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Author (up) Naicker, K.; Johnson, J.A.; Skogen, J.C.; Manuel, D.; Overland, S.; Sivertsen, B.; Colman, I. url  doi
  Title Type 2 Diabetes and Comorbid Symptoms of Depression and Anxiety: Longitudinal Associations With Mortality Risk Type Journal Article
  Year 2017 Publication Diabetes Care Abbreviated Journal Diabetes Care  
  Volume 40 Issue 3 Pages 352-358  
  Keywords Adult; Aged; Aged, 80 and over; Anxiety/*complications; Comorbidity; Depression/*complications; Diabetes Mellitus, Type 2/*complications; Female; Follow-Up Studies; Humans; Male; Middle Aged; Norway/epidemiology; Proportional Hazards Models; Risk Factors; Socioeconomic Factors; Surveys and Questionnaires; Young Adult  
  Abstract OBJECTIVE: Depression is strongly linked to increased mortality in individuals with type 2 diabetes. Despite high rates of co-occurring anxiety and depression, the risk of death associated with comorbid anxiety in individuals with type 2 diabetes is poorly understood. This study documented the excess mortality risk associated with symptoms of depression and/or anxiety comorbid with type 2 diabetes. RESEARCH DESIGN AND METHODS: Using data for 64,177 Norwegian adults from the second wave of the Nord-Trondelag Health Study (HUNT2), with linkage to the Norwegian Causes of Death Registry, we assessed all-cause mortality from survey participation in 1995 through to 2013. We used Cox proportional hazards models to examine mortality risk over 18 years associated with type 2 diabetes status and the presence of comorbid affective symptoms at baseline. RESULTS: Three clear patterns emerged from our findings. First, mortality risk in individuals with diabetes increased in the presence of depression or anxiety, or both. Second, mortality risk was lowest for symptoms of anxiety, higher for comorbid depression-anxiety, and highest for depression. Lastly, excess mortality risk associated with depression and anxiety was observed in men with diabetes but not in women. The highest risk of death was observed in men with diabetes and symptoms of depression only (hazard ratio 3.47, 95% CI 1.96, 6.14). CONCLUSIONS: This study provides evidence that symptoms of anxiety affect mortality risk in individuals with type 2 diabetes independently of symptoms of depression, in addition to attenuating the relationship between depressive symptoms and mortality in these individuals.  
  Address School of Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada icolman@uottawa.ca  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0149-5992 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:28077458 Approved no  
  Call Number HUNT @ maria.stuifbergen @ Serial 1961  
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Author (up) Naicker, K.; Manuel, D.; Overland, S.; Skogen, J.C.; Johnson, J.A.; Sivertsen, B.; Colman, I. url  doi
  Title Population attributable fractions for Type 2 diabetes: an examination of multiple risk factors including symptoms of depression and anxiety Type Journal Article
  Year 2018 Publication Diabetology & Metabolic Syndrome Abbreviated Journal Diabetol Metab Syndr  
  Volume 10 Issue Pages 84  
  Keywords Anxiety; Attributable fractions; Depression; Metabolic risk; Type 2 diabetes  
  Abstract Background: Population attributable fractions (PAFs) are frequently used to quantify the proportion of Type 2 diabetes cases due to single risk factors, an approach which may result in an overestimation of their individual contributions. This study aimed to examine Type 2 diabetes incidence associated with multiple risk factor combinations, including the metabolic syndrome, behavioural factors, and specifically, depression and anxiety. Methods: Using data from the population-based HUNT cohort, we examined incident diabetes in 36,161 Norwegian adults from 1995 to 2008. PAFs were calculated using Miettinen's case-based formula, using relative risks estimated from multivariate regression models. Results: Overall, the studied risk factors accounted for 50.5% of new diabetes cases (78.2% in men and 47.0% in women). Individuals exposed to both behavioural and metabolic factors were at highest risk of diabetes onset (PAF = 22.9%). Baseline anxiety and depression contributed a further 13.6% of new cases to this combination. Men appeared to be particularly vulnerable to the interaction between metabolic, behavioural and psychological risk factors. Conclusion: This study highlights the importance of risk factor clustering in diabetes onset, and is the first that we know of to quantify the excess fraction of incident diabetes associated with psychological risk factor interactions.  
  Address 1School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres., Room 308C, Ottawa, ON K1G 5Z3 Canada.0000 0001 2182 2255grid.28046.38  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1758-5996 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:30479670; PMCID:PMC6251110 Approved no  
  Call Number HUNT @ maria.stuifbergen @ Serial 2141  
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Author (up) Naicker, K.; Overland, S.; Johnson, J.A.; Manuel, D.; Skogen, J.C.; Sivertsen, B.; Colman, I. url  doi
  Title Symptoms of anxiety and depression in type 2 diabetes: Associations with clinical diabetes measures and self-management outcomes in the Norwegian HUNT study Type Journal Article
  Year 2017 Publication Psychoneuroendocrinology Abbreviated Journal Psychoneuroendocrinology  
  Volume 84 Issue Pages 116-123  
  Keywords Anxiety; Depression; Diabetes self-management; Metabolic control; Type 2 diabetes  
  Abstract OBJECTIVE: To determine if symptoms of depression and anxiety are differentially associated with clinical diabetes measures and self-management behaviours in individuals with Type 2 diabetes, and whether these associations vary by patient sex. RESEARCH DESIGN AND METHODS: A cross-sectional analysis using data from 2035 adults with Type 2 diabetes in the Nord-Trondelag Health Study. Multivariate logistic regression was used to explore associations between symptoms of depression and anxiety and waist girth, HDL cholesterol, systolic blood pressure, triglycerides, c-reactive protein, glycemic control, diet adherence, exercise, glucose monitoring, foot checks for ulcers, and the subjective patient experience. Analyses were stratified by sex. RESULTS: Depression was associated with a lower likelihood of avoiding saturated fats (OR=0.20 [95% CI: 0.06, 0.68]) and increased odds of physical inactivity (OR=1.69 [95% CI: 1.37, 2.72]). Anxiety was associated with increased odds of eating vegetables (OR=1.66 [95% CI: 1.02, 2.73]), and an over two-fold increase of feeling that having diabetes is difficult. In women, anxiety was associated with elevated c-reactive protein levels (OR=1.57 [95% CI: 1.05, 2.34]). In men, depressive symptoms were associated with elevated HbA1c (OR=5.00 [95% CI: 1.15, 8.23). CONCLUSIONS: Symptoms of depression and anxiety were differentially associated with some key diabetes-related measures. Our results suggest sex-specific differences with respect to two important clinical outcomes (i.e., anxiety and CRP in women and depression and glycemic control in men). These findings should alert practitioners to the importance of detection and management of psychological symptoms in individuals with Type 2 diabetes.  
  Address School of Public Health and Preventive Medicine, University of Ottawa, Ontario Canada. Electronic address: icolman@uottawa.ca  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0306-4530 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:28704763 Approved no  
  Call Number HUNT @ maria.stuifbergen @ Serial 1962  
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