The role of positive psychological wellbeing in walking speed differences among married and unmarried English older adults.

Objectives: Walking speed has been identified as an important indicator of functional independence and survival among older adults, with marital status being related to walking speed differences. We explored explanatory factors, with a focus on positive psychological wellbeing, in walking speed differences between married and non-married individuals in later life. Methods: We used wave 8 (2016/17) cross-sectional data from adults aged 60-79 years who participated in the English Longitudinal Study of Ageing (n = 3,743). An Oaxaca-Blinder decomposition was used to compute walking speed differences between married and unmarried individuals, and the portion of those differences that could be explained by characteristic differences in those groups, particularly wellbeing. Results: Overall, married individuals had walking speeds that were 0.073 m/s (95% confidence interval: 0.055-0.092 m/s) faster than their unmarried counterparts. This was primarily driven by differences between the married and separated/divorced group, and the widowed group. Included covariates explained roughly 89% of the overall walking speed difference. Positive psychological wellbeing consistently explained a significant portion of walking speed differences, ranging between 7% to 18% across comparisons. Conclusion: Although wealth has been previously found to partially explain walking speed differences by marital status, we found that positive psychological wellbeing also demonstrated pertinence to these differences.

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.

Loneliness and functional limitations among older adults with diabetes: Comparing directional models.

OBJECTIVE: Middle-aged and older adults with diabetes are at increased risk for loneliness and functional limitations. Cross-sectional and longitudinal associations between loneliness and functional limitations have been demonstrated among the general population, but have not been established among those with diabetes. The purpose of this study was to directly compare the following models describing the direction of the association between loneliness and functional limitations among people with diabetes: (1) loneliness leads to functional limitations, (2) functional limitations lead to loneliness, and (3) a bidirectional association between loneliness and functional limitations. METHODS: Data came from the Health and Retirement Study. Participants were middle-aged and older individuals with diabetes in the United States (n = 2934). Loneliness and functional limitations were measured at baseline, 4-year follow-up, and 8-year follow-up. Path models for each of the three models, as well as a stability model, were created. Model fit was compared using Akaike's Information Criteria (AIC). RESULTS: Participants were 54.6% female, 74.98% White, had a mean age of 69.66 years, had an average of 1.48 comorbid chronic conditions, and had diabetes for an average of 10.40 years. The bidirectional model best fit the data as evidenced by the lowest AIC value (AIC = 171,162.81). ∆AIC between the bidirectional model and the next best fitting model was 16.19, indicating strong support for selecting the bidirectional model. Higher levels of loneliness were associated with subsequent higher levels of functional limitations at some time points (ßs = 0.07, 0.02) and higher levels of functional limitations were associated with subsequent higher levels of loneliness (ßs = 0.13, 0.06) at all time points. CONCLUSION: Results suggest that the association between loneliness and functional limitations among individuals with diabetes is bidirectional. This study demonstrates the value of directly comparing directional models.

Fatigue Symptoms Associated With COVID-19 in Convalescent or Recovered COVID-19 Patients; a Systematic Review and Meta-Analysis.

BACKGROUND: The prevalence and prognosis of post-acute stage SARS-CoV-2 infection fatigue symptoms remain largely unknown. AIMS: We performed a systematic review to evaluate the prevalence of fatigue in post-recovery from SARS-CoV-2 infection. METHOD: Medline, Embase, PsycINFO, CINAHL, Web of Science, Scopus, trial registries, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for studies on fatigue in samples that recovered from polymerase chain reaction (PCR) diagnosed COVID-19. English, French, and Spanish studies were included. Meta-analyses were conducted separately for each recruitment setting. RESULTS: We identified 41 studies with 9,362 patients that recovered from COVID-19. Post-COVID-19 patients self-report of fatigue was higher compared to healthy controls (risk ratio (RR) = 3.688, 95%CI [2.502, 5.436], p < .001). Over 50% of patients discharged from inpatient care reported symptoms of fatigue during the first (event rate [ER] = 0.517, 95%CI [0.278, 0.749]) and second month following recovery (ER = 0.527, 95%CI [0.337, 0.709]). Ten percent of the community patients reported fatigue in the first-month post-recovery. Patient setting moderated the association between COVID-19 recovery and fatigue symptoms (R2 = 0.11, p < .001). Female patients recovering from COVID-19 had a greater self-report of fatigue (odds ratio [OR] = 1.782, 95%CI [1.531, 2.870]). Patients recruited through social media had fatigue above 90% across multiple time points. Fatigue was highest in studies from Europe. CONCLUSION: Fatigue is a symptom associated with functional challenges which could have economic and social impacts. Developing long-term planning for fatigue management amongst patients beyond the acute stages of SARS-CoV-2 infection is essential to optimizing patient care and public health outcomes. Further studies should examine the impact of sociodemographic, pandemic-related restrictions and pre-existing conditions on fatigue.

Trajectories of Depressive Symptoms and Incident Diabetes: A Prospective Study.

BACKGROUND: Elevated depressive symptoms are associated with an increased risk for diabetes. Depression is a heterogeneous and chronic condition in which symptoms may remit, emerge, lessen, or intensify over time. PURPOSE: The purpose of this study was to determine if trajectories of depressive symptoms measured at five time points over 8 years predicted incident diabetes over an 8-year follow-up in middle-aged and older adults. A secondary aim was to determine if trajectories of depressive symptoms predict incident diabetes, above and beyond depressive symptoms measured at a single time point. METHODS: Data came from the Health and Retirement Study (n = 9,233). Depressive symptoms were measured biennially from 1998 to 2006. Self-reported incident diabetes was measured during an 8-year follow-up. RESULTS: Five trajectories of depressive symptoms were identified (no depressive symptoms, low depressive symptoms, low-moderate depressive symptoms, moderate depressive symptoms, elevated and increasing depressive symptoms). Compared to the no depressive symptoms trajectory group (referent), all other trajectory groups were at higher risk of developing diabetes after adjusting for covariates. In most cases, trajectory group membership was associated with incident diabetes after controlling for depressive symptoms at a single time point. CONCLUSIONS: Patterns of depressive symptoms over time were associated with incident diabetes. Patterns of depressive symptoms may be more predictive of diabetes incidence than depressive symptoms measured at a single time point.

Prevalence and Correlates of Positive Mental Health Among Canadian Adults With Type 1 or Type 2 Diabetes: Results From the Canadian Community Health Survey---Mental Health.

OBJECTIVES: Current definitions of mental health are no longer limited to presence or absence of mental illness. Although dimensions of mental illness have been well studied among people with diabetes, little is known about positive mental health. Optimal positive mental health is referred to as "flourishing" and is characterized by happiness, psychological well-being and social well-being. Therefore, the purpose of this study was to examine the prevalence and correlates of flourishing mental health among Canadian adults diagnosed with diabetes. METHODS: Data came from participants >19 years of age in the Canadian Community Health Survey---Mental Health 2012, a national, cross-sectional survey. Positive mental health was measured with the Mental Health Continuum---Short Form, which categorizes individuals into flourishing, moderate and languishing mental health. RESULTS: Although the majority of participants with diabetes reported flourishing mental health (73.22%), flourishing mental health was more common among people without diabetes (76.56%). Among people with diabetes (n=2,024), those who were flourishing reported greater physical activity, better self-rated health, fewer comorbidities, less functional disability and were less likely to smoke compared with those who were not flourishing. Those who were flourishing were less likely to have a lifetime history of major depressive disorder or generalized anxiety disorder and were distinguished by some demographic characteristics. CONCLUSION: Among people with diabetes, flourishing mental health was associated with distinct behavioural, health and sociodemographic correlates.

Optimism and depressive symptoms following a diabetes diagnosis: Results from the Health and Retirement Study.

Depression is common among individuals with diabetes and contributes to poorer prognoses. Optimism is associated with enhanced mental health. Therefore, this study tested whether optimism buffered against increases in depressive symptoms following a diabetes diagnosis. Participants were drawn from the Health and Retirement Study (n = 328, Mage = 65.8). Optimism, assessed before diagnosis, was inversely associated with depressive symptoms within 2 (B = -.30, p = .004, ΔR2 = .02) and 6 (B = -.29, p = .008, ΔR2 = .02) years of a diabetes diagnosis. Results suggest that optimism is a protective factor for comorbid depressive symptoms.

Variety Salience and Enjoyment of Repetitiously Consumed Foods: a Field Experiment.

BACKGROUND: The formation of healthy eating habits is supported by repeatedly eating specific foods, but repetition can also reduce enjoyment of those foods. Making the variety in one's diet salient increases enjoyment of repetitiously consumed foods in a lab setting. Therefore, in a longitudinal field experiment, we tested a brief intervention to remind participants of the variety in their diet. We hypothesized that increasing salience of dietary variety would prevent declines in enjoyment of the food and increase the likelihood that participants would be willing to eat the food again later. METHOD: Participants (n = 139) ate a granola bar each day for 2 weeks. Before eating it, participants randomly assigned to the treatment condition recalled other recently consumed foods (to increase salience of dietary variety). Control subjects recalled variety in an unrelated domain (music). Participants reported their enjoyment of the granola bar after they ate it each day, and in a lab session after the study ended, the number of granola bars they took from a selection of snacks was counted. RESULTS: Self-reported feelings of enjoyment declined steadily, and contrary to our first hypothesis, increasing salience of dietary variety did not prevent this decline. Increasing salience of dietary variety did increase the likelihood that participants would choose to take the same kind of granola bar 2 weeks later. CONCLUSION: Brief exercises that make variety in one's diet more salient may not prevent reductions in enjoyment of a repetitiously consumed food, but may still support continued consumption of the food.

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.

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.

Dyadic Associations Between Body Mass Index and the Development of Type 2 Diabetes in Romantic Couples: Results From the Health and Retirement Study.

BACKGROUND: Body mass index (BMI) is linked to Type 2 diabetes (T2D). Although romantic partners influence each other's health outcomes, it is unclear if partner's BMI is related to the development of T2D. PURPOSE: To test prospective, dyadic associations between BMI and the development of T2D in middle-aged and older adult couples over 8 years. METHODS: Data came from 950 couples in the Health and Retirement Study. Neither partner had diabetes at baseline (2006). The actor-partner interdependence model was used to examine dyadic associations between BMI at baseline and the development of T2D during the next 8 years. RESULTS: After adjusting for covariates, a significant actor effect was observed such that one's BMI at baseline was positively associated with one's own odds of developing T2D during follow-up (odds ratio [OR] = 1.08, p < .001). A significant partner effect was also observed such that the BMI of one's partner at baseline was positively associated with one's own odds of developing T2D during follow-up above and beyond one's own baseline BMI (OR = 1.04, p = .003). These associations were not moderated by sex. This pattern of results held when BMI was coded categorically (not overweight/obese; overweight; obese). CONCLUSIONS: Partner's BMI was prospectively associated with the likelihood of developing T2D. Future research should consider interpersonal risk factors for chronic health conditions, such as T2D. There is an opportunity to develop theoretical models that specify how and when partner characteristics are linked to physical morbidity.

Longitudinal associations between number of cigarettes per day and depressive symptoms in adult smokers with type 2 diabetes: A path analysis approach.

OBJECTIVE: Three theoretical models describe the direction of the association between depressive symptoms and cigarettes per day (CPD) in smokers: 1) CPD predicts subsequent depressive symptoms, 2) depressive symptoms predict CPD, and 3) there is a bidirectional relation between CPD and depressive symptoms. The objective of the study was to compare the fit of these three theoretical models to data from a community-based sample of adults with type 2 diabetes (T2D) who smoke cigarettes. METHODS: Data were from adults with T2D who participated in the Evaluation of Diabetes Treatment Study. At baseline, 296 participants reported being a current smoker and were included in the analyses. Measures of CPD and depressive symptoms were collected annually over four years. Path models corresponding to the three directionality hypotheses were estimated. Model fit was compared, and the best fitting model was selected on the basis of Akaike's Information Criterion (AIC). RESULTS: The path model depicting a unidirectional association from CPD to subsequent depressive symptoms had the lowest AIC value (7110.94) and was thus identified as the best fitting model. Although some paths within the model did not meet conventional levels of statistical significance, in general, more CPD predicted higher levels of depressive symptoms at subsequent follow-up points. CONCLUSION: Amongst smokers with T2D, a primary smoking model, in which smoking precedes depressive symptoms, may best explain the longitudinal association between CPD and depressive symptoms. These findings further justify the need for early smoking cessation in diabetes care.

Habit strength as a moderator of the association between symptoms of poor mental health and unintentional non-adherence to oral hypoglycemic medication in adults with type 2 diabetes.

This study tested if habit strength for taking oral hypoglycemic medication moderated the association between poor mental health symptoms (i.e. depressive symptoms, diabetes distress) and unintentional non-adherence in 790 adults with type 2 diabetes. Data were cross-sectional. A habit strength × depressive symptom interaction was observed. Depressive symptoms were negatively associated with adherence if habit was weak or of average strength; no association was observed if habit was strong. A similar interaction emerged when diabetes distress was examined. Results suggest that habit strength might operate as a buffer in the association between poor mental health symptoms and medication adherence.

Alcohol consumption, depressive symptoms, and the incidence of diabetes-related complications.

BACKGROUND: Heavy alcohol consumption in individuals with type 2 diabetes mellitus (T2DM) is related to increased risks of diabetes-related micro- and macrovascular complications. Depressive symptoms may be relevant to this relationship, because high depressive symptoms are associated with an increased risk of complications. This study investigated whether the interaction between depressive symptoms and alcohol frequency was positively related to the development of neuropathy, retinopathy, nephropathy, and coronary artery disease (CAD), such that those with high depressive symptoms and high alcohol frequency will be at increased risk of complications. METHODS: Data were from five waves of the Evaluation of Diabetes Treatment annual survey including 1413 adults with T2DM in Quebec. Data on alcohol frequency (number of drinking occasions), depressive symptoms, and complications were collected annually. The development of each complication was investigated using multiple logistic regression analysis with generalized estimating equations. RESULTS: After adjusting for sociodemographic, lifestyle, and diabetes-related covariates, the interaction between alcohol frequency and depressive symptoms was positively related to the incidence of neuropathy and CAD, such that those with high depressive symptoms who drank the most frequently had the highest risk of neuropathy (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00-1.04; P = 0.04) and CAD (OR 1.02, 95% CI 1.00-1.04; P = 0.04). This interaction was not significantly related to retinopathy or nephropathy. CONCLUSION: Individuals with high depressive symptoms and high alcohol frequency may have a particularly high risk of neuropathy and CAD. Future prevention efforts should examine both alcohol frequency and depressive symptoms when evaluating the risk of complications.

Trajectories of social support in adults with type 2 diabetes: Associations with depressive symptoms and functional disability.

OBJECTIVES: Little is known about temporal trajectories of social support in adults with type 2 diabetes (T2D) and how they are associated with diabetes-related outcomes. This study identified and explored different trajectories of social support in a community sample of adults with T2D, as well as the extent to which different trajectories were prospectively associated with depressive symptoms and functional disability. METHODS: Data came from five annual waves of the Evaluation of Diabetes Treatment study (N = 1077). Social support, depressive symptoms, and functional disability were assessed via self-report. Separate analyses were conducted to examine the associations between social support trajectories, depressive symptoms, and functional disability, adjusting for demographic characteristics, diabetes-related covariates, and baseline depressive symptoms and functional disability. RESULTS: Latent class growth modeling identified four distinct social support trajectories. Trajectory Groups 1 and 2 comprised participants with persistently low and persistently moderate-low social support, respectively. Trajectory Groups 3 and 4 included participants with persistently moderate-high and persistently high social support, respectively. People with persistently low social support reported higher functional disability relative to those with persistently moderate-high and persistently high social support. CONCLUSIONS: The findings of the present study indicate that temporal patterns of social support are a predictor of future functional disability among adults with T2D.

Associations Between Depressive Symptoms and Indices of Obesity in Adults With Prediabetes and Normal Blood Glucose Levels: Results From the Emotional Health and Wellbeing Study.

OBJECTIVES: This study describes associations between depressive symptoms and indices of obesity in a community sample of adults with prediabetes. The strengths of these associations were compared to those observed in individuals with normal blood glucose levels. METHODS: Cross-sectional data came from the baseline assessment of the Emotional Health and Wellbeing Study. Participants were classified as meeting the American Diabetes Association criteria for prediabetes (n=1,152) or normal blood glucose levels (n=1,567). Indices of obesity included body mass index, waist circumference and fat mass index. RESULTS: After adjusting for sociodemographic covariates, greater depressive symptoms were associated with greater body mass index, waist circumference and fat mass index. These associations were stronger in participants with prediabetes compared to participants with normal blood glucose levels. The pattern of results observed for body mass index and waist circumference held after controlling for self-reported fruit and vegetable consumption, physical activity and sedentary time, but the strength of the interaction was attenuated for fat mass index. CONCLUSIONS: Depressive symptoms were more strongly associated with indices of obesity in people with prediabetes than in people with normal blood glucose levels. Depressive symptoms may be a barrier to weight management in people with prediabetes.

Comorbid depressive and anxiety symptoms and the risk of type 2 diabetes: Findings from the Lifelines Cohort Study.

BACKGROUND: Prior studies indicate that depression is a risk factor for type 2 diabetes (T2D), though there is considerable heterogeneity in reported estimates. Identifying homogeneous subgroups of depression strongly associated with T2D may be beneficial. This study examined associations between depression and anxiety comorbidity with the risk of T2D. METHODS: 78,025 participants from the Lifelines Cohort Study (age range = 30-75 years) without diabetes at baseline were included in this study. The Mini-International Neuropsychiatric Interview assessed depressive and anxiety symptoms at baseline. Incident T2D was assessed by self-report or hemoglobin A1c levels during an approximately 3.8-year follow-up period. Risk of T2D was compared across four groups (no depressive or anxiety symptoms, depressive symptoms alone, anxiety symptoms alone, comorbid depressive/anxiety symptoms) using mixed effects logistic regression analyses adjusted for sociodemographic, lifestyle, and cardiometabolic characteristics. RESULTS: 1,096 participants developed diabetes. Compared to those without depressive or anxiety symptoms (n = 74,467), those with comorbid depressive and anxiety symptoms (n = 743) were more likely to develop T2D (n = 28, OR = 2.12, 95% CI = 1.22-3.68). Depressive symptoms alone (n = 650) and anxiety symptoms alone (n = 2,165) were not significantly associated with T2D (n = 23 and n = 24, respectively, developed diabetes). Those with comorbid symptoms were also more likely to develop T2D compared to those with depressive symptoms alone (OR = 2.86, 95% CI = 1.25-6.54). LIMITATIONS: Depressive and anxiety symptom assessments were based on a screening tool. Hemoglobin A1c data were only available for a subset of participants. CONCLUSIONS: Depression with comorbid anxiety may be a subgroup of depression that is strongly associated with the risk of T2D.

Comparing Types of Financial Incentives to Promote Walking: An Experimental Test.

BACKGROUND: Offering people financial incentives to increase their physical activity is an increasingly prevalent intervention strategy. However, little is known about the relative effectiveness of different types of incentives. This study tested whether incentives based on specified reinforcement types and schedules differentially affected the likelihood of meeting a walking goal and explored if observed behavioural changes may have been attributable to the perceived value of the incentive. METHODS: A 2 (reinforcement type: cash reward, deposit contract) × 2 (schedule: fixed, variable) between-subjects experiment with a hanging control condition was conducted over 8 weeks (n = 153). RESULTS: Although walking was greater in the incentive conditions relative to the control condition, walking did not differ across incentive conditions. Exploratory analyses indicated that the perceived value of the incentive was associated with the likelihood of meeting the walking goal, but was not affected by reinforcement type or schedule. CONCLUSIONS: The reinforcement type and schedule manipulations tested in this study did not differentially affect walking. Given that walking behaviour was associated with perceived value, designing incentive strategies that optimise the perceived value of the incentive may be a promising avenue for future research.

Cardiometabolic dysregulation and cognitive decline: potential role of depressive symptoms.

BACKGROUND: Previous studies have examined associations of cardiometabolic factors with depression and cognition separately. Aims To determine if depressive symptoms mediate the association between cardiometabolic factors and cognitive decline in two community studies. METHOD: Data for the analyses were drawn from the Rotterdam Study, the Netherlands (n = 2940) and the Whitehall II study, UK (n = 4469). RESULTS: Mediation analyses suggested a direct association between cardiometabolic factors and cognitive decline and an indirect association through depression: poorer cardiometabolic status at time 1 was associated with a higher level of depressive symptoms at time 2 (standardised regression coefficient 0.07 and 0.06, respectively), which, in turn, was associated with greater cognitive decline between time 2 and time 3 (standardised regression coefficient of -0.15 and -0.41, respectively). CONCLUSIONS: Evidence from two independent cohort studies suggest an association between cardiometabolic dysregulation and cognitive decline and that depressive symptoms tend to precede this decline. Declaration of interest None.

Do mental disorders moderate the association between diabetes status and alcohol consumption?

Although heavy alcohol consumption is associated with diabetes-related complications, little is known about patterns of alcohol use among people with diabetes. Moreover, heavy drinking is more common among individuals with major depressive disorder (MDD), bipolar disorder (BD), and generalized anxiety disorder (GAD) than in the general population, and these disorders are often comorbid with diabetes. The present study tested the hypothesis that mental disorders moderate the association between diabetes status and alcohol consumption. A total of 14,302 adult participants aged 40-79 were included from the cross-sectional 2012 Canadian Community Health Survey-Mental Health (1,698 with diabetes). Data were analyzed using hierarchical linear regression models. MDD and BD, but not GAD, significantly moderated the association between diabetes status and alcohol quantity, such that the presence of diabetes was strongly and negatively associated with alcohol quantity if individuals had MDD or BD. There was no interaction between diabetes status and any of the mental disorders and alcohol frequency. This study suggests that among individuals with diabetes, those with comorbid MDD or BD drink less than those without MDD or BD. Further investigation of this association is needed and could help inform future alcohol-related interventions among individuals with diabetes.