact of depression on health expenses was assessed by multivariable linear regression models with log transformations. Multivariable logistic regression identified factors associated with depression and examined the likelihood of emergency department (ED) visit adjusting for demographic and health-related variables. RESULTS Among 2,400 subjects with migraine (approximate 54.3 million United States [US] individuals for years 2006-2012), 804 reported depression (representing 18.4 million individuals in the United States, 33.9%). Among migraineurs, nearly one-third received anti-migraine prescription drugs and approximately 65% with comorbid depression used antidepressants. Race (black vs white, odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.25, 0.52), sex (male vs female, OR: 0.67, 95% CI: 0.51, 0.87), perceived health status (fair to poor vs excellent-very good, OR: 2.58, 95% CI: 2.72. 4.71), insurance coverage (public vs private, OR: 1.59, 95%CI: 1.13, 2.24), and greater comorbidity (OR: 1.70, 95% CI: 1.28, 2.26) were significantly associated with comorbid depression in the subjects with migraine. Compared to migraine subjects without depression, the mean annual total health expenses per person ($10,012 vs. $4,740, P <.001) and mean migraine-related health expenses ($723 vs $499, P = .014) were significantly higher in those with depression. The odds of ED visit in migraineurs with comorbid depression were higher than in those without depression (OR: 1.36, 95% CI: 1.08, 1.71). CONCLUSION Comorbid depression in subjects with migraine was associated with higher total and migraine-related health expenses and increased likelihood of all-cause ED visits. Comorbid depression management might be incorporated into migraine intervention program to improve treatment outcomes and produce potential cost savings. Further studies are needed to assess long-term effects of depression on migraine progression and health care utilization patterns.
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Affiliation(s)
- Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA
| | - Mary L Davis-Ajami
- Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Zhiqiang Kevin Lu
- Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
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Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011. J Gen Intern Med 2016; 31:615-22. [PMID: 26969312 PMCID: PMC4870425 DOI: 10.1007/s11606-016-3650-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/28/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate differences in healthcare cost trends over 8 years in adults with diabetes and one of four categories of comorbid depression: no depression, unrecognized depression, asymptomatic depression, or symptomatic depression. RESEARCH DESIGN AND METHODS Data from the 2004-2011 Medical Expenditure Panel Survey (MEPS) was used to create nationally representative estimates. The dependent variable was total healthcare expenditures for the calendar year, including office-based, hospital outpatient, emergency room, inpatient hospital, prescription, dental, and home health care expenditures. The 2004-2011 direct medical costs were adjusted to a common 2014 dollar value. The primary independent variable was four mutually exclusive depression categories created from ICD-9-CM codes and the PHQ-2 depression screening tool. Healthcare expenditures were estimated using a two-part model and were adjusted for age, sex, race, marital status, education, health insurance, metropolitan statistical area status, region, income level, and comorbidities. RESULTS Based on a national sample of adults with diabetes (unweighted sample of 15,548, weighted sample of 17,465,579), 10.2 % had unrecognized depression, 13.6 % had asymptomatic depression, and 8.9 % had symptomatic depression. In the pooled sample, after adjusting for covariates, the incremental cost of unrecognized depression was $2872 (95 % CI 1660-4084), asymptomatic depression increased by $3347 (95 % CI 2568-4386), and symptomatic depression increased by $5170 (CI 95 % 3610-6731) compared to patients with no depression. CONCLUSIONS Adjusted analyses showed that expenditures were $2000-3000 higher for unrecognized and asymptomatic depression than no depression, and $5000 higher for symptomatic depression. Higher medical expenditures persisted over time, with only symptomatic depression showing a sustained decrease over time.
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Ishizawa K, Babazono T, Horiba Y, Nakajima J, Takasaki K, Miura J, Sakura H, Uchigata Y. The relationship between depressive symptoms and diabetic complications in elderly patients with diabetes: Analysis using the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET). J Diabetes Complications 2016; 30:597-602. [PMID: 26987919 DOI: 10.1016/j.jdiacomp.2016.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/16/2016] [Accepted: 02/02/2016] [Indexed: 11/24/2022]
Abstract
AIMS To investigate the association between likelihood or severity of depression and symptoms associated with diabetic complications in elderly Japanese patients with diabetes. METHODS This single-center cross-sectional study included 4283 patients with diabetes, 65 years and older (mean age was 73 ± 6 years, 38.7% were women, 3.9% had type 1 diabetes). Participants completed a self-administered questionnaire including items on subjective symptoms associated with diabetic microangiopathy, frequency of clinical visits due to vascular diseases (heart diseases, stroke, or gangrene), hospitalization, and the Patient Health Questionnaire-9 (PHQ-9), a simple but reliable measure of depression. The associations between severity of depression and diabetic complications were examined using logistic regression analysis. RESULTS According to the PHQ-9 scores, patients were classified into the following 3 categories: 0-4 points (n=2975); 5-9 points (n=842); and 10 or more points (n=466). Higher PHQ-9 scores were associated with increased odds ratios for retinopathy, symptoms related to peripheral polyneuropathy and autonomic neuropathy, and end-stage renal disease requiring dialysis after adjustment for age, gender, smoking status, and HbA1c (all p<0.05). CONCLUSIONS Significant relationships were found between depression severity and chronic diabetic complications among elderly Japanese patients with diabetes.
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Affiliation(s)
- Kaya Ishizawa
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Tetsuya Babazono
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Yu Horiba
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Junko Nakajima
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Keiko Takasaki
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Junnosuke Miura
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Hiroshi Sakura
- Department of Medicine, Medical Center East, Tokyo Women's Medical University School of Medicine, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-0011, Japan.
| | - Yasuko Uchigata
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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Egede LE, Bishu KG, Walker RJ, Dismuke CE. Impact of diagnosed depression on healthcare costs in adults with and without diabetes: United States, 2004-2011. J Affect Disord 2016; 195:119-26. [PMID: 26890289 PMCID: PMC4779740 DOI: 10.1016/j.jad.2016.02.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/23/2016] [Accepted: 02/06/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study used the Medical Expenditures Panel Survey (MEPS) to estimate the cost of diabetes, depression, and comorbid diabetes and depression over 8 years. METHODS An 8-year pooled dataset was created using the household and medical provider components of MEPS. Medical expenditures were adjusted to a common 2014 dollar value. Analyses used responses of 147,095 individuals ≥18 years of age for the years 2004-2011. The dependent variable in this study was total healthcare expenditure and the primary independent variables were diabetes and depression status. A two-part (probit/GLM) model was used to estimate the annual medical spending and marginal effects were calculated for incremental cost. RESULTS In the pooled sample, after adjusting for socio-demographic factors, comorbidities and time trend covariates, the incremental cost of depression only was $2654 (95% CI 2343-2966), diabetes was $2692 (95% CI 2338-3046), and both was $6037 (CI 95% 5243-6830) when compared to patients with none. Based on the unadjusted mean, annual average aggregate cost of depression only was estimated at $238.3 billion, diabetes only $150.1 billion and depression and diabetes together was $77.6 billion. CONCLUSION Costs at both the individual and aggregate level are significant, with comorbid diagnoses resulting in higher incremental costs than the sum of the costs for each diagnosis alone. In addition, while the cost of depression increased over time, the cost of diabetes decreased over time, much due to decreased inpatient costs. This study highlights the tremendous cost savings possible through more aggressive screening, diagnosis, and treatment of depression.
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Affiliation(s)
- Leonard E Egede
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, United States; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States.
| | - Kinfe G Bishu
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Rebekah J Walker
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, United States; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States
| | - Clara E Dismuke
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States
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Nicolau J, Simó R, Sanchís P, Ayala L, Fortuny R, Zubillaga I, Masmiquel L. Eating disorders are frequent among type 2 diabetic patients and are associated with worse metabolic and psychological outcomes: results from a cross-sectional study in primary and secondary care settings. Acta Diabetol 2015; 52:1037-44. [PMID: 25841588 DOI: 10.1007/s00592-015-0742-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/14/2015] [Indexed: 11/28/2022]
Abstract
AIMS Data regarding the prevalence of eating disorders (ED) and their influence on clinical outcomes among patients with type 2 diabetes (T2DM) are scarce. Our aim is to investigate the frequency of positive screening for ED, specifically binge eating disorder (BED), in a T2DM sample and analyze whether there are any differences among T2DM subjects with a positive screening for ED or BED. METHODS Three hundred and twenty subjects with T2DM were recruited randomly. All participants were evaluated for the presence of ED by completing the "Eating Attitudes Test-26" (EAT-26). In addition, the "Questionnaire of Eating and Weight Patterns-Revised" (QEWP-R) for the screening of BED was also implemented. Sociodemographic, clinical and biochemical parameters were also recorded. RESULTS According to EAT-26, 14 % of subjects screened positive for ED. Regarding QEWP-R, 16 % had a positive screening for ED, with BED having a frequency of 12.2 %, being the most prevalent one. There was a positive correlation between the scores obtained with the EAT-26 and the Beck Depression Inventory (p = 0.0014). Patients with BED were younger (57.5 ± 11.1 vs 63.3 ± 10.3 years; p = 0.004), with a lesser T2DM duration (8.5 ± 6.1 vs 12.1 ± 9.6 years; p = 0.002). Weight and BMI among subjects with BED were greater (89.1 ± 1.3 vs 82.4 ± 16.7 kg; p = 0.04 and 39.4 ± 10.3 vs 30.7 ± 5.5 kg/m(2); p = 0.01). The frequency of subjects with one admission related to T2DM or any other condition during the last year was higher (10 vs 3 %; p = 0.04 and 33 vs 21 %; p = 0.01). CONCLUSIONS ED among T2DM are frequent. Due to their deleterious effect on different metabolic and psychological outcomes, they should be diagnosed promptly, especially BED.
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Affiliation(s)
- Joana Nicolau
- Endocrinology and Nutrition Department, Hospital Son LLàtzer, University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra, Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain.
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Barcelona, Spain
| | - Pilar Sanchís
- Endocrinology and Nutrition Department, Hospital Son LLàtzer, University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra, Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - Luisa Ayala
- Endocrinology and Nutrition Department, Hospital Son LLàtzer, University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra, Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - Regina Fortuny
- Hormonal Laboratory Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Ivana Zubillaga
- Endocrinology and Nutrition Department, Hospital Son LLàtzer, University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra, Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - Lluís Masmiquel
- Endocrinology and Nutrition Department, Hospital Son LLàtzer, University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra, Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
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Brouwer A, van Raalte DH, Diamant M, Rutters F, van Someren EJ, Snoek FJ, Beekman AT, Bremmer MA. Light therapy for better mood and insulin sensitivity in patients with major depression and type 2 diabetes: a randomised, double-blind, parallel-arm trial. BMC Psychiatry 2015; 15:169. [PMID: 26204994 PMCID: PMC4513382 DOI: 10.1186/s12888-015-0543-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Major depression and type 2 diabetes often co-occur. Novel treatment strategies for depression in type 2 diabetes patients are warranted, as depression in type 2 diabetes patients is associated with poor prognosis and treatment results. Major depression and concurrent sleep disorders have been related to disturbances of the biological clock. The biological clock is also involved in regulation of glucose metabolism by modulating peripheral insulin sensitivity. Light therapy has been shown to be an effective antidepressant that 'resets' the biological clock. We here describe the protocol of a study that evaluates the hypothesis that light therapy improves mood as well as insulin sensitivity in patients with a major depressive episode and type 2 diabetes. METHODS/DESIGN This study is a randomised, double-blind, parallel-arm trial in 98 participants with type 2 diabetes and a major depressive episode, according to DSM-IV criteria. We will assess whether light therapy improves depressive symptoms and insulin sensitivity, our primary outcome measures, and additionally investigate whether these effects are mediated by restoration of the circadian rhythmicity, as measured by sleep and hypothalamic-pituitary-adrenal axis activity. Participants will be randomly allocated to a bright white-yellowish light condition or dim green light condition. Participants will undergo light therapy for half an hour every morning for 4 weeks at home. At several time points, namely before the start of light therapy, during light therapy, after completion of 4 weeks of light therapy and after 4 weeks follow-up, several psychometrical, psychophysiological and glucometabolic measures will be performed. DISCUSSION If light therapy effectively improves mood and insulin sensitivity in type 2 diabetes patients with a major depressive episode, light therapy may be a valuable patient friendly addition to the currently available treatment strategies. Additionally, if our data support the role of restoration of circadian rhythmicity, such an observation may guide further development of chronobiological treatment strategies in this patient population. TRIAL REGISTRATION The Netherlands Trial Register (NTR) NTR4942 . Registered 13 January 2015.
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Affiliation(s)
- Annelies Brouwer
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands. .,VU University Medical Centre (ZH4A63), Postal Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | | | - Michaela Diamant
- Diabetes Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Eus J.W. van Someren
- Departments of Integrative Neurophysiology and Medical Psychology, Centre for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Centre, Amsterdam, The Netherlands
| | - Frank J. Snoek
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Aartjan T.F. Beekman
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands
| | - Marijke A. Bremmer
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Centre and GGZ inGeest, Amsterdam, The Netherlands
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Huang CJ, Chiu HC, Hsieh HM, Yen JY, Lee MH, Chang KP, Li CY, Lin CH. Health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder: a national population-based cohort study. Gen Hosp Psychiatry 2015; 37:299-304. [PMID: 25936674 DOI: 10.1016/j.genhosppsych.2015.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/12/2015] [Accepted: 04/13/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate and compare health care utilization and expenditures between persons with diabetes comorbid with and without anxiety disorder in Taiwan. METHODS Health care utilization and expenditures among persons with diabetes with and without comorbid anxiety disorder in the period 2000-2004 were examined using the Taiwan's National Health Insurance claims data. Health care utilization included outpatient visits and use of hospital inpatient services, while expenditures included outpatient, inpatient and total medical expenditures. General estimation equation (GEE) models were used to analyze the factors associated with outpatient visits and expenditures, and multiple logistic regression analysis was applied to identify factors associated with hospitalization. RESULTS In the study period, the average number of annual outpatient visits was 43.11-50.37 and 29.82-31.42 for persons with diabetes comorbid with anxiety disorder and for those without anxiety disorder, respectively. The average annual total expenditure was NT$74,875-92,781 and NT$63,764-81,667, respectively. Controlling for covariates, the GEE models revealed that age and time were associated with outpatient visits. Income and time factor were associated with total expenditure. CONCLUSIONS Health care utilization and expenditures for persons with diabetes with comorbid anxiety disorder are significantly higher than those without anxiety disorder. The factors associated with health care utilization and expenditures are age, income and time.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ju-Yu Yen
- Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsuan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kao-Ping Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yi Li
- Division of Secretary, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
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Choi S, Hasche L, Nguyen D. Effects of depression on the subsequent year's healthcare expenditures among older adults: two-year panel study. Psychiatr Q 2015; 86:225-41. [PMID: 25262007 DOI: 10.1007/s11126-014-9324-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigated changes in depression status over 2 years and examined whether having depression in Year 1 is associated with greater healthcare expenditures in Year 2 among community-dwelling older adults. This study analyzed the Medical Expenditure Panel Survey (Panel 13, 2008-2009) for a nationally representative sample of 1,740 older adults (65+). The two self-reported depression measures used were the ICD-9-CM (depression) and Patient Health Questionnaire-2 (potential depression, scores 3 or higher). Using the combined two-part models, additional healthcare costs at Year 2 associated with the Year 1 depression status were calculated by the service type after adjusting for predisposing, enabling, and need covariates assessed at Year 2. Over 7.9% of older adults reported depression and an additional 6.5% presented with potential depression. The ICD-9 depression status was relatively stable; 84% continued reporting depression during Year 2. Those with depression at Year 1 spent $3,855 more on total healthcare, $1,053 more on office-based visits, and $929 more on prescription drugs during Year 2 compared with non-depressed people after controlling for other covariates, including healthcare needs (p < .05). While potential depression was less persistent (31.1% remained potentially depressed at Year 2), potential depression was associated with lower socio-economic status and greater healthcare expenditures from home health services and emergency department visits during Year 2. These results indicate the importance of monitoring depression in older adults, considering its impacts on the increases in healthcare expenditures in the following year even after controlling for co-occurring health conditions.
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Affiliation(s)
- Sunha Choi
- College of Social Work, The University of Tennessee, 322 Henson Hall, 1618 Cumberland Ave., Knoxville, TN, 37996-3333, USA,
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31
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Fiore V, Marci M, Poggi A, Giagulli VA, Licchelli B, Iacoviello M, Guastamacchia E, De Pergola G, Triggiani V. The association between diabetes and depression: a very disabling condition. Endocrine 2015; 48:14-24. [PMID: 24927794 DOI: 10.1007/s12020-014-0323-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 05/27/2014] [Indexed: 12/29/2022]
Abstract
Rates of depression are significantly increased in diabetic patients, and even more in the elderly. About 20-30% of patients with diabetes suffer from clinically relevant depressive disorders, 10% of which being affected by the major depression disorder. Moreover, people with depression seem to be more prone to develop an associated diabetes mellitus, and depression can worsen glycemic control in diabetes, with higher risk to develop complications and adverse outcomes, whereas improving depressive symptoms is generally associated with a better glycemic control. Thus, the coexistence of depression and diabetes has a negative impact on both lifestyle and quality of life, with a reduction of physical activity and an increase in the request for medical care and prescriptions, possibly increasing the healthcare costs and the susceptibility to further diseases. These negative aspects are particularly evident in the elderly, with further decrease in the mobility, worsening of disability, frailty, geriatric syndromes and increased mortality. Healthcare providers should be aware of the possible coexistence of depression and diabetes and of the related consequences, to better manage the patients affected by these two pathological conditions.
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Affiliation(s)
- Vincenzo Fiore
- Unit of Internal Medicine-Geriatrics, "S. Giovanni Evangelista" Hospital, Via Parrozzani 3, 00019, Tivoli (RM), Italy
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Choi S, Lee S, Matejkowski J, Baek YM. The relationships among depression, physical health conditions and healthcare expenditures for younger and older Americans. J Ment Health 2014; 23:140-5. [PMID: 24803220 DOI: 10.3109/09638237.2014.910643] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS Little is known about the extent depression adds to the costs of treatment for physical health conditions. This study examined the paths and the extent to which depression in conjunction with a physical health problem is associated with an increase in healthcare expenditures and how that is different between younger and older adults. METHODS Data from the 2007 Medical Expenditure Panel Survey (MEPS) were analyzed. Depression status and physical health conditions were identified through ICD-9 codes. The multiple group structural equation modeling (SEM) was employed to examine the moderated mediation effects. RESULTS Approximately 11% of adults had clinical depression. The multiple group SEM for both younger and older adult groups supports not only a direct effect of depression on expenditures but also an indirect effect via comorbid health conditions. Furthermore, the indirect effect was significantly more prominent among older respondents than among younger ones, indicating significant moderated mediation by age. CONCLUSIONS Depression has greater effects on comorbid health conditions and an increase in total healthcare expenditures through comorbid conditions among older adults. Findings of this study suggest that proper detection and treatment of depression is beneficial in reducing overall healthcare expenditures, especially among older adults.
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Affiliation(s)
- Sunha Choi
- College of Social Work, The University of Tennessee , Knoxville, TN , USA
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Poulsen KM, Pachana NA, McDermott BM. Health professionals' detection of depression and anxiety in their patients with diabetes: The influence of patient, illness and psychological factors. J Health Psychol 2014; 21:1566-75. [PMID: 25512198 DOI: 10.1177/1359105314559618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examines how often depression and anxiety, in patients with diabetes, are detected by health professionals; and whether detection is influenced by patient characteristics (age, gender), illness factors (duration of illness, diabetes control), and self-reported levels of depression and anxiety. Prevalence rates of clinically significant depression and anxiety were high (57% and 36%, respectively); however, of those identified, only 44 and 36 per cent, respectively, were detected by staff as depressed or anxious. The only significant predictors of detection were severity of depressive and anxious symptoms. Patient and illness characteristics did not influence whether professionals identified emotional problems in their patients.
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Affiliation(s)
- Kellee M Poulsen
- Mater Child and Youth Mental Health Service, Brisbane, Australia
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Hazel-Fernandez L, Li Y, Nero D, Moretz C, Slabaugh L, Meah Y, Baltz J, Costantino M, Patel NC, Bouchard J. Racial/ethnic and gender differences in severity of diabetes-related complications, health care resource use, and costs in a Medicare population. Popul Health Manag 2014; 18:115-22. [PMID: 25290044 DOI: 10.1089/pop.2014.0038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This retrospective cohort study evaluated associations of race/ethnicity and gender with outcomes of diabetes complications severity, health care resource utilization (HRU), and costs among Medicare Advantage health plan members with type 2 diabetes (T2DM). Medical and pharmacy claims were evaluated for 333,576 members continuously enrolled from January 1, 2010, to December 31, 2011, aged 18-89 years, with ≥1 primary diagnosis medical claim, or ≥2 claims with a secondary diagnosis of T2DM (International Classification of Diseases, Ninth Revision, Clinical Modification code 250.x0 or 250.x2). Complications severity assessment by Diabetes Complications Severity Index ranged from 0 (no complications) to 5+. Mean (SD) all-cause medical, pharmacy, and total costs were reported alongside all-cause HRU by place of service (outpatient, inpatient, emergency room [ER]) and number of visits. Multivariate regression showed being Hispanic, black, or male was associated with higher prevalence of more severe complications. This racial/ethnic disparity was more pronounced among females, among whom odds of having more severe complications were higher for Hispanic and black as compared to white females [(Hispanic vs. white odds ratio [OR], 1.40; 95% confidence interval [CI], 1.32-1.48), and (black vs. white OR, 1.22; 95% CI, 1.19-1.25)]. Regardless of gender, blacks had more ER visits than whites. White females incurred the highest total health care costs (mean annual costs: $13,086; 95% CI, $12,935-$13,240, vs. Hispanic females: $10,732; 95% CI, $10,406-$11,067). These effects held regardless of other demographic and clinical attributes. These findings suggest racial/ethnic and gender differences exist in certain T2DM clinical and economic outcomes.
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Sweileh WM, Abu-Hadeed HM, Al-Jabi SW, Zyoud SH. Prevalence of depression among people with type 2 diabetes mellitus: a cross sectional study in Palestine. BMC Public Health 2014; 14:163. [PMID: 24524353 PMCID: PMC3929146 DOI: 10.1186/1471-2458-14-163] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 02/11/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a common chronic metabolic disorder and one of the main causes of death in Palestine. Palestinians are continuously living under stressful economic and military conditions which make them psychologically vulnerable. The purpose of this study was to investigate the prevalence of depression among type II diabetic patients and to examine the relationship between depression and socio-demographic factors, clinical factors, and glycemic control. METHODS This was a cross-sectional study at Al-Makhfiah primary healthcare center, Nablus, Palestine. Two hundred and ninety-four patients were surveyed for the presence of depressive symptoms using Beck Depression Inventory (BDI-II) scale. Patients' records were reviewed to obtain data pertaining to age, sex, marital status, Body Mass Index (BMI), level of education, smoking status, duration of diabetes mellitus, glycemic control using HbA1C test, use of insulin, and presence of additional illnesses. Patients' medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). RESULTS One hundred and sixty four patients (55.8%) of the total sample were females and 216 (73.5%) were < 65 years old. One hundred and twenty patients (40.2%) scored ≥ 16 on BDI-II scale. Statistical significant association was found between high BDI-II score (≥ 16) and female gender, low educational level, having no current job, having multiple additional illnesses, low medication adherence and obesity (BMI ≥ 30 kg/m2). No significant association between BDI score and glycemic control, duration of diabetes, and other socio-demographic factors was found. Multivatriate analysis showed that low educational level, having no current job, having multiple additional illnesses and low medication adherence were significantly associated with high BDI-II scores. CONCLUSION Prevalence of depression found in our study was higher than that reported in other countries. Although 40% of the screened patients were potential cases of depression, none were being treated with anti-depressants. Psychosocial assessment should be part of routine clinical evaluation of these patients at primary healthcare clinics to improve quality of life and decrease adverse outcomes among diabetic patients.
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Affiliation(s)
- Waleed M Sweileh
- Department of Pharmacology/ Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | | | - Samah W Al-Jabi
- Department of Clinical and Comunity Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sa’ed H Zyoud
- Department of Pharmacology/ Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Mendenhall E, Norris SA, Shidhaye R, Prabhakaran D. Depression and type 2 diabetes in low- and middle-income countries: a systematic review. Diabetes Res Clin Pract 2014; 103:276-85. [PMID: 24485858 PMCID: PMC3982306 DOI: 10.1016/j.diabres.2014.01.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/16/2013] [Accepted: 01/01/2014] [Indexed: 01/28/2023]
Abstract
Eighty percent of people with type 2 diabetes reside in low- and middle-income countries (LMICs). Yet much of the research around depression among people with diabetes has been conducted in high-income countries (HICs). In this systematic review we searched Ovid Medline, PubMed, and PsychINFO for studies that assessed depression among people with type 2 diabetes in LMICs. Our focus on quantitative studies provided a prevalence of comorbid depression among those with diabetes. We reviewed 48 studies from 1,091 references. We found that this research has been conducted primarily in middle-income countries, including India (n = 8), Mexico (n = 8), Brazil (n = 5), and China (n = 5). There was variation in prevalence of comorbid depression across studies, but these differences did not reveal regional differences and seemed to result from study sample (e.g., urban vs rural and clinical vs population-based samples). Fifteen depression inventories were administered across the studies. We concluded that despite substantial diabetes burden in LMICs, few studies have reviewed comorbid depression and diabetes. Our review suggests depression among people with diabetes in LMICs may be higher than in HICs. Evidence from these 48 studies underscores the need for comprehensive mental health care that can be integrated into diabetes care within LMIC health systems.
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Affiliation(s)
- Emily Mendenhall
- Science, Technology, and International Affairs Program, Walsh School of Foreign Service, 301 Intercultural Center, Georgetown University, Washington D.C. 20057, United States.
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Rahul Shidhaye
- Indian Institute of Public Health and Public Health Foundation of India, Hyderabad, India
| | - Dorairaj Prabhakaran
- Centre of Excellence for Cardiometabolic Risk Reduction in South Asia (CARRS), and Centre for Chronic Disease Control, New Delhi, India
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Implications of comorbidity for primary care costs in the UK: a retrospective observational study. Br J Gen Pract 2014; 63:e274-82. [PMID: 23540484 DOI: 10.3399/bjgp13x665242] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear. AIM To investigate whether caring for patients with specific disease combinations increases or decreases primary care costs compared with treating separate patients with one condition each. DESIGN Retrospective observational study using data on 86 100 patients in the General Practice Research Database. METHOD Annual primary care cost was estimated for each patient including consultations, medication, and investigations. Patients with comorbidity were defined as those with a current diagnosis of more than one chronic condition in the Quality and Outcomes Framework. Multiple regression modelling was used to identify, for three age groups, disease combinations that increase (cost-increasing) or decrease (cost-limiting) cost compared with treating each condition separately. RESULTS Twenty per cent of patients had at least two chronic conditions. All conditions were found to be both cost-increasing and cost-limiting when co-occurring with other conditions except dementia, which is only cost-limiting. Depression is the most important cost-increasing condition when co-occurring with a range of conditions. Hypertension is cost-limiting, particularly when co-occurring with other cardiovascular conditions. CONCLUSION Three categories of comorbidity emerge, those that are: cost-increasing, mainly due to a combination of depression with physical comorbidity; cost-limiting because treatment for the conditions overlap; and cost-limiting for no apparent reason but possibly because of inadequate care. These results can contribute to efficient and effective management of chronic conditions in primary care.
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Egedeand LE, Simpson K. Epidemiology, treatment and costs of depression in adults with Type 2 diabetes. Expert Rev Pharmacoecon Outcomes Res 2014; 3:251-62. [DOI: 10.1586/14737167.3.3.251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting. BMC FAMILY PRACTICE 2013; 14:69. [PMID: 23710584 PMCID: PMC3669622 DOI: 10.1186/1471-2296-14-69] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/22/2013] [Indexed: 11/10/2022]
Abstract
Background Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, Malaysia. Methods The study was cross sectional in design and carried out in 12 randomly selected primary care government clinics in the Klang Valley, Malaysia. A total of 2508 eligible consenting respondents participated in the study. The Depression, Anxiety and Stress Scale (DASS) 21 questionnaire was used to measure depression, anxiety and stress symptoms. Data was analyzed using the SPSS version 16 software using both descriptive and inferential statistics. Results The prevalence of depression, anxiety and stress symptoms among Type II diabetics were 11.5%, 30.5% and 12.5% respectively. Using multiple logistic regression, females, Asian Indians, marital status (never married, divorced/widowed/separated), a family history of psychiatric illness, less than 2 years duration of diabetes and current alcohol consumption were found to be significant predictors of depression. For anxiety, unemployment, housewives, HbA1c level of more than 8.5%, a family history of psychiatric illness, life events and lack of physical activity were independent risk factors. Stress was significantly associated with females, HbA1c level of more than 8.5%, presence of co-morbidity, a family history of psychiatric illness, life events and current alcohol consumption. For depression (adjusted OR 2.8, 95% CI 1.1; 7.0), anxiety (adjusted OR 2.4, 95% CI 1.1;5.5) and stress (adjusted OR 4.2, 95% CI 1.8; 9.8), a family history of psychiatric illness was the strongest predictor. Conclusion We found the prevalence of depression, anxiety and stress symptoms to be high among Type II diabetics, with almost a third being classified as anxious. Screening of high risk Type II diabetics for depression, anxiety and stress symptoms in the primary care setting is recommended at regular intervals.
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Shrestha SS, Zhang P, Li R, Thompson TJ, Chapman DP, Barker L. Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008. Diabetes Res Clin Pract 2013; 100:102-10. [PMID: 23490596 PMCID: PMC5304910 DOI: 10.1016/j.diabres.2013.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/04/2013] [Accepted: 02/14/2013] [Indexed: 11/29/2022]
Abstract
AIM We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabetes (NITDM). METHODS We analyzed data for over 500,000 individuals with diagnosed diabetes from the 2008 U.S. MarketScan claims database. We grouped diabetic patients first by treatment mode (ITDM or NITDM), then by MDD status (with or without MDD), and finally by whether those with MDD used antidepressant medication. We estimated annual mean excess outpatient, inpatient, prescription drug, and total expenditures using regression models, controlling for demographics, types of health coverage, and comorbidities. RESULTS Among persons having ITDM, the estimated annual total mean expenditure for those with no MDD (the comparison group) was $19,625. For those with MDD, the expenditures were $12,406 (63%) larger if using antidepressant medication and $7322 (37%) larger if not using antidepressant medication. Among persons having NITDM, the corresponding estimated expenditure for the comparison group was $10,746, the excess expenditures were $10,432 (97%) larger if using antidepressant medication and $5579 (52%) larger if not using antidepressant medication, respectively. Inpatient excess expenditures were the largest of total excess expenditure for those with ITDM and MDD treated with antidepressant medication; for all others with diabetes and MDD, outpatient expenditures were the largest excess expenditure. CONCLUSIONS Among working-age adults with diabetes, MDD was associated with substantial excess medical expenditures. Implementing the effective interventions demonstrated in clinical trials and treatment guidelines recommended by professional organizations might reduce the economic burden of MDD in this population.
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Affiliation(s)
- Sundar S Shrestha
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA 30341, United States.
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Özgür Keşkek Ş, Ekşi Haydardedeoğlu F, Kırım S, Angay S, Ortoğlu G, Taşdemir M, Karaca A, Toledano Y, Saler T. Which increases depressive symptoms in obese patients; hypertension or diabetes? QSCIENCE CONNECT 2013. [DOI: 10.5339/connect.2013.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Abstract
In the near future, the majority of patients with diabetes will be adults aged 65 or older. Unlike young adults with diabetes, elderly diabetic people may be affected by a variety of comorbid conditions such as depression, cognitive impairment, muscle weakness (sarcopenia), falls and fractures, and physical frailty. These geriatric syndromes should be considered in the establishment of treatment goals in older adults with diabetes. Although there are several guidelines for the management of diabetes, only a few are specifically designed for the elderly with diabetes. In this review, we present specific conditions of elderly diabetes which should be taken into account in the management of diabetes in older adults. We also present advantages and disadvantages of various glucose-lowering agents that should be considered when choosing a proper regimen for older adults with diabetes.
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Affiliation(s)
- Kyung Soo Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Soo Kyung Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyung Mi Sung
- College of Nursing & Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Yong Wook Cho
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seok Won Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Molosankwe I, Patel A, José Gagliardino J, Knapp M, McDaid D. Economic aspects of the association between diabetes and depression: a systematic review. J Affect Disord 2012; 142 Suppl:S42-55. [PMID: 23062857 DOI: 10.1016/s0165-0327(12)70008-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The importance of co-morbid diabetes and depression is gaining increased attention. Quantifying the socio-economic and clinical impacts of co-morbidity is important given the high costs of these diseases. This review synthesised evidence on the economic impact of co-morbidity and potential cost-effectiveness of prevention and treatment strategies. METHODS 11 databases from 1980 until June 2011 searched. In addition, websites and reference lists of studies scrutinised and hand search of selected journals performed. Reviewers independently assessed abstracts, with economic data extracted from relevant studies. RESULTS 62 studies were identified. 47 examined the impact of co-morbidity on health care and other resource utilisation. 11 of these included productivity losses, although none quantified the impact of mortality. Most demonstrated an association between co-morbidity and increasing health service utilisation and cost. Adverse impacts on workforce participation and absenteeism were found. 15 economic evaluations were also identified. Most focused on primary care led collaborative and/or stepped care, suggesting actions may be cost effective. We did not identify any studies looking at actions to reduce the risk of diabetes in people with depression. LIMITATIONS Most studies are set in the US, which may be due to focus on English language databases. Few studies looked at impacts beyond one year or outside the health care system. CONCLUSIONS There is an evidence base demonstrating the adverse economic impacts of co-morbid diabetes and depression and potential for cost effective intervention. This evidence base might be strengthened through modelling studies on cost effectiveness using different time periods, contexts and settings.
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Affiliation(s)
- Iris Molosankwe
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
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Kirsh SR, Aron DC. Choosing targets for glycaemia, blood pressure and low-density lipoprotein cholesterol in elderly individuals with diabetes mellitus. Drugs Aging 2012; 28:945-60. [PMID: 22117094 DOI: 10.2165/11594750-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus in the 'elderly' poses unique management challenges that contribute to conflicting priorities. Individualized management requires taking into account each patient's medical history, functional ability, home care situation, life expectancy and his/her health beliefs; individuals value trade-offs (e.g. quantity versus quality of life, and side effects as well as risks versus long-term benefits) differently. Moreover, this decision making relies on imperfect evidence. Target goals for three intermediate outcomes - glycaemic control (glycosylated haemoglobin [HbA(1c)]), blood pressure control and lipid control (low-density lipoprotein cholesterol [LDL-C]) - help keep management on track. Of these, glycaemic control is usually the most complex. Glycaemic control alleviates symptoms of hyperglycaemia and can improve micro- and macrovascular outcomes. Tight glycaemic control (HbA(1c) <7%) clearly improves microvascular outcomes. However, hypoglycaemia and polypharmacy are the main drawbacks of tight control. Factors that influence the benefits and drawbacks include age, longevity and co-morbidities, including the geriatric 'syndromes' of frailty and falls. We favour the explicit risk-stratified approach of the Department of Veterans Affairs/Department of Defense (VA/DoD) guidelines, which set HbA(1c) target ranges based on physiological age or the presence/severity of major co-morbidities and microvascular complications. There are clear benefits of blood pressure and cholesterol control (primarily reduction of macrovascular events, but also microvascular events), and their overall cost effectiveness exceeds that of glycaemic control. Issues with treatment for hypertension include potential side effects of drugs, a potential increased risk of falls and risks of polypharmacy. Nevertheless, the evidence for a blood pressure target of <140/80 mmHg is reasonably strong if it can be achieved safely. In general, we recommend use of an HMG-CoA reductase inhibitor (statin) and an LDL-C target of <100 mg/dL, especially if an individual cannot tolerate a moderate dose of a statin.
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Affiliation(s)
- Susan R Kirsh
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH, USA
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Abstract
With the development of a measure of serious psychological distress (SPD) in 2002, more attention is being paid to the association of SPD with diabetes outcomes and processes of care. We review the literature on the relationship between SPD and diabetes processes of care and outcomes, as well as the literature on the relationship between specific mental health diagnoses and diabetes processes of care and outcomes during the 2010 to 2011 period. There is an extensive literature on the association of mental health diagnoses with diabetes outcomes, especially for depression. Because the Kessler scale measures a much broader range of mental health issues than any specific DSM-IV/Structured Clinical Interview for DSM Disorders diagnosis and is designed to assess SPD at the population level, additional research needs to be conducted both in clinical settings and using large administrative datasets to examine the association between SPD and diabetes outcomes and processes of care.
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Morris DW, Budhwar N, Husain M, Wisniewski SR, Kurian BT, Luther JF, Kerber K, Rush AJ, Trivedi MH. Depression treatment in patients with general medical conditions: results from the CO-MED trial. Ann Fam Med 2012; 10:23-33. [PMID: 22230827 PMCID: PMC3262466 DOI: 10.1370/afm.1316] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We studied the effect of 3 antidepressant treatments on outcomes (depressive severity, medication tolerability, and psychosocial functioning) in depressed patients having comorbid general medical conditions in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial. METHODS Adult outpatients who had chronic and/or recurrent major depressive disorder (MDD) with and without general medical conditions were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram plus placebo, (2) bupropion-SR plus escitalopram, or (3) venlafaxine-XR plus mirtazapine. At weeks 12 and 28, we compared response and tolerability between participants with 0, 1, 2, and 3 or more general medical conditions. RESULTS Of the 665 evaluable patients, 49.5% reported having no treated general medical conditions, 23.8% reported having 1, 14.8% reported having 2, and 11.9% reported having at least 3. We found only minimal differences in antidepressant treatment response between these groups having different numbers of conditions; patients with 3 or more conditions reported higher rates of impairment in social and occupational functioning at week 12 but not at week 28. Additionally, we found no significant differences between the 3 antidepressant treatments across these groups. CONCLUSIONS Patients with general medical conditions can be safely and effectively treated for MDD with antidepressants with no additional adverse effect or tolerability burden relative to their counterparts without such conditions. Combination therapy is not associated with an increased treatment response beyond that found with traditional monotherapy in patients with MDD, regardless of the presence and number of general medical conditions.
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Affiliation(s)
- David W Morris
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9086, USA.
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Al-Amer RM, Sobeh MM, Zayed AA, Al-Domi HA. Depression among adults with diabetes in Jordan: risk factors and relationship to blood sugar control. J Diabetes Complications 2011; 25:247-52. [PMID: 21601482 DOI: 10.1016/j.jdiacomp.2011.03.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 02/18/2011] [Accepted: 03/08/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aims of this study were to estimate the prevalence of undiagnosed depression among adults with diabetes mellitus in Jordan and to determine the factors that may indicate the presence of depression and to examine the relationship between depression and blood sugar control among Jordanian subjects with diabetes. METHODS A systemic random sample of 649 type 1 and type 2 diabetic patients aged 18-75 years was selected during the period from July 2009 to January 2010. A prestructured questionnaire was used for collecting the information about sociodemographic data and clinical characteristics. Depression was evaluated using the Patients' Health Questionnaire-8 (PHQ-8). A PHQ-8 score ≥10 has been recommended as a cutoff point for depression. Self-care management behaviors and barrier to adherence were collected. Weights and heights were measured. Glycated hemoglobin was abstracted from each patient directly after the interview. RESULT Of the 649, 128 (19.7) have depression according to the PHQ-8 scores. According to the multivariate analysis, females are more likely to develop depression than males with [odds ratio (OR), 1.91; P=001] and low-educated people versus educated people (OR, 3.09; P≤.002). Being on insulin treatment also has a significant association with depression (OR, 3.31; P=.001). Not following eating plans as recommended by dietitians, lacking self-monitoring blood glucose and increased barriers to adherence scale scores were also associated with depression among the subjects with diabetes. CONCLUSION The prevalence of depression among Jordanian subjects with type 1 and type 2 diabetes is high compared with some developed countries. This was associated with gender, educational level, insulin treatment, low self-management behaviors and increased barriers to adherence. This result shows the urgent need to include the routine screening of depression during outpatient visit, which might help prevention, early detection and management of depression.
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Affiliation(s)
- Rasmieh M Al-Amer
- Department of Community Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan.
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Le TK, Curtis B, Kahle-Wrobleski K, Johnston J, Haldane D, Melfi C. Treatment patterns and resource use among patients with comorbid diabetes mellitus and major depressive disorder. J Med Econ 2011; 14:440-7. [PMID: 21635215 DOI: 10.3111/13696998.2011.588507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To descriptively analyze patient characteristics, treatment patterns, and medical resource use of individuals with diabetes mellitus (DM) with and without comorbid major depressive disorder (MDD). RESEARCH DESIGN AND METHODS Using an administrative claims database, commercially insured adults diagnosed with DM were studied over the calendar years 2005 and 2006. Demographic characteristics, comorbid illnesses, medication use, resource utilization, and costs were examined descriptively among patients with DM both with and without comorbid MDD. RESULTS Patients with DM and MDD were found to have a high resource burden, compared to patients with DM without MDD. Specifically, these patients were found to be more likely to be diagnosed with other comorbid medical conditions, to use multiple medications, and to use more healthcare services such as inpatient visits, emergency admissions, and outpatient visits. Consistent with these findings, costs for these patients were found to be $19,707 per year, compared to $11,237 for patients with DM without comorbid MDD. LIMITATIONS The study utilizes data from an administrative claims database of insured individuals and hence, results may not be generalizable. Furthermore, the analysis is unable to examine clinical severity or indirect costs. CONCLUSION Compared to patients with DM and no comorbid MDD, patients with DM and MDD tend to have a larger burden of disease and to use more healthcare resources.
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Affiliation(s)
- T Kim Le
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis IN 46285, USA.
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Gesundheitsökonomische Aspekte psychischer Komorbidität bei somatischen Krankheiten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 54:120-7. [DOI: 10.1007/s00103-010-1187-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sousa VD, Zauszniewski JA, Jaber AF. Confirmatory factor analysis of the depressive cognition scale. Arch Psychiatr Nurs 2010; 24:397-407. [PMID: 21111294 DOI: 10.1016/j.apnu.2010.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 03/13/2010] [Accepted: 03/25/2010] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to validate the single-factor structure of the Depressive Cognition Scale (DCS) among individuals from the U.S. general population. The sample was composed of 629 adults from 42 states of the United States. All measures of model fit of the DCS exceeded the recommended criteria for the good model fit (χ(2)/df = 2.57, goodness-of-fitness index = .98, adjusted goodness-of-fitness index = .96, comparative fit index = .99, Tucker Lewis index = .98, root mean square error of approximation = .05, root mean residual = .01, and the P value for test of close fit = .464). Thus, the DCS was found to be a reliable and valid instrument to measure depressive cognitions among individuals from the general population.
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Affiliation(s)
- Valmi D Sousa
- The University of Kansas, School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, USA
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