Do communities matter after rehabilitation? The effect of socioeconomic and urban stratification on well-being after spinal cord injury

Botticello AL, Chen Y, Cao Y, Tulsky DS. Do communities matter after rehabilitation? The effect of socioeconomic and urban stratification on well-being after spinal cord injury.

Objective

To assess the influence of community-level socioeconomic status (SES) and urban composition on well-being after spinal cord injury (SCI) rehabilitation.

Design

Retrospective analysis of cross-sectional survey data.

Setting

Two participating centers in the SCI Model Systems (SCIMS) program.

Participants

Persons (N=1454) with traumatic SCI from New Jersey and Alabama enrolled in the SCIMS database in 2000 to 2009.

Intervention

Not applicable.

Main Outcome Measures

Dichotomous measures of perceived health (ill vs good health), life satisfaction (dissatisfied vs satisfied), and depressive symptoms (presence of a syndrome vs not) to assess well-being.

Results

Multilevel logistic regression was used to model community effects on each indicator of well-being. The likelihood of ill health and dissatisfaction with life in people with SCI, but not depressive symptoms, varied across communities. Community SES was related inversely to the odds of reporting ill health. However, the odds for dissatisfaction were higher in persons with SCI living in high SES and urban communities. Associations between community predictors and dissatisfaction with life were sustained after controlling for individual differences in injury severity, SES, and demographics, whereas individual SES was a stronger predictor of ill health than community SES.

Conclusion

This research suggests that community stratification influences the likelihood for diminished well-being for persons with SCI after rehabilitation. Understanding the contribution of communities in long-term outcomes after SCI rehabilitation is needed to inform future interventions aimed at preventing disability in this population.     

Predictors of Participation Enfranchisement After Spinal Cord Injury: The Mediating Role of Depression and Moderating Role of Demographic and Injury Characteristics

Objectives

(1) To examine the mediating effects of depressive symptoms on the relations between employment, grief, depression treatment, and participation enfranchisement after spinal cord injury (SCI); and (2) to examine the moderating role of demographic and injury characteristics, including sex, race, marital status, education, and injury level, and completeness on these relations.

Design

Cross-sectional survey as part of the Project to Improve Symptoms and Mood after SCI (PRISMS).

Setting

Rehabilitation facilities.

Participants

Persons with SCI (N=522; average age, 42y; 76% men; 64% white; 64% completed at least a high school education) enrolled from 2007 to 2011.

Interventions

Not applicable.

Main Outcome Measure

Participation enfranchisement.

Results

The final model fit the data relatively well (comparative fix index=.939; Tucker-Lewis Index=.894; root mean square error of approximation=.066; 90% confidence interval, .043–.089), explaining 32% of the variance in participation enfranchisement. Enfranchisement was positively related to employment and negatively related to depression. Grieving the loss of a loved one and the use of an antidepressant or psychotherapy were related to participation enfranchisement; these relations were mediated by depressive symptoms. Multigroup analyses supported the model's invariance across sex, marital status, severity of injury, and level of injury.

Conclusions

Depression appears to mediate the influence of employment, grief, and depression treatments on participation enfranchisement after SCI. These relations are applicable regardless of sex, marital status, and injury completeness and level. These findings highlight efforts to improve the detection and treatment of depression in SCI rehabilitation programs that may enhance participation.     

Weight matters: physical and psychosocial well being of persons with spinal cord injury in relation to body mass index

Chen Y, Cao Y, Allen V, Richards JS. Weight matters: physical and psychosocial well being of persons with spinal cord injury in relation to body mass index.

Objective

To examine the relationship of body mass index (BMI) with multiple health indices among persons with spinal cord injury (SCI).

Design

Multicenter cross-sectional study.

Setting

A total of 16 SCI Model Systems throughout the United States.

Participants

A total of 1107 men and 274 women (N=1381), mean age ± SD, 43.1±14.6 years (tetraplegia, 56.9%; complete injuries, 50.2%; mean years since injury ± SD, 7.8±8.6), who received follow-up in 2006 to 2009, were classified into 1 of the 4 BMI categories—underweight, normal, overweight, and obese—based on self-reported height and measured weight.

Interventions

Not applicable.

Main Outcome Measures

Rehospitalization, pain, self-perceived health, FIM, Craig Handicap Assessment and Reporting Technique, Patient Health Questionnaire-9 (PHQ-9), and the Diener's Satisfaction With Life Scale (SWLS).

Results

The prevalence of underweight, overweight, and obesity was 7.5%, 31.4%, and 22.1%, respectively, which varied by age, sex, marital status, education, and neurologic impairment. For those with tetraplegia and functional motor-complete injuries, rehospitalization occurred more frequently among obese persons, while days rehospitalized were the longest among underweight persons. Pain was more severe in those classified as obese. Community mobility was lower in the underweight, overweight, and obese groups than in those with normal weight. There was no significant association between BMI and self-perceived health, FIM, PHQ-9, and SWLS beyond the effect of neurologic impairment.

Conclusions

Prevention and intervention directed at those significantly overweight or underweight deserve consideration as priorities in the continuity of care for persons with SCI. Efforts should be targeted particularly to those at higher risk, including persons with more severe injuries, who are less educated, and who are living alone.     

Association of Internet Use and Depression Among the Spinal Cord Injury Population

Objective

To examine the relation between the frequency of Internet use and depression among people with spinal cord injury (SCI).

Design

Cross-sectional survey.

Setting

SCI Model Systems.

Participants

People with SCI (N=4618) who were interviewed between 2004 and 2010.

Interventions

Not applicable.

Main Outcome Measures

The frequency of Internet use and the severity of depressive symptoms were measured simultaneously by interview. Internet use was reported as daily, weekly, monthly, or none. The depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9), with 2 published criteria being used to screen for depressive disorder. The diagnostic method places more weight on nonsomatic items (ie, items 1, 2, and 9), and the cut-off method that determines depression by a (PHQ-9) score ≥10 places more weight on somatic factors. The average scores of somatic and nonsomatic items represented the severity of somatic and nonsomatic symptoms, respectively.

Results

Our multivariate logistic regression model indicated that daily Internet users were less likely to have depressive symptoms (odds ratio=.77; 95% confidence interval, .64–.93), if the diagnostic method was used. The linear multivariate regression analysis indicated that daily and weekly Internet usage were associated with fewer nonsomatic symptoms; no significant association was observed between daily or weekly Internet usage and somatic symptoms.

Conclusions

People with SCI who used the Internet daily were less likely to have depressive symptoms.     

Health, secondary conditions, and life expectancy after spinal cord injury

Krause JS, Saunders LL. Health, secondary conditions, and life expectancy after spinal cord injury.

Objective

To evaluate the association of health status, secondary health conditions, hospitalizations, and risk of mortality and life expectancy (LE) after spinal cord injury (SCI).

Design

Prospective cohort study.

Setting

Preliminary data were collected from a specialty hospital in the Southeastern United States, with mortality follow-up and data analysis conducted at a medical university.

Participants

Adults with traumatic SCI (N=1361), all at least 1-year postinjury at the time of assessment, were enrolled in the study. There were 325 deaths. After elimination of those with missing data on key variables, there were 267 deaths and 12,032 person-years.

Interventions

None.

Main Outcome Measures

The mortality status was determined by routine follow-up using the National Death Index through December 31, 2008. A logistic regression model was developed to estimate the probability of dying in any given year using person-years.

Results

A history of chronic pressure ulcers, amputations, a depressive disorder, symptoms of infections, and being hospitalized within the past year were all predictive of mortality. LE estimates were generated using the example of a man with noncervical, nonambulatory SCI. Using 3 age examples (20, 40, 60y), the greatest estimated lost LE was associated with chronic pressure ulcers (50.3%), followed by amputations (35.4%), 1 or more recent hospitalizations (18.5%), and the diagnosis of probable major depression (18%). Symptoms of infections were associated with a 6.7% reduction in LE for a 1 SD increase in infectious symptoms.

Conclusions

Several secondary health conditions represent risk factors for mortality and diminish LE after SCI. The presence of 1 or more of these factors should be taken as an indicator of the need for intervention.     

Spiritual well-being and depressive symptoms among cancer survivors

Purpose

Depression is common among patients diagnosed with cancer and may be inversely associated with spiritual well-being. While numerous strategies are employed to manage and cope with illness, spiritual well-being has become increasingly important in cancer survivorship research. This study examined the association between spiritual well-being and depressive symptoms.

Methods

This cross-sectional study utilized self-report data from 102 diverse cancer survivors recruited from peer-based cancer support groups in San Diego County. Depression was measured with the Patient Health Questionnaire-8 (PHQ-8) and spiritual well-being was measured with the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being (FACIT-Sp) comprised of two subscales (Meaning/Peace and Faith).

Results

Hierarchal regression analysis indicated that Meaning/Peace significantly predicted depressive symptoms after adjusting for socio-demographics, cancer stage, time since diagnosis, and Faith (p?<?.001).

Conclusions

Findings suggest that Spiritual Well-Being is a valuable coping mechanism and that Meaning/Peace has a unique advantage over Faith in protecting cancer survivors from the effects of depression symptoms; therefore, turning to Faith as source of strength may improve psychological well-being during survivorship.

Implications

Future programs and healthcare providers should be cognizant of the influential role of spiritual well-being in depression symptoms in an effort to improve psychological well-being among cancer survivors.     

Prevalence of depressive disorders in Rasht,Iran: A community based study

Introduction

Depression is a well known health problem worldwide. Prevalence of depressive disorders varies in different societies.

Aim

to determine the prevalence of depressive disorders and some associated factors in Rasht City (Northern part of Iran).

Materials and methods

4020 subjects were selected among 394925 residents of Rasht aged between 18–70 during 2003 – 2004. In the first phase, subjects were screened by Beck's Depression Inventory. In the second phase, those who scored more than 15 were assessed through semi-structured psychiatric interview (DSMIV-TR). Socio-demographic characteristics including age, gender, marital status, educational level, and socio-economic class were recorded as well.

Results

9.5% of samples (63% female and 37% male) were diagnosed by depressive disorders. The prevalence of minor depressive disorder, dysthymia and major depressive disorder was 5%, 2/5%, and 1% respectively. Socio-economic class was significantly associated with both depressive symptoms based on BDI score (p < 0.001) and depressive disorders based on clinical interview (p < 0.001).

Conclusion

Comparing to other studies, this study revealed that prevalence of dysthymic and minor depressive disorder were more than major depressive disorder, and low socio-economic class was the most significant risk factor associated with depression. Regarding our study limitations, researchers and policy makers should not consider our findings as conclusive results. Findings of this study could be applied by researchers using analytical methodology to assess relationship between depressive disorders and associated factors.

     

Depressive symptoms and perceived burdens related to being a student: Survey in three European countries

Background

Despite a high prevalence of depressive symptoms among university students, few studies have examined how this mental health problem is associated with perceived stress and perceived burdens related to being a student.

Methods

We conducted a cross-sectional study of 2,103 first year students from one western (Germany), one central (Poland), and one south-eastern European country (Bulgaria). The self-administered questionnaires included the modified Beck Depression Inventory and Cohen's Perceived Stress Scale. A 13 item scale measured perceived burdens related to being a student with four subscales: "Course work", "Relationships", "Isolation", and "Future".

Results

Depressive symptoms were highly prevalent in all three countries (M-BDI ≥35: 34% in Poland, 39% in Bulgaria, and 23% in Germany). Students felt more burdened by course work and bad job prospects ("Future") than by relationship problems or by feelings of isolation. The perceived burdens subscales "Future", "Relationship" and "Isolation" remained associated with depressive symptoms after adjusting for perceived stress, which displayed a strong association with depressive symptoms. The association between perceived stress and depressive symptoms differed by gender. These findings were similar in all three countries.

Conclusion

Perceived burdens related to studying are positively associated with higher depression scores among students, not only by mediation through perceived stress but also directly. While the strong association between perceived stress and depressive symptoms suggests the need for interventions that improve stress management, perceived burdens should also be addressed.

     

Concurrent Improvement in Both Binge Eating and Depressive Symptoms with Naltrexone/Bupropion Therapy in Overweight or Obese Subjects with Major Depressive Disorder in an Open-Label,Uncontrolled Study

Introduction

Binge eating disorder (BED) is associated with obesity and major depressive disorder (MDD). Naltrexone extended-release (ER)/bupropion ER (NB) is approved as an adjunct to diet and physical activity for chronic weight management. In a prospectively designed 24-week open-label, single-arm, single-site trial of 25 women with MDD and overweight/obesity, NB reduced weight and depressive symptoms.

Methods

This post hoc analysis investigated the relationship between change in self-reported binge eating behavior (evaluated with the Binge Eating Scale [BES]) and changes in weight, control of eating, and depressive symptoms.

Results

At baseline, 91% of subjects had moderate or severe BES scores, suggesting BED. BES scores were significantly improved from week 4, and by week 24, 83% reported “little or no problem.” Improvement in BES scores correlated with improvement in depressive symptoms and control of eating.

Conclusion

NB may be effective in reducing binge eating symptoms associated with MDD and overweight/obesity. Evaluation of NB in BED appears warranted.

Funding

Orexigen Therapeutics, Inc.

     

Elevated depressive symptoms, antidepressant use, and diabetes in a large multiethnic national sample of postmenopausal women

OBJECTIVE

To examine elevated depressive symptoms and antidepressant use in relation to diabetes incidence in the Women’s Health Initiative.

RESEARCH DESIGN AND METHODS

A total of 161,808 postmenopausal women were followed for over an average of 7.6 years. Hazard ratios (HRs) estimating the effects of elevated depressive symptoms and antidepressant use on newly diagnosed incident diabetes were obtained using Cox proportional hazards models adjusted for known diabetes risk factors.

RESULTS

Multivariable-adjusted HRs indicated an increased risk of incident diabetes with elevated baseline depressive symptoms (HR 1.13 [95% CI 1.07–1.20]) and antidepressant use (1.18 [1.10–1.28]). These associations persisted through year 3 data, in which respective adjusted HRs were 1.23 (1.09–1.39) and 1.31 (1.14–1.50).

CONCLUSIONS

Postmenopausal women with elevated depressive symptoms who also use antidepressants have a greater risk of developing incident diabetes. In addition, longstanding elevated depressive symptoms and recent antidepressant medication use increase the risk of incident diabetes.Adults with depression have an increased risk of developing diabetes (1,2). Antidepressant medication use has been implicated in the relationship between depression and diabetes (3–6), although few studies have investigated the independent effect of depression and antidepressant use (4,6). Using Women’s Health Initiative (WHI) data, we tested the hypotheses that 1) elevated depressive symptoms and antidepressant use would each be independently associated with an increased risk of diabetes, and 2) the combination of elevated depressive symptoms and antidepressant use would have a compounded effect on incident diabetes risk.     

Patterns, predictors, and associated benefits of driving a modified vehicle after spinal cord injury: findings from the National Spinal Cord Injury Model Systems

Norweg A, Jette AM, Houlihan B, Ni P, Boninger ML. Patterns, predictors, and associated benefits of driving a modified vehicle after spinal cord injury: findings from the National Spinal Cord Injury Model Systems.

Objectives

To investigate the patterns, predictors, and benefits associated with driving a modified vehicle for people with spinal cord injuries (SCIs).

Design

Cross-sectional retrospective survey design.

Settings

Sixteen Model SCI Systems (MSCISs) throughout the United States.

Participants

People (N=3726) post-SCI from the National MSCIS Database.

Interventions

Not applicable.

Main Outcome Measures

Driving, employment, and community reintegration post-SCI.

Results

The study found that 36.5% of the sample drove a modified vehicle after SCI. Significant predictors of driving a modified vehicle post-SCI included married at injury, younger age at injury, associate's degree or higher before injury, paraplegia, a longer time since the injury, non-Hispanic race, white race, male sex, and using a wheelchair for more than 40 hours a week after the injury (accounting for 37% of the variance). Higher activity of daily living independence (in total motor function) at hospital discharge also increased the odds of driving. Driving increased the odds of being employed at follow-up by almost 2 times compared with not driving postinjury (odds ratio, 1.85). Drivers tended to have higher community reintegration scores, especially for community mobility and total community reintegration. Driving was also associated with small health-related quality-of-life gains, including less depression and pain interference and better life satisfaction, general health status, and transportation availability scores.

Conclusions

The associated benefits of driving and the relatively low percentage of drivers post-SCI in the sample provide evidence for the need to increase rehabilitation and assistive technology services and resources in the United States devoted to facilitating driving after SCI.     

Mechanical ventilation, health, and quality of life following spinal cord injury

Charlifue S, Apple D, Burns SP, Chen D, Cuthbert JP, Donovan WH, Lammertse DP, Meade MA, Pretz CR. Mechanical ventilation, health, and quality of life following spinal cord injury.

Objective

To examine differences in perceived quality of life (QOL) at 1 year postinjury between people with tetraplegia who required mechanical ventilation assistance at discharge from rehabilitation and those who did not.

Design

Prospective cross-sectional examination of people with spinal cord injury (SCI) drawn from the SCI Model Systems National Database.

Setting

Community.

Participants

People with tetraplegia (N=1635) who sustained traumatic SCI between January 1, 1994, and September 30, 2008, who completed a 1-year follow-up interview, including 79 people who required at least some use of a ventilator at discharge from rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Satisfaction With Life Scale (SWLS); Craig Handicap Assessment and Reporting Technique (CHART)-Short Form Physical Independence, Mobility, Social Integration, and Occupation subscales; Patient Health Questionnaire-9 (PHQ-9), Medical Outcomes Study 36-Item Short-Form Health Survey self-perceived health status.

Results

Significant differences were found between the ventilator-user (VU) group and non–ventilator-user (NVU) group for cause of trauma, proportion with complete injury, neurologic impairment level, and number of rehospitalizations. The NVU group had significantly higher SWLS and CHART Social Integration scores than the VU group after controlling for selected covariates. The NVU group also had more positive perceived health status compared with a year previously and a lower incidence of depression assessed by using the PHQ-9 than the VU group. There were no significant differences between groups for perceived current health status.

Conclusions

People in this study who did not require mechanical ventilation at discharge from rehabilitation post-SCI reported generally better health and improved QOL compared with those who required ventilator assistance at 1 year postinjury. Nonetheless, the literature suggests that perceptions of QOL improve as people live in the community for longer periods.     

Depressive Symptoms and Risk of Type 2 Diabetes in a National Sample of Middle-Aged and Older Adults: The English Longitudinal Study of Aging

OBJECTIVE

To examine the association between baseline elevated depressive symptoms and incident type 2 diabetes in a national sample of people aged ≥50 years.

RESEARCH DESIGN AND METHODS

The sample consisted of 6,111 individuals free from self-reported doctor-diagnosed diabetes at baseline in 2002–2003. The eight-item Center for Epidemiological Studies–Depression (CES-D) scale was the measurement of depressive symptoms. Cox proportional hazards regression models were used to assess whether baseline elevated (≥4) depressive symptoms were associated with a higher risk of type 2 diabetes over 45.8 months of follow-up.

RESULTS

The hazard ratio (HR) for diabetes was 1.62 (95% CI 1.15–2.29) in a model adjusted for age, sex, marital status, education, total net household wealth, cardiovascular and psychiatric and other noncardiovascular comorbidities, BMI, and health behaviors for participants with elevated CES-D symptoms compared with those without. Complementary analysis performed for a subsample (n = 5,090) showed that additional adjustment of this model for use of antidepressants did not explain the association (HR 1.58, 95% CI 1.09–2.29).

CONCLUSIONS

Elevated depressive symptoms were associated with a higher risk of developing type 2 diabetes after accounting for sociodemographic, lifestyle, and clinical factors in a national sample of people aged ≥50 years.Depression is a known comorbid condition of diabetes. Individuals with diabetes have increased odds of being depressed and consistently higher prevalence rates of depression than their counterparts without diabetes (1). An accumulating body of research shows that type 2 diabetes is a risk factor for recurrent depression (2), but longitudinal studies also suggest that depression and elevated depressive symptoms are related to subsequent incidence of diabetes (3–10). Two recent meta-analyses of longitudinal studies suggest that depression is associated with a 40–60% increased risk of developing type 2 diabetes (11,12). The etiology and pathogenic mechanism of this association is poorly understood. It has been suggested that unhealthy behaviors (i.e., physical inactivity and smoking), obesity, and use of psychotropic medication may be parts of the causal pathway linking depression to type 2 diabetes (3,11,13).The majority of previous longitudinal studies on the association between depressive symptoms and incident diabetes have not accounted adequately for socioeconomic status (SES), and therefore their results might be biased because of residual confounding. They have also generally failed to account for baseline comorbidities such as cardiovascular, noncardiovascular, and psychiatric diseases, which might explain the association between depression and diabetes. Moreover, more research is needed on the use of antidepressants and other psychotropic medication as a depression-related risk factor for diabetes in older samples, since evidence on this issue is conflicting (6,8,9,14).We used data from the English Longitudinal Study of Aging (ELSA), a national prospective cohort study of community-dwelling middle-aged and older men and women, to examine whether baseline elevated depressive symptoms measured by the Center for Epidemiological Studies–Depression (CES-D) scale were associated with a higher risk of developing type 2 diabetes. We adjusted for a wide range of potential confounders including education and wealth as markers of SES and baseline comorbidities including psychiatric diseases. We then explored whether health behaviors, BMI, and use of antidepressants or other psychotropic medication mediated the association between elevated baseline depressive symptoms and incident type 2 diabetes.     

Depressive symptoms, antidepressant medication use, and insulin resistance: the PPP-Botnia Study

OBJECTIVE

Although insulin resistance (IR) may underlie associations between depressive symptoms and diabetes, previous findings have been contradictory. We examined whether depressive symptoms associate with IR and insulin secretion, and, additionally, whether antidepressant medication use may modulate such associations.

RESEARCH DESIGN AND METHODS

A total of 4,419 individuals underwent an oral glucose tolerance test (OGTT). Participants with previously or newly diagnosed diabetes are excluded from this sample. The homeostasis model assessment of IR (HOMA-IR) and corrected insulin response (CIR) were calculated. Depressive symptoms and antidepressant medication use were self-reported.

RESULTS

After controlling for confounding factors, depressive symptoms were associated with higher fasting and 30-min insulin during the OGTT and higher HOMA-IR but not CIR. Antidepressant medication use failed to modify these associations.

CONCLUSIONS

Depressive symptoms are associated with IR but not with changes in insulin response when corrected for IR in individuals without previously or newly diagnosed diabetes.Depressive symptoms are associated with type 2 diabetes (1) and the metabolic syndrome (2,3), and insulin resistance (IR) is thought to be the underlying factor. However, previous findings have been conflicting because depressive symptoms have been reported to be associated with both higher IR (4) and lower IR (5), whereas some studies have reported null associations (6,7). We examined associations of depressive symptoms with IR and insulin secretion in individuals without diabetes. We also tested if antidepressant medications modulated these associations, as one study suggests that antidepressant medication, such as the use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, may improve insulin sensitivity (8). Yet, one study reported that antidepressant medications and insulin sensitivity are not related (9), whereas some studies have reported that antidepressant medications may decrease insulin sensitivity and increase the risk of type 2 diabetes (10,11).     

Depression and family interaction among low-income, predominantly hispanic cancer patients: a longitudinal analysis

Purpose

Among cancer patients, family interaction has been associated with depression. According to the stress generation theory, depression among cancer patients triggers stressful interpersonal events that contribute to poor family interactions and additional depression. This conflict may occur with a spouse/partner or other family member, including extended family. This study evaluated the longitudinal association between depression and marital and family conflict among low-income, predominantly Hispanic cancer patients.

Methods

Data were collected during a randomized controlled clinical trial of depression treatment among 472 low-income cancer patients with baseline depression scores of 10 or more on the Patient Health Questionnaire-9 and whose depression symptoms and negative family interactions were assessed at baseline and at 6, 12, 18, and 24 months. Considering that not all participants were in an intimate relationship, only 237 participants were included in the analysis of marital conflict. Mixed linear modeling with and without decomposition of between- and within-person variability was conducted to examine the longitudinal association between family interaction and depression.

Results

Overall, family conflict was significantly associated with changes in depression over time, and marital conflict was significantly associated with mean depression levels over 2 years. In addition, within-subject change in both marital and family conflict was significantly associated with within-patient deviation from average depression levels.

Conclusions

Findings provide evidence of an association between depression and negative family interaction among depressed cancer patients. Cancer patients with clinically significant depressive symptoms may benefit from clinical assessment and psychotherapy relevant to family interaction.     

Association of depressive symptoms with impaired glucose regulation, screen-detected, and previously known type 2 diabetes: findings from the Finnish D2D Survey

OBJECTIVE

To study the association between impaired glucose regulation (IGR), screen-detected type 2 diabetes, and previously known diabetes and depressive symptoms.

RESEARCH DESIGN AND METHODS

Altogether, 2,712 participants from three hospital districts in Finland attended a health examination. Cutoff scores ≥10 and ≥16 in the 21-item Beck Depression Inventory (BDI-21) were used for depressive symptoms. The participants were defined as having known diabetes if they reported diabetes. An oral glucose tolerance test was used to detect normal glucose regulation (NGR), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and screen-detected diabetes. The participants were defined as having IGR if they had IFG or IGT.

RESULTS

Prevalence of depressive symptoms, defined as a BDI-21 cutoff score ≥10, was 14.4% for those with NGR, 13.7% for those with IGR, 14.8% for those with screen-detected diabetes, and 26.4% for those with previously known diabetes. The corresponding prevalences for a cutoff score ≥16 were 3.4, 3.4, 4.2, and 7.5%, respectively. Compared with NGR and adjusted for demographic, lifestyle, and biological factors, the odds ratios for IGR, screen-detected diabetes, and previously known diabetes were 0.91 (95% CI 0.69–1.20), 0.70 (0.45–1.08), and 1.35 (0.84–2.15), respectively, for a cutoff score ≥10. For a cutoff score ≥16, the corresponding odds ratios were 1.05 (0.62–1.76), 0.87 (0.40–1.90), and 1.56 (0.69–3.50), respectively.

CONCLUSIONS

Participants with diagnosed diabetes had a higher prevalence of depressive symptoms than participants with NGR, IGR, and previously unknown diabetes. When potential confounding factors were included in the analysis, previously known diabetes was not significantly associated with depressive symptoms.It is widely recognized that depression is more common among people with diabetes than in the general population (1). However, previous studies (2–10) that have assessed the relationship between depressive symptoms and impaired glucose tolerance (IGT) or diabetes have been inconsistent. A German study (4) that included 4,597 subjects and a Dutch study (2) that included 4,747 participants found no association between type 2 diabetes and depressive symptoms. In a general-practice setting study that included 2,849 male and 3,160 female subjects, depression was not more prevalent in people with screen-detected diabetes or impaired glucose regulation (IGR) than in people with normal glucose regulation (NGR) (5). Contrary to these studies, within the Hertfordshire Cohort Study (6) there was a relationship between depression scores and diagnosed and previously undiagnosed diabetes. A U.S. study (8) including 4,293 U.S. veterans indicated that men with undiagnosed type 2 diabetes had nearly double the odds of major depression compared with those with normal fasting glucose.In 1992, it was stated about the relationship between depression and diabetes that “the etiology is unknown but is probably complex; and biological, genetic, and psychological factors remain as potential contributors. Several neuroendocrine and neurotransmitter abnormalities common to both depression and diabetes have been identified, adding to etiological speculations” (11). It has been suggested that stress-induced activation of the hypothalamic-pituitary-adrenal axis may result in the development of metabolic abnormalities and depression (12). In addition, possible neuroendocrine abnormalities associated with both diabetes and depressive symptoms may include abnormalities in vitamin B₁₂ and sex hormone–binding globulin (SHBG) levels. Low vitamin B₁₂ levels have been found to relate to type 2 diabetes (13) and depressive symptoms (14–16). Low levels of SHBG may predict diabetes (17). SHBG binds circulating sex hormones, which have been suggested to be associated with depressive symptoms (18). In addition to these biological factors, the observed association between diabetes and depressive symptoms could be a reflection of the burden of diabetes and comorbidities.In the present study, our aim was to analyze the prevalence of depressive symptoms in people with NGR, IGR (including impaired fasting glycemia and impaired glucose tolerance), screen-detected (previously unknown) diabetes, and previously known type 2 diabetes. Furthermore, our aim was to study the association between glucose tolerance and depressive symptoms, taking into account potential confounding demographic and biological factors as well as comorbidity.     

Negative Life Events,Self-Perceived Competence,and Depressive Symptoms in Young Adults

Despite consistent support for Cole’s (1990, 1991) competency-based model of depression in children and adolescents, no studies have examined this model in adult samples and few have focused on congruence between domains of self-perceived competence and specific forms of negative life events. Addressing this gap in the current cross-sectional study, we found that forms of self-perceived competence may both moderate and partially mediate the link between negative events and young adults’ current depressive symptoms. Specifically, there was evidence for both the partial mediating and moderating roles of perceived global self-worth and self-perceived scholastic competence. In contrast, perceived social acceptance and negative social events appeared to be independent correlates of depressive symptoms.

Income and risk of mortality after spinal cord injury

Krause JS, Saunders LL, DeVivo MJ. Income and risk of mortality after spinal cord injury.

Objective

To evaluate the association of household income and formal education with risk of mortality after spinal cord injury (SCI).

Design

Cohort study.

Setting

Twenty hospitals designated as Model SCI Systems of care in the United States.

Participants

Adults (N=8027) with traumatic SCI, seen in one of the Model SCI Systems, who had at least 1 follow-up assessment between 1995 and 2006. All participants were at least 1 year postinjury at the time of assessment. There were 57,957 person-years and 1036 deaths. The follow-up period started with the first assessment between 1995 and 2006 and went until either the date of death or March 2009.

Interventions

Not applicable.

Main Outcome Measures

Mortality status was determined by routine follow-up supplemented by using the Social Security Death Index. A logistic regression model was developed to estimate the chance of dying in any given year.

Results

Educational status and income were significantly predictive of mortality after adjusting for age, sex, race, and severity of injury. Compared with those with household income of $75,000 or greater, the odds of mortality was greater for those who had income between $25,000 and $75,000 (1.61) and still higher for those with less than $25,000 a year (2.41). Life expectancy differed more as a function of household income than the economic subscale of the Craig Handicap Assessment and Reporting Technique.

Conclusion

There was a clear gradation in survival based on familial income (high, middle, low), not just an effect of the lowest income.