Type 1 diabetes mellitus and major depressive disorder: evidence for a biological link

Korczak, Daphne J.; Pereira, Sandra; Koulajian, Khajag; Matejcek, A.; Giacca, Adria

doi:10.1007/s00125-011-2240-3

Cited by 138 publications

(121 citation statements)

References 119 publications

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“…The results of the univariate analyses were similar when using continuous (rather than categorical) PHQ-8 depression scores (data not shown); however, the association between living alone (36) 216 (34) 1,980 (36) 142 (33) 2,054 (36) 91 ( (20) 141 (22) 1,063 (19) 98 (22) 1,111 (19) 56 (20) 1,148 (19)…”

Section: Depression Using Continuous Phq-8 Scorementioning

confidence: 72%

“…A recent review (36) outlines plausible biologic mechanisms that might explain the relationship of T1D and depression. Proposed mechanisms suggest shared biologic vulnerability and include the effects of increased circulating cytokines, insulin deficiency on neurogenesis/neurotransmitter metabolism, chronic hyperglycemia and/or iatrogenic hypoglycemia, and basal hyperactivity of the hypothalamicpituitary-adrenal axis (36). Further study is needed to elucidate these potential biological mechanisms linking depression to poor glycemic control for adults with T1D, as well as potential psychosocial mechanisms that have not been defined.…”

Section: Discussionmentioning

confidence: 99%

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Depression in Adults in the T1D Exchange Clinic Registry

et al. 2014

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OBJECTIVELittle is known about the frequency of depression in adults with type 1 diabetes (T1D) or its relationship to diabetes outcomes. The T1D Exchange clinic registry allowed us to explore depression in a large, heterogeneous sample. RESEARCH DESIGN AND METHODSParticipants ‡18 years old (N = 6,172; median age 34 years; median diabetes duration 16 years; 55% female; and 89% non-Hispanic white) completed the eight-item Patient Health Questionnaire (PHQ-8), a validated, reliable measure of current depression. Probable major depression was defined in four ways: PHQ-8 ‡10, PHQ-8 ‡12, per diagnostic algorithm, and as a continuous variable. Characteristics and clinical outcomes of those with and without depression were compared using logistic and linear regression models. RESULTSA total of 4.6-10.3% of participants were classified as probable major depression depending on how defined. Participants classified as depressed were more likely female, nonwhite race/ethnicity, to have a lower household income and lower education level, to exercise less often, to miss insulin doses, and to have one or more complications (neuropathy, nephropathy, treatment for retinopathy, or cardiovascular/cerebrovascular disease) (all P < 0.01). HbA 1c was higher in the depressed versus not depressed groups (8.4 6 1.7% [68 6 8.6 mmol/mol] vs. 7.8 6 1.4% [62 6 15.3 mmol/mol]; P < 0.001). Occurrence of one or more diabetic ketoacidosis events (11 vs. 4%; P < 0.001) and one or more severe hypoglycemic events (18 vs. 9%; P < 0.001) in the past 3 months was higher among depressed participants. CONCLUSIONSIn the T1D Exchange clinic registry, adults with probable major depression have worse clinical outcomes than those not depressed. Whether identification and treatment of depression improves diabetes outcomes requires study. Depression is common in T1D, and better identification and treatment of this comorbid condition is needed.The prevalence of depression is almost two times higher in persons with diabetes than it is in the general population (1-3). Not only do persons with diabetes have an increased risk of developing depression (4), but persons with depression have an increased risk of developing diabetes (5), which may relate to their use of antidepressants (6) or other biological or psychosocial factors associated with diabetes. Depression in diabetes is a particular concern because it is associated with poorer glycemic control (7) and regimen adherence (8), greater morbidity and mortality

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Section: Depression Using Continuous Phq-8 Scorementioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Depression in Adults in the T1D Exchange Clinic Registry

et al. 2014

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“…Patients with diabetes have an increased prevalence of depression (1,2,3). Depression in diabetes is associated with low quality of life (3), impaired glycemic control (3), increased frequency of complications (4,5,6), and all-cause mortality (6).…”

Section: Introductionmentioning

confidence: 99%

“…There are suggested overlapping biological links between depression and autoimmune diabetes indicated by high levels of circulating cytokines associated with both conditions, insulin deficiency impairing neurogenesis and neurotransmitter metabolism, a chronic hyperglycemic state and hypoglycemia episodes, and hyperactivity of the hypothalamic-pituitary-adrenal axis. All these factors may induce or worsen depression (1).…”

Section: Introductionmentioning

confidence: 99%

Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes

Melin

Thunander

Svensson³

et al. 2013

European Journal of Endocrinology

129

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Objective: The aim of this study was to explore the associations between inadequate glycemic control of diabetes and psychological, anthropometric, and lifestyle variables in a population-based cohort of type 1 diabetes patients. Design: Cross-sectional study. Methods: In this study, 292 patients with type 1 diabetes, aged 18-59 years, participated. Psychological data were assessed by self-report instruments: Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale-20. Anthropometrics, blood analyses, data from medical records, and data from the Swedish National Diabetes Registry were collected. Results: Self-reported depression (adjusted odds ratio (AOR) 4.8), obesity (AOR 4.3), and smoking (AOR 3.0) were independently associated with inadequate glycemic control of diabetes (HbA1cO8.6%). Gender-stratified analyses showed that self-reported depression (AOR 19.8) and obesity (AOR 7.0) in women and smoking in men (AOR 4.2) were associated with HbA1cO8.6%. Alexithymia, antidepressant medication, and physical inactivity were associated with HbA1cO8.6% only in bivariate analyses. Alexithymia, self-rated anxiety, physical inactivity, and absence of abdominal obesity were associated with self-reported depression. Conclusions: Depression was the only psychological factor independently associated with HbA1cO 8.6%. The association was of comparable importance as obesity and smoking, well-known risk factors for inadequate glycemic control and diabetes complications. The association between depression and HbA1cO8.6% was particularly strong for women. Alexithymia, which is a relatively stable personality trait, was associated with depression. In the future care of patients with diabetes, psychological aspects should be considered alongside anthropometrics and lifestyle factors in order to achieve the goals for HbA1c.

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“…Additional family factors, including decreased parental involvement in diabetes management [5], increased family conflict, and decreased family cohesion [6] have also been correlated with poorer disease control. The nature of the relationship between diabetes control and psychological stress, including stressful life events, however, is unclear [7,8]. One area of potential shared pathophysiology may be hypothalamic-pituitaryadrenal (HPA) axis dysfunction.…”

Section: Introductionmentioning

confidence: 99%

The Association of Cortisol Stress Response with Early Adversity and Diabetes Control in Adolescents with Diabetes

Korczak¹,

Manassis²

2016

J Depress Anxiety

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The specific aims of this study were to (1) evaluate the ability of a psychosocial stressor to induce an adequate stress response among adolescents with T1D; (2) examine predictors of stress responsiveness in this population and (3) evaluate the relationship of these factors with diabetes control. Based on previous research demonstrating the ability of a psychosocial stressor to elicit a cortisol response among children with a chronic inflammatory disorder, we hypothesized that the Trier Social Stress Task for Children 17]) would be an adequate stressor that causes a significant and reliable increase in cortisol levels among adolescents with T1DM. Further, we hypothesized that greater burden of stressful life events and increased family dysfunction would be associated with stress responsiveness and poorer overall diabetes control. Methodology ParticipantsSeventeen adolescents (nine male, eight female) with T1DM, followed in the diabetes clinic of a large paediatric hospital, participated in the study. The clinic provides routine diabetes care to 70% of the children and adolescents with T1DM in the Toronto area. English speaking participants aged 11-18 years were included in the study if they had a history of T1DM of at least one year. Clinic patients with comorbid medical illnesses, (apart from treated hypothyroidism or mild asthma), developmental delay, or taking psychotropic medication at the Abstract Objectives: The hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the relationship between increased stress and poor diabetes control in children with type 1 diabetes mellitus (T1DM).The objectives of this study were two-fold: (1) To evaluate the effectiveness of the Trier Social Stress Test for Children (TSST-C) in inducing psychosocial stress in children with T1DM; (2) To investigate predictors of the cortisol stress response to the TSST-C.Methods: Seventeen adolescents with T1DM were exposed to the TSST-C. Salivary cortisol was sampled pre-TSST-C and at six 10-minute intervals following the stress procedure. Measures of anxiety, depression, family functioning and early adversity were completed. Results:The TSST-C induced a significant increase in cortisol response (p<0.01). Early adversity predicted cortisol response to the stressor (p=0.01). Early adversity was also associated with poorer diabetes control (p=0.05). Conclusion:The TSST-C was effective in producing a stress response in children with diabetes. Whereas previous research has emphasized psychological pathways which contribute to the relationship between psychosocial stressors and poor diabetes control, this study suggests that biological dysfunction may also underlie the association.

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Type 1 diabetes mellitus and major depressive disorder: evidence for a biological link

Cited by 138 publications

References 119 publications

Depression in Adults in the T1D Exchange Clinic Registry

Depression in Adults in the T1D Exchange Clinic Registry

Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes

The Association of Cortisol Stress Response with Early Adversity and Diabetes Control in Adolescents with Diabetes

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