Marcel C. Adriaanse

Perceived risk for Type 2 diabetes in participants in a stepwise population-screening programme.

Aims To determine the risk perception of Type 2 diabetes in participants in a stepwise population‐screening programme.

Screening for Type 2 diabetes: an exploration of subjects' perceptions regarding diagnosis and procedure.

Aim To explore the psychological impact of a stepwise population‐screening project for Type 2 diabetes.

The psychological impact of screening for type 2 diabetes.

Until recently, there was little empirical data regarding the psychological impact of screening for type 2 diabetes. There is now some progress in this area, as evidenced by emerging population based studies reporting on the effects of screening for type 2 diabetes on perceived health status and well‐being.

Health-related quality of life in the first year following diagnosis of Type 2 diabetes: newly diagnosed patients in general practice compared with screening-detected patients. The Hoorn Screening Study

Aims  To determine health‐related quality of life (HRQoL) in the first year following diagnosis of Type 2 diabetes among newly diagnosed patients in general practice compared with patients detected by targeted population screening.

Symptoms of depression in people with Impaired Glucose Metabolism or Type 2 Diabetes Mellitus: The Hoorn Study.

Objective  To study the prevalence and risk factors of depressive symptoms, comparing subjects with normal glucose metabolism (NGM), impaired glucose metabolism (IGM) or Type 2 diabetes mellitus (DM2).

Diabetes-related symptom distress in association with glucose metabolism and co-morbidity: the Hoorn Study

OBJECTIVE—The purpose of this study was to determine the associations between diabetes-related symptom distress, glucose metabolism status, and comorbidities of type 2 diabetes. RESEARCH DESIGN AND METHODS—This was a cross-sectional sample of 281 individuals with normal glucose metabolism (NGM), 181 individuals with impaired glucose metabolism (IGM), and 107 subjects with type 2 diabetes. We used the revised type 2 Diabetes Symptom Checklist (DSC-R) to assess diabetes-related symptom distress. RESULTS—The total symptom distress score (range 0–100) was relatively low for diabetic subjects (mean ± SD 8.4 ± 9.4), although it was significantly different from that for subjects with IGM (6.5 ± 7.1) and NGM (6.1 ± 7.9) (F = 3.1, 2 d.f., P = 0.046). Ischemic heart disease was associated with elevated DSC-R scores on three subscales, whereas depression showed higher symptom distress levels across all DSC-R domains. CONCLUSIONS—Worsening glucose metabolism is associated with increasing diabetes-related symptom distress. This relationship is attenuated by ischemic heart disease and particularly by depression.

No substantial psychological impact of the diagnosis of Type 2 diabetes following targeted population screening: The Hoorn Screening Study.

Aims  To examine the impact of the diagnosis of Type 2 diabetes on psychological well‐being and perceived health status in subjects who participated in a targeted population‐screening programme.

Endothelial dysfunction is associated with a greater depressive symptom score in a general elderly population : The Hoorn Study

BACKGROUND Endothelial dysfunction (ED), low-grade inflammation (LGI) and oxidative stress (OxS) may be involved in the pathobiology of depression. Previous studies on the association of these processes in depression have yielded contradictory results. We therefore investigated comprehensively, in a population-based cohort study, the association between ED, LGI and OxS on the one hand and depressive symptoms on the other. METHOD We used data from the Hoorn Study and determined biomarkers of ED [flow-mediated dilatation (FMD), von Willebrand factor, soluble intercellular adhesion molecule 1 (sICAM-1), soluble vascular cell adhesion molecule 1, soluble thrombomodulin and soluble endothelial selectin], LGI [C-reactive protein, tumour necrosis factor-α, interleukin 6, interleukin 8, serum amyloid A, myeloperoxidase (MPO) and sICAM-1] and OxS (oxidized low density lipoprotein and MPO). Depressive symptoms were quantified by the Center for Epidemiologic Studies Depression Scale (CES-D) questionnaire (n = 493; age 68 years; 49.9% female). Regression analyses were performed with the use of biomarker Z scores. Adjustments were made for age, sex and glucose metabolism status (cohort stratification variables) and prior cardiovascular disease, hypertension, waist-to-hip ratio, cholesterol levels, education level, physical activity, dietary habits, and the use of antihypertensive and/or lipid-lowering medication and/or metformin (potential confounders). RESULTS After adjustment for age, sex and glucose metabolism status, one standard deviation increase in the ED Z score was associated with a 1.9 [95% confidence interval (CI) 0.7-3.1] higher CES-D score. Additional adjustments did not materially change this result. LGI and OxS were not associated with the CES-D score. CONCLUSIONS ED, as quantified by an array of circulating biomarkers and FMD, was independently associated with depressive symptoms. This study supports the hypothesis that ED plays an important role in the pathobiology of depression.

Prevalence of psychosocial problems in Dutch children aged 8-12 years and its association with risk factors and quality of life.

AIMS To determine the prevalence of psychosocial problems among Dutch children aged 8-12 years and studying its association with risk factors and quality of life. METHODS This study was conducted within the framework of a community-based health study in the north-west region of the Netherlands. The cross-sectional study sample consisted of 2703 children (1392 boys and 1311 girls). Psychosocial problems and quality of life were measured with the extended version of the Strengths and Difficulties Questionnaire (SDQ) and KIDSCREEN-10, respectively. Questionnaires and data about risk factors (parental education level, ethnicity, family structure, income, chronic diseases and life events) were completed by the parents or caregivers. RESULTS The prevalence of psychosocial problems (SDQ score > or =14) in the total sample was 10.4%. The prevalence was higher in boys compared with girls (13.9% v. 6.6%, OR= 2.28; 95% CI = 1.75-2.97). Boys had significantly more hyperactivity/inattention, conduct, peer relationship and prosocial behaviour problems compared with girls. Risk factors associated with psychosocial problems were: one or more chronic disease(s), life event(s), a low parental educational level (for boys only) and an income under a modal level. Psychosocial problems were significantly inverse related with quality of life in the total sample (rho = -0.47). CONCLUSIONS Psychosocial problems are common in children, especially among boys, and are inversely related with childrens quality of life. The identified risk factors in this study can be useful for developing targeted prevention strategies aimed at children at high risk for psychosocial problems.

Perceptions of risk in adults with a low or high risk profile of developing type 2 diabetes; a cross-sectional population-based study.

OBJECTIVE To compare the perceived seriousness and risk of type 2 diabetes among low risk with high risk profile non-diabetic subjects and examine the relationship of perceived risk with multiple self-reported risk indicators. METHODS A cross-sectional population-based study among 4435 low risk profile and 2607 high risk profile non-diabetic residents of the Hoorn region, participating in a stepwise type 2 diabetes screening study. Main outcome measures were perceived seriousness and risk of diabetes in subjects categorized (low vs. high risk profile) using the Symptom Risk Questionnaire. RESULTS 85.0% of the low risk and 81.2% of the high risk profile subjects perceived diabetes as a moderate to very serious disease. About half (43.0%) of all 7042 subjects reported that they do not know their risk of having diabetes. The mean perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects (difference = 2.8%; 95% confidence interval [CI] = 1.8% to 3.8%; P < 0.001). This difference was mostly explained by having a parent or sibling with diabetes, frequent thirst and claudication (difference = 0.6%; 95% CI = -0.7% to 1.9%). Interestingly, perceived risk decreased with increasing age within both groups (P for trend < 0.001). CONCLUSIONS Both low risk and high risk profile subjects perceive diabetes as a serious disease. Even among those at high risk profile for type 2 diabetes, almost half appeared not to know their risk. Perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects. Furthermore, perceived risk decreases with increasing age. PRACTICE IMPLICATIONS This study points to a greater need to effectively address peoples (mis)perceptions, and how to raise the awareness and understanding of type 2 diabetes and its risk factors in the general population in order to influence early detection and healthy lifestyle changes.