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Fanelli G, Raschi E, Hafez G, Matura S, Schiweck C, Poluzzi E, Lunghi C. The interface of depression and diabetes: treatment considerations. Transl Psychiatry 2025; 15:22. [PMID: 39856085 PMCID: PMC11760355 DOI: 10.1038/s41398-025-03234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 12/11/2024] [Accepted: 01/10/2025] [Indexed: 01/27/2025] Open
Abstract
This state-of-the-art review explores the relationship between depression and diabetes, highlighting the two-way influences that make treatment challenging and worsen the outcomes of both conditions. Depression and diabetes often co-occur and share genetic, lifestyle, and psychosocial risk factors. Lifestyle elements such as diet, physical activity, and sleep patterns play a role on the development and management of both conditions, highlighting the need for integrated treatment strategies. The evidence suggests that traditional management strategies focusing on either condition in isolation fall short of addressing the intertwined nature of diabetes and depression. Instead, integrated care models encompassing psychological support and medical management are recommended to improve treatment efficacy and patient adherence. Such models require collaboration across multiple healthcare disciplines, including endocrinology, psychiatry, and primary care, to offer a holistic approach to patient care. This review also identifies significant patient-related barriers to effective management, such as stigma, psychological resistance, and health literacy, which need to be addressed through patient-centered education and support systems. Future directions for research include longitudinal studies in diverse populations to further elucidate causal relationships and the exploration of novel therapeutic targets, as well as the effectiveness of healthcare models aimed at preventing the onset of one condition in individuals diagnosed with the other.
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Affiliation(s)
- Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
| | - Silke Matura
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Carmen Schiweck
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
- Population Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada.
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Kulzer B. [Cognition and depression in older people with diabetes]. DER NERVENARZT 2024; 95:46-52. [PMID: 38189938 DOI: 10.1007/s00115-023-01599-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 01/09/2024]
Abstract
Cognitive dysfunction, dementia and depression are typical comorbidities of diabetes and are more common in older people with diabetes than in the general population. Both comorbid diseases have a substantial impact on the therapy of diabetes and lead to a reduction of the functional level in everyday life, the quality of life and are associated with increased mortality. This article summarizes the most important results on the etiology of cognitive dysfunction and depression and their consequences for clinical practice.
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Affiliation(s)
- Bernhard Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim, (FIDAM), 97980, Bad Mergentheim, Johann-Hammer-Str. 24, Deutschland.
- Diabetes Zentrum Mergentheim, (DZM), Theodor Klotzbücher Str. 12, 97980, Bad Mergentheim, Deutschland.
- Otto-Friedrich-Universität Bamberg, Lehrstuhl für klinische Psychologie, Kapuzinerstraße 16, 96047, Bamberg, Deutschland.
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Tegegne KD, Gebeyehu NA, Kassaw MW. Depression and determinants among diabetes mellitus patients in Ethiopia, a systematic review and meta-analysis. BMC Psychiatry 2023; 23:209. [PMID: 36991387 PMCID: PMC10052826 DOI: 10.1186/s12888-023-04655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Primary studies have estimated the prevalence of depression and its determinants among diabetes patients. However, studies synthesizing this primary evidence are limited. Hence, this systematic review aimed to determine the prevalence of depression and identify determinants of depression among diabetes in Ethiopia. METHODS This systematic review and meta-analysis included a search of PubMed, Google Scholar, Scopus, Science Direct, PsycINFO, and Cochrane library. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Data were pooled using a random-effects model. Forest plots, and Egger's regression test were all used to check for publication bias. Heterogeneity (I)2 was computed. Subgroup analysis was done by region, publication year, and depression screening instrument. In addition, the pooled odds ratio for determinants was calculated. RESULTS Sixteen studies, including 5808 participants were analyzed. The prevalence of depression in diabetes was estimated to be 34.61% (95% CI: 27.31-41.91). According to subgroup analysis by study region, publication year, and screening instrument, the highest prevalence was observed in Addis Ababa (41.98%), studies published before 2020 (37.91%), and studies that used Hospital Anxiety and Depression Scale (HADS-D) (42.42%,) respectively. Older age > 50 years (AOR = 2.96; 95% CI: 1.71-5.11), being women (AOR = 2.31; 95% CI: 1.57, 3.4), longer duration with diabetes (above 5 years) (AOR = 1.98; 95% CI: 1.03-3.8), and limited social support (AOR = 2.37; 95% CI: 1.68-3.34), were the determinants of depression in diabetic patients. CONCLUSION The results of this study suggest that the prevalence of depression in diabetes is substantial. This result underscores the importance of paying particular attention to prevent depression among diabetes. Being older, not attending formal education, longer duration with diabetes, having comorbidity, and low adherence to diabetes management were all associated. These variables may help clinicians identify patients at high risk of depression. Future studies focusing on the causal association between depression and diabetes are highly recommended.
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Affiliation(s)
- Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolita Sodo, Ethiopia
| | - Mesfin Wudu Kassaw
- School of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Weinstein AA, De Avila L, Kannan S, Paik JM, Golabi P, Gerber LH, Younossi ZM. Interrelationship between physical activity and depression in nonalcoholic fatty liver disease. World J Hepatol 2022; 14:612-622. [PMID: 35582293 PMCID: PMC9055201 DOI: 10.4254/wjh.v14.i3.612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is associated with a sedentary lifestyle and depressive symptoms. It is also well established that physical inactivity and depressive symptoms are related. However, an investigation of the interaction between all of these factors in NAFLD has not been previously conducted.
AIM To investigate the interrelationship between physical inactivity and depressive symptoms in individuals with NAFLD.
METHODS Data from the Rancho Bernardo Study of Healthy Aging were utilized. 589 individuals were included in the analyses (43.1% male; 95.8% non-Hispanic white; aged 60.0 ± 7.0 years). NAFLD was defined by using the hepatic steatosis index, depression using the Beck Depression Inventory, and physical activity by self-report of number of times per week of strenuous activity. Multivariable generalized linear regression models with Gamma distribution were performed to investigate the proposed relationship.
RESULTS About 40% of the sample had evidence of NAFLD, 9.3% had evidence of depression, and 29% were physically inactive. Individuals with NAFLD and depression were more likely to be physically inactive (60.7%) compared to individuals with neither NAFLD nor depression (22.9%), individuals with depression without NAFLD (37.0%), and individuals with NAFLD without depression (33.3%). After accounting for various comorbidities (i.e., age, sex, diabetes, hypertension, obesity), individuals with NAFLD and higher levels of physical activity were at a decreased odds of having depressive symptoms [16.1% reduction (95% confidence interval: -25.6 to -5.4%), P = 0.004], which was not observed in those without NAFLD.
CONCLUSION Individuals with NAFLD have high levels of physical inactivity, particularly those with depressive symptoms. Because this group is at high risk for poor outcomes, practitioners should screen for the coexistence of depressive symptoms and NAFLD. This group should receive appropriate interventions aimed at increasing both participation and levels of intensity of physical activity.
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Affiliation(s)
- Ali A Weinstein
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States
- Global and Community Health, George Mason University, Fairfax, VA 22030, United States
| | - Leyla De Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States
| | - Saisruthi Kannan
- Global and Community Health, George Mason University, Fairfax, VA 22030, United States
| | - James M Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States
| | - Lynn H Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA 22042, United States
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA 22042, United States
- Inova Medicine, Inova Health System, Falls Church, VA 22042, United States
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van der Feltz‐Cornelis C, Allen SF, Holt RIG, Roberts R, Nouwen A, Sartorius N. Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis. Brain Behav 2021; 11:e01981. [PMID: 33274609 PMCID: PMC7882189 DOI: 10.1002/brb3.1981] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/02/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes. METHODS Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported. RESULTS Forty-three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta-analysis. Our meta-analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA1 c and depressive outcome. High baseline HbA1 c was associated with a greater reduction in HbA1 c. CONCLUSION All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group-based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA1 c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.
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Affiliation(s)
| | - Sarah F. Allen
- Department of Health SciencesHull York Medical SchoolUniversity of YorkYorkUK
| | - Richard I. G. Holt
- Human Development and HealthFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Richard Roberts
- Department of Family Medicine & Community HealthUniversity of WisconsinMadisonWIUSA
| | - Arie Nouwen
- Department of PsychologyMiddlesex UniversityLondonUK
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
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Norman G, Westby MJ, Vedhara K, Game F, Cullum NA. Effectiveness of psychosocial interventions for the prevention and treatment of foot ulcers in people with diabetes: a systematic review. Diabet Med 2020; 37:1256-1265. [PMID: 32426913 DOI: 10.1111/dme.14326] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
Abstract
AIM To identify and synthesize the evidence for the effectiveness of psychosocial interventions to promote the healing, and/or reduce the occurrence of, foot ulceration in people with diabetes. METHODS In March 2019 we searched CENTRAL, Medline, Embase and PsycInfo for randomized controlled trials of interventions with psychosocial components for people with diabetes. The primary outcomes of this review were foot ulceration and healing. We assessed studies using the Cochrane risk-of-bias tool, the TIDieR checklist and GRADE. We conducted narrative synthesis and random-effects meta-analysis. RESULTS We included 31 randomized controlled trials (4511 participants), of which most (24 randomized controlled trials, 4093 participants) were prevention studies. Most interventions were educational with a modest psychosocial component. Ulceration and healing were not reported in most studies; secondary outcomes varied. Evidence was of low or very low quality because of high risks of bias and imprecision, and few studies reported adherence or fidelity. In groups where participants had prior ulceration, educational interventions had no clear effect on new ulceration (low-quality evidence). Two treatment studies, assessing continuous pharmacist support and an intervention to promote understanding of well-being, reported healing but their evidence was also of very low quality. CONCLUSION Most psychosocial intervention randomized controlled trials assessing foot ulcer outcomes in people with diabetes were prevention studies, and most interventions were primarily educational. Ulcer healing and development were not well reported. There is a need for better understanding of psychological and behavioural influences on ulcer incidence, healing and recurrence in people with diabetes. Randomized controlled trials of theoretically informed interventions, which assess clinical outcomes, are urgently required. (PROSPERO registration: CRD42016052960).
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Affiliation(s)
- G Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M J Westby
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - K Vedhara
- Division of Primary Care, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - F Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - N A Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK
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Lee J, Callaghan T, Ory M, Zhao H, Foster M, Bolin JN. Effect of Study Design and Survey Instrument to Identify the Association Between Depressive Symptoms and Physical Activity in Type 2 Diabetes, 2000-2018: A Systematic Review. DIABETES EDUCATOR 2019; 46:28-45. [DOI: 10.1177/0145721719893359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Previous studies have used a variety of survey measurement options for evaluating the association between physical activity (PA) and depressive symptoms, raising questions about the types of instruments and their effect on the association. This study aimed to identify measures of PA and depressive symptoms and findings of their association given diverse instruments and study characteristics in type 2 diabetes (T2DM). Methods Online databases, Medline, Embase, CINAHL, and PsycINFO were searched on July 20, 2018, and January 8, 2019. Our systematic review included observational studies from 2000 to 2018 that investigated the association between PA and depressive symptoms in T2DM. Results Of 2294 retrieved articles, 28 studies were retained in a focused examination and comparison of the instruments used. There were a range of standard measures, 10 for depressive symptoms and 7 for PA, respectively. Patient Health Questionnaire (PHQ) for depressive symptoms and study-specific methods for PA were the most popular. Overall, 71.9% found a significant association between PA and depressive symptoms. Among studies classified as high quality or reliability, the figure was 81.8%. Conclusion A majority of the sample found an association between depressive symptoms and PA, which is fairly consistent across study characteristics. The findings provide the evidence for the health benefits of PA on reducing depressive symptoms in persons with T2DM, suggesting active engagement in PA for effective diabetes management. However, guidelines for objective measurements and well-designed prospective studies are needed to strengthen the evidence base and rigor for the association and its directionality.
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Affiliation(s)
- Jusung Lee
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Marcia Ory
- Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas
| | - Hongwei Zhao
- Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas
| | - Margaret Foster
- Medical Sciences Library, Texas A&M University, College Station, Texas
| | - Jane N. Bolin
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
- School of Nursing, Texas A&M University, College Station, Texas
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Khaledi M, Haghighatdoost F, Feizi A, Aminorroaya A. The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol 2019; 56:631-650. [PMID: 30903433 DOI: 10.1007/s00592-019-01295-9] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/02/2019] [Indexed: 02/06/2023]
Abstract
AIMS Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies. METHODS MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11". RESULTS In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%). CONCLUSION Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.
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Affiliation(s)
- Mohammad Khaledi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Sarda A, Munuswamy S, Sarda S, Subramanian V. Using Passive Smartphone Sensing for Improved Risk Stratification of Patients With Depression and Diabetes: Cross-Sectional Observational Study. JMIR Mhealth Uhealth 2019; 7:e11041. [PMID: 30694197 PMCID: PMC6371066 DOI: 10.2196/11041] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/19/2018] [Accepted: 11/25/2018] [Indexed: 01/03/2023] Open
Abstract
Background Research studies are establishing the use of smartphone sensing to measure mental well-being. Smartphone sensor information captures behavioral patterns, and its analysis helps reveal well-being changes. Depression in diabetes goes highly underdiagnosed and underreported. The comorbidity has been associated with increased mortality and worse clinical outcomes, including poor glycemic control and self-management. Clinical-only intervention has been found to have a very modest effect on diabetes management among people with depression. Smartphone technologies could play a significant role in complementing comorbid care. Objective This study aimed to analyze the association between smartphone-sensing parameters and symptoms of depression and to explore an approach to risk-stratify people with diabetes. Methods A cross-sectional observational study (Project SHADO—Analyzing Social and Health Attributes through Daily Digital Observation) was conducted on 47 participants with diabetes. The study’s smartphone-sensing app passively collected data regarding activity, mobility, sleep, and communication from each participant. Self-reported symptoms of depression using a validated Patient Health Questionnaire-9 (PHQ-9) were collected once every 2 weeks from all participants. A descriptive analysis was performed to understand the representation of the participants. A univariate analysis was performed on each derived sensing variable to compare behavioral changes between depression states—those with self-reported major depression (PHQ-9>9) and those with none (PHQ-9≤9). A classification predictive modeling, using supervised machine-learning methods, was explored using derived sensing variables as input to construct and compare classifiers that could risk-stratify people with diabetes based on symptoms of depression. Results A noticeably high prevalence of self-reported depression (30 out of 47 participants, 63%) was found among the participants. Between depression states, a significant difference was found for average activity rates (daytime) between participant-day instances with symptoms of major depression (mean 16.06 [SD 14.90]) and those with none (mean 18.79 [SD 16.72]), P=.005. For average number of people called (calls made and received), a significant difference was found between participant-day instances with symptoms of major depression (mean 5.08 [SD 3.83]) and those with none (mean 8.59 [SD 7.05]), P<.001. These results suggest that participants with diabetes and symptoms of major depression exhibited lower activity through the day and maintained contact with fewer people. Using all the derived sensing variables, the extreme gradient boosting machine-learning classifier provided the best performance with an average cross-validation accuracy of 79.07% (95% CI 74%-84%) and test accuracy of 81.05% to classify symptoms of depression. Conclusions Participants with diabetes and self-reported symptoms of major depression were observed to show lower levels of social contact and lower activity levels during the day. Although findings must be reproduced in a broader randomized controlled study, this study shows promise in the use of predictive modeling for early detection of symptoms of depression in people with diabetes using smartphone-sensing information.
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Affiliation(s)
- Archana Sarda
- Sarda Centre for Diabetes and Selfcare, Aurangabad, India
| | - Suresh Munuswamy
- DST Health Informatics Rapid Design Lab, Indian Institute of Public Health-Hyderabad, Hyderabad, India
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Hapunda G, Abubakar A, Pouwer F, van de Vijver F. Depressive Symptoms Are Negatively Associated with Glucose Testing and Eating Meals on Time among Individuals with Diabetes in Zambia. Diabetes Metab J 2017; 41:440-448. [PMID: 29199409 PMCID: PMC5741553 DOI: 10.4093/dmj.2017.41.6.440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/27/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Depression is an established risk factor for cardiovascular diseases and mortality among individuals living with diabetes, and impaired self-care behaviors may play a mediating role. In Africa, this association is not very well known. In this study, we examined the associations between depressive symptoms and different aspects of diabetes self-care in Zambian individuals with diabetes mellitus. METHODS A total of 157 individuals with diabetes mellitus participated. The sample was drawn from four city hospitals in Zambia. Diabetes self-care was assessed using the diabetes self-care inventory, and depression was assessed using the major depression inventory. RESULTS Fifty-nine percent of the sample had type 1 diabetes mellitus. Variations in self-care activities and behaviors were reported as least adhered to by individuals with type 1 and type 2 diabetes mellitus, in adolescent and adult patients. Regression analysis indicated that there was no association between total diabetes self-care and the depression total score. However, depression was associated with poor glucose testing and not eating meals on time by patients with diabetes. CONCLUSION Some variance on poor self-care was explained by demographic characteristics, specifically age, body mass index, and to some extent, socioeconomic status. Recognition and successful treatment of depression in patients with diabetes might help to optimize self-care behaviors, especially glucose testing and eating meals on time. However, this hypothesis needs further testing.
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Affiliation(s)
- Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia.
| | - Amina Abubakar
- Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
- Department of Public Health, Pwani University, Kilifi, Kenya
- Neuroassessment, Center for Geographic Medicine Research, Neurosciences Research Group, Kilifi, Kenya
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Fons van de Vijver
- Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
- Work Well Unit, North-West University, Potchefstroom, South Africa
- School of Psychology, University of Queensland, Brisbane, Australia
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Depression and anxiety disorders in people with diabetes. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: As the global number of diabetes and the burden of depression together with other mental disorders increases, there is a need for better understanding of the connection between these diseases. In patients with diabetes, mental disorders are more common than in the general population, especially anxiety disorders and depression, which are often difficult to detect by health professionals.
Material and methods: Using the keywords searched in the international bibliographic databases: Embase, Medline, Science Direct, Web of Science. We analyzed clinical trials published in English and international journals
Results: Patients with diabetes are exposed to serious physical and mental complications. The occurence of depression and psychiatric disorders among people with diabetes was twice as frequent as in the general population. There are also studies showing a higher risk of suicide among people with diabetes. In addition, patients with both diseases, diabetes and depression, had an increased risk of cardiovascular complications and increased mortality and higher costs of health care. Diabetic patients have increased incidence of anxiety disorders in relation to non-diabetic patients by 20%.
Conclusion: Further researches and integration of medical and psychological treatment are needed. Cooperation between psychiatrists and diabetologists can reduce mental and physical harm in patients with diabetes.
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Abstract
Type 2 diabetes is a chronic disease that is increasing in prevalence globally. Cardiovascular disease is a major cause of mortality and morbidity in diabetes, and lifestyle and clinical risk factors do not fully account for the link between the conditions. This article provides an overview of the evidence concerning the role of psychosocial stress factors in diabetes risk, as well as in cardiovascular complications in people with existing diabetes. Several types of psychosocial factors are discussed including depression, other types of emotional distress, exposure to stressful conditions, and personality traits. The potential behavioral and biological pathways linking psychosocial factors to diabetes are presented and implications for patient care are highlighted.
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Affiliation(s)
- Ruth A. Hackett
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
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Brown MT, Bussell J, Dutta S, Davis K, Strong S, Mathew S. Medication Adherence: Truth and Consequences. Am J Med Sci 2016; 351:387-99. [PMID: 27079345 DOI: 10.1016/j.amjms.2016.01.010] [Citation(s) in RCA: 231] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/13/2016] [Accepted: 09/22/2015] [Indexed: 11/15/2022]
Abstract
Improving medication adherence may have a greater influence on the health of our population than in the discovery of any new therapy. Patients are nonadherent to their medicine 50% of the time. Although most physicians believe nonadherence is primarily due to lack of access or forgetfulness, nonadherence can often be an intentional choice made by the patient. Patient concealment of their medication-taking behavior is often motivated by emotions on the part of both provider and patient, leading to potentially dire consequences. A review of the literature highlights critical predictors of adherence including trust, communication and empathy, which are not easily measured by current administrative databases. Multifactorial solutions to improve medication adherence include efforts to improve patients' understanding of medication benefits, access and trust in their provider and health system. Improving providers' recognition and understanding of patients' beliefs, fears and values, as well as their own biases is also necessary to achieve increased medication adherence and population health.
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Affiliation(s)
- Marie T Brown
- Department of Medicine, Rush Medical College, Chicago, Illinois.
| | - Jennifer Bussell
- Department of Medicine, Clinical Faculty Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Suparna Dutta
- Department of Medicine, Rush Medical College, Chicago, Illinois
| | | | - Shelby Strong
- Fantus General Medicine Clinic, John H. Stroger Jr Hospital, Chicago, Illinois
| | - Suja Mathew
- Department of Internal Medicine, Cook County Health and Hospital System, Chicago, Illinois
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Hajna S, Ross NA, Joseph L, Harper S, Dasgupta K. Neighbourhood Walkability and Daily Steps in Adults with Type 2 Diabetes. PLoS One 2016; 11:e0151544. [PMID: 26991308 PMCID: PMC4798718 DOI: 10.1371/journal.pone.0151544] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/01/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction There is evidence that greater neighbourhood walkability (i.e., neighbourhoods with more amenities and well-connected streets) is associated with higher levels of total walking in Europe and in Asia, but it remains unclear if this association holds in the Canadian context and in chronic disease populations. We examined the relationships of different walkability measures to biosensor-assessed total walking (i.e., steps/day) in adults with type 2 diabetes living in Montreal (QC, Canada). Materials and Methods Participants (60.5±10.4 years; 48.1% women) were recruited through McGill University-affiliated clinics (June 2006 to May 2008). Steps/day were assessed once per season for one year with pedometers. Neighbourhood walkability was evaluated through participant reports, in-field audits, Geographic Information Systems (GIS)-derived measures, and the Walk Score®. Relationships between walkability and daily steps were estimated using Bayesian longitudinal hierarchical linear regression models (n = 131). Results Participants who reported living in the most compared to the least walkable neighbourhoods completed 1345 more steps/day (95% Credible Interval: 718, 1976; Quartiles 4 versus 1). Those living in the most compared to the least walkable neighbourhoods (based on GIS-derived walkability) completed 606 more steps per day (95% CrI: 8, 1203). No statistically significant associations with steps were observed for audit-assessed walkability or the Walk Score®. Conclusions Adults with type 2 diabetes who perceived their neighbourhoods as more walkable accumulated more daily steps. This suggests that knowledge of local neighborhood features that enhance walking is a meaningful predictor of higher levels of walking and an important component of neighbourhood walkability.
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Affiliation(s)
- Samantha Hajna
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada
| | - Nancy A. Ross
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada
- Department of Geography, McGill University, 805 Sherbrooke Street West, Montréal, QC, Canada
| | - Lawrence Joseph
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada
- Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, Montréal, QC, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada
| | - Kaberi Dasgupta
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada
- Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, Montréal, QC, Canada
- * E-mail:
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Doherty AM, Gayle C, Ismail K. 3 Dimensions of Care for Diabetes: integrating diabetes care into an individual's world. PRACTICAL DIABETES 2015. [DOI: 10.1002/pdi.1987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- AM Doherty
- 3 Dimensions of Care for Diabetes; King's College Hospital NHS Foundation Trust; London UK
| | - C Gayle
- King's College Hospital NHS Foundation Trust; London UK
| | - K Ismail
- King's College London, and Consultant Liaison Psychiatrist; King's College Hospital NHS Foundation Trust; London UK
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O'Donnell A, de Vries McClintock HF, Wiebe DJ, Bogner HR. Neighborhood Social Environment and Patterns of Depressive Symptoms Among Patients with Type 2 Diabetes Mellitus. Community Ment Health J 2015; 51:978-86. [PMID: 25761720 PMCID: PMC4567942 DOI: 10.1007/s10597-015-9855-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
This study sought to examine whether neighborhood social environment was related to patterns of depressive symptoms among primary care patients with type 2 diabetes mellitus (DM). Neighborhood social environment was assessed in 179 patients with type 2 DM. Individual patient residential data at baseline was geo-coded at the tract level and was merged with measures of neighborhood social environment. Depressive symptoms at baseline and at 12-week follow up were assessed using the nine-item Patient Health Questionnaire (PHQ-9). Patients in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage were much less likely to have a persistent pattern of depressive symptoms compared to a pattern of few or no depressive symptoms (adjusted odds ratio (OR) = 0.06, 95 % confidence interval (CI) [0.01, 0.36]). Detrimental neighborhood influences may amplify risk for persistent depressive symptoms.
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Affiliation(s)
- Alison O'Donnell
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather F de Vries McClintock
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Douglas J Wiebe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
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Nishijima T, Kita I. Deleterious effects of physical inactivity on the hippocampus: New insight into the increasing prevalence of stress-related depression. ACTA ACUST UNITED AC 2015. [DOI: 10.7600/jpfsm.4.253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Takeshi Nishijima
- Laboratory of Behavioral Physiology, Graduate School of Human Health Sciences, Tokyo Metropolitan University
| | - Ichiro Kita
- Laboratory of Behavioral Physiology, Graduate School of Human Health Sciences, Tokyo Metropolitan University
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Hazel-Fernandez L, Xu Y, Moretz C, Meah Y, Baltz J, Lian J, Kimball E, Bouchard J. Historical cohort analysis of treatment patterns for patients with type 2 diabetes initiating metformin monotherapy. Curr Med Res Opin 2015; 31:1703-16. [PMID: 26154837 DOI: 10.1185/03007995.2015.1067194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe treatment regimen changes of patients with type 2 diabetes mellitus (T2DM) initiating metformin monotherapy, and assess factors associated with those changes 12 months post-initiation. METHODS Retrospective cohort analysis of medical, pharmacy and laboratory claims of 17,527 Medicare Advantage (MAPD) Humana members aged 18-89, who had ≥1 medical claim with primary diagnosis or ≥2 medical claims with secondary diagnosis of T2DM (ICD-9-CM code 250.x0 or 250.x2) who filled an initial prescription for metformin (GPI code 2725) between 1 January 2008 and 30 September 2011. The main outcome measure was change in metformin monotherapy during the 12 months following initiation. Factors associated with treatment changes during follow-up were examined using Cox proportional hazards regression models. RESULTS Fifty-nine percent of patients (mean age 69.6 years) remained on metformin monotherapy with no changes. Discontinuation was the most common treatment change (33%), followed by addition (5%), and switching (2%) to other antidiabetics. Of patients who discontinued treatment (median time to discontinuation = 90 days), 61% did not reinitiate any diabetic treatment during the follow-up period. Among patients who added or switched to other antidiabetics, sulfonylureas were the most common addition or replacement agent. Predictors of discontinuation were being female, Black or Hispanic, low-income subsidy eligible, having higher initial out-of-pocket metformin costs, or a diagnosis of depression. Discontinuation was less likely during follow-up if patients had higher pre-index pill burdens or records of a pre-index A1C screening test. A higher risk of discontinuation was observed for patients with low baseline A1C. One study limitation was that exact discontinuation dates could not be determined using claims. CONCLUSIONS The findings suggest that gender, race, ethnicity, depression, and low income status were contributory factors to metformin discontinuation. More intensive monitoring and treatment adjustments may be warranted for patients newly initiated on metformin. This could ultimately improve morbidity, mortality, and costs associated with poor glycemic control.
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Affiliation(s)
| | - Yihua Xu
- a a Comprehensive Health Insights Inc. , Louisville , KY , USA
| | - Chad Moretz
- a a Comprehensive Health Insights Inc. , Louisville , KY , USA
| | | | | | - Jean Lian
- c c Novo Nordisk Inc. , Plainsboro , NJ , USA
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Orsak G, Stevens AM, Brufsky A, Kajumba M, Dougall AL. The Effects of Reiki Therapy and Companionship on Quality of Life, Mood, and Symptom Distress During Chemotherapy. J Evid Based Complementary Altern Med 2014; 20:20-7. [DOI: 10.1177/2156587214556313] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This pilot study examined the effects of Reiki therapy and companionship on improvements in quality of life, mood, and symptom distress during chemotherapy. Thirty-six breast cancer patients received usual care, Reiki, or a companion during chemotherapy. First, data were collected from patients receiving usual care. Second, patients were randomized to either receive Reiki or a companion during chemotherapy. Questionnaires assessing quality of life, mood, symptom distress, and Reiki acceptability were completed at baseline and chemotherapy sessions 1, 2, and 4. Reiki was rated relaxing with no side effects. Reiki and companion groups reported improvements in quality of life and mood that were greater than those seen in the usual care group. Interventions during chemotherapy, such as Reiki or companionship, are feasible, acceptable, and may reduce side effects.
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Affiliation(s)
| | | | - Adam Brufsky
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Psychometric properties of the Exercise Self-efficacy Scale in Dutch Primary care patients with type 2 diabetes mellitus. Int J Behav Med 2014; 21:394-401. [PMID: 23550033 DOI: 10.1007/s12529-013-9308-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Excercise self-efficacy is believed to influence physical activity bahavior. PURPOSE The purpose of this study is to assess the psychometric aspects of the Exercise Self-efficacy Scale (ESS) in a type 2 diabetes Dutch Primary care sample. METHOD Type 2 diabetes patients (n = 322; <80 years old) filled in the ESS and the short questionnaire to assess health enhancing physical activity (SQUASH). The structural validity of the ESS was assessed by means of principal axis factor analyses and confirmatory factor analysis. In addition, reliability and concurrent validity with the SQUASH outcomes "total" and "leisure time minutes/week of moderate to vigorous intensity physical activity" were evaluated. T tests and ANOVAs were used to examine ESS scores in subgroups. In addition, a 13-item version of the ESS was developed. RESULTS Analyses were performed on complete cases (n = 255). Exploratory factor analysis suggested one underlying factor (total explained variance 54 %), with good internal consistency (α = 0.95). Confirmatory factor analysis showed a poor fit, as did a three-factor model suggested in an earlier research. Therefore, a 13-item ESS was developed with one underlying factor (total explained variance 59 %) and good internal consistency (α = 0.95). Both the 18-item and 13-item ESS correlated significantly with total and leisure time physical activity. ESS scores differed significantly between categories of education level and physical activity level. CONCLUSION The 13-item ESS had sound psychometric properties in a large sample of primary care type 2 diabetes patients. The 13-item ESS could be useful in (intervention) research on physical activity in type 2 diabetes patients.
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Doherty AM, Gaughran F. The interface of physical and mental health. Soc Psychiatry Psychiatr Epidemiol 2014; 49:673-82. [PMID: 24562320 DOI: 10.1007/s00127-014-0847-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 02/05/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE The interaction between physical and mental health is complex. In this paper we aim to provide an overview of the main components of this relationship and to identify how care could be improved for people with co-morbidities. METHODS We performed a literature search of MedLine, Ovid and Psycinfo and identified studies that examined the association between mental illness and physical illness. We also examined the key policy documents and guidelines in this area. RESULTS People with mental health conditions are at higher risk of developing physical illness, have those conditions diagnosed later and have much higher mortality rates. Conversely, people with a diagnosis of physical illness, especially cardiovascular disease, diabetes and cancer have a greater chance of developing a mental health problem. When both mental and physical illnesses conditions are present together, there are higher overall rates of morbidity, healthcare utilisation, and poorer quality of life. CONCLUSIONS Physicians and psychiatrists need to be aware of the co-occurrence of mental and physical health problems and the challenges posed for both general and mental health services. There is a need to screen appropriately in both settings to ensure timely diagnosis and treatment. Liaison psychiatry provides psychological assessment and treatment for people with physical illness, but there is a gap in the provision of physical healthcare for people with severe mental illness. There is a need for public policy to drive this forward to overcome the institutional barriers to equitable access to healthcare and for educators to reverse the tendency to teach mind and body as separate systems.
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Pommer AM, Prins L, van Ranst D, Meijer JW, Van't Hul A, Janssen J, Pouwer F, Pop VJM. Development and validity of the Patient-centred COPD Questionnaire (PCQ). J Psychosom Res 2013; 75:563-71. [PMID: 24290047 DOI: 10.1016/j.jpsychores.2013.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE COPD-guidelines recommend regular evaluation of both the degree of airway obstruction and health-status to provide adequate treatment. Numerous health-status questionnaires have been developed of which the 'Clinical-COPD-Questionnaire' and the 'COPD-Assessment-Test' are best known; although highly recommended, both have several limitations regarding structure, content, and/or methodological qualities. In the present study a new COPD-specific instrument was developed to measure impairment: the 'Patient-centred-COPD-Questionnaire' (PCQ). METHODS Six focus groups with COPD patients and (lung) health care providers from primary, secondary and tertiary (rehabilitation) care were formed to discuss aspects of COPD most relevant to patients' daily lives. Eighty candidate items were derived for explorative factor analyses (EFA) to test their psychometric properties (study I, n=541). These resulted in an 18-item scale that was further explored by confirmatory factor analyses (CFA) and construct and concurrent validity assessment (study II, n=412). RESULTS EFA in study I suggested a reliable three component solution ('shortness of breath', 'acceptance of COPD' and 'confidence in care'). In study II this model was confirmed with CFA, and significant and clinically relevant correlations were found between the PCQ subscales, and other COPD specific and general health questionnaires. Furthermore, multivariate analyses of covariance revealed that more severely ill patients reported more impairment. CONCLUSIONS The PCQ is a questionnaire with three dimensions to assess the impact of COPD on daily life that is easy to complete. For the first time, a dimension referring to 'confidence in care' is included in a tool that assesses COPD-related impairment.
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Affiliation(s)
- Antoinette M Pommer
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, P.O. Box 90153, Warandelaan, Tilburg, The Netherlands.
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Huang Y, Wei X, Wu T, Chen R, Guo A. Collaborative care for patients with depression and diabetes mellitus: a systematic review and meta-analysis. BMC Psychiatry 2013; 13:260. [PMID: 24125027 PMCID: PMC3854683 DOI: 10.1186/1471-244x-13-260] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/01/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diabetic patients with depression are often inadequately treated within primary care. These comorbid conditions are associated with poor outcomes. The aim of this systematic review was to examine whether collaborative care can improve depression and diabetes outcomes in patients with both depression and diabetes. METHODS Medline, Embase, Cochrane library and PsyINFO were systematically searched to identify relevant publications. All randomized controlled trials of collaborative care for diabetic patients with depression of all ages who were reported by depression treatment response, depression remission, hemoglobin A1c (HbA1c) values, adherence to antidepressant medication and/or oral hypoglycemic agent were included. Two authors independently screened search results and extracted data from eligible studies. Dichotomous and continuous measures of outcomes were combined using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) either by fixed or random-effects models. RESULTS Eight studies containing 2,238 patients met the inclusion criteria. Collaborative care showed a significant improvement in depression treatment response (RR = 1.33, 95% CI = 1.05-1.68), depression remission (adjusted RR = 1.53, 95% CI =1.11-2.12), higher rates of adherence to antidepressant medication (RR = 1.79, 95% CI = 1.19-2.69) and oral hypoglycemic agent (RR = 2.18, 95% CI = 1.61-2.96), but indicated a non-significant reduction in HbA1c values (MD = -0.13, 95% CI = -0.46-0.19). CONCLUSIONS Improving depression care in diabetic patients is very necessary and important. Comparing with usual care, collaborative care was associated with significantly better depressive outcomes and adherence in patients with depression and diabetes. These findings emphasize the implications for collaborative care of diabetic patients with depression in the future.
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Affiliation(s)
- Yafang Huang
- School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China.
| | - Xiaoming Wei
- Datun Community Health Service Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Tao Wu
- Research Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Rui Chen
- School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China
| | - Aimin Guo
- School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China
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Pouwer F, Nefs G, Nouwen A. Adverse effects of depression on glycemic control and health outcomes in people with diabetes: a review. Endocrinol Metab Clin North Am 2013; 42:529-44. [PMID: 24011885 DOI: 10.1016/j.ecl.2013.05.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the past decades, important advances have been achieved in the psychological aspects of diabetes. This article reviews the associations between diabetes, depression, and adverse health outcomes. The article provides an update on the literature regarding the prevalence of depression in diabetes, discusses the impact of depression on diabetes self-care and glycemic control in people with diabetes, and summarizes the results of longitudinal studies that have investigated depression as a risk factor for adverse health outcomes.
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Affiliation(s)
- François Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases CoRPS, Tilburg University, Warandelaan 2, PO Box 90153, Tilburg 5000 LE, The Netherlands.
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Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PLoS One 2013; 8:e57058. [PMID: 23472075 PMCID: PMC3589463 DOI: 10.1371/journal.pone.0057058] [Citation(s) in RCA: 291] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/17/2013] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the association between depression and all-cause and cardiovascular mortality in people with diabetes by systematically reviewing the literature and carrying out a meta-analysis of relevant longitudinal studies. Research Design and Methods PUBMED and PSYCINFO were searched for articles assessing mortality risk associated with depression in diabetes up until August 16, 2012. The pooled hazard ratios were calculated using random-effects models. Results Sixteen studies met the inclusion criteria, which were pooled in an overall all-cause mortality estimate, and five in a cardiovascular mortality estimate. After adjustment for demographic variables and micro- and macrovascular complications, depression was associated with an increased risk of all-cause mortality (HR = 1.46, 95% CI = 1.29–1.66), and cardiovascular mortality (HR = 1.39, 95% CI = 1.11–1.73). Heterogeneity across studies was high for all-cause mortality and relatively low for cardiovascular mortality, with an I-squared of respectively 78.6% and 39.6%. Subgroup analyses showed that the association between depression and mortality not significantly change when excluding three articles presenting odds ratios, yet this decreased heterogeneity substantially (HR = 1.49, 95% CI = 1.39–1.61, I-squared = 15.1%). A comparison between type 1 and type 2 diabetes could not be undertaken, as only one study reported on type 1 diabetes specifically. Conclusions Depression is associated with an almost 1.5-fold increased risk of mortality in people with diabetes. Research should focus on both cardiovascular and non-cardiovascular causes of death associated with depression, and determine the underlying behavioral and physiological mechanisms that may explain this association.
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Mommersteeg PMC, Herr R, Zijlstra WP, Schneider S, Pouwer F. Higher levels of psychological distress are associated with a higher risk of incident diabetes during 18 year follow-up: results from the British household panel survey. BMC Public Health 2012; 12:1109. [PMID: 23259455 PMCID: PMC3551824 DOI: 10.1186/1471-2458-12-1109] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 12/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reviews have shown that depression is a risk factor for the development of type 2 diabetes. However, there is limited evidence for general psychological distress to be associated with incident diabetes. The aim of the present study was to test whether persons who report higher levels of psychological distress are at increased risk to develop type 2 diabetes during 18 years follow up, adjusted for confounders. METHODS A prospective analysis using data from 9,514 participants (41 years, SD=14; 44% men) of the British Household Panel Survey. The General Health Questionnaire 12 item version was used to assess general psychological distress, diabetes was measured by means of self-report. Cox proportional hazards regression models were used to calculate the multivariate-adjusted hazard ratio (HR) of incident diabetes during 18 years follow up, comparing participants with low versus high psychological distress at baseline (1991). RESULTS A total of 472 participants developed diabetes 18 year follow up. Those with a high level of psychological distress had a 33% higher hazard of developing diabetes (HR=1.33, 95% CI 1.10-1.61), relative to those with a low level of psychological distress, adjusted for age, sex, education level and household income. After further adjustment for differences in level of energy, health status, health problems and activity level, higher psychological distress was no longer associated with incident diabetes (HR=1.10, 95% CI 0.91-1.34). CONCLUSIONS Higher levels of psychological distress are a risk factor for the development of diabetes during an 18 year follow up period. This association may be potentially mediated by low energy level and impaired health status.
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Affiliation(s)
- Paula M C Mommersteeg
- CoRPS, Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
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Mathew CS, Dominic M, Isaac R, Jacob JJ. Prevalence of depression in consecutive patients with type 2 diabetes mellitus of 5-year duration and its impact on glycemic control. Indian J Endocrinol Metab 2012; 16:764-8. [PMID: 23087861 PMCID: PMC3475901 DOI: 10.4103/2230-8210.100671] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
CONTEXT Type 2 diabetes mellitus doubles the odds of suffering from depressive illness. Co-morbid depression is associated with poorer outcomes in diabetes mellitus in terms of glycemic control, medication adherence, quality of life, physical activity, and blood pressure control. AIM The present study aims to estimate the prevalence of depression among a consecutive group of patients with type 2 diabetes and assess its impact on glycemic and blood pressure control. SETTING Outpatient department of the endocrinology department of a university affiliated teaching hospital in north India. SUBJECTS Consecutive adult patients (18-65 years) with type 2 diabetes mellitus of over 5-year duration with no prior history of psychiatric illnesses or intake of anti-depressants. MATERIALS AND METHODS A semi-structured questionnaire was used for demographic data, HbA1c was obtained to assess glycemic control, and blood pressure was recorded twice during patient interview to assess blood pressure control. Depression was assessed with the Major Depression Inventory and scores obtained were classified as consistent with mild, moderate and severe depression. Data was analyzed with SPSS v16, and multiple logistical regression test was done to compare the effect of depression on glycemic control after adjusting for age and sex. RESULTS Of the 80 patients interviewed, 31 (38.8%) had depressive symptoms. Among them 20 (25%) had mild depression, 10 (12.5%) had moderate depression, and 1 (1.3%) had severe depression. CONCLUSIONS Over one third of patients with type 2 diabetes mellitus of over 5-year duration had depressive symptoms. The presence of depressive symptoms was associated with a significant worsening of glycemic control.
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Affiliation(s)
- Cynthia Susan Mathew
- Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College, Ludhiana, India
| | - Mini Dominic
- Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College, Ludhiana, India
| | - Rajesh Isaac
- Department of Community Health, Christian Medical College, Ludhiana, India
| | - Jubbin J. Jacob
- Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College, Ludhiana, India
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de Burgos-Lunar C, Gómez-Campelo P, Cárdenas-Valladolid J, Fuentes-Rodríguez CY, Granados-Menéndez MI, López-López F, Salinero-Fort MA. Effect of depression on mortality and cardiovascular morbidity in type 2 diabetes mellitus after 3 years follow up. The DIADEMA study protocol. BMC Psychiatry 2012; 12:95. [PMID: 22846516 PMCID: PMC3495641 DOI: 10.1186/1471-244x-12-95] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 06/26/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus and depression are highly prevalent diseases that are associated with an increased risk of cardiovascular disease and mortality. There is evidence about a bidirectional association between depressive symptoms and type 2 diabetes mellitus. However, prognostic implications of the joint effects of these two diseases on cardiovascular morbidity and mortality are not well-known. METHOD/DESIGN A three-year, observational, prospective, cohort study, carried out in Primary Health Care Centres in Madrid (Spain). The project aims to analyze the effect of depression on cardiovascular events, all-cause and cardiovascular mortality in patients with type 2 diabetes mellitus, and to estimate a clinical predictive model of depression in these patients.The number of patients required is 3255, all them with type 2 diabetes mellitus, older than 18 years, who regularly visit their Primary Health Care Centres and agree to participate. They are chosen by simple random sampling from the list of patients with type 2 diabetes mellitus of each general practitioner.The main outcome measures are all-cause and cardiovascular mortality and cardiovascular morbidity; and exposure variable is the major depressive disorder.There will be a comparison between depressed and not depressed patients in all-cause mortality, cardiovascular mortality, coronary artery disease and stroke using the Chi-squared test. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors that might alter the effect recorded will be taken into account in this analysis. To assess the effect of depression on the mortality, a survival analysis will be used comparing the two groups using the log-rank test. The control of potential confounding variables will be performed by the construction of a Cox regression model. DISCUSSION Our study's main contribution is to evaluate the increase in the risk of cardiovascular morbidity and mortality, in depressed Spanish adults with type 2 diabetes mellitus attended in Primary Health Care Setting. It would also be useful to identify subgroups of patients for which the interventions could be more beneficial.
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Affiliation(s)
- Carmen de Burgos-Lunar
- Unidad de Epidemiología Clínica e Investigación, Hospital Carlos III, (C/ Sinesio Delgado, 10), Madrid, (28029), Spain.
| | - Paloma Gómez-Campelo
- Fundación de Investigación Biomédica, Hospital Carlos III, (C/ Sinesio Delgado, 10), Madrid, (28029), Spain
| | - Juan Cárdenas-Valladolid
- Unidad de Apoyo Técnico, Gerencia Adjunta de Planificación y Calidad del Servicio Madrileño de Salud, (C/ O’Donell, 55), Madrid, (28007), Spain
| | | | | | - Francisco López-López
- Centro de Salud Vicente Muzas, Dirección Asistencial Este, Servicio Madrileño de Salud, Madrid, Spain
| | - Miguel A Salinero-Fort
- Fundación de Investigación Biomédica, Hospital Carlos III, (C/ Sinesio Delgado, 10), Madrid, (28029), Spain
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Sharma AN, Elased KM, Lucot JB. Rosiglitazone treatment reversed depression- but not psychosis-like behavior of db/db diabetic mice. J Psychopharmacol 2012; 26:724-32. [PMID: 22331176 DOI: 10.1177/0269881111434620] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objective of the present study was to examine the effect of long-term management of insulin resistance and hyperglycemia on neurobehavioral deficits in db/db mice. In this study, 5-week-old db/db and lean control mice were fed with rosiglitazone (20 mg/kg/day) mixed or standard chow for a duration of 5 weeks. Mice were monitored weekly for blood glucose concentration. Five weeks after the onset of treatment, they were subjected to the forced swim test (FST), pre-pulse inhibition (PPI), open field test (OFT) and fear-potentiated startle (FPS) test to examine for depression, psychosis-like behavior, locomotor activity and emotional learning, respectively. Rosiglitazone normalized hyperglycemia and improved glucose tolerance. Rosiglitazone significantly reduced immobility time in the FST in db/db mice, suggesting an antidepressant-like effect. However, rosiglitazone failed to reverse disruption of PPI in db/db mice, indicating its ineffectiveness against psychosis-like behavior. In the OFT, rosiglitazone did not affect the activity of db/db mice, suggesting its antidepressant-like effect was independent of changes in locomotor activity. In the FPS test, db/db mice showed impaired emotional learning and rosiglitazone failed to correct it. In conclusion, long-term blood glucose management in type-2 diabetics may help to limit the co-occurrence of depression but not the psychotic symptoms and ability to cope with stress.
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Affiliation(s)
- Ajaykumar N Sharma
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
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Vedhara K, Beattie A, Metcalfe C, Roche S, Weinman J, Cullum N, Price P, Dayan C, Cooper A, Campbell R, Chalder T. Development and preliminary evaluation of a psychosocial intervention for modifying psychosocial risk factors associated with foot re-ulceration in diabetes. Behav Res Ther 2012; 50:323-32. [DOI: 10.1016/j.brat.2012.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/20/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
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de Groot M, Doyle T, Kushnick M, Shubrook J, Merrill J, Rabideau E, Schwartz F. Can lifestyle interventions do more than reduce diabetes risk? Treating depression in adults with type 2 diabetes with exercise and cognitive behavioral therapy. Curr Diab Rep 2012; 12:157-66. [PMID: 22350739 PMCID: PMC3314326 DOI: 10.1007/s11892-012-0261-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The epidemic of metabolic syndrome, prediabetes, and type 2 diabetes is global in scope and comprehensive in its impact on individuals, health care systems, and societies. One in four patients with diabetes will experience depression in their lifetime. Comorbid depression is associated with poorer outcomes, greater functional disability, and early mortality. Prior studies have demonstrated beneficial effects of exercise as an efficacious form of treatment for depression in the general population. Few studies have evaluated this strategy in patients with prediabetes or type 2 diabetes. Program ACTIVE (Appalachians Coming Together to Increase Vital Exercise) was designed to treat depression among adults with type 2 diabetes by pairing aerobic activity with individual cognitive behavioral therapy. This combination treatment approach has been shown to be feasible to implement in a rural environment and promising in terms of depression, diabetes, and cardiovascular outcomes. Data from this study suggest that exercise can be used to achieve multiple benefits for adults with type 2 diabetes. Future work to compare this approach to singular treatment strategies for adults at risk for type 2 diabetes is needed.
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Affiliation(s)
- Mary de Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Pommer AM, Pouwer F, Denollet J, Pop VJM. Managing co-morbid depression and anxiety in primary care patients with asthma and/or chronic obstructive pulmonary disease: study protocol for a randomized controlled trial. Trials 2012; 13:6. [PMID: 22236488 PMCID: PMC3269377 DOI: 10.1186/1745-6215-13-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 01/11/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma are common chronic diseases that are frequently accompanied by depression and/or anxiety. However, symptoms of depression and anxiety are often not recognized and therefore not treated. Currently, only a few studies have tested new clinical approaches that could improve the treatment of co-morbid depression and anxiety in these groups of patients. METHODS/DESIGN The present randomized controlled study will be conducted within the framework of PoZoB (Praktijk Ondersteuning Zuid-Oost Brabant), a large primary care organization in the Netherlands. Patients with asthma/COPD and co-morbid anxiety/depression will be included in order to test the effectiveness of a disease management approach to treat these co-morbid disorders. Important elements of this approach are: 1) systematic screening to improve detection of anxiety and depression 2) treatment in case of positive screening 3) monitoring of anxiety and depression 4) intensified treatment in case of non-remission (stepped care). DISCUSSION The present study is a large primary care study on the treatment of co-morbid depression and anxiety in patients with asthma and COPD. Strengths of this study are its randomized design, the focus on implementation in primary care and the fact that it applies the latest findings on the treatment of depression and anxiety. First results are expected in 2012/2013.
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Affiliation(s)
- Antoinette M Pommer
- Department of Medical Psychology & Neuropsychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, (Warandelaan), Tilburg, (P.O. Box 90153), The Netherlands
| | - François Pouwer
- Department of Medical Psychology & Neuropsychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, (Warandelaan), Tilburg, (P.O. Box 90153), The Netherlands
| | - Johan Denollet
- Department of Medical Psychology & Neuropsychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, (Warandelaan), Tilburg, (P.O. Box 90153), The Netherlands
| | - Victor JM Pop
- Department of Medical Psychology & Neuropsychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, (Warandelaan), Tilburg, (P.O. Box 90153), The Netherlands
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Bogner HR, Morales KH, de Vries HF, Cappola AR. Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial. Ann Fam Med 2012; 10:15-22. [PMID: 22230826 PMCID: PMC3262455 DOI: 10.1370/afm.1344] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 10/12/2011] [Accepted: 10/25/2011] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Depression commonly accompanies diabetes, resulting in reduced adherence to medications and increased risk for morbidity and mortality. The objective of this study was to examine whether a simple, brief integrated approach to depression and type 2 diabetes mellitus (type 2 diabetes) treatment improved adherence to oral hypoglycemic agents and antidepressant medications, glycemic control, and depression among primary care patients. METHODS We undertook a randomized controlled trial conducted from April 2010 through April 2011 of 180 patients prescribed pharmacotherapy for type 2 diabetes and depression in primary care. Patients were randomly assigned to an integrated care intervention or usual care. Integrated care managers collaborated with physicians to offer education and guideline-based treatment recommendations and to monitor adherence and clinical status. Adherence was assessed using the Medication Event Monitoring System (MEMS). We used glycated hemoglobin (HbA(1c)) assays to measure glycemic control and the 9-item Patient Health Questionnaire (PHQ-9) to assess depression. RESULTS Intervention and usual care groups did not differ statistically on baseline measures. Patients who received the intervention were more likely to achieve HbA(1c) levels of less than 7% (intervention 60.9% vs. usual care 35.7%; P < .001) and remission of depression (PHQ-9 score of less than 5: intervention 58.7% vs. usual care 30.7%; P < .001) in comparison with patients in the usual care group at 12 weeks. CONCLUSIONS A randomized controlled trial of a simple, brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care. An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practices with competing demands for limited resources.
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Affiliation(s)
- Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Otterman NM, van Schie CHM, van der Schaaf M, van Bon AC, Busch-Westbroek TE, Nollet F. An exercise programme for patients with diabetic complications: a study on feasibility and preliminary effectiveness. Diabet Med 2011; 28:212-7. [PMID: 21219432 DOI: 10.1111/j.1464-5491.2010.03128.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the feasibility and preliminary effectiveness of an exercise programme for patients with diabetic complications. METHODS In this pre-post design study, 22 patients from a diabetic foot outpatient clinic participated in a 12-week individualized exercise programme, consisting of aerobic and resistance exercise, with specific safety precautions. Feasibility was assessed on the basis of programme adherence, adverse events, achievement of the target training intensity and patient satisfaction. Preliminary effectiveness was evaluated with pre-post-changes in blood glucose regulation (HbA(1c) ), muscle strength (isometric peak torque) and perceived limitations in functioning (Patient Specific Function Scale with visual analogue scale). RESULTS Twenty patients completed the exercise programme with a high mean attendance (85%). No training-related severe adverse events occurred. The target training intensity was achieved by 70% of the participants. Patient satisfaction was high. HbA(1c) decreased from 8.2% before to 7.8% after the programme (P=0.005), muscle strength increased from 136.4 to 150.4 Nm (P = 0.046) and perceived limitations in functioning decreased from 7.2 to 5.8 mm (P=0.003). CONCLUSIONS The prescribed exercise programme had a potentially positive effect on blood glucose regulation, muscle strength and perceived limitations in functioning in patients with diabetic complications.
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Affiliation(s)
- N M Otterman
- Department of Rehabilitation, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands.
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Geulayov G, Goral A, Muhsen K, Lipsitz J, Gross R. Physical inactivity among adults with diabetes mellitus and depressive symptoms: results from two independent national health surveys. Gen Hosp Psychiatry 2010; 32:570-6. [PMID: 21112447 DOI: 10.1016/j.genhosppsych.2010.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 09/08/2010] [Accepted: 09/09/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the association between depressive symptoms and physical inactivity in community samples of patients with diabetes mellitus (DM). METHODS Two representative samples of Israeli adults (age ≥21 years) were analyzed: The First Israeli National Health Interview Survey (INHIS-1) (n=9509) and the Israel National Health Survey (INHS) (n=4859). Information was obtained about past-month depressive symptoms, physician-diagnosed DM and physical activity. Multiple logistic regression models were used to examine the association between level of depressive symptoms and physical inactivity among individuals with DM, adjusting for potential confounders. RESULTS Prevalence of DM ranged from 7.2% (INHIS-1) to 8.7% (INHS). In both samples, physical inactivity was significantly more prevalent among persons with significant depressive symptoms, compared to those without depressive symptoms [INHIS-1: 67.0% vs. 50.6%; adjusted odds ratio (AOR): 1.57; 95% confidence interval (95% CI), 1.05-2.35, P=.03; INHS: 71.4% vs. 43.9%; AOR: 2.67; 95% CI, 1.67-4.27, P<.0001]. CONCLUSIONS Depressive symptoms were associated with a higher likelihood of physical inactivity in persons with DM. Body mass index of patients reporting no regular physical activity was elevated compared to persons who were physically active. This finding supports the view that identification and management of depression should be part of interventions designed to improve self care behaviors in patients with DM.
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Affiliation(s)
- Galit Geulayov
- The Gertner Institute of Epidemiology and Health Policy Research, Tel Hashomer 53621, Israel.
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Nefs G, Pouwer F, Denollet J, Pop VJ. Psychological risk factors of micro- and macrovascular outcomes in primary care patients with type 2 diabetes: rationale and design of the DiaDDZoB Study. BMC Public Health 2010; 10:388. [PMID: 20594337 PMCID: PMC2914779 DOI: 10.1186/1471-2458-10-388] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 07/01/2010] [Indexed: 11/30/2022] Open
Abstract
Background Depression is a common psychiatric complication of diabetes, but little is known about the natural course and the consequences of depressive symptoms in primary care patients with type 2 diabetes. While depression has been related to poor glycemic control and increased risk for macrovascular disease, its association with microvascular complications remains understudied. The predictive role of other psychological risk factors such as Type D (distressed) personality and the mechanisms that possibly link depression and Type D personality with poor vascular outcomes are also still unclear. Methods/Design This prospective cohort study will examine: (1) the course of depressive symptoms in primary care patients with type 2 diabetes; (2) whether depressive symptoms and Type D personality are associated with the development of microvascular and/or macrovascular complications and with the risk of all-cause or vascular mortality; and (3) the behavioral and physiological mechanisms that may mediate these associations. The DiaDDZoB Study is embedded within the larger DIAZOB Primary Care Diabetes study, which covers a comprehensive cohort of type 2 diabetes patients treated by over 200 primary care physicians in South-East Brabant, The Netherlands. These patients will be followed during their lifetime and are assessed annually for demographic, clinical, lifestyle and psychosocial factors. Measurements include an interviewer-administered and self-report questionnaire, regular care laboratory tests and physical examinations, and pharmacy medication records. The DiaDDZoB Study uses data that have been collected during the original baseline assessment in 2005 (M0; N = 2,460) and the 2007 (M1; N = 2,225) and 2008 (M2; N = 2,032) follow-up assessments. Discussion The DiaDDZoB Study is expected to contribute to the current understanding of the course of depression in primary care patients with type 2 diabetes and will also test whether depressed patients or those with Type D personality are at increased risk for (further) development of micro- and cardiovascular disease. More knowledge about the mechanisms behind this association is needed to guide new intervention studies.
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Affiliation(s)
- Giesje Nefs
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands
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Perveen S, Otho MS, Siddiqi MN, Hatcher J, Rafique G. Association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan. Diabetol Metab Syndr 2010; 2:17. [PMID: 20298616 PMCID: PMC2858101 DOI: 10.1186/1758-5996-2-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 03/19/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan. METHODS From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from diabetic Out Patient Department (OPD) of Civil Hospital, Karachi. They were matched on age and sex with controls (n = 296), who were attendants sitting in the medical out patient department of the same hospital, recruited on the basis of absence of classical symptoms of polyuria and polydipsia along with random blood glucose level of <200 mg/dl measured by a glucometer. Depression was identified by the Siddiqui Shah Depression Scale. Conditional logistic regression was applied to examine the association of depression and other independent variables with newly diagnosed type 2 diabetes at 95% C.I. and P < 0.05. RESULTS The study comprised of 592 subjects with 432(73%) males and 160(27%) females. Depression was significantly associated with newly diagnosed type 2 diabetes having mild level (mOR: 3.86; 95%CI: 2.22,6.71) and moderate to severe level (mOR: 3.41; 95%CI: 2.07,5.61). History of (h/o) gestational diabetes (mOR: 2.83; 95%CI: 1.05,7.64), family h/o diabetes (mOR: 1.59; 95%CI: 1.04,2.43), nuclear family (mOR: 1.75; 95%CI: 1.14,2.69), BMI (mOR: 1.62; 95%CI: 1.01,2.60 for obese and mOR: 2.12; 95%CI: 1.19,3.79 for overweight vs healthy to underweight) were also significantly associated with outcome, adjusting for age, sex, marital status, h/o smoking and h/o high BP. CONCLUSIONS Diabetics should be screened simultaneously for depression and concomitant preventive strategies for gestational diabetes, nuclear family and high BMI should also be used to prevent mortality/morbidity among patients between 25 to 60 years of age.
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Affiliation(s)
- Shazia Perveen
- Cardiothoracic Section, Department of Surgery, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
| | - Muhammad S Otho
- Global Funds for AIDS, TB and Malaria, Round 7, Directorate of Malaria, 1st Floor, Allergy Center Chak Shehzad, Islamabad
| | | | - Juanita Hatcher
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Ghazala Rafique
- Epidemiology and Biostatistics Division, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Muhsen K, Garty-Sandalon N, Gross R, Green MS. Psychological distress is independently associated with physical inactivity in Israeli adults. Prev Med 2010; 50:118-22. [PMID: 20004684 DOI: 10.1016/j.ypmed.2009.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 11/30/2009] [Accepted: 12/02/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Limited data exist on the link between psychological distress and regular physical activity in the general population. We examined the association of psychological distress with physical inactivity, independently of sociodemographic and behavioral factors in a large community sample. We also examined whether psychological distress is related to limitations in day-to-day activities due to emotional problems. METHODS Information on physical activity, sociodemographic, and behavioral factors was obtained through telephone interviews of 5708 subjects aged > or = 21 years from a cross-sectional study-the first Israeli National Health Interview Survey (2003-2004). Psychological distress and limitations due to emotional problems were measured using the five-item Mental Health scale (MHI-5) and role emotional scales derived from the SF-36 questionnaire. RESULTS In multivariate analyses, high psychological distress level was associated with increased odds of physical inactivity among both men (adjusted OR=1.30, 95% CI=1.09-1.55) and women (adjusted OR=1.31, 95% CI=1.11-1.53). Psychological distress was strongly associated with limitations in day-to-day activities due to emotional problems. CONCLUSIONS In this cross-sectional study of adult men and women, psychological distress was independently associated with physical inactivity. Psychological distress may limit day-to-day activities in general and reduce the success of health promotion activities. These findings could help in identifying subjects facing difficulties in initiation and adherence to these activities.
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Affiliation(s)
- Khitam Muhsen
- Israel Center for Disease Control, Ministry of Health, Gertner Institute, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel.
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Abstract
Emotional problems such as depression, anxiety and diabetes-specific distress are common in patients with type 2 diabetes mellitus (T2DM) but often remain unrecognized and thus untreated. The present Review focuses on the extent of this problem and discusses whether we should screen for depression, anxiety and diabetes-specific distress in patients with this condition. Depression has received by far the greatest attention from researchers. Strong evidence exists that depression affects 10-20% of patients with T2DM, but it is often unrecognized. Several guidelines have therefore recommended periodic assessments of emotional well-being in patients with T2DM. However, this recommendation is not based on strong evidence, as the effects of screening (case-finding) on psychological outcomes and diabetes outcomes have not been tested in a randomized controlled study. Results from studies in patients without T2DM have shown that screening for depression does not improve outcomes. On the other hand, collaborative care approaches for depression in patients with type 1 diabetes mellitus (T1DM) or T2DM seem to be effective. Intervention studies for anxiety or diabetes-specific emotional distress are currently lacking, and further research that can help to optimize antidepressant treatment is also urgently needed.
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Affiliation(s)
- François Pouwer
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands.
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Koopmans B, Pouwer F, de Bie RA, Leusink GL, Denollet JKL, Pop VJM. Associations between vascular co-morbidities and depression in insulin-naive diabetes patients: the DIAZOB Primary Care Diabetes study. Diabetologia 2009; 52:2056-63. [PMID: 19669635 PMCID: PMC2744805 DOI: 10.1007/s00125-009-1460-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 06/16/2009] [Indexed: 12/02/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to determine the prevalence of depression in insulin-naive diabetes patients and to investigate the associations between different forms of vascular co-morbidity and depression. METHODS Cross-sectional data were used from a primary-care sample of 1,269 insulin-naive (i.e. not using insulin therapy) diabetes patients participating in the DIAZOB Primary Care Diabetes study. Demographics, vascular co-morbidities, clinical and lifestyle characteristics, and psychosocial factors were assessed. Depression symptoms were measured with the Edinburgh Depression Scale, with a score >11 defined as depression. The chi (2) and Student's t tests were used to compare groups with and without vascular co-morbidities. Rates and odds ratios of depression were calculated for each vascular co-morbidity, with diabetes only as the reference group, correcting for age and sex. Single and multiple logistic regression analyses were performed to test a more comprehensive model regarding the likelihood of depression in diabetes. RESULTS The prevalence of depression was 11% in the total sample with little difference between the groups with and without any vascular co-morbidity (11.2% vs 10.0%). Single vascular co-morbidities were not associated with increased rates of depression. The final model predicting depression included: having multiple vascular co-morbidities compared with none; having less social support; having experienced a recent stressful life event; female sex; and being a smoker. CONCLUSIONS/INTERPRETATION Rates of depression in those with one additional vascular co-morbidity did not differ from patients with diabetes only. Vascular co-morbidities were only associated with higher depression scores in case of multiple co-morbidities.
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Affiliation(s)
- B. Koopmans
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
| | - F. Pouwer
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
| | - R. A. de Bie
- CAPHRI School, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | | | - J. K. L. Denollet
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
| | - V. J. M. Pop
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
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