The association between antidepressant use and glycemic control in the Southern Community Cohort Study (SCCS).

INTRODUCTION: Among people with diabetes, comorbid depression has been associated with suboptimal health outcomes. However, the independent impact of antidepressant use on glycemic control (A1C) has not been well understood. RESEARCH DESIGN AND METHODS: The Southern Community Cohort Study collected self-reported antidepressant use and measured continuous A1C in a sample of racially diverse adults with and without diabetes who visited community health clinics serving low-income families in the southeastern United States (N=2445). Crude and adjusted linear regression models were used to examine the relationships between using specific antidepressant subclasses and continuous A1C. RESULTS: Although use of any single antidepressant subclass was not a significant predictor of A1C level, there was a significant association between using multiple antidepressant subclasses and higher A1C, specifically among individuals with diabetes (standardized effect size=.12, p=.04). CONCLUSION: Among adults with diabetes, the use of multiple antidepressant subclasses may be a risk factor for suboptimal glycemic control. Prospective studies are needed to confirm the direction of this observation, as the present study was limited by a cross-sectional design and small sample size.

Maternal education, birth weight, and infant mortality in the United States.

This research determines whether the observed decline in infant mortality with socioeconomic level, operationalized as maternal education (dichotomized as college or more, versus high school or less), is due to its "indirect" effect (operating through birth weight) and/or to its "direct" effect (independent of birth weight). The data used are the 2001 U.S. national African American, Mexican American, and European American birth cohorts by sex. The analysis explores the birth outcomes of infants undergoing normal and compromised fetal development separately by using covariate density defined mixture of logistic regressions (CDDmlr). Among normal births, mean birth weight increases significantly (by 27-108 g) with higher maternal education. Mortality declines significantly (by a factor of 0.40-0.96) through the direct effect of education. The indirect effect of education among normal births is small but significant in three cohorts. Furthermore, the indirect effect of maternal education tends to increase mortality despite improved birth weight. Among compromised births, education has small and inconsistent effects on birth weight and infant mortality. Overall, our results are consistent with the view that the decrease in infant death by socioeconomic level is not mediated by improved birth weight. Interventions targeting birth weight may not result in lower infant mortality.