Ghislaine Badawi

Association of diabetes with anxiety: A systematic review and meta-analysis

OBJECTIVES Anxiety has been shown to be associated with poor outcomes in people with diabetes. However, there has been little research which has specifically examined whether diabetes mellitus is associated with an increased likelihood of co-morbid anxiety. The aim of this systematic review and meta-analysis was to determine whether people with diabetes are more likely to have anxiety disorders or elevated anxiety symptoms than people who do not have diabetes. METHODS A systematic review was performed by three independent reviewers who searched for articles that examined the association between anxiety and diabetes in adults 16 or older. Those studies that met eligibility criteria were put forward for meta-analysis using a random-effects model. RESULTS A total of twelve studies with data for 12,626 people with diabetes were eligible for inclusion in the systematic review and meta-analysis. Significant and positive associations were found for diabetes with both anxiety disorders, 1.20 (1.10-1.31), and elevated anxiety symptoms, 1.48 (1.02-1.93). The pooled OR for all studies that assessed anxiety was 1.25 (1.10-1.39). CONCLUSIONS Results from this meta-analysis provide support that diabetes is associated with an increased likelihood of having anxiety disorders and elevated anxiety symptoms.

Childhood emotional abuse and eating symptoms in bulimic disorders: An examination of possible mediating variables

OBJECTIVE We sought to estimate prevalences of childhood emotional abuse (CEA) in bulimic and normal-eater control groups, and to replicate previous findings linking CEA to severity of eating symptoms in BN. We also examined potential mediators of the link between CEA and disordered eating. METHOD Women diagnosed with a bulimic disorder (n = 176) and normal-eater women (n = 139) were assessed for childhood traumata, eating-disorder (ED) symptoms and psychopathological characteristics (ineffectiveness, perfectionism, depression, and affective instability) thought to be potential mediators of interest. RESULTS CEA was more prevalent in the bulimic than in the nonbulimic group, and predicted severity of some eating-symptom indices. Ineffectiveness and affective instability both mediated relationships between CEA and selected ED symptoms. DISCUSSION We found CEA to predict eating pathology through mediating effects of ineffectiveness and affective instability. CEA might influence severity of ED symptoms by impacting an individuals self-esteem and capacity for affect regulation.

Indicators of self-rated health in the Canadian population with diabetes.

Diabet. Med. 29, 1021–1028 (2012)

Self-rated health: A predictor for the three year incidence of major depression in individuals with Type II diabetes

BACKGROUND To determine whether self-rated health was a predictor for the three year incidence of major depression in people with Type II diabetes. METHODS Data was collected as part a population-based telephone survey of adults with diabetes, in Québec, Canada (2008-2011). Adults with Type II diabetes who did not have major depression at baseline were assessed at three follow-up interviews conducted 12, 24 and 36 months after baseline. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Self-rated health status was determined by asking participants to rate their health on a scale from excellent to poor. RESULTS The sample consisted of 1265 adults with Type II diabetes who did not have major depression at baseline. 36% of individuals who had developed major depression at follow up rated their health as fair or poor at baseline compared to 14.4% of those who had not developed major depression. Logistic regression analyses indicated fair or poor self-rated health at baseline to be predictive of a twofold increased risk for major depression at follow-up, even after adjusting for socio-demographic characteristics, lifestyle-related behaviors, disability and diabetes characteristics (OR=2.05, 95% CI 1.20-3.48). LIMITATIONS We have focused on current depression (last two weeks) and we have used a questionnaire (PHQ-9) rather than a clinical interview for the assessment of depression. CONCLUSIONS Self-rated health status might be a predictor for developing major depression in people with diabetes in addition to well established risk factors.

Cortisol responses on the dexamethasone suppression test among women with Bulimia-spectrum eating disorders: associations with clinical symptoms.

INTRODUCTION Evidence associates Bulimia Nervosa (BN) with altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis, but the clinical implications of such alterations need to be better understood. We contrasted cortisol responses to the dexamethasone suppression test (DST) in bulimic and non-eating disordered women and examined relationships among DST cortisol responses, eating symptoms and co-morbid disturbances. METHOD Sixty women with Bulimia Spectrum (BS) Disorders (either BN or normal weight Eating Disorder NOS with regular binge eating or purging) and 54 non-eating disordered women of similar age and body mass index participated in a 0.5 mg DST, and completed interviews and questionnaires assessing eating symptoms and co-morbid psychopathology. RESULTS Compared with the normal-eater group, the BS women demonstrated significantly less DST suppression. Among BS women, DST non-suppression was associated with more severe depression, anxiety and eating preoccupations. CONCLUSIONS Our findings show BS women to show less DST suppression compared to normal eater women, and results link extent of non-suppression, in BS individuals, to severity of depression, anxiety and eating preoccupations.

Molecular-genetic correlates of self-harming behaviors in eating-disordered women: findings from a combined Canadian-German sample.

Across populations, findings suggest that rates of self-mutilation, suicidal acts, and other self-harming behaviors (SHBs) may be influenced by polymorphisms that code for activity of the serotonin transporter (e.g., 5HTTLPR) and the enzyme, monoamine oxidase A (e.g., MAOAuVNTR). SHBs being common in patients with Eating Disorders (EDs), we evaluated (in a large sample of eating-disordered women) relationships between triallelic 5HTTLPR and MAOAuVNTR variants, on the one hand, and SHBs, on the other. We had 399 eating-disordered women report on eating symptoms and lifetime history of SHBs, and provide blood samples for genotyping. Individuals carrying high-function MAOAuVNTR alleles reported a history of SHBs about twice as often as did carriers of low-function alleles. We obtained no comparable main effect of 5HTTLPR, or MAOAuVNTR×5HTTLPR interaction effect. Genetic variations did not predict severity of eating symptoms. As in other populations, our findings link the MAOAuVNTR high-function alleles with increased risk of self-directed harm in bulimic females. We discuss theoretical and clinical ramifications of our results.

Self-rated diabetes control in a Canadian population with type 2 diabetes: associations with health behaviours and outcomes.

AIMS Diabetes control is a multifaceted process involving successful adherence to a self-care regimen as indicated by improved health outcomes. The aim of this study was to ascertain the construct validity of self-reported diabetes control in a population-based survey. METHODS This study assessed 1848 participants with type 2 diabetes who took part in the Montreal Diabetes Health and Wellbeing Study in Quebec, Canada. Participants were administered the diabetes complications index as well as sociodemographic and health questions. RESULTS Fair/poor diabetes control was associated with being less likely to check blood glucose weekly, being less likely to drink alcohol, being more likely to report being physically inactive, reporting fair/poor eating habits, being obese and having 1 or more diabetes complications. When all variables were included in a regression model the two variables most strongly associated with poor fair/poor diabetes control were reporting fair/poor eating habits (odds ratio 1.36, 95% CI 1.00-1.85) and having 2 or more diabetes complications (odds ratio 1.60, 95% CI 1.06-2.40). CONCLUSIONS Results from this study indicate that self-rated diabetes control has associations with diabetes-specific self-care behaviours and outcomes, and is a general indicator of self-care and diabetes-related complications in a population-based survey.

Epistatic interaction between 5HTTLPR and TPH2 polymorphisms predicts novelty seeking in women with bulimia nervosa spectrum disorders

In individuals with Bulimia Nervosa (BN) and without eating disorders, variations along dimensions such as impulsivity and sensation seeking are influenced by genetic factors that code for serotonin (5-HT) system activity. Low-function alleles of the serotonin transporter polymorphism (5HTTLPR) have been linked to sensation seeking, impulsivity and affective instability in samples of women with BN (Steiger et al., 2005,2007), while the T allele of Tryptophan hydroxylase-2 (TPH2) is associated with impulsivity and lowered harm avoidance in individuals without an eating disorder (Reuter et al., 2007; Stoltenberg et al., 2006). To our knowledge, no study to date has examined psychopathological correlates of TPH2, or the interaction of 5HTTLPR and TPH2 in women with BN. We examined the interaction of 5HTTLPR and a commonly studied SNP of TPH2 ( 703G4T; rs4570625) on psychopathological traits and severity of eating symptoms in a sample of women with BN-spectrum disorders. We hypothesized that individuals carrying a low function allele of 5HTTLPR and the T allele of TPH2 would demonstrate elevations on measures of affective instability, sensation seeking, impulsivity and possibly eating pathology. The present study received ethics board approval from the Douglas Institute. All participants gave informed consent and were compensated. Data were collected as part of a larger study concerning the contribution of selected neurotransmitter-/neuroendocrine-system genes to phenotypic variations in BN. Participants were 273 women, 177 (64.8%) of whom met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for BN purge type, 14 (5.1%) for BN non-purge type, and 82 (30.1%) for Eating Disorder Not Otherwise Specified (EDNOS; variants representing subthreshold BN). Mean age was 25.91 (76.62), while mean BMI (kg/m) was 22.62 (73.84). Almost the entire sample (95.3%) were of Caucasian descent, and 127 women (50.8% of the sample) were using a psychoactive medication when tested (data available from 250 of 273 participants). Participants completed the Eating Attitudes Test (EAT-26) (Garner et al., 1982), the Dimensional Assessment for Personality Pathology (DAPP) (Livesley et al., 1992) that tapped traits in the impulsive-dysregulated spectrum (i.e., stimulus seeking, affective instability, and self-harming behaviors), and the Barratt Impulsiveness Scale (BIS), version 11 (Patton et al., 1995). DNA samples were obtained from whole blood. Genotyping procedures have been described in detail elsewhere (Steiger et al., 2007; Thaler et al., 2012). We applied hierarchical multiple regressions to explore effects of 5HTTLPR [using both biallelic and triallelic models: carriers of

Self-rated health in diabetes: Should the question be the first administered?

In 599 individuals with Type 2 diabetes, mode of administration of self-rated health did not affect ratings when the item was placed before or after health-related questions. 85% of individuals had stable ratings providing support for comparisons across studies using the measure in this population.

Response to Kawada: Self-rated health and depression of patients with diabetes: how to handle with wide range of ageing and diabetic status?

1 Badawi G, Gariepy G, Page V, Schmitz N. Indicators of self-rated health in the Canadian population with diabetes. Diabet Med 2012; 29: 1021–1028. 2 Badawi G, Page V, Smith KJ, Gariepy G, Malla A, Wang J et al. Self-rated health: a predictor for the three year incidence of major depression in individuals with Type II diabetes. J Affect Disord 2013; 145: 100–105. 3 Wexler DJ, Porneala B, Chang Y, Huang ES, Huffman JC, Grant RW. Diabetes differentially affects depression and self-rated health by age in the US. Diabetes Care 2012; 35: 1575–1577.