Background: Diabetes mellitus and depression are serious common diseases, and the number of people with both conditions is rising steadily. Depression in people with diabetes mellitus results in poorer prognosis through different mechanisms. On the other hand, the presence of diabetes in individuals with depression increases functional impairment that is associated with depression.Aims: The study aimed to assess the prevalence and factors associated with depression among adults with type 2 diabetes mellitus attending a diabetes clinic in Cairo, Egypt.Methods: A cross-sectional study was conducted among adult patients with diabetes type 2 attending a diabetes clinic in the endocrinology department in Ain Shams University Teaching Hospital, Cairo, Egypt. Data were collected through face-to-face interviews by trained psychiatrists and from patients' records.Results: The prevalence of depression among diabetic patients was 21.8% (95% CI [15.6%, 29.1%]). Depression was more common among younger age groups and those with a higher level of education. There was no significant difference between those with lifetime depression compared to those without depression regarding physical health complications.Conclusions: The prevalence of depression among patients with type 2 diabetes is high. Given the impact of co-morbid diabetes and depression, diabetic patients should be routinely screened for the latter condition.

Cel pracy Zaburzenia lękowe są istotnymi czynnikami predykcyjnymi samobójczości i uważa się je za niezależne czynniki ryzyka prób samobójczych. Występują one często u osób z cukrzycą typu 2 (T2DM) i wiążą się z dłuższym czasem trwania cukrzycy oraz gorszymi wynikami leczenia. Celem pracy było zbadanie związków między zaburzeniami lękowymi a myślami i zachowaniami samobójczymi u osób z T2DM, ocena częstości występowania samobójczości wśród osób z T2DM w wybranych europejskich krajach oraz określenie, czy zaburzenia lękowe były predyktorami aktualnych objawów samobójczości w tej populacji, przy wykorzystaniu danych z międzynarodowego badania International Prevalence and Treatment of Diabetes and Depression study (INTERPRET-DD). Metoda Próba badawcza obejmowała 1063 osoby dorosłe z T2DM z 6 europejskich krajów. Obecność zaburzeń lękowych i samobójczości oceniano za pomocą MINI International Neuropsychiatric Interview. Grupę uczestników z aktualnym ryzykiem samobójczym porównano z grupą uczestników bez ryzyka samobójczego. Wyniki Uczestnicy z Niemiec częściej deklarowali objawy samobójczości niż osoby z innych krajów, natomiast osoby z Serbii i Ukrainy zgłaszały je rzadziej. Depresja i zaburzenia lękowe znacząco wpłynęły na częstsze występowanie samobójczości u osób z T2DM. Agorafobia była istotnym predyktorem samobójczości przy kontrolowaniu depresji. Osoby z T2DM i współchorobowością agorafobii mieli 4,86 razy większe szanse wystąpienia objawów samobójczości niż osoby bez agorafobii. Wnioski Agorafobia była istotnym czynnikiem predykcyjnym samobójczości u osób z T2DM.

BACKGROUND:There are limited data on the role of body image in patients with type 2 diabetes. The purpose of this study was to compare body self-esteem in this group with norms for the general Polish population and to investigate the relationship between body self-esteem and the psychological and clinical characteristics of the course of diabetes. METHODS:A group of 100 consecutive adult patients with type 2 diabetes (49 women and 51 men) aged 35 to 66 years were assessed using the Body Esteem Scale (BES), World Health Organization-Five Well-Being Index (WHO-5), Problem Areas in Diabetes Scale (PAID), and Hamilton Rating Scale for Depression (HAM-D). RESULTS:In comparison to norms for the general population, women with type 2 diabetes had lower body self-esteem only in the dimension of Physical Condition (M = 30.71; SD = 7.11 versus M = 32.96; SD = 5.69; P = 0.003), whereas men in the dimensions of Physical Condition (M = 42.43; SD = 9.43 versus M = 48.30; SD = 8.42; P <0.001) and Upper Body Strength (M = 32.16; SD = 6.60 versus M = 33.97; SD = 5.86; P = 0.015). There were moderate or weak positive correlations between the overall BES score and/or its dimensions and subjective well-being, and negative correlations between the overall BES score and/or its dimension and the severity of depression symptoms, level of glycated hemoglobin (HbA1c), body mass index (BMI), and diabetes-related distress among women. Among men, BES scores were positively correlated with well-being, and negatively, with BMI and diabetes-related distress. A correlation of r = 0.39 between BES scores and HbA1c levels was relatively high compared with values for other psychosocial factors. Both in women and men, a high Physical Condition score was a significant predictor of better well-being, less severe depression, and milder diabetes-related distress. Among men, it was also a significant predictor of lower BMI, whereas among women, BMI was predicted by Weight Concern. CONCLUSIONS:Persons with diabetes seem to have lower body self-esteem than the general population, which is significantly associated with clinical and psychological characteristics of the diabetes course. The observed differences and relationships are gender-specific.

Purpose The aim of this study was to assess the structure and validate the Polish version of the Problem Areas in Diabetes (PAID) scale, as the current translations of the original English version significantly vary in their psychometric properties. Patients and Methods Two hundred and sixteen consecutive Polish outpatients were invited to participate in this international cross-sectional study on depression in diabetes. The research was based on the demographic and clinical characteristics of the study population, including the level of glycated hemoglobin (HbA1c) and scores obtained in the Polish versions of the following questionnaires: PAID, World Health Organization-Five Well-Being Index (WHO-5), Patient Health Questionnaire 9 (PHQ-9). The psychiatric diagnosis was conducted with the use of Mini-International Neuropsychiatric Interview (M.I.N.I.). Results Exploratory factor analyses yielded a 1-factor structure that included all 20 items. The internal consistency of the Polish version of PAID was high (Cronbach α = 0.97). There were significant positive correlation between PAID and PHQ-9 and a negative correlation between PAID and WHO-5. We also observed a negative association between PAID scores and age and a positive correlation between PAID and HbA1c levels. Patients with depression reported significantly higher PAID scores as compared with those without depressive symptoms. Conclusion The Polish version of PAID has a one-factor structure and is a reliable, valid outcome measure for Polish outpatients with type 2 diabetes and it may constitute a useful instrument for screening for psychologic issues in diabetic patients during their appointments at the diabetes clinic.

OBJECTIVE:To assess the prevalence of mental disorders in patients with type 2 diabetes mellitus (DM2) and their relationship with laboratory findings, somatic comorbidities and psychosocial consequences.MATERIAL AND METHODS:In the frames of the INTERPRET-DD multicenter 200 T2DM patients from primary care (47 men and 153 women) from the Russian sample were studied. The psychometric assessment included MINI-6, HAMD-17, PHQ-9, PAID, WHO-5.RESULTS:One hundred and seventeen patients (58.5%) have mental disorders. Current mental disorders were diagnosed in 93 (46.5%) of patients. Depression (depressive episode, recurrent depressive disorder, bipolar affective disorder type II) was identified in 34 (17.0%), dysthymia in 26 (13.0%), and anxiety spectrum disorders in 39 (19.5%). In about half of the cases, anxiety disorders were combined with depression. The most severe problems were observed in the patients with depression and dysthymia. Patients with social phobia had significantly higher levels of glycated hemoglobin compared to patients without mental disorders. The significant decrease of systolic arterial pressure and body mass index was observed in patients with agoraphobia compared to patients without mental disorders. In addition, there was an increased prevalence of chronic ischemic heart disease in recurrent depression, dysthymia and generalized anxiety disorder, higher prevalence of neuropathy in depressive episode and recurrent depression and nephropathy in panic disorder.CONCLUSION:Depressive and anxiety disorders, as well as severe psychosocial problems, are consistently associated with T2DM. At the same time, concomitant somatic disorders and complications of DM2 are not just by chance comorbid to various forms of mental disorders, which allows for a new look at the problem of comorbidity/multimorbidity in T2DM.

Aims This study evaluated the psychometric characteristics of the Polish version of the PHQ-9 in detecting major depression (MDD) and ‘MDD and/or dysthymia’ in people with and without type 2 diabetes. Methods Participants were randomly selected from a diabetes outpatient facility (N = 216) and from among patients admitted to a medical center and psychiatric hospital (N = 99). The participants completed the PHQ-9. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to identify the presence of psychiatric symptoms. The optimal cut-offs for PHQ-9 in people with and without type 2 diabetes were investigated based on two methods: 1) Youden’s index which identifies cut-off points useful in scientific research; 2) a second method of two-stage screening for depressive disorders to provide guidance for clinical practice. Results The Polish version of the PHQ-9 is a reliable and valid screening tool for depression in people with and without type 2 diabetes. An optimal cut-off of ≥ 7 was indicated by Youden’s index and ≥ 5 by the two-stage method for screening for MDD and ‘MDD and/or dysthymia’ in the group with type 2 diabetes. A cut-off of ≥ 11 was optimal for screening for both MDD and ‘MDD and/or dysthymia’ among people without diabetes (Youden’s index). The two-stage approach suggested a ≥ 10 score for screening for MDD and ≥ 9 for screening for ‘MDD and/or dysthymia’ in people without diabetes. Conclusions A lower cut-off score of the PHQ-9 is recommended for people with type 2 diabetes as compared to the general population.

Diabetic MedicineVolume 36, Issue 7 p. 911-912 Letter Comment on the consensus report on the management of hyperglycaemia in Type 2 diabetes by the American Diabetes Association and the European Association for the Study of Diabetes T. Skinner, T. Skinner orcid.org/0000-0002-0018-6963 University of Copenhagen, Denmark Steno Diabetes Centre Copenhagen, DenmarkSearch for more papers by this authorM. Byrne, M. Byrne School of Psychology, National University of Ireland, Galway, IrelandSearch for more papers by this authorJ. K. Dickinson, J. K. Dickinson Diabetes Education and Management, Teachers College Columbia University, New York, NY, USASearch for more papers by this authorL. Fisher, L. Fisher orcid.org/0000-0001-9481-9727 Family and Community Medicine, University of California San Francisco, San Francisco, LA, USASearch for more papers by this authorM. Funnell, M. Funnell University of Michigan Medical School, Ann Arbor, MI, USASearch for more papers by this authorS. Guzman, S. Guzman Behavioural Diabetes Institute, San Diego, CA, USASearch for more papers by this authorC. Hendrieckx, C. Hendrieckx Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia Deakin University, AustraliaSearch for more papers by this authorN. Hermanns, N. Hermanns orcid.org/0000-0002-9610-0975 Jazindiabetes, (Diabetes & Me), SloveniaSearch for more papers by this authorK. Kanc, K. Kanc Forschungsinstitut Diabetes-Akademie, Bad Mergentheim, GermanySearch for more papers by this authorC. Lloyd, C. Lloyd orcid.org/0000-0002-8863-3069 Open University, Milton Keynes, UKSearch for more papers by this authorA. Mocan, A. Mocan Emergency Clinical County Hospital, Cluj-Napoca, RomaniaSearch for more papers by this authorA. Nouwen, A. Nouwen orcid.org/0000-0002-0609-4082 Middlesex University, London, UKSearch for more papers by this authorF. Pouwer, F. Pouwer University of Southern Denmark, Odense, DenmarkSearch for more papers by this authorN. Saleh-Stattin, N. Saleh-Stattin Academic Primary Health Care Centre, Stockholm, SwedenSearch for more papers by this authorF. Snoek, F. Snoek Amsterdam UMC, Amsterdam, NetherlandsSearch for more papers by this authorJ. Speight, J. Speight orcid.org/0000-0002-1204-6896 Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia Deakin University, AustraliaSearch for more papers by this authorJ. Sturt, J. Sturt Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, UKSearch for more papers by this authorM. Vallis, M. Vallis orcid.org/0000-0002-0165-5936 Dalhousie University, Halifax, CanadaSearch for more papers by this authorJ. Wagner, J. Wagner Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USASearch for more papers by this authorI. Willaing, I. Willaing Steno Diabetes Centre Copenhagen, DenmarkSearch for more papers by this authorD. Young-Hyman, D. Young-Hyman National Institute of Health, Bethesda, MD, USASearch for more papers by this authorV. Zoffmann, V. Zoffmann University of Copenhagen, DenmarkSearch for more papers by this author T. Skinner, T. Skinner orcid.org/0000-0002-0018-6963 University of Copenhagen, Denmark Steno Diabetes Centre Copenhagen, DenmarkSearch for more papers by this authorM. Byrne, M. Byrne School of Psychology, National University of Ireland, Galway, IrelandSearch for more papers by this authorJ. K. Dickinson, J. K. Dickinson Diabetes Education and Management, Teachers College Columbia University, New York, NY, USASearch for more papers by this authorL. Fisher, L. Fisher orcid.org/0000-0001-9481-9727 Family and Community Medicine, University of California San Francisco, San Francisco, LA, USASearch for more papers by this authorM. Funnell, M. Funnell University of Michigan Medical School, Ann Arbor, MI, USASearch for more papers by this authorS. Guzman, S. Guzman Behavioural Diabetes Institute, San Diego, CA, USASearch for more papers by this authorC. Hendrieckx, C. Hendrieckx Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia Deakin University, AustraliaSearch for more papers by this authorN. Hermanns, N. Hermanns orcid.org/0000-0002-9610-0975 Jazindiabetes, (Diabetes & Me), SloveniaSearch for more papers by this authorK. Kanc, K. Kanc Forschungsinstitut Diabetes-Akademie, Bad Mergentheim, GermanySearch for more papers by this authorC. Lloyd, C. Lloyd orcid.org/0000-0002-8863-3069 Open University, Milton Keynes, UKSearch for more papers by this authorA. Mocan, A. Mocan Emergency Clinical County Hospital, Cluj-Napoca, RomaniaSearch for more papers by this authorA. Nouwen, A. Nouwen orcid.org/0000-0002-0609-4082 Middlesex University, London, UKSearch for more papers by this authorF. Pouwer, F. Pouwer University of Southern Denmark, Odense, DenmarkSearch for more papers by this authorN. Saleh-Stattin, N. Saleh-Stattin Academic Primary Health Care Centre, Stockholm, SwedenSearch for more papers by this authorF. Snoek, F. Snoek Amsterdam UMC, Amsterdam, NetherlandsSearch for more papers by this authorJ. Speight, J. Speight orcid.org/0000-0002-1204-6896 Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia Deakin University, AustraliaSearch for more papers by this authorJ. Sturt, J. Sturt Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, UKSearch for more papers by this authorM. Vallis, M. Vallis orcid.org/0000-0002-0165-5936 Dalhousie University, Halifax, CanadaSearch for more papers by this authorJ. Wagner, J. Wagner Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USASearch for more papers by this authorI. Willaing, I. Willaing Steno Diabetes Centre Copenhagen, DenmarkSearch for more papers by this authorD. Young-Hyman, D. Young-Hyman National Institute of Health, Bethesda, MD, USASearch for more papers by this authorV. Zoffmann, V. Zoffmann University of Copenhagen, DenmarkSearch for more papers by this author First published: 20 February 2019 https://doi.org/10.1111/dme.13934Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume36, Issue7July 2019Pages 911-912 RelatedInformation

Aims: The aim of this study was to validate and report the factorial analysis of the World Health Organization's 5-itemWell-being Index (WHO-5) among outpatients with type 2 diabetes. We investigated the psychometric properties of the WHO-5 and its suitability for identifying potential depressive symptoms in Polish adults with diabetes. Methods: Participants were randomly chosen among Polish diabetes outpatients and invited to participate in the cross-sectional study (N = 216). Participants completed the Polish version of the WHO-5, Problem Areas in Diabetes Scale and Patient Health Questionnaire. Results: Factor analyses identified the one-factor structure of the Polish version of the WHO-5. The internal consistency of the Polish version of the WHO-5 is satisfying. With regard to convergent validity, there were significant negative associations between the WHO-5 and PAID, the PHQ-9, HbA1c and the amount of medical complications. The AUC indicates that the WHO-5 is an effective measure for identifying depressive symptoms. The optimal cut off values of <= 12 yielded the best sensitivity/specificity trade-off for identifying depression among people with diabetes. Conclusions: The Polish version of the WHO-5 is a reliable, valid outcome measure for outpatients with type 2 diabetes and can be a useful instrument for screening for depression in people with diabetes. (C) 2019 Elsevier B.V. All rights reserved.

BACKGROUND:Diabetes mellitus is a global health problem and one of the most common medical conditions in pregnancy. A wide range of modifiable risk factors are associated with diabetes mellitus in pregnancy, and it is widely acknowledged that preconception care (PCC) is beneficial for women with pre-existing diabetes mellitus. However, uptake of PCC services is low. OBJECTIVES:To systematically review qualitative research on PCC for women with pre-existing diabetes mellitus of childbearing age, identify facilitators of and barriers to uptake of PCC and establish themes and gaps in knowledge. Through qualitative interviews explore views on the provision of, and facilitators of and barriers to the uptake of, PCC. DESIGN:Mixed methods encompassing a systematic review and qualitative interviews. SETTING:Two secondary care sites and 11 primary care sites. PARTICIPANTS:Women of childbearing age with pre-existing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) of white British or Pakistani origin. INTERVENTIONS:None. ANALYSIS:A narrative synthesis of the literature using thematic analysis and a thematic analysis of the qualitative interview data using the method of constant comparison. RESULTS:Eighteen qualitative studies were included in the systematic review and a quality appraisal was carried out using relevant criteria for qualitative research appraisal, including a narrative summary of study quality. Twelve interviews with women with pre-existing T1DM or T2DM were carried out. This fell short of the original aim of interviewing 48 women owing to challenges in recruitment, especially in primary care. A synthesis of these data shows that uptake of PCC is influenced by a range of factors, including the complexity of pregnancy planning, the skill and expertise of health professionals who provide care to women with diabetes mellitus, the role of health professionals in the delivery of PCC, and the quality of relationships between women and health professionals. LIMITATIONS:Owing to significant challenges with recruitment of participants, particularly in primary care, 12 interviews with women with pre-existing T1DM or T2DM were carried out, which fell short of the a priori sample size. CONCLUSIONS:Reconceptualising PCC to place greater emphasis on pregnancy planning, fertility and contraception would lower some of the existing barriers to uptake of care. It is important to clarify who is responsible for the delivery of PCC to women with pre-existing diabetes mellitus and to ensure that the correct expertise is available so that opportunities for advice giving are maximised. Relationships between women and health professionals should be based on a partnership approach that encourages mutual trust and respect, focusing on positive change rather than negative outcomes. FUTURE WORK:Further research is needed to investigate the views and experiences of stakeholders that commission, design and deliver PCC services for women with pre-existing diabetes mellitus; to explore experiences of women from minority or ethnically diverse backgrounds; to investigate the role of family support in contraception, pregnancy planning and PCC; and to investigate the management of diabetes mellitus in neonatal care and its role in breastfeeding. STUDY REGISTRATION:This study is registered as PROSPERO CRD42014015592 and ISRCTN12983949. FUNDING:The National Institute for Health Research Health Technology Assessment programme.

Background: Ethnic minorities report poorer evaluations of primary health care compared to White British patients. Emerging evidence suggests that when a doctor and patient share ethnicity and/or language this is associated with more positive reports of patient experience. Whether this is true for adults in English general practices remains to be explored.Methods: We analysed data from the 2010/2011 English General Practice Patient Survey, which were linked to data from the NHS Choices website to identify languages which were available at the practice. Our analysis was restricted to single-handed practices and included 190,582 patients across 1,068 practices. Including only single-handed practices enabled us to attribute, more accurately, reported patient experience to the languages that were listed as being available. We also carried out sensitivity analyses in multi-doctor practices. We created a composite score on a 0-100 scale from seven survey items assessing doctor-patient communication. Mixed-effect linear regression models were used to examine how differences in reported experience of doctor communication between patients of different self-reported ethnicities varied according to whether a South Asian language concordant with their ethnicity was available in their practice. Models were adjusted for patient characteristics and a random effect for practice.Results: Availability of a concordant language had the largest effect on communication ratings for Bangladeshis and the least for Indian respondents (p < 0.01). Bangladeshi, Pakistani and Indian respondents on average reported poorer communication than White British respondents [-2.9 (95% CI -4.2, -1.6), -1.9 (95% CI -2.6, -1.2) and -1.9 (95% CI -2.5, -1.4), respectively]. However, in practices where a concordant language was offered, the experience reported by Pakistani patients was not substantially worse than that reported by White British patients (-0.2, 95% CI -1.5,+1.0), and in the case of Bangladeshi patients was potentially much better (+ 4.5, 95% CI -1.0,+ 10.1). This contrasts with a worse experience reported among Bangladeshi (-3.3, 95% CI -4.6, -2.0) and Pakistani (-2.7, 95% CI -3.6, -1.9) respondents when a concordant language was not offered.Conclusions: Substantial differences in reported patient experience exist between ethnic groups. Our results suggest that patient experience among Bangladeshis and Pakistanis is improved where the practice offers a language that is concordant with the patient's ethnicity.

OBJECTIVETo determine whether type A behavior predicts all-cause mortality and incident coronary artery disease (CAD) in a type 1 diabetic population.RESEARCH DESIGN AND METHODSFollow-up data (22 years) from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset type 1 diabetes were analyzed for the 506 participants who completed the Bortner Rating Scale (measuring type A behavior) and Beck Depression Inventory (BDI) at baseline (1986-1988). CAD comprised myocardial infarction as determined by hospital records/Q waves on electrocardiogram (ECG), CAD death (determined by a mortality classification committee), angiographic stenosis, ischemic ECG, and angina.RESULTSThere were 128 deaths (25.3%) during follow-up. Univariate analysis showed an inverse relationship between Bortner scores and all-cause mortality (P = 0.01), which remained significant after allowing for age, sex, duration, HbA(1c), education, smoking, BMI, and physical activity (P = 0.03). However, the addition of BDI scores attenuated the relationship (P = 0.11) with a significant interaction (P = 0.03) such that any protective effect against mortality was limited among individuals with lower BDI scores (bottom three quintiles) (P = 0.07), whereas no effect was seen in those with higher BDI scores (P = 0.97). Bortner scores showed only a borderline association with incident CAD (P = 0.09).CONCLUSIONSThose with higher type A behavior have lower all-cause mortality in our type 1 diabetic population, an effect that interacts with depressive symptomatology such that it is only operative in those with low BDI scores. Further research should focus on understanding this interaction.

Recently, there has been a growing interest in psychological problems in people with diabetes and a concomitant increasing concern that these often go unreported and, thus, unidentified and treated. This has serious implications for both the self-management of diabetes and the individual's quality of life. In this review article we consider the question of screening for depression in people with diabetes within a national health service in the UK. The inadequacies of psychological care for patients with diabetes are discussed, in particular with regard to the importance of distinguishing between depressive symptoms and emotional distress related to having diabetes. Criteria for assessing the validity of screening for depression are discussed, together with national and international recommendations, with particular emphasis on current practice. The screening strategy currently recommended for implementation in primary care in the UK is outlined. The need for rigorous evaluation of screening initiatives is highlighted and a key conclusion is that case-finding alone is unlikely to be effective in terms of improving patient outcomes unless considered and applied in the context of overall case management. This review highlights the barriers and challenges to optimizing care for patients with co-morbid diabetes and depression, and outlines the therapies currently available in the UK, which might be disseminated in other countries.