A network analysis of depressive symptoms in adults with and without diabetes: findings from the Irish longitudinal study on ageing.

OBJECTIVES: This study aimed to estimate networks of depressive symptoms among Irish adults with and without diabetes at two time points and compare between the two groups at each time point using data from the Irish Longitudinal Study on Ageing (TILDA). METHODS: Participants were from Wave 1 (2009-2011) and Wave 4 (2016) of TILDA, with n = 639 participants with diabetes and n = 7,837 without diabetes at Wave 1, and n = 1,151 with diabetes and n = 4,531 without diabetes at Wave 4. Depressive symptoms were measured using the 8 items of the Center for Epidemiologic Studies Depression Scale. Network psychometric analysis was used to examine symptom centrality, symptom-level associations, and network comparisons at each time point. RESULTS: Stable, strongly connected networks emerged for people with and without diabetes at both time points. The symptoms of feeling depressed, feeling like everything's an effort, not enjoying life, feeling sad, and couldn't get going were the most central nodes in all networks, which did not differ between people with and without diabetes. However, for people with diabetes, the network was more densely connected at Wave 4, when the sample was predominately people with newly diagnosed diabetes. Furthermore, the relationship between 'felt lonely' and 'couldn't get going' and between 'not enjoying life' and 'sad' was significantly stronger for people with diabetes than for those without. CONCLUSIONS: This study provides a more detailed understanding of the structure of depressive symptoms at two time points in older Irish adults with and without type 1 or type 2 diabetes.

Childhood maltreatment and the risk of impaired glucose metabolism or type 2 diabetes in young adults: Findings from the Lifelines Cohort Study.

We examined the associations between childhood maltreatment and the risk of impaired glucose metabolism (IGM) or type 2 diabetes (T2D) in young adults aged 18-35. Participants (N = 8506) from the Lifelines Cohort Study without IGM or diabetes at baseline (2007-2013) were included. Childhood maltreatment was assessed by the Childhood Trauma Questionnaire (CTQ) and incident IGM/T2D was assessed by haemoglobin A1c levels (≥5.7%) in 2014-2017. There were 223 (2.6%) cases of IGM/T2D during the follow-up period. After adjusting for sociodemographic and health/lifestyle covariates and follow-up time, only the CTQ Sexual Abuse subscale was significantly associated with IGM/T2D (RR = 1.05 [95% CI = 1.01, 1.10]). The association remained when additionally accounting for depressive and anxiety symptoms (RR = 1.05 [95% CI = 1.00, 1.09]). Childhood sexual abuse was associated with an increased risk of IGM/T2D in young adults, highlighting the long-term metabolic consequences of childhood maltreatment.

Neighbourhood characteristics and socioeconomic inequalities in child mental health: Cross-sectional and longitudinal findings from the Growing Up in Ireland study.

This study examined the role of neighbourhood characteristics in explaining socioeconomic inequalities in child mental health (the total difficulties score from the Strengths and Difficulties Questionnaire) using data from Cohort '08 of Growing Up in Ireland Waves 3 (age 5; baseline) and 5 (age 9; follow-up). Twenty neighbourhood items were grouped into neighbourhood safety, built environments, cohesion, interaction, and disorder. Data were analysed using regression, single and multiple mediation, and network psychometric analyses. We found that neighbourhood safety, cohesion, interaction, and disorder were associated with child mental health. These four domains separately (by up to 18 %) or in concert (by up to 23 %) partially explained socioeconomic inequalities in child mental health. Built environments may explain socioeconomic inequalities in mental health in urban children only. Findings from network analysis indicated that specific concerns over "people being drunk or taking drugs in public" and "this is a safe neighbourhood" had the strongest connections with child mental health. Improving neighbourhood characteristics may be important to reduce socioeconomic inequalities in child mental health in Ireland.

Prediabetes and the risk of type 2 diabetes: Investigating the roles of depressive and anxiety symptoms in the Lifelines cohort study.

AIMS: Depression and anxiety may increase the risk of progressing from prediabetes to type 2 diabetes. The present study examined the interactions between prediabetes status and elevated depressive and anxiety symptoms with the risk of type 2 diabetes. METHODS: Participants (N = 72,428) were adults aged 40 years and above without diabetes at baseline from the Lifelines Cohort Study (58% female; mean age = 51.4 years). The Mini-International Neuropsychiatric Interview screened for elevated symptoms of major depressive disorder and generalized anxiety disorder. Glycated haemoglobin A1c (HbA1c ) levels determined prediabetes status at baseline (2007-2013), and HbA1c and self-reported diabetes diagnoses determined diabetes status at follow-up (2014-2017). Groups were formed for elevated depressive and anxiety symptoms, respectively, and prediabetes status at baseline (elevated depressive/anxiety symptoms with prediabetes, elevated depressive/anxiety symptoms alone, and prediabetes alone), and compared to a reference group (no prediabetes or anxiety/depression) on the likelihood of developing diabetes during the follow-up period. RESULTS: N = 1300 (1.8%) participants developed diabetes. While prediabetes alone was associated with incident diabetes (OR = 5.94; 95% CI = 5.10-6.90, p < 0.001), the group with combined prediabetes and depressive symptoms had the highest likelihood of developing diabetes over follow-up (OR = 8.29; 95% CI = 5.58-12.32, p < 0.001). Similar results were found for prediabetes and anxiety symptoms (OR = 6.57; 95% CI = 4.62-9.33, p < 0.001), compared to prediabetes alone (OR = 6.09; 95% CI = 5.23-7.11, p < 0.001), though with a smaller effect. The interaction between depressive symptoms and prediabetes was synergistic in age-and-sex adjusted analyses. CONCLUSIONS: Individuals with elevated depressive, and to some extent anxiety, symptoms in combination with prediabetes may represent a high-risk subgroup for type 2 diabetes.

Trait Anger, Hostility, and the Risk of Type 2 Diabetes and Diabetes- Related Complications: A Systematic Review of Longitudinal Studies.

BACKGROUND: Research suggests associations between trait anger, hostility, and type 2 diabetes and diabetes-related complications, though evidence from longitudinal studies has not yet been synthesized. OBJECTIVE: The present systematic review examined findings from longitudinal research on trait anger or hostility and the risk of incident type 2 diabetes or diabetes-related complications. The review protocol was pre-registered in PROSPERO (CRD42020216356). METHODS: Electronic databases (MEDLINE, PsychINFO, Web of Science, and CINAHL) were searched for articles and abstracts published up to December 15, 2020. Peer-reviewed longitudinal studies with adult samples, with effect estimates reported for trait anger/hostility and incident diabetes or diabetes-related complications, were included. Title and abstract screening, full-text screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale were conducted by two independent reviewers. A narrative synthesis of the extracted data was conducted according to the Synthesis Without Meta-Analysis guidelines. RESULTS: Five studies (N = 155,146 participants) met the inclusion criteria. While results were mixed, our synthesis suggested an overall positive association between high trait-anger/hostility and an increased risk of incident diabetes. Only one study met the criteria for the diabetes-related complications outcome, which demonstrated a positive association between hostility and incident coronary heart disease but no significant association between hostility and incident stroke. CONCLUSION: Based on the available longitudinal evidence, trait anger and hostility are associated with an increased risk of diabetes. Longitudinal studies are needed to investigate the association between trait-anger or hostility and the risk of diabetes-related complications.

Diabetes Distress, Depressive Symptoms, and Anxiety Symptoms in People With Type 2 Diabetes: A Network Analysis Approach to Understanding Comorbidity.

OBJECTIVE: In this study, we aimed to explore interactions between individual items that assess diabetes distress, depressive symptoms, and anxiety symptoms in a cohort of adults with type 2 diabetes using network analysis. RESEARCH DESIGN AND METHODS: Participants (N = 1,796) were from the Montreal Evaluation of Diabetes Treatment (EDIT) study from Quebec, Canada. A network of diabetes distress was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the DDS-17 items, the nine items of the Patient Health Questionnaire (PHQ-9), and the seven items of the Generalized Anxiety Disorder Assessment (GAD-7). Network analysis was used to identify central items, clusters of items, and items that may act as bridges between diabetes distress, depressive symptoms, and anxiety symptoms. RESULTS: Regimen-related and physician-related problems were among the most central (highly connected) and influential (most positive connections) in the diabetes distress network. The depressive symptom of failure was found to be a potential bridge between depression and diabetes distress, being highly connected to diabetes distress items. The anxiety symptoms of worrying too much, uncontrollable worry, and trouble relaxing were identified as bridges linking both anxiety and depressive items and anxiety and diabetes distress items, respectively. CONCLUSIONS: Regimen-related and physician-related diabetes-specific problems may be important in contributing to the development and maintenance of diabetes distress. Feelings of failure and worry are potentially strong candidates for explaining comorbidity. These individual diabetes-specific problems and mental health symptoms could hold promise for targeted interventions for people with type 2 diabetes.

Adverse childhood experiences and cognitive function in adulthood: examining the roles of depressive symptoms and inflammation in a prospective cohort study.

PURPOSE: Adverse childhood experiences (ACEs) have been associated with cognitive decline in adulthood. However, the underlying mechanisms implicated remain unclear. This study investigated depressive symptoms and systemic inflammation as potential mediators of the association between ACEs and later cognitive function. METHODS: Participants were adults aged 50 + from the English Longitudinal Study of Ageing (N = 3029; 54.8% female). Measures included self-reported ACEs at wave 3 (2006-2007), C-reactive protein (CRP) and depressive symptoms at wave 4 (2008-2009), and cognitive function at waves 3 and 7 (2014-2015). Mediation analyses examined the direct associations between ACEs and cognitive function at wave 7 and the indirect associations via depressive symptoms and CRP at wave 4. In a first set of analyses, models were adjusted for sociodemographic factors and baseline cognitive function. In a second set of analyses, models were additionally adjusted for BMI and health behaviours (n = 1915). RESULTS: Cumulative ACEs exposure positively predicted depressive symptoms (b = 0.184, s.e. = 0.034, p < .001), which in turn predicted poorer cognitive function at wave 7 (b = - 0.035, s.e. = 0.008, p < .001). ACEs also positively predicted systemic inflammation as measured by CRP (b = 0.031, s.e. = 0.01, p = 0.0016). However, CRP did not mediate the association between ACEs and later cognitive function (b = - 0.0002, 95% CI: - 0.002, 0.002). CONCLUSION: These findings suggest that ACEs may be related to cognitive decline partly via depressive symptoms and corroborate prior research linking ACEs with systemic inflammation in adulthood.

Depression-related weight change and incident diabetes in a community sample.

This cohort study aimed to compare the incidence of type 2 diabetes in adults with depression-related weight gain, depression-related weight loss, depression with no weight change, and no depression. The study sample included 59,315 community-dwelling adults in Ontario, Canada. Depression-related weight change in the past 12 months was measured using the Composite International Diagnostic Interview-Short Form. Participants were followed for up to 20 years using administrative health data. Cox proportional hazards models compared the incidence of type 2 diabetes in adults with depression-related weight change and in adults with no depression. Adults with depression-related weight gain had an increased risk of type 2 diabetes compared to adults no depression (HR 1.70, 95% CI 1.32-2.20), adults with depression-related weight loss (HR 1.62, 95% CI 1.09-2.42), and adults with depression with no weight change (HR 1.39, 95% CI 1.03-1.86). Adults with depression with no weight change also had an increased risk of type 2 diabetes compared to those with no depression (HR 1.23, 95% CI 1.04-1.45). Associations were stronger among women and persisted after adjusting for attained overweight and obesity. Identifying symptoms of weight change in depression may aid in identifying adults at higher risk of type 2 diabetes and in developing tailored prevention strategies.

Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EMHS and UK Biobank datasets.

BACKGROUND: The prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but measurement invariance of the PHQ-9 across groups of people with and without diabetes has not yet been investigated. METHODS: Data from three independent cohorts from the USA (n=1,886 with diabetes, n=4,153 without diabetes), Quebec, Canada (n= 800 with diabetes, n= 2,411 without diabetes), and the UK (n=4,981 with diabetes, n=145,570 without diabetes), were used to examine measurement invariance between adults with and without diabetes. A series of multiple group confirmatory factor analyses were performed, with increasingly stringent model constraints applied to assess configural, equal thresholds, and equal thresholds and loadings invariance, respectively. One-factor and two-factor (somatic and cognitive-affective items) models were examined. RESULTS: Results demonstrated that the most stringent models, testing equal loadings and thresholds, had satisfactory model fit in the three cohorts for one-factor models (RMSEA = .063 or below and CFI = .978 or above) and two-factor models (RMSEA = .042 or below and CFI = .989 or above). LIMITATIONS: Data were from Western countries only and we could not distinguish between type of diabetes. CONCLUSIONS: Results provide support for measurement invariance between groups of people with and without diabetes, using either a one-factor or a two-factor model. While the two-factor solution has a slightly better fit, the one-factor solution is more parsimonious. Depending on research or clinical needs, both factor structures can be used.

Adverse Childhood Experiences and the Risk of Coronary Heart Disease in Adulthood: Examining Potential Psychological, Biological, and Behavioral Mediators in the Whitehall II Cohort Study.

Background This study investigated potential psycho-bio-behavioral mediators of the association between adverse childhood experiences (ACEs) and the risk of coronary heart disease (CHD) in adulthood. Methods and Results Participants were 5610 British civil servants (mean age, 55.5; 28% women) from the Whitehall II cohort study without CHD at baseline in 1997 to 1999 (wave 5) when retrospective data on the number of ACEs were collected via questionnaire (range, 0-8). Potential mediators assessed at wave 5 included depression and anxiety symptoms, health behaviors (smoking, alcohol dependence, sleep, and physical activity), and cardiometabolic dysregulations. New diagnoses of CHD (myocardial infarction, definite angina, coronary artery bypass grafting, or percutaneous transluminal coronary angioplasty) were assessed from wave 6 (2001) to wave 11 (2012-2013). Logistic regressions examined associations between ACEs, potential mediators, and CHD during the follow-up period. Natural indirect effects were examined using mediation analysis. A total of 566 (10.1%) participants developed CHD during the follow-up period. ACEs were associated with an increased likelihood of CHD (odds ratio per ACE, 1.09; 95% CI, 1.00-1.19). Controlling for age and sex, mediation analyses revealed an indirect effect of depression symptoms (natural indirect effects, 1.05; 95% CI, 1.03-1.07), anxiety symptoms (natural indirect effects, 1.12; 95% CI, 1.10-1.15), and a greater number of cardiometabolic dysregulations (natural indirect effects, 1.02; 95% CI, 1.01-1.03) in the association between ACEs and incident CHD. Behavioral factors were not statistically significant mediators. Conclusions Depression symptoms, anxiety symptoms, and cardiometabolic dysregulations partially mediated the association between ACEs and CHD. Regular screening and treatment of symptoms of psychological disorders and cardiometabolic dysregulations may help mitigate the long-term health burden of ACEs.

Associations between cognitive function, metabolic factors and depression: A prospective study in Quebec, Canada.

BACKGROUND: Metabolic risk factors, low cognitive function and history of depression are known risk factors for future depressive episodes. This paper aims to evaluate the potential interactions between these factors on the risk of a major depressive episodes in middle-age. METHODS: Baseline and follow-up data from a population-based study of Quebec, Canada were used. The sample consisted of 1788 adults between 40 and 69 years of age without diabetes. Cognitive function and metabolic risk factors were assessed at baseline. Three cognitive domains were assessed: processing speed, episodic memory and executive function. History of depression was assessed five years later by a clinical interview. Logistic regression analysis was conducted to evaluate interactions between individual metabolic factors, low cognitive function, and depression history. RESULTS: Participants with a comorbidity of at least one metabolic factor, history of depression and low cognitive function had the highest risk of experiencing a depressive episode in middle age. The highest risk was observed in individuals with abdominal obesity, low cognitive function, and a history of depression (OR= 8.66, 95% CI 3.83-19.59). The risks for those with abdominal obesity only, depression history only, and low cognitive function were 1.20 (95%CI 0.71-2.02), 3.10 (95%CI 1.81-5.24), and 1.39 (95%CI 0.72-2.67), respectively. LIMITATIONS: Depression was only assessed at follow-up. CONCLUSION: Metabolic risk factors comorbid with low cognitive function in middle-aged individuals with a history of depression were associated with an increased risk of a future depressive episode. This study highlights the importance of screening for metabolic and cognitive comorbidities in patients with a history of depression.

Implicit Affect, Heart Rate Variability, and the Metabolic Syndrome.

OBJECTIVE: Greater negative affect has been associated with an increased risk of the metabolic syndrome (METs). However, all studies to date have examined this association using explicit affect measures based on subjective ratings of emotional experiences. Prior studies suggest that implicit affect, representing the automatic, prereflective appraisal process involved in conscious emotional experiences, is associated with physiological stress responses independent of explicit affect. Furthermore, low resting heart rate variability (HRV) may increase the risk of stress-related diseases. The goals of this study were to evaluate the associations between implicit and explicit affect and METs and to assess whether these associations were amplified by lower HRV. METHODS: This secondary analysis of a larger study included 217 middle-aged women who completed measures of implicit affect, explicit affect, high-frequency HRV, and the different components of METs. RESULTS: There was a significant interaction between implicit negative affect and HRV predicting METs (odds ratio = 0.57, 95% confidence interval = 0.35-0.92), such that the combination of higher implicit affect and lower HRV was associated with a greater likelihood of METs. Similarly, there was a main effect of implicit negative affect as well as an interaction between implicit negative affect and HRV on the lipid accumulation product (b (standard error) = -0.06 (0.02), 95% confidence interval = -0.11 to -0.02), a combination of waist circumference and triglycerides. CONCLUSIONS: Higher implicit negative affect in the context of lower HRV may be related to a greater risk of METs. The present findings highlight the relevance of including implicit affect measures in psychosomatic medicine research.

Association between depressive symptoms, metabolic risk factors, and cognitive function: cross-sectional results from a community study in Quebec, Canada.

OBJECTIVE: To investigate the cross-sectional association between depressive symptoms and metabolic risk factors with cognitive function in a middle-aged population. METHODS: A stratified subsample of the CARTaGENE (CaG) cohort (n = 1991) was used to compare cognitive function outcomes between groups. The stratification was based on the presence of depressive symptoms and metabolic dysregulation (MetD): the presence of a) neither condition (reference group); b) MetD only; c) depressive symptoms only; and d) both depressive symptoms and MetD. Individuals with type 2 diabetes were excluded. Three cognitive domains were assessed: processing speed, episodic memory, and executive function. An overall cognitive function score, standardized for age and education, was computed. Poor cognitive function was defined as the lower quartile of the overall cognitive function distribution. Linear and logistic regression analyses were conducted. RESULTS: The poorest cognitive performance was observed in the group with both depressive symptoms and MetD, followed by the group with depressive symptoms only, then the group with MetD only and the reference group. Mean (SD) overall cognition scores for the four groups were -0.25 (1.13), -0.13 (1.05), 0.11 (0.90), and 0.15 (0.93), respectively. Linear regression analyses suggested a linear increase in cognitive function across groups.In the logistic regression analyses, the highest risk of poor cognitive function was observed in the comorbid (depressive symptoms and MetD) group (adjusted OR = 1.99, 95% CI 1.46, 2.71). CONCLUSION: Comorbidity of depressive symptoms and MetD was associated with reduced cognitive performance in middle-aged adults without diabetes.KEY POINTSPoor cognitive function is a major public health concern and can be potentially prevented by targeting its modifiable risk factors.Metabolic dysregulation and depression have both been independently associated with poor cognitive function.Comorbidity of metabolic dysregulation and depressive symptoms is associated with an increased risk of poor cognitive function in middle-aged individuals.Future health interventions might benefit by screening for comorbidity in patients with poor cognitive function and by targeting depression and metabolic dysregulation together.

Measures of depression and incident type 2 diabetes in a community sample.

PURPOSE: The purpose of this study was to estimate associations between distinct measures of depression and incident type 2 diabetes. METHODS: Our sample consisted of 30,360 community-dwelling adults aged 40 to 69 in Canada. Depression was defined as elevated depressive symptoms using the Patient Health Questionnaire 9, diagnoses of depression in administrative data, or antidepressant use from a medication inventory. Type 2 diabetes was ascertained in administrative data over up to 7 years of follow-up. Cox proportional hazards models were used to estimate associations between different measures of depression and incident diabetes. RESULTS: In separate models, elevated depressive symptoms were associated with a 17% increased risk of type 2 diabetes (hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.02-1.34), diagnoses of depression were associated with a 20% increased risk (HR 1.20, 95% CI 0.94-1.52), and antidepressant use was associated with a 19% increased risk (HR 1.19, 95% CI 1.01-1.41). When examining combinations of measures in the same model, depressive symptoms paired with antidepressant use and depressive symptoms paired with diagnoses of depression were associated with the highest risk of type 2 diabetes. CONCLUSIONS: Various measures of depression and combinations of measures can be used to identify older adults at higher risk of type 2 diabetes in research and public health.

Job strain and the incidence of heart diseases: A prospective community study in Quebec, Canada.

OBJECTIVE: Job strain (high psychological demands and low decision control) is associated with cardiovascular diseases, however it remains unclear if the associations are explained by depressive symptoms, and whether there are sex differences. The objective of the present study was to evaluate the association between job strain and heart diseases in a middle-aged population-based cohort. METHODS: Baseline data were from CARTaGENE, a community survey of adults aged 40-60 years in Quebec, Canada. Incidence of heart diseases was examined in 8073 individuals by linking survey data with administrative data. Cox regression models were used to examine the association between job strain and heart disease, adjusting for sociodemographic characteristics, behavioral and clinical factors, and depressive symptoms. RESULTS: In total, 557 (6.9%) participants developed heart diseases over an average follow-up of 6.6 years. Job strain was associated with an increased risk of heart diseases in women (adjusted HR = 1.63, 95% CI 1.02-2.64) after controlling for depressive symptoms, behavioral and clinical factors. There was no overall association between job strain and heart diseases in men (adjusted HR = 0.96, 95% CI 0.62-1.49); an association was observed only in men aged 50 years and older. Incidence of heart diseases and high job strain was highest in those with labour jobs, and lowest in those with professional jobs. CONCLUSION: Job strain was associated with an increased risk of heart diseases in middle-aged women and in men aged 50 years and older. This association was not accounted for by depressive symptoms or sociodemographic, clinical, and behavioral factors.

The association between job strain, depressive symptoms, and cardiovascular disease risk: results from a cross-sectional population-based study in Québec, Canada.

PURPOSE: Job strain (high psychological demands and low decision control) has been associated with cardiovascular disease (CVD). It is unclear if job strain is associated with CVD risk score independently of depression, an established risk factor for CVD. This study investigated whether there is an association between job strain and CVD risk score, when depressive symptoms are controlled for. Sex differences were examined. METHODS: Data came from the CARTaGENE study, a community health survey of adults in Québec, Canada (n = 7848). Participants were working adults aged 40-69 years. CVD risk was estimated using the Framingham risk score. Job strain was measured as the ratio of job demands to control using the Job Content Questionnaire. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Regression analyses were conducted to examine the association between job strain and CVD risk score controlling for depressive symptoms. There was no interaction effect between job strain and depressive symptoms in the association with CVD risk score. RESULTS: High job strain was reported in approximately 21% of participants, high Framingham risk score was observed in approximately 9%. Job strain was associated with the Framingham risk score (B = 0.73, p < 0.001, adjusted for age, sex, and education) and controlling for depressive symptoms did not significantly change the association (B = 0.59, p < 0.001). CONCLUSION: The results suggest that the job strain is associated with CVD risk score and that this association is not explained by depressive symptoms. Similar associations were observed for males and females.

Measures of depression and risk of type 2 diabetes: A systematic review and meta-analysis.

BACKGROUND: Depression is associated with an increased risk of type 2 diabetes. This study aimed to determine whether the association between depression and incident type 2 diabetes differs by measure of depression. METHODS: Data sources included MEDLINE, EMBASE, PsycINFO, CINAHL, ProQuest Dissertations & Theses Global, Web of Science Emerging Sources Citation Index and Conference Proceedings Citation Index, Cochrane Library, the University of York Center for Reviews and Dissemination, abstracts from the PsychoSocial Aspects of Diabetes conference. INCLUSION CRITERIA: comparison of participants with and without depression, depression measured at age 18 or older, longitudinal follow-up with an outcome of type 2 diabetes, effect estimate adjusted for important confounders, full-text available in English or French, and study at overall low or moderate risk of bias. Two reviewers extracted data and assessed study quality. RESULTS: Twenty-one studies reporting twenty-five effect estimates were included. Depressive symptom scales, clinical interviews, physician diagnoses, and use of antidepressants were all associated with an increased risk of incident type 2 diabetes. When all measures of depression were combined, the meta-analyzed risk ratio for type 2 diabetes was 1.18 (95% CI 1.12-1.24, I2=45.4%). Results did not provide conclusive evidence that the association between depression and incident diabetes differs by measure of depression. LIMITATIONS: Results showed heterogeneity and evidence of publication bias. CONCLUSIONS: Results suggest that various measures of depression may be used to identify individuals at higher risk of type 2 diabetes.

Anxiety and Depression Symptom Comorbidity and the Risk of Heart Disease: A Prospective Community-Based Cohort Study.

OBJECTIVE: The goal of this study was to examine the independent and joint associations between anxiety and depression symptoms with the risk of heart disease. METHODS: A total of 30,635 participants from the CARTaGENE community cohort study in Quebec who did not have heart diseases at baseline were included in the study. Baseline anxiety and depression symptoms were assessed using validated questionnaires. Survey data were linked with diagnostic codes from a public insurance database to examine incident heart disease during a 7-year follow-up period. Cox regression analyses were conducted comparing groups with high anxiety only, high depression only, comorbid anxiety and depression, and no/low symptoms of both on the risk of heart disease. Additional analyses examined anxiety and depression using continuous questionnaire symptom scores, data-driven comorbidity groups, and diagnostic codes. Covariates included sociodemographic characteristics, health behaviors, diabetes, and hypertension. RESULTS: In the main analyses, we found that, although depression without anxiety symptoms was associated with an increased risk of heart disease (hazard ratio = 1.35, 95% confidence interval = 1.04-1.74), there was no significant association for anxiety without depression symptoms (hazard ratio = 1.00, 95% confidence interval = 0.71-1.41). High anxiety assessed with diagnostic codes or by examining latent classes was, however, associated with a higher risk of heart disease. CONCLUSIONS: The association between anxiety and incident heart disease may be accounted for by comorbid depression, particularly when anxiety and depression symptoms are assessed using self-report questionnaires. Differing methods of assessment and analysis, and adjustment for comorbid depression may explain differences in findings across different studies on anxiety and the risk of heart disease.

The association between sleep and diabetes outcomes - A systematic review.

AIM: This study aimed to systematically review the prevalence of diagnosed sleep disorders in people with diabetes and to determine the association between sleep disorders and blood glucose levels and diabetes outcomes. METHODS: We conducted a literature search in the following databases: MEDLINE (Pubmed), EMBASE, CINAHL, PsychInfo and Web of Science Citation Index. Meta-analysis (random-effects models) was conducted to estimate the prevalence of sleep disorders in people with diabetes. RESULTS: Forty-one articles measured the prevalence of sleep disorders in adults with diabetes. The estimated pooled prevalence of sleep disorders in diabetes was estimated to be 52% (95% CI 42-63%). The highest pooled prevalence was observed for unspecified sleep apnea (69%; 95% CI: 59-78%), followed by obstructive sleep apnea (60%; 95% CI 39-80%), and restless leg syndrome (27%; 95% CI 20-34%). Eleven studies examined the association between sleep disorders and diabetes control and complications. The presence of comorbid sleep disorders was associated with increased diabetes outcomes. CONCLUSIONS: Diagnosed sleep disorders are highly prevalent in people with diabetes. Sleep disorders are associated with diabetes outcomes, though there was considerable heterogeneity across studies.

Dyadic associations between physical activity and body mass index in couples in which one partner has diabetes: results from the Lifelines cohort study.

Physical activity and body mass index (BMI) are linked to the prevention and management of type 2 diabetes (T2D). Romantic partners influence each other's health and the behavioral management of T2D often involves both partners. Therefore, this study examined dyadic associations between physical activity and BMI in couples in which one partner has T2D. Data came from the Lifelines cohort study. The actor-partner interdependence model was applied to cross-sectional data from 1133 couples in which only one partner had T2D. The physical activity of the person with diabetes was inversely associated with his/her partner's BMI. However, partner physical activity was not associated with the BMI of the person with diabetes. These results suggest that people with diabetes may influence the BMI of their partners. Future research should consider how people with diabetes influence the health outcomes of their partners, which is an area that is often overlooked in the literature.