Gina Abbott

History of major depressive disorder and endothelial function in postmenopausal women.

Objective: To determine whether history of depression is associated with endothelium-dependent flow-mediated dilation (FMD) in postmenopausal women. Methods: Thirty-nine postmenopausal women with no known or suspected cardiovascular disease participated. Nineteen had a positive lifetime history of major depressive disorder, and 20 were never depressed. None were currently depressed, and all had been free of major depressive disorder and antidepressant medications for ≥1 year. History of depression was assessed with the Structured Clinical Interview for DSM-IV, enhanced by a modified version of the timeline follow-back method. Current depressive symptoms were measured with the Center for Epidemiological Studies Depression scale (CES-D). Brachial artery FMD was measured with ultrasound and calculated as percent dilation from baseline. Results: After controlling for current subclinical depressive symptoms, ethnicity, hormone replacement therapy, and presence of the metabolic syndrome, previously depressed women showed significantly and clinically meaningful lower FMD than never depressed women. Controlling the same covariates, there was a dose-response relationship between number of depressive episodes and FMD. Examination of FMD means showed a significant negative correlation between number of depressive episodes and FMD. Conclusion: In postmenopausal women, depression continues to show a negative relationship to endothelial functioning even after years of remission. This relationship is not accounted for by residual depressive symptoms. Implications pertain to exclusion of previously depressed persons from control groups in research exploring the relationship between depression and cardiovascular disease. CHD = coronary heart disease; FMD = flow-mediated dilation; CES-D = Center for Epidemiological Studies Depression questionnaire; BMI = body mass index; SCID = Structured Clinical Interview for DSM-IV; TLFB = timeline follow-back; HRT = hormone replacement therapy.

Depression and Depression Care in Diabetes Relationship to perceived discrimination in African Americans

Depression is more prevalent in both African Americans and Caucasians with diabetes (1) than in nondiabetic control subjects (2), and it is associated with worse diabetes outcomes (3,4). Prospective studies (5) show that everyday encounters with discrimination predict subsequent depressive symptoms in nondiabetic individuals. When discrimination is perceived, specifically in health care, it may also interfere with depression care. This study investigated perceived discrimination, depressive symptoms, and depression care in diabetic African Americans. Participants were African-American adults with diabetes attending 2004–2006 American Diabetes Association health fairs in northeastern U.S. cities. Attendees responded to a sign advertising “Research for African Americans with diabetes.” After informed consent, participants completed questionnaires and provided fingerprick blood samples for A1C assessment (6). Participants were paid

Depressive Symptoms and Diabetes Control in African Americans

5.00 and given A1C results with referrals to community health centers. Demographic questions included age, sex, insurance, primary care provider, and socioeconomic status (SES), which was assessed with income and education. A medical history questionnaire asked about physician-diagnosed disorders (including depression) and whether medication was taken for each disorder. These questions were modeled after the Centers for Disease Control’s survey questions (7,8) for patient report of physician-diagnosed disorders. Participants completed three additional questionnaires, as follows. The Center for Epidemiological Studies Depression (CESD) scale (9) is a 20-item measure of depressive symptoms. A score of >21 discriminates between depressed and nondepressed individuals in medical populations (10,11). α in this sample was 0.87. The Schedule of Racist Events (SRE) (12) is an 18-item questionnaire that measures frequency and stressfulness of racial discrimination situations (e.g., in …

Endothelial dysfunction and history of recurrent depression in postmenopausal women with Type 2 diabetes: a case-control study ☆

This study of African Americans with diabetes investigated: (1) the relationship between depressive symptoms and glycemic control; (2) the relationship between depressive symptoms and long-term diabetes complications; (3) the relationship between depressive symptoms and medication usage; and (4) the effects of demographic and diabetes variables on these relationships. One-hundred twenty five African American diabetic adults who were attending health fairs reported demographic and medical history and provided blood samples for A1c assessment of glycemic control. They also completed the Centers for Epidemiological Studies Depression questionnaire, and the Diabetes Self-Care Inventory. After controlling for confounders, higher depressive symptoms were associated with higher A1c, more long-term diabetes complications, and more diabetes medications. Diabetes self-care did not fully account for these relationships. The relationship between depression and poor diabetes control exists in African Americans as it does in Whites. Providers are encouraged to attend to depression in their African American patients with diabetes.

Invasiveness as a Barrier to Self-Monitoring of Blood Glucose in Diabetes

OBJECTIVES This study of postmenopausal women with Type 2 diabetes mellitus (T2DM) investigated (1) history of depression as a predictor of endothelium-dependent flow-mediated dilation (FMD); (2) the relative associations of single and recurrent depressive disorders with FMD; and (3) cortisol as a potential mechanism. METHODS Participants were nonsmoking, naturally postmenopausal women with T2DM with no known vascular disease. All were free of current mood disorder. On average, the 44 participants were 63 years of age, White, diabetic for 6 years, and were in adequate glycemic control. Thirty-eight percent were never depressed, 19% had experienced one disorder, and 43% had experienced recurrent disorders. History of depression was assessed with Structured Clinical Interview for Diagnostic and Statistical Manual-IV. Current depressive symptoms were measured with Center for Epidemiological Studies Depression (CESD) scale. FMD was assessed by standard procedures and calculated as percent change in brachial artery diameter from baseline. RESULTS Women with history of recurrent depression showed vasoconstriction (mean=-1%), which was significantly different from women with history of single depression (mean=+6) and never depressed women (mean=+5) (P<.05), both of whom showed similar levels of vasodilation. In logistic regression controlling for hypertension, duration of diabetes, and glycemic control, history of recurrent depressive disorders predicted greater likelihood of vasoconstriction (P<.05, odds ratio=4.23) but history of single depressive disorder did not. Controlling for current depressive symptoms did not account for effects of past recurrent depressive disorders. Cortisol was not related to FMD. CONCLUSIONS In postmenopausal women with T2DM, recurrent depressive disorders, even in full remission, are associated with endothelial dysfunction. Potential mechanisms of the relationship between depression and endothelial dysfunction other than cortisol warrant investigation.