Who Benefits from Diabetes Self-Management Interventions? The Influence of Depression in the Latinos en Control Trial

Background

Depressive symptoms are common among adults with diabetes. Depression and social support may influence diabetes self-management.

Purpose

This study aimed to examine change in depressive symptoms and the role of depression and support on clinical and dietary outcomes among Latinos with type 2 diabetes participating in a diabetes self-management intervention.

Methods

Participants (N?=?252) were randomized to the intervention or usual care. Mixed effects models were used to examine interaction effects between intervention status and depressive symptoms (Centers for Epidemiologic Studies Depression (CES-D) score) and support for diabetes self-management behaviors at baseline. Outcomes were measured at baseline and 4 and 12 months and included dietary quality, physical activity, depressive symptoms, and hemoglobin A1c levels.

Results

Intervention participants had lower CES-D scores at follow-up than control participants. An interaction effect between intervention status and CES-D scores predicted diet quality.

Conclusion

Latinos with depressive symptoms may derive the greatest benefits from diabetes self-management interventions. Additional research on support during diabetes self-management interventions is warranted.     

Spouse Confidence in Self-Efficacy for Arthritis Management Predicts Improved Patient Health

Background

In addition to patient self-efficacy, spouse confidence in patient efficacy may also independently predict patient health outcomes. However, the potential influence of spouse confidence has received little research attention.

Purpose

The current study examined the influence of patient and spouse efficacy beliefs for arthritis management on patient health.

Methods

Patient health (i.e., arthritis severity, perceived health, depressive symptoms, lower extremity function), patient self-efficacy, and spouse confidence in patients’ efficacy were assessed in a sample of knee osteoarthritis patients (N?=?152) and their spouses at three time points across an 18-month period. Data were analyzed using structural equation models.

Results

Consistent with predictions, spouse confidence in patient efficacy for arthritis management predicted improvements in patient depressive symptoms, perceived health, and lower extremity function over 6 months and in arthritis severity over 1 year.

Conclusions

Our findings add to a growing literature that highlights the important role of spouse perceptions in patients’ long-term health.     

Stress and Coping Predicts Adjustment and Glycemic Control in Adolescents with Type 1 Diabetes

Background

Adolescents with type 1 diabetes are at increased risk for deteriorating glycemic control, poor quality of life, and depressive symptoms. Stress and coping are related to these outcomes in adolescents with diabetes, yet few studies have examined these constructs longitudinally.

Purpose

This study aimed to describe stress and coping in adolescents with type 1 diabetes and to examine coping strategies as predictors of adolescent adjustment (i.e., depressive symptoms, quality of life) and glycemic control.

Methods

Adolescents with type 1 diabetes completed measures of diabetes-related stress, coping, symptoms of depression, and quality of life at baseline, 6 months, and 12 months. Data on glycemic control were collected from the adolescents’ medical charts.

Results

The adolescents’ use of primary control coping (e.g., problem solving) and secondary control engagement coping (e.g., positive thinking) strategies predicted significantly fewer problems with quality of life and fewer depressive symptoms over time. In contrast, the use of disengagement coping strategies (e.g., avoidance) predicted more problems with quality of life and depressive symptoms. Coping was not a significant predictor of glycemic control. Coping mediated the effects of diabetes-related stress on depressive symptoms and quality of life.

Conclusions

The ways in which adolescents with type 1 diabetes cope with diabetes-related stress predict quality of life and symptoms of depression but not glycemic control. Through the use of screening to identify adolescent’s diabetes-related stress and targeted interventions to improve coping strategies, there is potential to improve outcomes.

     

The Psychosocial Context Impacts Medication Adherence After Acute Coronary Syndrome

Background

Depression is associated with poor adherence to medications and worse prognosis in patients with acute coronary syndrome (ACS).

Purpose

To determine whether cognitive, behavioral, and/or psychosocial vulnerabilities for depression explain the association between depression and medication adherence among ACS patients.

Methods

One hundred sixty-nine ACS patients who agreed to have their aspirin adherence measured using an electronic pill bottle for 3 months were enrolled within 1 week of hospitalization. Linear regression was used to determine whether depression vulnerabilities predicted aspirin adherence after adjustment for depressive symptoms, demographics, and comorbidity.

Results

Of the depression vulnerabilities, only role transitions (beta?=??3.32; P?=?0.02) and interpersonal conflict (beta -3.78; P?=?0.03) predicted poor adherence. Depression vulnerabilities did not mediate the association between depressive symptoms and medication adherence.

Conclusions

Key elements of the psychosocial context preceding the ACS including major role transitions and conflict with close contacts place ACS patients at increased risk for poor medication adherence independent of depressive symptoms.     

Depressive symptom trajectories in the first 10 years of diabetes diagnosis: antecedent factors and link with future disability in Taiwan

Purpose

This study identified depressive symptom trajectories in the years after diabetes diagnosis, examined factors that predict the probability for people following a specific trajectory, and investigated how the trajectories are associated with subsequent disability.

Methods

We drew data from a nationally representative survey in Taiwan to identify adults aged 50 and older diagnosed with diabetes; 487 patients newly diagnosed with diabetes during 1996–2007 were included. Time axis was set to zero when diabetes was first reported in any given wave in the survey, and data related to depressive symptoms after that were recorded. We used group-based semi-parametric mixture models to identify trajectories of depressive symptoms and multinomial logistic regressions to examine factors associated with the trajectories.

Results

Older adults with newly diagnosis of diabetes in Taiwan follow different trajectories of depressive symptoms over time. Being female, lower educated, not married/partnered, with lower self-rated health, hospitalizations, more limitations in physical function, less regular exercise before diagnosis, and not regularly using anti-diabetic medication at the beginning of their diagnosis were factors associated with increasing or high stable depressive symptom trajectories. Those who experienced high depressive symptoms were more likely than individuals with stable depressive symptoms to have physical limitations in the last follow-up interview.

Conclusions

Depressive symptom trajectories after diabetes diagnosis were associated with select sociodemographic, health, and lifestyle factors before diagnosis, and also predicted subsequent disability. Risk groups identified in the present study may be used for personalized diabetes care that prevents diabetes-related distress and future disability.

     

Physical activity patterns and risk of depression in young adulthood: a 20-year cohort study since childhood

Purpose

Little is known about how physical activity patterns during childhood and adolescence are associated with risk of subsequent depression. We examined prospective and retrospective associations between leisure physical activity patterns from childhood to adulthood and risk of clinical depression in young adulthood.

Methods

Participants (759 males, 871 females) in a national survey, aged 9–15 years, were re-interviewed approximately 20 years later. Leisure physical activity was self-reported at baseline (1985) and follow-up (2004–2006). To bridge the interval between the two time-points, historical leisure activity from age 15 years to adulthood was self-reported retrospectively at follow-up. Physical activity was categorized into groups that, from a public health perspective, compared patterns that were least beneficial (persistently inactive) with those increasingly beneficial (decreasing, increasing and persistently active). Depression (major depressive or dysthymic disorder) was assessed using the Composite International Diagnostic Interview.

Results

Compared with those persistently inactive, males who were increasingly and persistently active had a 69 and 65 % reduced risk of depression in adulthood, respectively (all p < 0.05). In retrospective analyses, females who were persistently active had a 51 % reduced risk of depression in adulthood (p = 0.01). Similar but non-significant trends were observed for leisure physical activity in females and historical leisure activity in males. Results excluded those with childhood onset of depression and were adjusted for various sociodemographic and health covariates.

Conclusions

Findings from both prospective and retrospective analyses indicate a beneficial effect of habitual discretionary physical activity since childhood on risk of depression in young adulthood.     

Prevalence, correlates, and symptom profiles of depression among men with a history of military service

Purpose

The purpose of this study was to examine the prevalence, correlates, and symptom profiles of depressive disorders in men with a history of military service.

Methods

Data were obtained from the 2006 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regressions were used to identify correlates of lifetime and current depression. Regularly occurring symptom profiles were identified via cluster analysis.

Results

Prevalence of lifetime and current depression was similar in men with and without a history of military service. Younger age was positively, and black minority status, being in a relationship and self-reported good health were negatively associated with a lifetime diagnosis of depression. Other minority status (non-Hispanic, non-black) was positively, and older age, some college, being in a relationship, and self-reported good health were negatively associated with current depression. A cluster of younger men who experience significant depressive symptoms but may not report depressed mood or anhedonia was identified.

Conclusions

Depression is as prevalent in men with a history of military service as it is in men without a history. Research should focus on subpopulations of men with a history of military service in which depression may be more prevalent or burdensome. Younger men with significant depressive symptoms may be missed by standard depression screens and still be at elevated risk for negative outcomes associated with depression.     

COPD and Depressive Symptoms: Findings from the Guangzhou Biobank Cohort Study

Background

Chronic obstructive pulmonary disease (COPD) co-exists with depression, but important questions remain about the determinants of this association.

Purpose

We examined the association of depressive symptoms with three aspects of COPD: self-reports of physician-diagnosed COPD, chronic respiratory symptoms, and airway obstruction.

Methods

We used data from the Guangzhou Biobank Cohort Study (n?=?7,995). Airway obstruction was assessed by spirometry. A score ??4 on the 15-item Geriatric Depression Scale was used as a cutoff for depressive symptoms.

Results

Self-reported COPD was positively associated with depressive symptoms but airway obstruction was not. Compared to those free of both respiratory symptoms and airway obstruction those reporting respiratory symptoms were more likely to have depressive symptoms regardless of whether they had obstruction or not.

Conclusions

In this Chinese population, a self-reported physician diagnosis of COPD and symptom perception, but not airway obstruction, appeared as main determinants of depressive symptoms.     

The effects of parent–child relationships on later life mental health status in two national birth cohorts

Purpose

Abusive and neglectful parenting is an established determinant of adult mental illness, but longitudinal studies of the impact of less severe problems with parenting have yielded inconsistent findings. In the face of growing interest in mental health promotion, it is important to establish the impact of this potentially remediable risk factor.

Methods

Participants: 8,405 participants in the 1958 UK birth cohort study, and 5,058 in the 1970 birth cohort study Exposures: questionnaires relating to the quality of relationships with parents completed at age 16?years. Outcomes: 12-item General Health Questionnaire and the Malaise Inventory collected at age 42?years (1958 cohort) and 30?years (1970 cohort). Statistical methodology: logistic regression analyses adjusting for sex, social class and teenage mental health problems.

Results

1958 cohort: relationships with both mother and father predicted mental health problems in adulthood; increasingly poor relationships were associated with increasing mental health problems at age 42?years. 1970 cohort: positive items derived from the Parental Bonding Instrument predicted reduced risk of mental health problems; negative aspects predicted increased risk at age 30?years. Odds of mental health problems were increased between 20 and 80% in fully adjusted models.

Conclusions

Results support the hypothesis that problems with parent–child relationships that fall short of abuse and neglect play a part in determining adult mental health and suggest that interventions to support parenting now being implemented in many parts of the Western world may reduce the prevalence of mental illness in adulthood.     

Onset of efficacy and tolerability following the initiation dosing of long-acting paliperidone palmitate: post-hoc analyses of a randomized, double-blind clinical trial

Background

Depression, cardiovascular disease (CVD) risk factors and cognitive impairment are important causes of disability and poor health outcomes. In combination they lead to an even worse prognosis. Internet or web-based interventions have been shown to deliver efficacious psychological intervention programs for depression on a large scale, yet no published studies have evaluated their impact among patients with co-existing physical conditions. The aims of this randomised controlled trial are to determine the effects of an evidence-based internet intervention program for depression on depressive mood symptoms, cognitive function and treatment adherence in patients at risk of CVD.

Methods/Design

This study is an internet-based, double-blind, parallel group randomised controlled trial. The trial will compare the effectiveness of online cognitive behavioural therapy with an online attention control placebo. The trial will consist of a 12-week intervention phase with a 40-week follow-up. It will be conducted in urban and rural New South Wales, Australia and will recruit a community-based sample of adults aged 45 to 75 years. Recruitment, intervention, cognitive testing and follow-up data collection will all be internet-based and automated. The primary outcome is a change in severity of depressive symptoms from baseline to three-months. Secondary outcomes are changes in cognitive function and adherence to treatment for CVD from baseline to three, six and 12-months.

Discussion

Prior studies of depression amongst patients with CVD have targeted those with previous vascular events and major depression. The potential for intervening earlier in these disease states appears to have significant potential and has yet to be tested. Scalable psychological programs using web-based interventions could deliver care to large numbers in a cost effective way if efficacy were proved. This study will determine the effects of a web-based intervention on depressive symptoms and adherence to treatment among patients at risk of CVD. In addition it will also precisely and reliably define the effects of the intervention upon aspects of cognitive function that are likely to be affected early in at risk individuals, using sensitive and responsive measures.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000085077     

The relationship between cognitive ability and depression: a longitudinal data analysis

Purpose

There is literature indicating cognitive ability and depression are related, but few studies have examined the direction of the relationship. This study examined the relationship between depression levels and cognitive abilities from adolescence to early adulthood.

Methods

Using the National Longitudinal Study of Adolescent Health (n = 14,322), this study used path modeling to investigate the relationship between depression and cognitive ability at baseline and again 8 years later.

Results

After controlling for initial levels of depression, cognitive ability, and other covariates, depressive symptoms in adolescence are related to cognitive ability in early adulthood, but adolescent cognitive ability is not related to adult depression levels. Moreover, after controlling for adolescent levels of depression and cognitive ability, the cognitive ability–depression relationship disappears in adulthood.

Conclusions

The cognitive ability–depression relationship appears early in life, and it is likely that the presence of depressive symptoms leads to lower cognitive ability. Thus, intervening at early signs of depression not only can help alleviate depression, but will likely have an effect of cognitive ability as well.     

Development and predictors of mental ill-health and wellbeing from childhood to adolescence

Purpose

The aim is to investigate the (1) longitudinal development in mental ill-health and wellbeing from ages 11 to 14, (2) predictors of changes in mental health outcomes, and (3) sex and reporter differences.

Method

Data are taken from 9553 participants in the Millennium Cohort Study, with both mental ill-health (parent- and self-report) and wellbeing outcomes of the cohort members measured at ages 11 and 14. A range of childhood socio-demographic, human capital, family and wider environment risk and protective factors are investigated.

Results

Wellbeing has weak stability and mental ill-health has moderate stability between ages 11 and 14 and large sex differences emerge in all the mental health outcomes investigated, with girls experiencing lower wellbeing and greater symptoms of mental illness at age 14. Raw associations between outcomes, and differences in their predictors, indicate varying patterns emerging for parent- and self-reported mental ill-health, with parent-reported symptoms in childhood a poor predictor of both self-reported wellbeing and depressive symptoms in adolescence. Investigating the emergent sex differences in prevalences highlights childhood risk and protective factors at this age that are more salient in females, including family income, school connectedness, cognitive ability, whereas peer relationships and bullying were equally relevant for mental health development in both males and females.

Conclusion

Low–moderate stability of mental health outcomes stresses the importance of the transition period for mental health, highlighting an intervention window at these ages for prevention. Socio-economic status is associated with mental health development in females but not in males at this age, highlighting a sex-specific vulnerability of deprivation associated with poorer mental health in adolescent females.

     

Psychosocial Stress Predicts Abnormal Glucose Metabolism: The Australian Diabetes, Obesity and Lifestyle (AusDiab) Study

Background

The evidence supporting a relationship between stress and diabetes has been inconsistent.

Purpose

This study examined the effects of stress on abnormal glucose metabolism, using a population-based sample of 3,759, with normoglycemia at baseline, from the Australian Diabetes, Obesity and Lifestyle study.

Methods

Perceived stress and stressful life events were measured at baseline, with health behavior and anthropometric information also collected. Oral glucose tolerance tests were undertaken at baseline and 5-year follow-up. The primary outcome was the development of abnormal glucose metabolism (impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes), according to WHO 1999 criteria.

Results

Perceived stress predicted incident abnormal glucose metabolism in women but not men, after multivariate adjustment. Life events showed an inconsistent relationship with abnormal glucose metabolism.

Conclusions

Perceived stress predicted abnormal glucose metabolism in women. Healthcare professionals should consider psychosocial adversity when assessing risk factor profiles for the development of diabetes.     

Multidimensional health locus of control and depressive symptoms in the multi-ethnic population of the Netherlands

Purpose

Ethnic inequalities in health in Western societies are well-documented but poorly understood. We examined associations between health locus of control (HLC) and depressive symptoms among native and non-native Dutch people in the Netherlands.

Methods

We used hierarchical multiple linear regression analyses on a representative sample of the multi-ethnic population of Amsterdam and The Hague (n = 10,302). HLC was measured with the multidimensional health locus of control scale. Depressive symptoms were measured with the Kessler Psychological Distress scale.

Results

Multivariate analyses showed that HLC contributes to ethnic differences in the prevalence of depressive symptoms. Respondents who scored high on external locus of control (PHLC) were more likely to have depressive symptoms than those with a low score on PHLC (β = 0.133, p < 0.001). Conversely, respondents scoring high on internal locus of control (IHLC) were less likely to have depressive symptoms compared to those scoring low on IHLC (β = ?0.134, p < 0.001). The associations were most pronounced among Turkish-Dutch and Moroccan-Dutch respondents.

Conclusion

Our findings suggest that HLC contributes to ethnic inequalities in depressive symptoms, especially among Turkish and Moroccan ethnic groups. Professionals (e.g. clinicians and policy makers) need to take HLC into account when assessing and treating depression among ethnic minority groups, particularly in Turkish and Moroccan populations. Future research should look further into the associations within these groups.     

Sub-syndromal depression in adolescents attending primary care: frequency, clinical features and 6 months outcome

Background

The nature of adolescent sub-syndromal depression has not been investigated in primary care.

Aims

To document frequency, characteristics and 6 month outcome of sub-syndromal depression amongst adolescent primary care attenders.

Method

Primary care attenders (13–18 years) completed depression screening questionnaires (Mood and Feelings Questionnaires) at consultation and at 6 month follow-up. Those screening positive were interviewed with the K-SADS. Sub-syndromal depression was defined as high levels of depressive symptoms in the absence of depressive disorder.

Results

Two hundred and seventy four questionnaires were completed at consultation: the estimated rate of sub-syndromal depression was 25 %. These young people were clinically intermediary between those without depressive symptoms and those with depressive disorder; at 6-months follow-up 57 % had persistent depressive symptoms and 12 % had developed a depressive disorder. Negative life events during the follow-up period and a positive family history of depression were the strongest predictors of symptom persistence and the development of depressive disorder, respectively.

Conclusion

Sub-syndromal depression is common and persistent, in adolescent primary care attenders and it deserves attention.     

Prevalence and factors related to depressive symptoms among family caregivers of nursing home residents in Taiwan

Purpose

The purpose of this cross-sectional study was to understand the prevalence and risk factors for depressive symptoms among nursing home residents’ family caregivers in Taiwan.

Methods

Family caregivers (n = 191) of nursing home residents were recruited by stratified random sampling from 16 nursing homes throughout Taiwan. Data were collected from caregivers in face-to-face interviews on depressive status (using the Center for Epidemiologic Studies Depression Scale; CES-D), on meaning ascribed to visiting nursing home residents (using the Family Meaning of Nursing-Home Visits scale), and on demographic data. Factors related to depressive symptoms were analyzed by multiple logistic regression.

Results

The prevalence of depressive status among family caregivers was 29.8 % as determined by the CES-D cutoff score of ≥10. The non-depressed group (CES-D <10) tended to visit residents for emotional maintenance (odds = 0.54), while the depressed group (CES-D ≥10) tended to visit due to sense of responsibility for monitoring care quality (odds = 3.25). These results demonstrate that risk factors for depressive symptoms in family caregivers were their age, self-perceived health status, education level, and being the resident’s main caregiver before admission.

Conclusion

These results fill a gap in knowledge by providing detailed, evidence-based data on family caregivers’ priorities for visiting nursing home residents and it is related to depression. These results also provide useful information for designing intervention protocols to reduce depressive symptoms in family caregivers of nursing home residents, not only in Asian countries, but also in western countries with many Chinese/Asian immigrants.     

Depressive symptoms during adolescence: comparison between epidemiological and high risk sampling

Purpose

Both epidemiological (unselected) and high risk (screening on known risk criteria) samplings have been used to investigate the course of affective disorders. Selecting individuals on multiple risk criteria may create a sample not comparable to individuals with similar risk criteria within the general population. This study compared depressive symptoms across the two sampling methods to test this possibility.

Methods

The high risk Cambridge Hormones and Moods Project (CHAMP) screened and recruited adolescents aged 12 to 16. A total of 905 (710 high risk) individuals participated and were reassessed at three follow-ups. The ROOTS epidemiological sample consisted of 1,208 14-year-olds reassessed at 15.5 and 17?years. The risk profile for CHAMP was recreated in the ROOTS study. Both samples completed the Moods and Feelings Questionnaire, a self-report measure of current depressive symptoms.

Results

Comparing individuals with the same high risk profiles across the CHAMP and ROOTS studies revealed no significant differences in mean depression scores. Combining the samples revealed that for females, mean depression scores were maintained from 12 to 15?years then declined by 17?years. For males, scores declined from 12 throughout adolescence. High risk status led to consistently higher levels of depressive symptoms in female adolescents but result in little change within male adolescents.

Conclusions

The high risk design recruited adolescents with a depression symptoms profile comparable to the general population for both sexes. High risk status may alter the trajectory of depressive symptoms in female adolescents only. Males may be less sensitive to recent adversity.     

Parental socio-economic position during childhood as a determinant of self-harm in adolescence

Purpose

Socio-economic position (SEP) during childhood and parental social mobility have been associated with subsequent health outcomes in adolescence and adulthood. This study investigates whether parental SEP during childhood is associated with subsequent self-harm in adolescence.

Methods

This study uses data from a prospective birth-cohort study (the Avon Longitudinal Study of Parents and Children) which followed 14,610 births in 1991–1992 to age 16–18 years (n = 4,810). The association of parental SEP recorded pre-birth and throughout childhood with self-harm was investigated using logistic regression models, with analyses conducted separately for those reporting self-harm (a) with and (b) without suicidal intent. The impact of missing data was investigated using multiple imputation methods.

Results

Lower parental SEP was associated with increased risk of offspring self-harm with suicidal intent, with less consistent associations evident for self-harm without suicidal intent. Associations were somewhat stronger in relation to measures of SEP in later childhood. Depressive symptoms appeared to partially mediate the associations. Adolescents of parents reporting consistently low income levels during childhood were approximately 1.5 times more likely to engage in SH than those never to report low income.

Conclusions

Lower SEP during childhood is associated with the subsequent risk of self-harm with suicidal intent in adolescence. This association is stronger in those experiencing consistently lower SEP.     

Family size and perinatal circumstances, as mental health risk factors in a Scottish birth cohort

Purpose

Higher maternal parity and younger maternal age have each been observed to be associated with subsequent offspring suicidal behaviour. This study aimed to establish if these, and other variables from the perinatal period, together with family size, are also associated with other psychiatric morbidity.

Methods

Linked datasets of the Scottish Morbidity Record and Scottish death records were used to follow up, into young adulthood, a birth cohort of 897,685. In addition to the index maternity records, mothers’ subsequent pregnancy records were identified, allowing family size to be estimated. Three independent outcomes were studied: suicide, self-harm, and psychiatric hospital admission. Data were analysed using Cox regression.

Results

Younger maternal age and higher maternal parity were independently associated with increased risk in offspring of suicide, of self-harm and of psychiatric admission. Risk of psychiatric admission was higher amongst those from families of three or more, but, compared with only children, those with two or three siblings had a lower risk of self harm.

Conclusion

Perinatal and family composition factors have a broad influence on mental health outcomes. These data suggest that the existence of younger, as well as elder siblings may be important.