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Tested the buffering model of social support among 158 adults with diabetes. We predicted that, among patients with higher levels of illness-related impairment, adequate social support would act as a buffer against depression. Measures included the Beck Depression Inventory; the Sickness Impact Profile; and an assessment of the adequacy of social support to enable the patient to deal with illness-related tasks, domestic chores, financial responsibilities, and emotional needs. Depressive symptoms correlated positively with functional impairment (r = .58, p less than .001) and negatively with the adequacy of social support (r = -.31, p less than .001). In addition, social support moderated depression in the face of greater impairment such that, among patients who reported the most illness-related functional disabilities, adequate support provided a relative protection from depression. The findings suggest that individuals with inadequate support are most at risk to become depressed when disability related to illness increases.
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PMID:Influence of functional impairment and social support on depressive symptoms in persons with diabetes. 228 83

A previous investigation of IST in Rochester, Minnesota, from 1960 through 1979 yielded an incidence of 1.1/100,000 person-years. The rate in women was almost three times higher than that in men. Thyroid disorders, other endocrine disorders, right-hand preference, symptomatic ovarian cysts, other disorders of the female genito-reproductive system, emotional depression, cerebral aneurysm, and family history of diabetes mellitus were common. In 347 cases of IST personally evaluated (151 seen between 1969-1971, a sample of 49 seen in 1978, and 147 other cases evaluated in 1985) the female-to-male ratio was 1.6:1. The mean age at onset was 43.5 years for women and 42 years for men, and the distributions of age at onset were virtually identical for the two sexes. Thyroid disorder was prevalent in all three referral patients samples. The increased frequency of thyroid disorder was due to a high overall frequency in female patients, 28.4% (95% confidence interval, 22.3-34.4%). Thyroid disorders were 4.5 times more frequent in women with IST than in men with IST. In the control population of 61 patients with peripheral sensory neuropathy, in which sex distribution and mean age at onset of symptoms were comparable to those in IST patients, the incidence of thyroid disorder overall was only 8.2% (in women, 6.6%). Only 12 of the 347 referral IST patients were non-right-handers. Five of these 12 were female patients (2.3% of the 215 women; 95% confidence interval, 0.3-4.3%), significantly below the anticipated frequency (10%) or the observed frequency (10% and 15.16%) in two attempted control populations. Light eyes seem to be unusually common in IST patients, as are personal and family histories of essential tremor. These results may reflect shared biologic risk factors which relate age, gender or estradiol/testosterone function, cerebral anatomic and chemical lateralization, endocrinopathy including elevated thyrotropin levels, immune status, emotional depression, common cells of origin in the neural crest, race, and familial occurrence to IST and other focal dystonias and essential tremor.
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PMID:Spasmodic torticollis: clinical and biologic features and their implications for focal dystonia. 340 May 4

Sleep disorders are common and well documented in patients with Parkinson's disease (PD). However, most data on sleep in patients with PD are derived from selected patient populations. This community-based survey evaluated the prevalence of and risk factors for sleep disturbances in an unselected group of 245 patients with PD and two control groups of similar age and sex distribution: 100 patients with another chronic disease (diabetes mellitus) and 100 healthy elderly persons. Nearly two thirds of the patients with PD reported sleep disorders, significantly more than among patients with diabetes (46%) and healthy control subjects (33%). About a third of the patients with PD rated their overall nighttime problem as moderate to severe. The most common sleep disorders reported by the patients with PD were frequent awakening (sleep fragmentation) and early awakening. Sleep initiation showed no significant difference compared with the control groups. Pain and cramps were not more prevalent among the patients with PD, but they were more likely to report sleep disturbed by myoclonic jerks. Use of sedatives was common in all three groups but significantly higher in the PD group than in the healthy elderly. Symptoms of depression and duration of levodopa treatment showed a significant correlation with sleep disorders in the PD group. This community-based study confirms that sleep disorders are common and distressing in patients with PD. The strong correlation between depression and sleep disorders in patients with PD underlines the importance of identifying and treating both conditions in these patients.
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PMID:A community-based study of sleep disorders in patients with Parkinson's disease. 982 12

Depressive symptoms are common among patients with diabetes and may have a significant impact on self-management and health outcomes. In this study we predicted that: 1) there would be a significant association between depressive symptoms and diabetes symptom burden, physical functioning, diabetes self-care, and HbA1c levels; and, 2) that the association between depressive symptoms and HbA1c levels would be significantly greater in type 1, as compared to type 2 diabetic patients. This cross-sectional observational study of 276 type 1 and 199 type 2 diabetes patients took place in a tertiary care specialty clinic. We collected self-reported data on depressive symptoms, complications, medical comorbidity, diabetes symptoms, diabetes self-care behaviors, physical functioning, and demographics. From automated data we determined mean HbA1c levels over the prior year. We performed linear regression analyses to assess the association between depressive symptoms and diabetes symptom perception, diabetes self-care behaviors, physical functioning, and glycemic control. Among patients with type 1 and 2 diabetes, depressive symptoms were associated with greater diabetes symptom reporting, poorer physical functioning, and less adherence to exercise regimens and diet. There was a significant association between depressive symptoms and HbA1c levels in type 1, but not type 2 diabetic patients. Because of their association with clinical aspects of diabetes care such as diabetes symptom reporting and adherence to diabetes self-care, depressive symptoms are important to recognize in treating patients with diabetes.
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PMID:The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. 1285 Jun 56

Symptoms of depression may predict incident diabetes independently or through established risk factors for diabetes. US men and women aged 25-74 years who were free of diabetes at baseline (n = 6,190) were followed from 1971 to 1992 (mean, 15.6 years; standard deviation, 6) for incident diabetes. Depressive symptoms were measured by using the General Well-Being Depression subscale and were categorized to compare persons with high (9%), intermediate (32%), and low (59%) numbers of symptoms. The incidence of diabetes was highest among participants reporting high numbers of depressive symptoms (7.3 per 1,000 person-years) and did not differ between persons reporting intermediate and low numbers of symptoms (3.4 and 3.6 per 1,000 person-years, respectively) (p < 0.01 for high vs. low). In the subset of participants with less than a high school education (a marker of low socioeconomic status), the risk of developing diabetes was three times higher (95% confidence interval: 2.0, 4.7) for persons reporting high versus low numbers of depressive symptoms. These results persisted following adjustment for established diabetes risk factors. Depressive symptoms had no impact on diabetes incidence among persons with at least a high school education. Results suggest an independent role for depressive symptoms in the development of diabetes in populations with low educational attainment.
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PMID:Symptoms of depression as a risk factor for incident diabetes: findings from the National Health and Nutrition Examination Epidemiologic Follow-up Study, 1971-1992. 1293 96

Studies have found an association between glycemic status and indices of health-related quality of life in people with diabetes mellitus and comorbid depression. No study to date has examined the relative strength of influences of glycemic status and health-related quality of life on depression in people with diabetes mellitus, nor have important moderators in this relationship been examined. This study examined the relative strength of correlations between glycemic status and health-related quality of life and depressive symptoms and the degree to which those correlations were moderated by sociodemographic variables in 146 people with type 2 diabetes. Depressive symptoms were measured with the Centers for Epidemiological Studies--Depression (CES-D) scale. Health-related quality of life was measured with the SF-36 Health Survey. Hemoglobin A1c (HbA1c) was used as a measure of glycemic status and body mass index and waist-hip ratio were measured. Results indicated that SF-36 scores accounted for a greater proportion of the variance in CES-D scores. The association between CES-D and SF-36 scores was moderated by HbA1c, sex, education, marital status, and social support. The implications and limitations of these results were discussed in the context of past studies.
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PMID:Biological, psychosocial, and sociodemographic variables associated with depressive symptoms in persons with type 2 diabetes. 1459 52

A large-scale national representative community survey of 11,122 persons aged more than 35 years included the investigation of the coincidence of depressive symptoms, vital exhaustion, cardiovascular disorders, stroke, and myocardial infarction. A total of 20.3% of the survey participants reported having experienced a cardiovascular disorder (CVD). Of the subjects reporting a CVD, 52.1% exhibited depressive symptoms (22.0% subthreshold depressive symptoms, 30.1% clinical depression), and 69.7% exhibited vital exhaustion. The authors investigated 3 cardiovascular subgroups: (1) subjects having experienced a myocardial infarction (MI), (2) subjects having experienced stroke, and (3) subjects with a CVD but no experience of either an MI or a stroke. The frequency and severity of depressive symptoms did not differ significantly in the 3 subgroups. CVD subjects with no MI or stroke had almost as high frequencies of depressive symptoms and vital exhaustion as patients who experienced stroke or MI. The strength of relationships between these psychological variables and CVDs do not differ significantly from the relationships between hypertension or diabetes and CVDs. Depressive symptoms and increased vital exhaustion have exceptionally high comorbidity with CVDs. The authors detected the same high comorbidity among patients with a milder CVD and without stroke or MI. The assessment and management of depressive symptoms and vital exhaustion should be routine procedure in clinical cardiology.
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PMID:The relationship of biological and psychological risk factors of cardiovascular disorders in a large-scale national representative community survey. 1652 47

Depressive symptoms are common among patients with diabetes and may have a significant impact on self-management and health outcomes. The prevalence of both depression and diabetes varies by race. We examined whether race is also an effect modifier in the association between mental health rated "not good" and diabetes using the national Behavioral Risk Factor Surveillance System (BRFSS) data from 2002 to 2005. We found that the prevalence of diabetes among Native American respondents was almost double that among Whites. Respondents with at least two weeks of mental health rated "not good" are significantly higher among diabetic patients than among non-diabetic patients. Native Americans (NAs) with at least two weeks of mental health rated "not good" were more likely to have diabetes. This association is stronger in NAs than in Whites. Future research should focus on a better understanding of the pathophysiological mechanisms underlying this plausible association between poor mental health and diabetes.
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PMID:Mental health status and diabetes among Whites and Native Americans: is race an effect modifier? 1767 16

The association between depression and cardiovascular disease is well documented. Nevertheless, the process through which they are linked remains unknown, as does the direction of this relationship. Studies have suggested both that depression is a risk factor for heart disease and that heart disease is a risk factor for depression. A number of studies have established that a relationship exists between depression and inflammation, with alterations in the levels of inflammatory markers (IL-1, IL-6, TNF-alpha and others). Depressive symptoms have also been identified in many diseases characterized by inflammatory processes e.g. rheumatoid arthritis, bronchial asthma, diabetes, tuberculosis and cardiovascular diseases. In this brief viewpoint, we explain and propose how to use Chagas disease, a disorder characterized by inflammatory processes and leading to cardiovascular and autonomic problems, as a model for studying the directionality of the relationship between heart disease and depression.
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PMID:Chagas disease as a mechanistic model for testing a novel hypothesis. 1836 74

Diabetes has been associated with depression since Thomas Willis' work in 1684 (Rubin and Peyrot in Diabetes Metab Rev 18:173-175, 2002). The aim of this study is to identify social and clinical factors independently associated with depression in individuals with type 1 diabetes. We carried out a descriptive transversal study with 110 type 1 diabetes patients, administered a questionnaire and obtained demographical and diabetes-related data (number of years from diagnosis, initial admission at diagnosis, glycated hemoglobin, number of complications, insulin dose, number of insulin injections per day, admission for ketoacidosis or hypoglycemia at diagnosis, and specific diabetes complications such as nephropathy, retinopathy, peripheral neuropathy, coronariopathy, and amputation). Depressive symptoms were quantified using the Hamilton Score. We used T tests to investigate potential relations between the covariates and depression (Hamilton score). We concluded the following: as few as 10% of our patients had glycated hemoglobin under 7%; women had more symptoms of depression, and there are four independent factors associated with depression in individuals with type 1 diabetes mellitus: age, Graffar score, admission for ketoacidosis, and insulin dose.
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PMID:Independent factors associated with depression in type 1 diabetes mellitus. 1930 Aug 97


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