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Horner FS, Helgeson VS. Psychosocial predictors of short-term glucose among people with diabetes: A narrative review. J Behav Med 2025; 48:207-229. [PMID: 39702741 PMCID: PMC11929727 DOI: 10.1007/s10865-024-00536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 11/21/2024] [Indexed: 12/21/2024]
Abstract
Type 1 and type 2 diabetes are metabolic disorders that require one to manage one's blood glucose levels on a daily basis through a series of behaviorally complex tasks. Research shows that psychosocial factors, including mood, stress, and social relationships, have a significant influence on one's ability to maintain these disease management routines and achieve healthy blood glucose levels. However, researchers have typically approached these questions from a between-person perspective. Here, we argue for greater consideration of short-term, within-person links of psychosocial factors-including mood, stress, and social interactions-to glucose outcomes. Drawing from existing social and health psychology theories, we put forth an organizing theoretical framework describing how psychosocial experiences may operate on glucose outcomes over subsequent hours. We then review the small but burgeoning literature of intensive longitudinal studies that have examined the short-term effects of negative affect, positive affect, stress, and social interactions on glucose outcomes. Findings showed somewhat stronger links for negative affect and stress compared to positive affect and social interactions, but studies varied greatly in their methodologies, making direct comparisons challenging. A number of findings, particularly in the social interaction literature, depended on dispositional or contextual factors, further complicating interpretation. There was little investigation of the mechanistic pathways that may connect psychosocial factors to glucose outcomes, and few studies conducted lagged analyses to probe the directionality of these links. We conclude by proposing best practices for future research that will address the key weaknesses in the extant literature.
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Affiliation(s)
- Fiona S Horner
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.
| | - Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
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2
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Horner FS, Helgeson VS, Korytkowski MT. Links of positive affect and stress to HbA1c: a prospective longitudinal study. J Behav Med 2023; 46:849-859. [PMID: 37071343 PMCID: PMC10111289 DOI: 10.1007/s10865-023-00408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/06/2023] [Indexed: 04/19/2023]
Abstract
While affect is linked to a number of diabetes outcomes, the specific role of positive affect (PA) in HbA1c remains unclear. The present study examined whether PA prospectively predicted lower HbA1c among adults with type 2 diabetes and whether this relation was moderated by stress. Participants were 123 adults (44.7% female; 60.2% White, 39.8% Black) recently diagnosed with type 2 diabetes. Perceived stress, diabetes-specific distress, and PA were assessed at baseline; HbA1c was assessed at baseline (T1), six months (T2), and five years (T3). PA was cross-sectionally associated with lower HbA1c at T1 and prospectively predicted lower HbA1c at T3. PA interacted with both measures of T1 stress to predict T1 HbA1c, and PA interacted with T3 perceived stress to predict T3 HbA1c. Interactions were consistent with stress buffering. Sensitivity analyses attentuated findings, but robust evidence remained for PA as a protective factor for blood glucose five years later and for a stress-buffering effect of PA on diabetes-specific distress. Findings suggest PA may be a clinically useful indicator among adults with type 2 diabetes and may be particularly important for those experiencing the greatest stress from their disease.
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Affiliation(s)
- Fiona S Horner
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.
| | - Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
| | - Mary T Korytkowski
- Center for Diabetes and Endocrinology, University of Pittsburgh Medical Center, Pittsburgh, USA
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3
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Shapira A, Volkening LK, Borus JS, Laffel LM. Ecological Momentary Assessment of Positive and Negative Affect and Associations with Blood Glucose in Teens with Type 1 Diabetes. J Diabetes Sci Technol 2023; 17:195-200. [PMID: 34330178 PMCID: PMC9846400 DOI: 10.1177/19322968211035451] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Affect (i.e., emotions) can be associated with diabetes self-care and ambient glucose in teens with type 1 diabetes (T1D). We used momentary sampling to examine associations of daily affectwithblood glucose (BG) monitoring,BG levels,and BG variability in teens with T1D. METHOD Over 2 weeks, 32 teens reported positive and negative affect (Positive and Negative Affect Scale) and BG levels on handheld computers 4x/day, coordinated with planned daily BG checks. BG values were classified as: in-range (70-180 mg/dL); low (<70 mg/dL); severe low (<54 mg/dL); high (>180 mg/dL); severe high (>250 mg/dL). Daily BG variability was derived from BG coefficient of variation (BGCV). To determine associations of positive and negative affect with BG checks, BG levels, and BGCV, separate generalized estimating equations were performed, adjusting for demographic and diabetes-related variables, for the overall sample and stratified by HbA1c (≤8%, >8%). RESULTS Teens (44% male, ages 14-18, 63% pump-treated, HbA1c 8.8 ± 1.4%) reported 51% in-range, 6% low (2% severe low), and 44% high (19% severe high) BG. In teens with HbA1c ≤8%, positive affect was associated with in-range BG (OR = 1.08, 95% CI = 1.04-1.13, P = .0002), reduced odds of very low glucose (OR = 0.35, 95% CI = 0.16-0.74, P = .006), and less daily BGCV (β = -0.9; 95% CI = -1.6, -0.2; P = .01). In teens with HbA1c >8%, negative affect was associated with less likelihood of checking BG (OR = 0.75, 95% CI = 0.64-0.87, P = .0003). CONCLUSIONS Our findings shed light on individual differences in metabolic reactivity based on glycemic levels and the importance of incorporating affect into automated insulin delivery systems.
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Affiliation(s)
- Amit Shapira
- Harvard Medical School, Joslin Diabetes
Center, Boston, MA, USA
| | | | - Joshua S. Borus
- Harvard Medical School, Boston
Children’s Hospital, Boston, MA, USA
| | - Lori M. Laffel
- Harvard Medical School, Joslin Diabetes
Center, Boston, MA, USA
- Harvard Medical School, Boston
Children’s Hospital, Boston, MA, USA
- Lori M. Laffel, MD, MPH, Harvard Medical
School, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA.
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Hermanns N, Ehrmann D, Shapira A, Kulzer B, Schmitt A, Laffel L. Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes. Diabetologia 2022; 65:1883-1894. [PMID: 35380233 PMCID: PMC9522821 DOI: 10.1007/s00125-022-05685-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
Monitoring of glucose plays an essential role in the management of diabetes. However, to fully understand and meaningfully interpret glucose levels, additional information on context is necessary. Important contextual factors include data on behaviours such as eating, exercise, medication-taking and sleep, as well as data on mental health aspects such as stress, affect, diabetes distress and depressive symptoms. This narrative review provides an overview of the current state and future directions of precision monitoring in diabetes. Precision monitoring of glucose has made great progress over the last 5 years with the emergence of continuous glucose monitoring (CGM), automated analysis of new glucose variables and visualisation of CGM data via the ambulatory glucose profile. Interestingly, there has been little progress in the identification of subgroups of people with diabetes based on their glycaemic profile. The integration of behavioural and mental health data could enrich such identification of subgroups to stimulate precision medicine. There are a handful of studies that have used innovative methodology such as ecological momentary assessment to monitor behaviour and mental health in people's everyday life. These studies indicate the importance of the interplay between behaviour, mental health and glucose. However, automated integration and intelligent interpretation of these data sources are currently not available. Automated integration of behaviour, mental health and glucose could lead to the identification of certain subgroups that, for example, show a strong association between mental health and glucose in contrast to subgroups that show independence of mental health and glucose. This could inform precision diagnostics and precision therapeutics. We identified just-in-time adaptive interventions as a potential means by which precision monitoring could lead to precision therapeutics. Just-in-time adaptive interventions consist of micro-interventions that are triggered in people's everyday lives when a certain problem is identified using monitored behaviour, mental health and glucose variables. Thus, these micro-interventions are responsive to real-life circumstances and are adaptive to the specific needs of an individual with diabetes. We conclude that, with current developments in big data analysis, there is a huge potential for precision monitoring in diabetes.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Amit Shapira
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Lori Laffel
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
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5
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Abascal L, Vela A, Sugden S, Kohlenberg S, Hirschberg A, Young A, Lane K, Merlo G. Incorporating Mental Health Into Lifestyle Medicine. Am J Lifestyle Med 2022; 16:570-576. [PMID: 36072684 PMCID: PMC9442472 DOI: 10.1177/15598276221084250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
The evidence-based interconnection between mental health with lifestyle medicine practice is discussed. The extent to which physical health, and mental and behavioral health overlap are significant, and their interaction is seen in many ways. These bidirectional influences form a continuous thread through all lifestyle medicine pillars. The intersection of mental health and lifestyle should be considered and applied to provide optimal evidence-based lifestyle medicine for all patient populations who will benefit from the specific attention to diet, physical activity, relationships, stress, sleep, and substance use. Lifestyle medicine can be utilized to directly address and treat a range of mental health symptoms and disorders, and physical illnesses. In addition, behavior change skills and addressing the psychological factors contributing to barriers are crucial to helping patients reach their lifestyle medicine goals. Approaches to practice that attend to, and address, mental and behavioral health are relevant to and necessary for all types of providers who work within the lifestyle medicine framework.
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Affiliation(s)
- Liana Abascal
- California School of Professional Psychology - San Diego Campus
| | - Alyssa Vela
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Steve Sugden
- Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | - Allison Young
- NYU Grossman School of Medicine, Palm Beach Gardens, FL, USA
| | - Karen Lane
- Life Ideals Private Practice, Windham, ME, USA
| | - Gia Merlo
- New York University, New York, NY, USA
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6
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Li Y, Storch EA, Ferguson S, Li L, Buys N, Sun J. The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2022; 189:109965. [PMID: 35718018 DOI: 10.1016/j.diabres.2022.109965] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/10/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS This meta-analysis aims to update former meta-analyses from randomized controlled trials (RCT) focused on the efficacy of CBT for diabetes. METHODS Five databases were searched for RCTs. Primary outcomes were glycated hemoglobin (HbA1c), fasting blood glucose (FBS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). Secondary outcomes were depression, anxiety and distress symptoms, quality of life, sleep quality. RESULTS 32 RCTs were included. Results revealed that CBT could reduce HbA1c: -0.14% (95% CI: -0.25 to -0.02%, P = 0.020); FBS: -15.48 mg/dl (95% CI: -30.16 to -0.81 mg/dl, P = 0.040); DBP: -2.88 mmHg (95% CI: -4.08 to -1.69 mmHg, P < 0.001); depression symptoms: -0.90 (95% CI: -1.22 to -0.57, P < 0.001); anxiety symptoms: -0.28 (95% CI: -0.50 to -0.07, P = 0.009); improve sleep quality: -0.92 (95% CI: -1.77 to -0.07, P = 0.030). Subgroup analysis indicated that CBT has siginificantly reduced HbA1c when delivered as a group-based and face-to-face method, and psycho-education, behavioral, cognitive, goal-setting, homework assignment strategies were applied as central strategies. CONCLUSION CBT was an effective treatment for diabetes patients, significantly reduced their HbA1c, FBS, DBP, depression and anxiety symptoms, and improved sleep quality.
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Affiliation(s)
- Yanni Li
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Samantha Ferguson
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province 315010, China
| | - Nicholas Buys
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Q422, Australia.
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7
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Jenkins BN, Cross MP, Donaldson CD, Pressman SD, Fortier MA, Kain ZN, Cohen S, Martin LT, Farkas G. The subcomponents of affect scale (SAS): validating a widely used affect scale. Psychol Health 2021:1-19. [PMID: 34846253 DOI: 10.1080/08870446.2021.2000612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE There is a need for a brief affect scale that also encompasses different components of affect relevant for researchers interested in physiological and health outcomes. The Subcomponents of Affect Scale (SAS) meets this need. This 18-item scale has nine positive and nine negative affect items encompassing six subscales (calm, well-being, vigour, depression, anxiety, anger). Previous research using the SAS has demonstrated its predictive validity, but no work has tested its subscale structure or longitudinal validity. DESIGN Data from the Common Cold Project in which individuals (N = 610) completed the SAS over the course of seven days were used. RESULTS Confirmatory factor analysis demonstrated the reliability of the subscale structure of the SAS across seven days (positive affect subscale structure: CFIs ≥ 0.98; negative affect subscale structure: CFIs ≥ 0.94 with day 6 CFI = 0.91) and tests of factorial invariance showed the scale is valid to use over time. CONCLUSIONS These results confirm the psychometric validity of the subscale structure of the SAS and imply that the subscales can be used longitudinally, allowing for its use in health research as well as non-health research that can benefit from its subscale structure and longitudinal capabilities.
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Affiliation(s)
- Brooke N Jenkins
- Department of Psychology, Chapman University, Orange, CA, USA.,Center on Stress & Health, University of California, Irvine, Irvine, CA, USA.,Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA
| | - Marie P Cross
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Candice D Donaldson
- Department of Psychology, Chapman University, Orange, CA, USA.,Center on Stress & Health, University of California, Irvine, Irvine, CA, USA
| | - Sarah D Pressman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Michelle A Fortier
- Center on Stress & Health, University of California, Irvine, Irvine, CA, USA.,Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA.,Department of Psychological Science, University of California, Irvine, Irvine, CA, USA.,Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, USA.,Department of Pediatric Psychology, CHOC Children's, Orange, CA, USA
| | - Zeev N Kain
- Center on Stress & Health, University of California, Irvine, Irvine, CA, USA.,Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA.,Department of Pediatrics, CHOC Children's, Orange, CA, USA.,Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Sheldon Cohen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Logan T Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - George Farkas
- School of Education, University of California, Irvine, Irvine, CA, USA
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8
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Personality and Subjective Well-Being: Towards Personalized Persuasive Interventions for Health and Well-Being. Online J Public Health Inform 2020; 12:e1. [PMID: 32547678 DOI: 10.5210/ojphi.v12i1.10335] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Subjective well-being (SWB) is an individual's judgment about their overall well-being. Research has shown that activities that elevate people's sense of SWB have a significant effect on their overall health. There are two dimensions of SWB: Affective and Cognitive dimensions. However, studies on SWB usually focus more on one dimension, ignoring the other dimension. Also, most existing studies on SWB focused on individuals from Western cultures. Research has shown that the influence of personality on subjective well-being is moderated by culture. Thus, to advance research in personalizing persuasive health interventions, this study focuses on Africans (n=732). Specifically, we investigate the relationship between the Big-Five personality traits and both dimensions of SWB using the constructs: Happiness, Satisfaction with Life, Social, Psychological and Emotional well-being. Our results reveal that health informatics designers who design persuasive technologies to promote SWB would need to tailor designs along personality traits and SWB constructs. Accordingly, for users high in Agreeableness, the design should be focus on promoting their feelings of Happiness and Social Well-being. For users who exhibit Neuroticism, designers should focus on designing to promote Psychological well-being and Emotional well-being. Based on our findings, we offer guidelines for tailoring persuasive health interventions to promote individuals' SWB based on their personality. We thus highlight areas personal health informatics design can benefit. CCS CONCEPTS • Human-centered computing → Personalization → HCI design and evaluation methods → User models.
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9
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Lindsay KL, Buss C, Wadhwa PD, Entringer S. The Effect of a Maternal Mediterranean Diet in Pregnancy on Insulin Resistance is Moderated by Maternal Negative Affect. Nutrients 2020; 12:nu12020420. [PMID: 32041106 PMCID: PMC7071160 DOI: 10.3390/nu12020420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/26/2020] [Accepted: 02/05/2020] [Indexed: 02/06/2023] Open
Abstract
There is inconsistent evidence that healthy dietary interventions can effectively mitigate the risk of adverse outcomes associated with elevated insulin resistance in pregnancy, suggesting that other moderating factors may be at play. Maternal psychological state is an important factor to consider in this regard, because stress/mood state can directly influence glycemia and a bidirectional relationship may exist between nutrition and psychological state. The objective of this study was to examine the interaction between maternal negative affect and diet quality on third trimester insulin resistance. We conducted a prospective longitudinal study of N = 203 women with assessments in early and mid-pregnancy, which included an ecological momentary assessment of maternal psychological state, from which a negative affect score (NAS) was derived, and 24-h dietary recalls, from which the Mediterranean Diet Score (MDS) was computed. The homeostasis model assessment of insulin resistance (HOMA-IR) was computed from third trimester fasting plasma glucose and insulin values. Early pregnancy MDS was inversely associated with the HOMA-IR, but this did not maintain significance after adjusting for covariates. There was a significant effect of the mid-pregnancy MDS*NAS interaction term with the HOMA-IR in the adjusted model, such that a higher negative affect was found to override the beneficial effects of a Mediterranean diet on insulin resistance. These results highlight the need to consider nutrition and affective state concurrently in the context of gestational insulin resistance.
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Affiliation(s)
- Karen L. Lindsay
- Departments of Pediatrics, University of California, Irvine, CA 92697, USA
- UC Irvine Development, Health and Disease Research Program, University of California, Irvine, CA 92697, USA; (C.B.); (P.D.W.); (S.E.)
- Correspondence: ; Tel.: +1-7-144-568-401
| | - Claudia Buss
- UC Irvine Development, Health and Disease Research Program, University of California, Irvine, CA 92697, USA; (C.B.); (P.D.W.); (S.E.)
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany
| | - Pathik D. Wadhwa
- UC Irvine Development, Health and Disease Research Program, University of California, Irvine, CA 92697, USA; (C.B.); (P.D.W.); (S.E.)
- Departments of Psychiatry & Human Behavior, and Obstetrics & Gynecology, University of California, Irvine, CA 92697, USA
| | - Sonja Entringer
- UC Irvine Development, Health and Disease Research Program, University of California, Irvine, CA 92697, USA; (C.B.); (P.D.W.); (S.E.)
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany
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10
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Kretchy IA, Koduah A, Ohene-Agyei T, Boima V, Appiah B. The Association between Diabetes-Related Distress and Medication Adherence in Adult Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. J Diabetes Res 2020; 2020:4760624. [PMID: 32190697 PMCID: PMC7071811 DOI: 10.1155/2020/4760624] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/31/2020] [Accepted: 02/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a major public health problem associated with distress. T2DM can affect health outcomes and adherence to medications. Little is however known about the association between diabetes distress and medication adherence among patients with T2DM in Ghana. OBJECTIVE The objective of the present study is twofold: to estimate distress associated with T2DM and to examine its association with medication adherence. METHODS A hospital-based cross-sectional study was conducted among 188 patients with T2DM recruited from a diabetes specialist outpatient clinic at the Pantang Hospital in Accra, Ghana. Data were obtained using the Problem Areas In Diabetes (PAID) scale and the Medication Adherence Report Scale. RESULTS The findings showed that about 44.7% of the patients showed high levels of diabetes-related distress. Poor adherence to medications was recorded in 66.5% of the patients. Patients who were highly distressed had 68% lower odds of adhering to their medications compared to those who were not (OR: 0.32, 95% CI: 0.15-0.65). A principal component analysis revealed four areas of T2DM distress which were conceptualized as negative emotions about diabetes, dietary concerns and diabetes care, dissatisfaction with external support, and diabetes management helplessness. CONCLUSION Our findings suggest that diabetes distress is a significant determinant of medication adherence behaviour in patients with T2DM. Thus, incorporating routine screening for distress into the standard diabetes care within the Ghanaian health system and having health practitioners adopt holistic approaches to diabetes management will be important context-specific interventions to improve adherence and health outcomes of people living and coping with T2DM.
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Affiliation(s)
- Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Ghana
| | - Thelma Ohene-Agyei
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Ghana
| | - Vincent Boima
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
| | - Bernard Appiah
- Centre for Science and Health Communication, PMB M71, Ministries, Accra, Ghana
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University Health Science Center, 212 Adriance Lab Rd, 1266 TAMU, College Station, Texas, USA
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11
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Wagner JA, Feinn R, Lampert R, Bermúdez-Millán A, Pérez-Escamilla R. Changes in negative affect and changes in heart rate variability among low-income latinos with type 2 diabetes in a randomized, controlled stress management trial. J Psychosom Res 2019; 124:109774. [PMID: 31443815 DOI: 10.1016/j.jpsychores.2019.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Structural equation modeling examined the relationship between change in negative affect (NA) and change in heart rate variability (HRV) among 121 Latinos with type 2 diabetes. METHODS This study leveraged data from the Community Health Workers Assisting Latinos Manage Stress and Diabetes (CALMSD) study which compared diabetes education vs diabetes education plus stress management. Participants completed surveys of NA at baseline and again 8-10 weeks later. They also wore 7‑lead, 3-channel ambulatory ECG monitors for 24 h at both time points. The latent variable NA was modeled by observed scores on symptoms of depression, anxiety, diabetes distress, and wellbeing (reversed). The latent variable HRV was modeled by observed scores in the time domain (the standard deviation of the R-R interval [SDNN] and the root mean square of the successive differences [RMSSD]) and in the frequency domain, i.e., log-transformed ultra-low frequency, very-low frequency, low frequency, and high frequency. RESULTS At baseline, there were strong, negative cross-sectional associations between NA and HRV. Baseline NA predicted change in HRV, whereas baseline HRV did not predict change in NA. Controlling for fasting glucose and treatment assignment did not meaningfully alter the findings. Stress management improved NA but not HRV. At followup, a greater reduction (improvement) in NA was associated with a larger increase (improvement) in HRV, with a small-to-medium negative association that approached statistical significance. CONCLUSIONS Findings indicate a longitudinal relationship between NA and HRV, and suggest that improvement in one may be associated with improvement in the other.
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Affiliation(s)
- Julie A Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, United States of America.
| | - Richard Feinn
- Quinnipiac University School of Medicine, United States of America
| | - Rachel Lampert
- Yale University School of Medicine, United States of America
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12
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Predictor of depressive disorders in patients with antineutrophil cytoplasmic antibody-associated vasculitis. Clin Rheumatol 2019; 38:3485-3491. [DOI: 10.1007/s10067-019-04657-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/16/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
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The Role of Affect and Coping in Diabetes Self-Management in Rural Adults with Uncontrolled Diabetes and Depressive Symptoms. J Clin Psychol Med Settings 2019; 25:55-65. [PMID: 29332264 DOI: 10.1007/s10880-017-9527-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Many patients with diabetes have poorly controlled blood sugar levels and remain at risk for serious diabetes complications, despite access to effective diabetes treatments and services. Using the transactional model of stress and coping framework, the study investigated the contributions of affect (Positive and Negative Affect Schedule) and coping (maladaptive and adaptive coping from the Brief Cope) on diabetes self-management behaviors, namely diet and exercise. One hundred seventy-eight rural adults with uncontrolled diabetes and moderate depressive symptoms completed the measures. Multiple regression analyses demonstrated that positive affect and negative affect were significantly associated with diet and exercise, even after adjusting for diabetes severity, illness intrusiveness, and diabetes knowledge. However, two path analyses clarified that adaptive coping mediated the relationships between affect (positive and negative) and self-management behaviors (diet and exercise). Comprehensive diabetes treatments that include self-management support can assist patients in recognition and use of adaptive emotion-focused coping skills.
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Zhou Y, Dong Z, A R, Liao Z, Guo J, Liu C, Sun X. The prevalence of impaired glucose regulation in anxiety disorder patients and the relationship with hypothalamic-pituitary-adrenal axis and hypothalamic-pituitary-thyroid axis activity. J Evid Based Med 2019; 12:51-55. [PMID: 27792263 DOI: 10.1111/jebm.12224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/27/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the prevalence of impaired glucose regulation (IGR) in patients with anxiety disorders and the relationship with hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes function. METHODS From September 2013 to May 2015, a total of 646 patients with anxiety disorders who matched the criteria of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems participated in our study, which was conducted in the Psychiatric Inpatient Department of the West China Hospital of Sichuan University. The results from 75-g glucose tolerance tests, and morning (8:00 am) serum cortisol (PTC), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), TT3, TT4, FT3, and FT4 levels were collected. The Hamilton Anxiety Scale was administered to assess the severity of anxiety. SPSS 17.0 software was used for statistical analysis. RESULTS The crude prevalence of impaired glucose regulation was 24.61% in patients with anxiety disorders patients. In the 18- to 40-year age group with impaired glucose regulation (IGR), both ACTH and PTC levels were higher than the control group (P < 0.05). In the 61- to 75-year age group with IGR, the TSH level was lower and the FT4 level was higher than the control group (P < 0.05). CONCLUSION The results herein partially confirm that the prevalence of IGR in patients with anxiety disorders is high. Impaired glucose in the younger age group is closely associated with HPA axis function, while impaired glucose in the older age group is closely associated with HPT axis alteration. Therefore, routine blood glucose and endocrine function testing in patients with anxiety disorder is of clinical importance to prevent the development of diabetes.
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Affiliation(s)
- Yaling Zhou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zaiquan Dong
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ruhan A
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zongbing Liao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Guo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Cancan Liu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xueli Sun
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Mulvaney SA, Vaala S, Hood KK, Lybarger C, Carroll R, Williams L, Schmidt DC, Johnson K, Dietrich MS, Laffel L. Mobile Momentary Assessment and Biobehavioral Feedback for Adolescents with Type 1 Diabetes: Feasibility and Engagement Patterns. Diabetes Technol Ther 2018; 20:465-474. [PMID: 29882677 PMCID: PMC6025702 DOI: 10.1089/dia.2018.0064] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Integration of momentary contextual and psychosocial factors within self-management feedback may provide more specific, engaging, and personalized targets for problem solving. METHODS Forty-four youth ages 13-19 with type 1 diabetes (T1D) were provided a Bluetooth meter and completed the 30-day protocol. Participants were randomized to "app + meter" or "meter-only" groups. App + meter participants completed mealtime and bedtime assessment each day. Assessments focused on psychosocial and contextual information relevant for self-management. Graphical feedback integrated self-monitored blood glucose (SMBG), insulin, and Bluetooth-transmitted blood glucose data with the psychosocial and contextual data. App + meter participants completed an interview to identify data patterns. RESULTS The median number of momentary assessments per participant was 80.0 (range 32-120) with 2.60 per day. By 2 weeks participants had an average of 40.77 (SD 12.23) assessments. Dose-response analyses indicated that the number of app assessments submitted were significantly related to higher mean daily SMBG (r = -0.44, P < 0.05) and to lower% missed mealtime SMBG (r = -0.47, P < 0.01). Number of feedback viewing sessions was also significantly related to a lower% missed mealtime SMBG (r = -0.44, P < 0.05). Controlling for baseline variables, mixed-effects analyses did not indicate group × time differences in mean daily SMBG. Engagement analyses resulted in three trajectory groups distinguished by assessment frequencies and rates of decline. Engagement group membership was significantly related to gender, mean daily SMBG, and HbA1c values. CONCLUSIONS Momentary assessment combined with device data provided a feasible means to provide novel personalized biobehavioral feedback for adolescents with T1D. A 2-week protocol provided sufficient data for self-management problem identification. In addition to feedback, more intensive intervention may need to be integrated for those patients with the lowest self-management at baseline.
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Affiliation(s)
- Shelagh A. Mulvaney
- School of Nursing, Vanderbilt University, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah Vaala
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Korey K. Hood
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Cindy Lybarger
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rachel Carroll
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Laura Williams
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | | | - Kevin Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Lori Laffel
- Joslin Diabetes Center, Harvard University, Boston, Massachusetts
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Coombs LJ, Burston B, Liu D. Importance of an alternative approach to measuring quality in a volume-to-value world: a case study of diabetes care. BMJ Open Qual 2018; 6:e000216. [PMID: 29435512 PMCID: PMC5736086 DOI: 10.1136/bmjoq-2017-000216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 11/04/2022] Open
Abstract
Background To develop a statistical tool that allows practitioners and/or their practice managers to easily select the relevant range in which volume and value are maximised. Methods Data for the study were based on 55 primary care practices that participated in the Colorado Improving Performance in Practice programme in 2014. We used two composite variables including the volume of processes of care variables listed in Diabetes Practice Guidelines and value (quality) as measured by changes in the intermediate outcomes. We assessed volume/value trade-offs using a multilevel model with a time-varying covariate partitioned into a between-practice and within-practice effect. Results The study revealed a strong linear relationship between volume and value (P<0.0001). Specifically, practices with an above-average volume of care as measured by their process of care scores also had above-average quality outcomes (expected value 57; average volume 49.48) as quantified by their intermediate outcome scores. Additionally, in those months when practices provided a volume of care that exceeded their average process of care score, further improvements occurred in quality as measured by intermediate outcome scores (P<0.0001). Conclusion Such findings suggest an inherent linkage between volume of care and quality. This statistical approach, if provided as an app containing an easy-to-use statistical calculator, will allow practice managers and clinicians to systematically identify volume/quality trade-offs, thereby reducing undertreatment and/or overtreatment among patients with chronicities.
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Affiliation(s)
- Letoynia Jenee Coombs
- Department of Family Medicine, The University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Betty Burston
- Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada, Las Vegas, Nevada, USA
| | - Darren Liu
- Department of Public Health, Des Moines University, Des Moines, Iowa, USA
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Mean Levels and Variability in Affect, Diabetes Self-Care Behaviors, and Continuously Monitored Glucose: A Daily Study of Latinos With Type 2 Diabetes. Psychosom Med 2017; 79:798-805. [PMID: 28437381 PMCID: PMC5573602 DOI: 10.1097/psy.0000000000000477] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated between- and within-person associations among mean levels and variability in affect, diabetes self-care behaviors, and continuously monitored glucose in Latinos with type 2 diabetes. METHODS Fifty participants (M [SD] age = 57.8 [11.7] years, 74% women, mean [SD] glycosylated hemoglobin A1c = 8.3% [1.5%]) wore a "blinded" continuous glucose monitor for 7 days, and they responded to twice daily automated phone surveys regarding positive affect, negative affect, and self-care behaviors. RESULTS Higher mean levels of NA were associated with higher mean glucose (r = .30), greater percent hyperglycemia (r = .34) and greater percentage of out-of-range glucose (r = .34). Higher NA variability was also related to higher mean glucose (r = .34), greater percent of hyperglycemia (r = .44) and greater percentage of out-of-range glucose (r = .43). Higher positive affect variability was related to lower percentage of hypoglycemia (r = -.33). Higher mean levels of self-care behaviors were related to lower glucose variability (r = -.35). Finally, higher self-care behavior variability was related to greater percentage of hyperglycemia (r = .31) and greater percentage of out-of-range glucose (r = -.28). In multilevel regression models, within-person increases from mean levels of self-care were associated with lower mean levels of glucose (b = -7.4, 95% confidence interval [CI] = -12.8 to -1.9), lower percentage of hyperglycemia (b = -0.04, 95% CI = -0.07 to -0.01), and higher percentage of hypoglycemia (b = 0.02, 95% CI = 0.01 to 0.03) in the subsequent 10-hour period. CONCLUSIONS Near-to-real time sampling documented associations of glucose with affect and diabetes self-care that are not detectable with traditional measures.
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Diener E, Pressman SD, Hunter J, Delgadillo-Chase D. If, Why, and When Subjective Well-Being Influences Health, and Future Needed Research. Appl Psychol Health Well Being 2017; 9:133-167. [PMID: 28707767 DOI: 10.1111/aphw.12090] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We review evidence on whether subjective well-being (SWB) can influence health, why it might do so, and what we know about the conditions where this is more or less likely to occur. This review also explores how various methodological approaches inform the study of the connections between subjective well-being and health and longevity outcomes. Our review of this growing literature indicates areas where data are substantial and where much more research is needed. We conclude that SWB can sometimes influence health, and review a number of reasons why it does so. A key open question is when it does and does not do so-in terms of populations likely to be affected, types of SWB that are most influential (including which might be harmful), and types of health and illnesses that are most likely to be affected. We also describe additional types of research that are now much needed in this burgeoning area of interest, for example, cross-cultural studies, animal research, and experimental interventions designed to raise long-term SWB and assess the effects on physical health. This research area is characterised both by potentially extremely important findings, and also by pivotal research issues and questions.
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Affiliation(s)
- Ed Diener
- University of Virginia and University of Utah and the Gallup Organization, USA
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Conti C, Di Francesco G, Fontanella L, Carrozzino D, Patierno C, Vitacolonna E, Fulcheri M. Negative Affectivity Predicts Lower Quality of Life and Metabolic Control in Type 2 Diabetes Patients: A Structural Equation Modeling Approach. Front Psychol 2017; 8:831. [PMID: 28596745 PMCID: PMC5443140 DOI: 10.3389/fpsyg.2017.00831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 05/08/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction: It is essential to consider the clinical assessment of psychological aspects in patients with Diabetes Mellitus (DM), in order to prevent potentially adverse self-management care behaviors leading to diabetes-related complications, including declining levels of Quality of Life (QoL) and negative metabolic control. Purpose: In the framework of Structural Equation Modeling (SEM), the specific aim of this study is to evaluate the influence of distressed personality factors as Negative Affectivity (NA) and Social Inhibition (SI) on diabetes-related clinical variables (i.e., QoL and glycemic control). Methods: The total sample consists of a clinical sample, including 159 outpatients with Type 2 Diabetes Mellitus (T2DM), and a control group composed of 102 healthy respondents. All participants completed the following self- rating scales: The Type D Scale (DS14) and the World Health Organization QoL Scale (WHOQOLBREF). Furthermore, the participants of the clinical group were assessed for HbA1c, disease duration, and BMI. The observed covariates were BMI, gender, and disease duration, while HbA1c was considered an observed variable. Results: SEM analysis revealed significant differences between groups in regards to the latent construct of NA and the Environmental dimension of QoL. For the clinical sample, SEM showed that NA had a negative impact on both QoL dimensions and metabolic control. Conclusions: Clinical interventions aiming to improve medication adherence in patients with T2DM should include the psychological evaluation of Type D Personality traits, by focusing especially on its component of NA as a significant risk factor leading to negative health outcomes.
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Affiliation(s)
- Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Giulia Di Francesco
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Lara Fontanella
- Department of Legal and Social Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy.,Psychiatric Research Unit, Mental Health Centre North Zealand, University of CopenhagenHillerød, Denmark
| | - Chiara Patierno
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
| | - Mario Fulcheri
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-PescaraChieti, Italy
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20
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Novak JR, Anderson JR, Johnson MD, Hardy NR, Walker A, Wilcox A, Lewis VL, Robbins DC. Does Personality Matter in Diabetes Adherence? Exploring the Pathways between Neuroticism and Patient Adherence in Couples with Type 2 Diabetes. Appl Psychol Health Well Being 2017; 9:207-227. [PMID: 28401663 DOI: 10.1111/aphw.12087] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Personality has received some attention in the Type 2 diabetes literature; however, research has not linked personality and diabetes adherence behaviors (diet and exercise), identified pathways through which they are associated, nor taken into consideration important contextual factors that influence behavior (the patient's partner). METHODS Dyadic data from 117 married, heterosexual couples in which one member is diagnosed with Type 2 diabetes was used to explore associations between each partner's neuroticism and patient dietary and exercise adherence through the pathways of negative affect, depression symptoms, and couple-level diabetes efficacy (both patient and spouse report of confidence in the patient's ability to adhere to diabetes management regimens). RESULTS Results revealed that higher levels of neuroticism were associated with lower patient dietary and exercise adherence through (1) higher levels of depression symptoms (for patients' neuroticism) and negative affect (for spouses' neuroticism), and (2) lower levels of couple-level diabetes efficacy. CONCLUSIONS The results from this study provide evidence that both patient and spouse personality traits are associated with patient dietary and exercise adherence through increased emotional distress-albeit different emotional pathways for patients and spouses-and lower couple confidence in the patients' ability to manage their diabetes.
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Affiliation(s)
| | | | | | | | - Ann Walker
- University of Kansas Medical Center, USA
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21
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Feng X, Astell-Burt T. Impact of a type 2 diabetes diagnosis on mental health, quality of life, and social contacts: a longitudinal study. BMJ Open Diabetes Res Care 2017; 5:e000198. [PMID: 28243446 PMCID: PMC5316913 DOI: 10.1136/bmjdrc-2016-000198] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 12/03/2016] [Accepted: 12/17/2016] [Indexed: 12/03/2022] Open
Abstract
AIMS The aim was to examine whether a type 2 diabetes mellitus (T2DM) diagnosis increases the odds of psychological distress, a worsening in overall quality of life, and a potential reduction in social contacts. METHOD Longitudinal data were obtained from the 45 and Up Study (baseline 2006-2008; 3.4±0.95 years follow-up time). Fixed effects logistic and negative binomial regression models were fitted on a complete case on outcome sample that did not report T2DM at baseline (N=26 344), adjusted for time-varying confounders. The key exposure was doctor-diagnosed T2DM at follow-up. Outcome variables examined included the Kessler Psychological Distress Scale, self-rated quality of life, and four indicators of social contacts. RESULTS A modest increase in the odds of psychological distress associated with T2DM diagnosis (OR=1.30) was not statistically significant (95% CI 0.75 to 2.25). A T2DM diagnosis was associated with a fivefold increase in the odds of a participant reporting that their quality of life had become significantly poorer (OR 5.49, 95% CI 1.26 to 23.88). T2DM diagnosis was also associated with a reduction in times spent with friends and family (RR 0.88, 95% CI 0.82 to 0.95), contacts by telephone (RR 0.95, 95% CI 0.87 to 1.02), attendance at social clubs or religious groups (RR 0.82, 95% CI 0.73 to 0.91), and the number of people nearby but outside the home that participants felt they could rely on (RR 0.92, 95% CI 0.86 to 0.98). CONCLUSIONS A T2DM diagnosis can have important impacts on quality of life and on social contacts, which may have negative impacts on mental health and T2DM management in the longer term.
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Affiliation(s)
- Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Gupta S, Anderson R, Holt RI. Greater variation in affect is associated with lower fasting plasma glucose. Heliyon 2016; 2:e00160. [PMID: 27699281 PMCID: PMC5037241 DOI: 10.1016/j.heliyon.2016.e00160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/24/2016] [Accepted: 09/09/2016] [Indexed: 11/30/2022] Open
Abstract
Background Depression and bipolar illness are associated with a 2–3 fold increase in the prevalence of diabetes. However, it is unknown whether variation in mood affects glucose metabolism. The aim of this study was to assess whether changes in affect were related to fasting plasma glucose and glycated haemoglobin. Methods 379 men and 441 women who took part in the 2003 Health Survey for England and had valid data for GHQ12 and fasting blood glucose were included. Mood variability was assessed by the General Health Questionnaire 12 (GHQ12). Fasting plasma glucose and glycated haemoglobin (HbA1c) were measured by standard laboratory methodology and their relationship to variability assessed using linear regression. Results There was a significant inverse relationship between fasting blood glucose, but not HbA1c, and variability score (R2 = 0.327, p = 0.02) after adjusting for sociodemographic factors, anthropometric measurements, lifestyle, and use of medication. Conclusion This study has shown an inverse association between changes in affect and fasting plasma glucose. This unexpected finding suggests that the association between affect and glucose is more complex than previously thought. Fasting blood glucose may reflect the operation of homeostatic mechanisms that are disturbed in certain mental states and are associated, therefore, with altered risk of diabetes and related metabolic conditions. This may have implications for the management of those with such conditions and with mental disorders.
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Affiliation(s)
- Sunjai Gupta
- Institute of Psychiatry, Psychology and Neurology, Kings College, De Crespigny Park, London SE5 8AF, UK
| | | | - Richard Ig Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, UK
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Rook KS, August KJ, Choi S, Franks MM, Stephens MAP. Emotional reactivity to daily stress, spousal emotional support, and fasting blood glucose among patients with type 2 diabetes. J Health Psychol 2016; 21:2538-2549. [DOI: 10.1177/1359105315581064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Stress is associated with higher blood glucose in patients with diabetes, but the strength of this association varies considerably across patients. The current daily diary study of 129 patients with type 2 diabetes examined whether individual differences in emotional stress reactivity were associated with fasting blood glucose and whether emotional support provided by spouses moderated this association. Greater stress reactivity was related to greater variability in patients’ fasting glucose readings and, among patients with less support, to higher fasting glucose levels. Investigating individual differences in emotional stress reactivity may help to clarify the role of stress in blood glucose control.
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Ein-Dor T, Coan JA, Reizer A, Gross EB, Dahan D, Wegener MA, Carel R, Cloninger CR, Zohar AH. Sugarcoated isolation: evidence that social avoidance is linked to higher basal glucose levels and higher consumption of glucose. Front Psychol 2015; 6:492. [PMID: 25954240 PMCID: PMC4407480 DOI: 10.3389/fpsyg.2015.00492] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/06/2015] [Indexed: 11/13/2022] Open
Abstract
Objective: The human brain adjusts its level of effort in coping with various life stressors as a partial function of perceived access to social resources. We examined whether people who avoid social ties maintain a higher fasting basal level of glucose in their bloodstream and consume more sugar-rich food, reflecting strategies to draw more on personal resources when threatened. Methods: In Study 1 (N = 60), we obtained fasting blood glucose and adult attachment orientations data. In Study 2 (N = 285), we collected measures of fasting blood glucose and adult attachment orientations from older adults of mixed gender, using a measure of attachment style different from Study 1. In Study 3 (N = 108), we examined the link between trait-like attachment avoidance, manipulation of an asocial state, and consumption of sugar-rich food. In Study 4 (N = 115), we examined whether manipulating the social network will moderate the effect of attachment avoidance on consumption of sugar-rich food. Results: In Study 1, fasting blood glucose levels corresponded with higher attachment avoidance scores after statistically adjusting for time of assessment and interpersonal anxiety. For Study 2, fasting blood glucose continued to correspond with higher adult attachment avoidance even after statistically adjusting for interpersonal anxiety, stress indices, age, gender, social support and body mass. In Study 3, people high in attachment avoidance consume more sugar-rich food, especially when reminded of asocial tendencies. Study 4 indicated that after facing a stressful task in the presence of others, avoidant people gather more sugar-rich food than more socially oriented people. Conclusion: Results are consistent with the suggestion that socially avoidant individuals upwardly adjust their basal glucose levels and consume more glucose-rich food with the expectation of increased personal effort because of limited access to social resources. Further investigation of this link is warranted.
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Affiliation(s)
- Tsachi Ein-Dor
- School of Psychology, Interdisciplinary Center Herzliya , Herzliya, Israel
| | - James A Coan
- University of Virginia, Charlottesville , VA, USA
| | - Abira Reizer
- Ariel University Center of Samaria , Ariel, Israel
| | | | | | | | - Rafael Carel
- Machon Mor Medical Center , Haifa, Israel ; Haifa University , Haifa, Israel
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Chew BH, Shariff-Ghazali S, Fernandez A. Psychological aspects of diabetes care: Effecting behavioral change in patients. World J Diabetes 2014; 5:796-808. [PMID: 25512782 PMCID: PMC4265866 DOI: 10.4239/wjd.v5.i6.796] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/05/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
Patients with diabetes mellitus (DM) need psychological support throughout their life span from the time of diagnosis. The psychological make-up of the patients with DM play a central role in self-management behaviors. Without patient’s adherence to the effective therapies, there would be persistent sub-optimal control of diseases, increase diabetes-related complications, causing deterioration in quality of life, resulting in increased healthcare utilization and burden on healthcare systems. However, provision of psychosocial support is generally inadequate due to its challenging nature of needs and demands on the healthcare systems. This review article examines patient’s psychological aspects in general, elaborates in particular about emotion effects on health, and emotion in relation to other psychological domains such as cognition, self-regulation, self-efficacy and behavior. Some descriptions are also provided on willpower, resilience, illness perception and proactive coping in relating execution of new behaviors, coping with future-oriented thinking and influences of illness perception on health-related behaviors. These psychological aspects are further discussed in relation to DM and interventions for patients with DM. Equipped with the understanding of the pertinent nature of psychology in patients with DM; and knowing the links between the psychological disorders, inflammation and cardiovascular outcomes would hopefully encourages healthcare professionals in giving due attention to the psychological needs of patients with DM.
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Birnbaum-Weitzman O, Goldberg R, Hurwitz BE, Llabre MM, Gellman MD, Gutt M, McCalla JR, Mendez AJ, Schneiderman N. Depressive symptoms linked to 1-h plasma glucose concentrations during the oral glucose tolerance test in men and women with the metabolic syndrome. Diabet Med 2014; 31:630-6. [PMID: 24344735 PMCID: PMC3988212 DOI: 10.1111/dme.12356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/25/2013] [Accepted: 10/26/2013] [Indexed: 11/29/2022]
Abstract
AIMS The addition of the 1-h plasma glucose concentration measure from an oral glucose tolerance test to prediction models of future Type 2 diabetes has shown to significantly strengthen their predictive power. The present study examined the relationship between severity of depressive symptoms and hyperglycaemia, focusing on the 1-h glucose concentration vs. fasting and 2-h glucose measures from the oral glucose tolerance test. METHODS Participants included 140 adults with the metabolic syndrome and without diabetes who completed a baseline psychobiological assessment and a 2-h oral glucose tolerance test, with measurements taken every 30 min. Depressive symptoms were assessed using the Beck Depression Inventory. RESULTS Multivariate linear regression revealed that higher levels of depressive symptoms were associated with higher levels of 1-h plasma glucose concentrations after adjusting for age, gender, ethnicity, BMI, antidepressant use and high-sensitivity C-reactive protein. Results were maintained after controlling for fasting glucose as well as for indices of insulin resistance and secretion. Neither fasting nor 2-h plasma glucose concentrations were significantly associated with depressive symptoms. CONCLUSIONS Elevated depressive symptoms in persons with the metabolic syndrome were associated with greater glycaemic excursion 1-h following a glucose load that was not accounted for by differences in insulin secretory function or insulin sensitivity. Consistent with previous findings, this study highlights the value of the 1-h plasma glucose measurement from the oral glucose tolerance test in the relation between depressive symptoms and glucose metabolism as an indicator of metabolic abnormalities not visible when focusing on fasting and 2-h post-oral glucose tolerance test measurements alone.
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Affiliation(s)
- O Birnbaum-Weitzman
- Behavioral Medicine Research Center, University of Miami, Miami, FL, USA; Department of Psychology, University of Miami, Miami, FL, USA
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Abstract
Despite its pervasiveness in primary care, deficient sleep often is underappreciated as a cue to other health risks. Accordingly, this review discusses contemporary evidence-based perspectives on impaired sleep and its associations with other lifestyle medicine concerns, including obesity, cardiovascular conditions, psychological problems, and health-compromising habits. The potential clinical benefits of promoting sleep health also will be considered.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
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Hessler D, Fisher L, Glasgow RE, Strycker LA, Dickinson LM, Arean PA, Masharani U. Reductions in regimen distress are associated with improved management and glycemic control over time. Diabetes Care 2014; 37:617-24. [PMID: 24170750 PMCID: PMC3931383 DOI: 10.2337/dc13-0762] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cross-sectional and longitudinal associations among regimen distress (RD), self-management, and glycemic control were undertaken to explore mechanisms of operation among these variables. RESEARCH DESIGN AND METHODS In a behavioral randomized control trial (RCT) to reduce RD, 392 adults with type 2 diabetes were assessed for RD, diet, exercise, medication adherence, and HbA1c at baseline and at 4 and 12 months. Associations among RD, self-management, and HbA1c were examined in cross-sectional analyses at baseline, in prospective analyses using baseline values to predict change over time, and in time-varying analyses. RESULTS At baseline, greater RD and poorer medication adherence were independently associated with higher HbA1c (P = 0.05 and P < 0.001, respectively), and greater RD was associated with poorer medication adherence (P = 0.03). No consistent pattern of significant prospective associations was found. Significant time-varying findings showed that decreases in RD were associated with improvements in medication adherence (P < 0.01), physical activity (P < 0.001), and HbA1c (P = 0.02) over time following intervention. Changes in self-management were not associated with changes in HbA1c over time. CONCLUSIONS In the context of an RCT to reduce distress, RD, self-management, and HbA1c were interrelated in cross-sectional and time-varying analyses. Decreases in RD were associated with improvements in both self-management and HbA1c over 12 months. Findings point to the complex and likely multifaceted pathways of association among these key constructs, with results indicating significant linkages between RD and both self-management and glycemic control over time.
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Abstract
Diabetes mellitus is a chronic disease which has been associated with depression. Depression is more common in adults with type 2 diabetes mellitus (T2DM) as compared to those without. Both micro- and macro vascular diabetic complications are associated with depression and have shown to increase the risk of mood disorder. Further, poor glycemic control in T2DM patients could lead to more complications of diabetes and such patients are more likely to develop depression. More research is needed in this area to determine the exact relationship between depression and T2DM and to unfold the mystery of mechanism behind this.
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Caldwell JM, Patterson-Kane L. The Treatment of Comorbid Anxiety in a Male With Poorly Controlled Diabetes in a Very Remote Primary Health Care Service. Clin Case Stud 2013. [DOI: 10.1177/1534650113507992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rural Australians are shown to have poorer health and mental-health outcomes compared with their metropolitan counterparts, particularly for diabetes. Individuals with diabetes often meet criteria for comorbid mental-health conditions, such as anxiety and depression. Psychological treatment, as an adjunct to medical care, for individuals with diabetes is shown to improve overall health and wellbeing. This article describes a 38-year-old male who was referred to a very remote primary health care service by his diabetes educator for strategies to reduce work-related stress and improve his diabetes mismanagement. Mindfulness-based cognitive behavior therapy techniques were used, over six sessions, in the context of a rural and very remote community. Pre- and post-intervention measures showed a reduction in anxiety, distress, and improvement in his perception of his quality of life. Clinical implications for psychological treatment of diabetes and comorbid mental-health issues in rural and remote communities are discussed.
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Choi SE, Rush EB, Henry SL. Negative emotions and risk for type 2 diabetes among Korean immigrants. THE DIABETES EDUCATOR 2013; 39:679-88. [PMID: 23793726 PMCID: PMC3815651 DOI: 10.1177/0145721713492566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to examine the relationship between negative emotions and bio-behavioral risk factors among Korean immigrants at risk for type 2 diabetes (T2DM). METHODS Data were collected from 148 Korean immigrant adults who are "at risk" for T2DM as defined by having family history of T2DM in first-degree relatives, body mass index greater than 23, or history of gestational diabetes in women. Participants completed questionnaires and underwent biological measures. Negative emotions included feeling nervous, hopeless, restless, anxious, and stressed as well as depressive symptoms. RESULTS High percentages of participants had T2DM risk factors including overweight, greater than normal waist to hip ratio, and blood glucose readings that are indicative of T2DM. Feeling stressed was the most commonly reported negative emotion (66%), followed by feeling anxious (51%), restless (38%), nervous (30%), and hopeless (13%). Experience of negative emotions was significantly related to behavioral risk factors; higher levels of experiencing negative emotions were related to increased soda intake and a decreased likelihood of doing at least 10 minutes of moderate exercise. Stress and anxiety were each negatively related to moderate exercise, and depressive symptoms were negatively related to both moderate and vigorous exercise. No significant relationship was found between negative emotions and biological risk factors. CONCLUSIONS Findings suggest that negative emotions, individually and taken together, may be related to T2DM risk behaviors in high-risk Korean immigrants. Behavioral interventions to prevent T2DM in this population should consider assessing and addressing negative emotions.
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Affiliation(s)
- Sarah E Choi
- Program in Nursing Science, College of Health Sciences, University of California, Irvine, California (Dr Choi)
| | - Elizabeth B Rush
- Department of Psychology and Social Behavior, School of Social Ecology, University of California, Irvine, California (Ms Rush, Ms Henry)
| | - Shayna L Henry
- Department of Psychology and Social Behavior, School of Social Ecology, University of California, Irvine, California (Ms Rush, Ms Henry)
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Madhu M, Abish A, Anu K, Jophin RI, Kiran AM, Vijayakumar K. Predictors of depression among patients with diabetes mellitus in Southern India. Asian J Psychiatr 2013; 6:313-7. [PMID: 23810139 DOI: 10.1016/j.ajp.2013.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 01/20/2013] [Accepted: 01/29/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Diabetes mellitus and depression are major public health problems and are significantly linked with each other. This research study intends to assess for undiagnosed depression and its predictors among adult diabetic patients. METHODS A cross-sectional study was done among 100 patients with type 2 diabetes mellitus attending the diabetic clinic of a tertiary care hospital. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9). Chi-square test was performed and odds ratios (OR) with 95% confidence interval (95% CI) were obtained. Mann Whitney U and Pearson correlation tests were done. Logistic regression was carried out to determine the predictors of depression and adjusted odds ratios with 95% confidence intervals were obtained. RESULTS The prevalence of depression was 49% (95% CI 39.1-58.9%). The predictors of depression were female gender, elevated fasting blood sugar (FBS) level, physical disability and lack of physician's advice about lifestyle modifications. FBS values were significantly higher in depressed individuals as compared to the non-depressed (p value 0.002). A positive correlation (r=0.38, p value 0.01) was obtained between PHQ-9 scores and the FBS values of the diabetic subjects. CONCLUSIONS Subjects with diabetes are highly prone for comorbid depression. Physicians should be sensitive towards the need for assessing for possible depression and its risk factors in diabetic patients.
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Affiliation(s)
- Mathew Madhu
- Department of Community Medicine, Govt Medical College, Trivandrum 695 011, Kerala, India
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Affiliation(s)
- M A Sabin
- Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia
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Penckofer SM, Ferrans C, Mumby P, Byrn M, Emanuele MA, Harrison PR, Durazo-Arvizu RA, Lustman P. A psychoeducational intervention (SWEEP) for depressed women with diabetes. Ann Behav Med 2013; 44:192-206. [PMID: 22777878 DOI: 10.1007/s12160-012-9377-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Clinically significant depression is present in 25 % of individuals with type 2 diabetes, its risk being doubled in women. PURPOSE To examine the effectiveness of the Study of Women's Emotions and Evaluation of a Psychoeducational (SWEEP), a group therapy for depression treatment based on cognitive behavioral therapy principles that was developed for women with type 2 diabetes was conducted. METHODS Women with significantly elevated depression symptoms (Center for Epidemiologic Studies Depression Scale ≥16) were randomized to SWEEP (n = 38) or usual care (UC, n = 36). RESULTS Multilevel modeling indicated that SWEEP was more effective than UC in reducing depression (mean difference of -15 vs. -7, p < .01), decreasing trait anxiety (mean difference of -15 vs. -5, p < .01), and improving anger expression (mean difference of -12 vs. -5, p < .05). Although SWEEP and UC had improvements in fasting glucose (mean difference of -24 vs. -1 mg/dl) and HbA1c (mean difference of -0.4 vs. -0.1 %), there were no statistically significant differences between groups. CONCLUSIONS SWEEP was more effective than UC for treating depressed women with type 2 diabetes. Addition of group therapy for depression meaningfully expands the armamentarium of evidence-based treatment options for women with diabetes.
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Affiliation(s)
- Sue M Penckofer
- School of Nursing, Loyola University Chicago, Maywood, IL, USA.
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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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Robertson SM, Stanley MA, Cully JA, Naik AD. Positive emotional health and diabetes care: concepts, measurement, and clinical implications. PSYCHOSOMATICS 2012; 53:1-12. [PMID: 22221716 DOI: 10.1016/j.psym.2011.09.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/20/2011] [Accepted: 09/22/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Numerous studies describe the effect of emotional problems, including diabetes-related distress and depression, on diabetes outcomes. Little attention has been devoted to positive emotional health and its potential role in facilitating patients' self-management and improved outcomes. OBJECTIVE This review describes the conceptualization and measurement of three empirically-tested aspects of positive emotional health (well-being, positive affect, resilience) in the diabetes literature and their relationship to diabetes outcomes. METHOD A literature review was conducted using PubMed and the Cochrane Library databases from 1970 to January 2011 to identify studies focused on well-being, positive affect, and resilience in diabetes patients. RESULTS Twenty-two studies were identified based on our inclusion criteria. Well-being studies were least likely to include conceptualizations and relied on two primary measurement instruments compared to more heterogeneous presentations found in positive affect and resilience studies. All three aspects of positive emotional health were linked to health-related outcomes and self-management. CONCLUSION Positive emotional health may facilitate chronic care self-management and improved health outcomes. We present a model to guide future research and intervention development efforts designed to enhance positive emotional health.
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Affiliation(s)
- Suzanne M Robertson
- Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
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Penckofer S, Quinn L, Byrn M, Ferrans C, Miller M, Strange P. Does glycemic variability impact mood and quality of life? Diabetes Technol Ther 2012; 14:303-10. [PMID: 22324383 PMCID: PMC3317401 DOI: 10.1089/dia.2011.0191] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Diabetes is a chronic condition that significantly impacts quality of life. Poor glycemic control is associated with more diabetes complications, depression, and worse quality of life. The impact of glycemic variability on mood and quality of life has not been studied. METHODS A descriptive exploratory design was used. Twenty-three women with type 2 diabetes wore a continuous glucose monitoring system for 72 h and completed a series of questionnaires. Measurements included (1) glycemic control shown by glycated hemoglobin and 24-h mean glucose, (2) glycemic variability shown by 24-h SD of the glucose readings, continuous overall net glycemic action (CONGA), and Fourier statistical models to generate smoothed curves to assess rate of change defined as "energy," and (3) mood (depression, anxiety, anger) and quality of life by questionnaires. RESULTS Women with diabetes and co-morbid depression had higher anxiety, more anger, and lower quality of life than those without depression. Certain glycemic variability measures were associated with mood and quality of life. The 24-h SD of the glucose readings and the CONGA measures were significantly associated with health-related quality of life after adjusting for age and weight. Fourier models indicated that certain energy components were significantly associated with depression, trait anxiety, and overall quality of life. Finally, subjects with higher trait anxiety tended to have steeper glucose excursions. CONCLUSIONS Data suggest that greater glycemic variability may be associated with lower quality of life and negative moods. Implications include replication of the study in a larger sample for the assessment of blood glucose fluctuations as they impact mood and quality of life.
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Affiliation(s)
- Sue Penckofer
- Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA.
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Papelbaum M, Moreira RO, Coutinho W, Kupfer R, Zagury L, Freitas S, Appolinário JC. Depression, glycemic control and type 2 diabetes. Diabetol Metab Syndr 2011; 3:26. [PMID: 21978660 PMCID: PMC3212883 DOI: 10.1186/1758-5996-3-26] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 10/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Comorbid depression in diabetes has been suggested as one of the possible causes of an inadequate glycemic control. The purpose of this study was to investigate the association between major depression and the glycemic control of type 2 diabetes mellitus (T2DM). METHODS Seventy T2DM patients were evaluated. They underwent a psychiatric examination using the following instruments: Structured Clinical Interview for DSM-IV and Beck Depression Inventory. The diabetes status was assessed in the short-term (glycemia, glycated hemoglobin) clinical control. RESULTS The presence of current depression was observed in 18.6% (13/70). In addition, type 2 diabetes patients who displayed depression evidenced higher levels of glycated hemoglobin (8.6 ± 2.0 vs. 7.5 ± 1.8; p = 0.05) when compared to those who did not exhibit a mood disorder. CONCLUSIONS In our sample, the presence of depression seems to impact on the short-term control of T2DM. The authors discuss the clinical utility of these findings in the usual treatment of diabetes.
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Affiliation(s)
- Marcelo Papelbaum
- Obesity and Eating Disorders Group, Psychiatry Institute of the Federal University of Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Rodrigo O Moreira
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - Walmir Coutinho
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - Rosane Kupfer
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - Leão Zagury
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - Silvia Freitas
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
| | - José C Appolinário
- Obesity and Eating Disorders Group, Psychiatry Institute of the Federal University of Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
- Department of Diabetes, State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, 20211-340, Brazil
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Lee SA, Guajardo NR. Affect intensity and alexithymia differentially influence the relationship between neuroticism and depressive symptomatology among college students. PERSONALITY AND INDIVIDUAL DIFFERENCES 2011. [DOI: 10.1016/j.paid.2010.11.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fasting Blood Glucose and Depressive Mood among Patients with Mental Illness in a Medicaid Managed Care Program. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:862708. [PMID: 21738870 PMCID: PMC3124031 DOI: 10.1155/2011/862708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/21/2011] [Accepted: 04/04/2011] [Indexed: 12/31/2022]
Abstract
Objective. This study explores the relationship between depressive symptoms, as measured by the PHQ-9 depression screen and blood glucose levels among patients with diabetes enrolled in Gold Choice, a Medicaid managed care program for individuals with mental illness and/or substance abuse. Methods. The PHQ-9 was mailed to 454 Gold Choice members and a questionnaire was mailed to their physicians requesting current HbA1c% and fasting blood glucose (FBG) levels. The pearson product-moment correlation was used to describe the association between PHQ-9 scores and FBG levels. Results. The PHQ-9 response rate was 55% (N = 249). Laboratory results were received for 141 patients. The correlation between FBG and PHQ-9 scores was modest but statistically significant: r = 0.21 , P = 0.015. Conclusion. A statistically significant association was found between FBG and PHQ-9 depression scores. This finding supports current recommendations that physicians be alert to depressive symptoms among patients with diabetes or impaired glucose metabolism.
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Abstract
The goal of this article is to review the recent literature on measures of glycemic variability, links between glycemic variability and psychological functioning, and methods for examining these links. A number of commonly used measures of glycemic variability are reviewed and compared, including recently proposed methods. Frequently used measures of glycemic variability are also discussed in the context of research that uses continuous glucose monitoring for the collection of blood glucose data. The results of previous studies that have examined the link between psychological functioning and glycemic variability within relatively short-term time frames are reviewed. Methods for examining glycemic variability and its link with psychological functioning are discussed so that important research questions can be addressed to aid in understanding the effect of changes in psychological functioning on glycemic variability and vice versa in future research.
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Affiliation(s)
- Joseph R Rausch
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Terre L. Is There a Connection Between Diabetes and Psychological Dysfunction? Am J Lifestyle Med 2010. [DOI: 10.1177/1559827610375905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This review discusses evidence-based perspectives on the relationship between diabetes and psychological distress. Future directions for inquiry and clinical management also are addressed.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City,
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Cunningham J. Socio-economic gradients in self-reported diabetes for Indigenous and non-Indigenous Australians aged 18-64. Aust N Z J Public Health 2010; 34 Suppl 1:S18-24. [PMID: 20618286 DOI: 10.1111/j.1753-6405.2010.00547.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine and compare socio-economic gradients in diabetes among Indigenous and non-Indigenous Australians. METHODS I analysed weighted data on self-reported diabetes and a range of socio-economic status (SES) measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004-05. RESULTS After adjusting for age, diabetes prevalence was significantly higher among those of lower SES in both Indigenous and non-Indigenous populations. The age- and sex-adjusted odds ratios (OR) for diabetes for the lowest versus the highest SES group were similar for the two populations on many variables. For example, the OR for the lowest quintile of equivalised household income (compared with quintiles 3-5 combined) was 2.3 (95% CI 1.6-3.4) for the Indigenous population and 2.0 (95% CI 1.5-2.8) for the non-Indigenous population. However, Indigenous people of high SES had greater diabetes prevalence than low SES non-Indigenous people on every SES measure examined. CONCLUSION Socio-economic status explains some but not all of the difference in diabetes prevalence between Indigenous and non-Indigenous Australians. Other factors that may operate across the socio-economic spectrum, such as racism, stress, loss and grief, may also be relevant and warrant further examination. IMPLICATIONS Indigenous Australians do not constitute a homogeneous group with respect to socio-economic status or diabetes prevalence, and this diversity must be recognised in developing measures to redress Indigenous health disadvantage.
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Affiliation(s)
- Joan Cunningham
- Menzies School of Health Research and Institute of Advanced Studies, Charles Darwin University, Northern Territory.
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Koerner SS, Shirai Y, Kenyon DB. Sociocontextual circumstances in daily stress reactivity among caregivers for elder relatives. J Gerontol B Psychol Sci Soc Sci 2010; 65:561-72. [PMID: 20595204 DOI: 10.1093/geronb/gbq045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Using a daily diary design, we examined whether emotional and physical reactivity in the face of care-related stressors is more intense for caregivers (CGs) living with lower levels of available socioemotional support and higher numbers of extrinsic stressors. Sixty-three CGs reported their experiences based on the past 24 hr (i.e., number of caregiving tasks, care recipient problem behaviors, family disagreements regarding care, depressive symptoms, feelings of burden, physical symptoms) on eight consecutive survey days; they also reported on extrinsic stressors and available socioemotional support. Multilevel analyses indicated significant moderator effects: within-person patterns of reactivity to care-related stressors were especially strong for CGs with lower levels of available socioemotional support and higher numbers of extrinsic stressors. For example, managing additional care recipient problem behaviors on a given day was more strongly associated with increased depressive and physical health symptoms as well as feelings of burden for CGs with relatively high numbers of extrinsic stressors. Implications for intervention are discussed.
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Affiliation(s)
- Susan Silverberg Koerner
- Division of Family Studies and Human Development, PO Box 210078, University of Arizona, Tucson, AZ 85721-0078, USA.
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Abstract
Hypertension is on a worrisome public health trajectory. This review discusses some key contributing dynamics as well as considerations for progress toward the prevention and control of hypertension and its comorbidities.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City,
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47
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Fisher L, Mullan JT, Skaff MM, Glasgow RE, Arean P, Hessler D. Predicting diabetes distress in patients with Type 2 diabetes: a longitudinal study. Diabet Med 2009; 26:622-7. [PMID: 19538238 PMCID: PMC2740749 DOI: 10.1111/j.1464-5491.2009.02730.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS Diabetes distress (DD) is a condition distinct from depression that is related to diabetes outcomes. In those without distress initially, little is known about what indicators place patients at risk for subsequent distress over time. METHODS From a community-based, three-wave, 18-month study of Type 2 diabetic patients (n = 506), we identified patients with no DD at T1 who displayed DD at T2, T3 or both (n = 57). Using logistic regression with full and trimmed models, we compared them with patients with no DD at all three time points (n = 275) on three blocks of variables: patient characteristics (demographics, depression, extra-disease stress), biological (HbA(1c), body mass index, comorbidities, complications, blood pressure, non-high-density lipoprotein-cholesterol), and behavioural variables (diet, exercise). Selected interactions with stress and major depressive disorder (MDD) were explored. RESULTS The odds of becoming distressed over time were higher for being female, previously having had MDD, experiencing more negative events or more chronic stress, having more complications, and having poor diet and low exercise. Negative life events increased the negative effects of both high HbA(1c) and high complications on the emergence of distress over time. CONCLUSIONS We identified a list of significant, independent direct and interactive predictors of high DD that can be used for patient screening to identify this high-risk patient cohort. Given the impact of high DD on diabetes behavioural and biological indicators, the findings suggest the usefulness of regularly appraising both current life and disease-related stressors in clinical care.
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Affiliation(s)
- L Fisher
- Departments of Family and Community Medicine, UCSF, PO Box 0900, San Francisco, CA 94143, USA.
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