Arie Nouwen

Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis

Aims/hypothesisAn earlier meta-analysis showed that diabetes is a risk factor for the development and/or recurrence of depression. Yet whether this risk is different for studies using questionnaires than for those relying on diagnostic criteria for depression has not been examined. This study examined the association of diabetes and the onset of depression by reviewing the literature and conducting a meta-analysis of longitudinal studies on this topic.MethodsEMBASE, MEDLINE and PsycInfo were searched for articles published up to September 2009. All studies that examined the relationship between type 2 diabetes and the onset of depression were included. Pooled relative risks were calculated using fixed and random effects models.ResultsEleven studies met our inclusion criteria for this meta-analysis. Based on the pooled data, including 48,808 cases of type 2 diabetes without depression at baseline, the pooled relative risk was 1.24 (95% CI 1.09–1.40) for the random effects model. This risk was significantly higher for studies relying on diagnostic criteria of depression than for studies using questionnaires. However, this difference was no longer significant when controlled for year of publication.Conclusions/interpretationCompared with non-diabetic controls, people with type 2 diabetes have a 24% increased risk of developing depression. The mechanisms underlying this relationship are still unclear and warrant further research.

Motivation and dietary self-care in adults with diabetes: are self-efficacy and autonomous self-regulation complementary or competing constructs?

This study examined constructs drawn from social-cognitive theory (A. Bandura, 1986) and self-determination theory (E. L. Deci & R. M. Ryan, 1985, 1991) in relation to dietary self-care and life satisfaction among 638 individuals with diabetes. A motivational model of diabetes dietary self-care was proposed, which postulates direct links between self-efficacy/autonomous self-regulation, and adherence/ life satisfaction. Structural equation modeling showed that both self-efficacy and autonomous self-regulation were associated with adherence (betas = .54 and .21, respectively) and with life satisfaction (betas = .15 and .34, respectively). Constraint analyses confirmed that self-efficacy was significantly more associated with adherence, whereas autonomous self-regulation was significantly more associated with life satisfaction. According to the model, interventions for dietary self-care and life satisfaction should focus on increasing self-efficacy and autonomous self-regulation.

The assessment of diabetes-related cognitive and social factors: the Multidimensional Diabetes Questionnaire.

The purpose of this study was to examine the psychometric properties of the recently developed Multidimensional Diabetes Questionnaire (MDQ). The MDQ which is theoretically linked to a social learning perspective of diabetes, was designed to provide a comprehensive assessment of diabetes-related cognitive and social factors. It includes 41 items grouped into three sections: (1) perceptions related to diabetes and related social support, (2) positive and misguided reinforcing behaviors related to self-care activities, and (3) self-efficacy and outcome expectancies. Confirmatory factor analyses, conducted on a sample of 249 patients with non-insulin-dependant diabetes mellitus, supported the construct validity of the MDQ. Adequate internal consistency and significant demographic, psychological, behavioral, and disease-related correlates were found. The MDQ may prove valuable in understanding individual differences in adjustment to diabetes.

Prevalence of Depression in Individuals With Impaired Glucose Metabolism or Undiagnosed Diabetes: A systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium

OBJECTIVE Meta-analyses have shown that the risk for depression is elevated in type 2 diabetes. Whether this risk in individuals with impaired glucose metabolism (IGM) or undiagnosed diabetes (UDD) is elevated relative to normal glucose metabolism (NGM) or decreased relative to previously diagnosed type 2 diabetes (PDD) has not been the subject of a systematic review/meta-analysis. This study examined the prevalence of depression in IGM and UDD subjects relative to each other and to NGM and PDD subjects by reviewing the literature and conducting a meta-analysis of studies on this topic. RESEARCH DESIGN AND METHODS EMBASE and MEDLINE databases were searched for articles published up to May 2010. All studies that compared the prevalence of depression in subjects with IGM and UDD were included. Odds ratios (ORs) were calculated using fixed and random-effects models. RESULTS The meta-analysis showed that the risk for depression was not increased in IGM versus NGM subjects (OR 0.96, 95% CI 0.85–1.08). Risk for depression did not differ between individuals with UDD and individuals with either NGM (OR 0.94, 95% CI 0.71–1.25) or IGM (OR 1.16, 95% CI 0.88–1.54). Finally, individuals with IGM or UDD both had a significantly lower risk of depression than individuals with PDD (OR 0.59, 95% CI 0.48–0.73, and OR 0.57, 95% CI 0.45–0.74, respectively). CONCLUSIONS Results of this meta-analysis show that the risk of depression is similar for NGM, IGM, and UDD subjects. PDD subjects have an increased risk of depression relative to IGM and UDD subjects.

The relationship between paraspinal EMG and chronic low back pain

&NA; Two models of the relationship between paraspinal EMG and low back pain have been proposed. Specific predictions arising from these are listed and the literature relating to them reviewed. Recent research on patterns of EMG rather than absolute levels is also discussed. It is concluded that there is no consistent evidence that low back pain patients have elevated paraspinal EMG, or that its reduction is likely to be an active ingredient in biofeedback therapy. Research on paraspinal EMG patterns is still preliminary, and therefore treatment based on their modification is experimental.

Psychological factors associated with emergency room visits among asthmatic patients

This study was designed to investigate physiological and psychological characteristics of subjects with high-frequency emergency room (ER) visits. Asthma status, psychological functioning and predispositions, psychosocial adaptation to asthma, and health behaviors were measured for 30 patients who had two or more ER visits during the last 2 years. These subjects were matched for age, sex, and corticosteroid use with 30 subjects who had no unscheduled ER visits for the same period. No significant differences were found for measures of asthma status. Among the asthma-specific variables, the number of hyperventilation-bronchoconstriction symptoms did not distinguish between the groups. High attenders reported more panic-fear symptoms, lower self-efficacy, and more perceived interference. There were no differences for measures of anxiety/depression, self-focused attention, or health locus of control. However, these variables were found to be significant predictors of panic-fear symptoms, lower selfefficacy, and more perceived interference.

Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes

This cross-sectional study examined the joint effects of self-efficacy and illness representations on dietary self-care and diabetes distress in adolescents with type 1 diabetes by comparing two theoretical models: the Self-regulation Model (Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common-sense representations of illness danger. In S. Rachman (Ed.), Medical Psychology (Vol. 2, pp. 7–30). New York: Pergamon.) and Social Cognitive Theory (Bandura, A. (1997). Self efficacy: The exercise of control. New York: W.H. Freeman.). One hundred and fifty-one adolescents with type 1 diabetes completed self-report measures of dietary self-efficacy, illness representations, dietary self-care and diabetes distress. Data were analysed using structural equation modelling. The model best supported by the data (Leventhals Self-regulation Model) showed that dietary self-efficacy, perceived consequences and treatment effectiveness had direct and independent effects on both dietary self-care and diabetes distress. Together with dietary self-efficacy, perceived short-term treatment effectiveness was a significant predictor of dietary self-care. Age was found to be a negative predictor of short-term treatment effectiveness beliefs. Diabetes distress was best predicted by self-efficacy and perceived consequences. It can be concluded that to target effectively dietary self-care and distress, clinicians should focus on key illness representation variables (perceived short-term treatment effectiveness and perceived consequences) in conjunction with self-efficacy.

EMG biofeedback used to reduce standing levels of paraspinal muscle tension in chronic low back pain

Abstract Twenty chronic low back pain (LBP) patients with relatively high standing paraspinal EMG levels (> 5 gmV) were randomly assigned to 2 groups. One group (N = 10) received EMG biofeedback training to reduce standing paraspinal EMG levels, the other group (N = 10) served as a waiting list control group. Changes in perceived pain (duration × intensity) and paraspinal EMG in standing position were measured at a 3 week pretreatment baseline, during the 3 week treatment period, and at a 3 week post‐treatment baseline. Compared to patients in the waiting list control group, those who received EMG biofeedback showed a significant decrease in standing paraspinal EMG from pretreatment to post‐treatment baseline. However, no significant differences in reported pain were found during these periods. It is concluded that reduction of standing paraspinal EMG does not lead to reduction in pain.

Relations of diabetes intrusiveness and personal control to symptoms of depression among adults with diabetes.

The generalizability of a model linking illness characteristics to psychosocial well-being was tested in a cross-sectional study of 237 adults with type 2 diabetes. It was hypothesized that diabetic complications increase illness intrusiveness, which in turn increases depressive symptomatology either directly or indirectly by reducing personal control over health outcomes. Illness intrusiveness was defined as the result of disruptions of valued activities and interests due to constraints imposed by the illness. An excellent fit of this model to the data was found using structural equation modeling. The model explained 65% of the variance in depressive symptomatology. Assessment of an alternative model excluding personal control suggested that the extent to which diabetes intrudes in life, rather than diabetic complications per se or personal control, is a key factor in relation to depressive symptomatology in individuals with diabetes.

Adverse Effects of Depression on Glycemic Control and Health Outcomes in People with Diabetes: A Review

In the past decades, important advances have been achieved in the psychological aspects of diabetes. This article reviews the associations between diabetes, depression, and adverse health outcomes. The article provides an update on the literature regarding the prevalence of depression in diabetes, discusses the impact of depression on diabetes self-care and glycemic control in people with diabetes, and summarizes the results of longitudinal studies that have investigated depression as a risk factor for adverse health outcomes.