The aim of this study was to validate and report the factorial analysis of the World Health Organization's 5-item Well-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.
Aim
To investigate whether there is a bidirectional longitudinal association of depression with HbA1c.
Methods
We conducted a systematic literature search in PubMed, PsycINFO, CINAHL and EMBASE for observational, longitudinal studies published from January 2000 to September 2020, assessing the association between depression and HbA1c in adults. We assessed study quality with the Newcastle‐Ottawa‐Scale. Pooled effect estimates were reported as partial correlation coefficients (rp) or odds ratios (OR).
Results
We retrieved 1642 studies; 26 studies were included in the systematic review and eleven in the meta‐analysis. Most studies (16/26) focused on type 2 diabetes. Study quality was rated as good (n = 19), fair (n = 2) and poor (n = 5). Of the meta‐analysed studies, six investigated the longitudinal association between self‐reported depressive symptoms and HbA1c and five the reverse longitudinal association, with a combined sample size of n = 48,793 and a mean follow‐up of 2 years. Higher levels of baseline depressive symptoms were associated with subsequent higher levels of HbA1c (partial r = 0.07; [95% CI 0.03, 0.12]; I238%). Higher baseline HbA1c values were also associated with 18% increased risk of (probable) depression (OR = 1.18; [95% CI 1.12,1.25]; I20.0%).
Conclusions
Our findings support a bidirectional longitudinal association between depressive symptoms and HbA1c. However, the observed effect sizes were small and future research in large‐scale longitudinal studies is needed to confirm this association. Future studies should investigate the role of type of diabetes and depression, diabetes distress and diabetes self‐management behaviours. Our results may have clinical implications, as depressive symptoms and HbA1c levels could be targeted concurrently in the prevention and treatment of diabetes and depression.
Registration
PROSPERO ID CRD42019147551.
The development and assessment of the psychometric properties of the Polishlanguage version of the Toronto Alexithymia Scale (Bagby et al., 1994a,b) is described in this article. The aim of this study was to translate the TAS -20 into Polish and establish the psychometric properties of this instrument evaluating alexithymia.Materials and Methods: Data were collected via self-report measures from a total sample of 676 participants: a total of 180 participants (115 males and 65 females) diagnosed with alcohol dependence, and 496 control group (347 males and 149 females).Results: Confirmatory factor analyses found the factor structure of the original Englishlanguage TAS 20 for the three subscales translated into Polish: Difficulty in Identifying Feeling (DIF); Difficulty in Describing Feeling (DDF); Externally Oriented Thinking (EOT). All three subscales showed good internal consistency in non-clinical group and two subscales, DIF and DDF in alcohol addict group. Several EOT items loaded poorly on their intended factor.
Conclusion:The results from the present study indicate that the Polish version of the TAS -20 is a reliable and valid measure of alexithymia with good levels of internal consistency, homogeneity, and construct validity. We conclude that the TAS-20 has, for the most part, adequate psychometric properties, though interpretation should focus only on the total scale score and DIF and DDF subscales, especially in clinical groups.
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