Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews.

AIMS/HYPOTHESIS: Estimates of the global prevalence of type 2 diabetes vary between 6% and 9%. The prevalence of type 2 diabetes has been investigated in psychiatric populations but a critical appraisal of the existing evidence is lacking, and an overview is needed. This umbrella review summarises existing systematic reviews of observational studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder. METHODS: We searched PubMed, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews from inception to 17 January 2021 and screened reference lists of included systematic reviews. On the basis of prespecified criteria, we included systematic reviews investigating the prevalence of type 2 diabetes in adults (aged ≥18 years) with a psychiatric disorder. Titles and abstracts of 5155 identified records and full texts of 431 selected studies were screened by two independent reviewers, based on predefined eligibility criteria and an a priori developed extraction form, following the PRISMA and MOOSE guidelines. Risk of bias was assessed with the ROBIS instrument. Data extracted from primary studies were synthesised using random-effects meta-analyses. RESULTS: A total of 32 systematic reviews with 245 unique primary studies were identified and met inclusion criteria. Twelve had low risk of bias. They reported type 2 diabetes prevalence estimates ranging from 5% to 22% depending on the specific psychiatric disorder. We meta-analysed data for ten categories of psychiatric disorders and found the following prevalence estimates of type 2 diabetes: in people with a sleep disorder: 40%; binge eating disorder: 21%; substance use disorder: 16%; anxiety disorder: 14%; bipolar disorder: 11%; psychosis: 11%; schizophrenia: 10%; a mixed group of psychiatric disorders: 10%; depression: 9%; and in people with an intellectual disability 8%. All meta-analyses revealed high levels of heterogeneity. CONCLUSIONS/INTERPRETATION: Type 2 diabetes is a common comorbidity in people with a psychiatric disorder. Future research should investigate whether routine screening for type 2 diabetes and subsequent prevention initiatives for these people are warranted. PROSPERO registration no. CRD42020159870.

The role of mental disorders in precision medicine for diabetes: a narrative review.

This narrative review aims to examine the value of addressing mental disorders as part of the care of people with type 1 and type 2 diabetes in terms of four components of precision medicine. First, we review the empirical literature on the role of common mental disorders in the development and outcomes of diabetes (precision prevention and prognostics). We then review interventions that can address mental disorders in individuals with diabetes or at risk of diabetes (precision treatment) and highlight recent studies that have used novel methods to individualise interventions, in person and through applications, based on mental disorders. Additionally, we discuss the use of detailed assessment of mental disorders using, for example, mobile health technologies (precision monitoring). Finally, we discuss future directions in research and practice and challenges to addressing mental disorders as a factor in precision medicine for diabetes. This review shows that several mental disorders are associated with a higher risk of type 2 diabetes and its complications, while there is suggestive evidence indicating that treating some mental disorders could contribute to the prevention of diabetes and improve diabetes outcomes. Using technologically enabled solutions to identify mental disorders could help individuals who stand to benefit from particular treatments. However, there are considerable gaps in knowledge and several challenges to be met before we can stratify treatment recommendations based on mental disorders. Overall, this review demonstrates that addressing mental disorders as a facet of precision medicine could have considerable value for routine diabetes care and has the potential to improve diabetes outcomes.

The association between interpersonal problems and treatment outcome in the eating disorders: A systematic review.

OBJECTIVE: To review systematically the eating disorder literature in order to examine the association between pre-treatment interpersonal problems and treatment outcome in people diagnosed with an eating disorder. METHODS: Six relevant databases were searched for studies in which interpersonal problems prior to treatment were examined in relation to treatment outcome in patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS). RESULTS: Thirteen studies were identified (containing 764 AN, 707 BN and 48 EDNOS). The majority of studies indicated that interpersonal problems at the start of therapy were associated with a detrimental treatment outcome. CONCLUSIONS: Individuals with a binge/purge-type of eating disorder may be particularly vulnerable to interpersonal issues and these issues may lead to poorer treatment recovery by reducing the individual's ability to engage in the treatment process on a functional level. The clinical and research implications are discussed.

Trends in Incidence of Hospitalization for Hypoglycemia and Diabetic Ketoacidosis in Individuals With Type 1 or Type 2 Diabetes With and Without Severe Mental Illness in Denmark From 1996 to 2020: A Nationwide Study.

OBJECTIVE: To examine trends in incidence of acute diabetes complications in individuals with type 1 or type 2 diabetes with and without severe mental illness (SMI) in Denmark by age and calendar year. RESEARCH DESIGN AND METHODS: We conducted a cohort study using nationwide registers from 1996 to 2020 to identify individuals with diabetes, ascertain SMI status (namely, schizophrenia, bipolar disorder, or major depression) and identify the outcomes: hospitalization for hypoglycemia and diabetic ketoacidosis (DKA). We used Poisson regression to estimate incidence rates (IRs) and incidence rate ratios (IRRs) of recurrent hypoglycemia and DKA events by SMI, age, and calendar year, accounting for sex, diabetes duration, education, and country of origin. RESULTS: Among 433,609 individuals with diabetes, 8% had SMI. Risk of (first and subsequent) hypoglycemia events was higher for individuals with SMI than for those without SMI (for first hypoglycemia event, IRR: type 1 diabetes, 1.77 [95% CI 1.56-2.00]; type 2 diabetes, 1.64 [95% CI 1.55-1.74]). Individuals with schizophrenia were particularly at risk for recurrent hypoglycemia events. The risk of first DKA event was higher in individuals with SMI (for first DKA event, IRR: type 1 diabetes, 1.78 [95% CI 1.50-2.11]; type 2 diabetes, 1.85 [95% CI 1.64-2.09]). Except for DKA in the type 2 diabetes group, IR differences between individuals with and without SMI were highest in younger individuals (<50 years old) but stable across the calendar year. CONCLUSIONS: SMI is an important risk factor for acute diabetes complication and effective prevention is needed in this population, especially among the younger population and those with schizophrenia.

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.

Investigating the DSM-5 and the ICD-11 PTSD symptoms using network analysis across two distinct samples.

OBJECTIVE: Posttraumatic stress disorder (PTSD) has long been debated with a recent focus on the consequences of having two different diagnostic descriptions of PTSD (i.e., the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition [DSM-5] and the International Classification of Diseases-11th Edition [ICD-11]). Research has modeled PTSD as a network of interacting symptoms according to both diagnostic systems, but the relations between the two systems remain unclear regarding which symptoms are more central or interconnected. To answer this question, the present study is the first study to investigate the combined network structure of PTSD symptoms according to both systems using validated measurements (i.e., the International Trauma Questionnaire [ITQ] and the Posttraumatic Stress Disorder Checklist 5 [PCL-5] across two distinct trauma samples [a community sample, N = 2,367], and a military sample, N = 657). METHOD: We estimated two Gaussian Graphical Models of the combined ICD-11 and DSM-5 PTSD symptoms across the two samples. RESULTS: Five of the six most central symptoms were the same across both samples. CONCLUSIONS: The results underline that a combination of five symptoms representing both diagnostic systems may hold central positions and potentially be important for treatment. However, the implications depend on if the different diagnostic descriptions can be reconciled in an indexical rather than constitutive perspective. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Elevated risk of developing type 2 diabetes in people with a psychiatric disorder: What is the role of health behaviors and psychotropic medication?

AIMS: Several psychiatric disorders are linked with an increased risk of developing type 2 diabetes (T2D), but the mediating mechanisms are unclear. We aimed to investigate health behaviors, obesity, psychotropic medication use, and comorbidity as potential mediating mechanisms explaining these associations. METHODS: We combined data from a large population-based survey with register-based data and followed a sample of 250,013 Danes (≥16 years) for up to 8.9 years. We conducted mediation analyses investigating 10 potential mediators of the associations between psychiatric disorders and incident T2D. RESULTS: Individuals with a substance use disorder, schizophrenia, mood disorder, neurotic disorder, eating disorder, or a personality disorder had a significantly higher risk of developing T2D. Organic disorders, intellectual disabilities, developmental and behavioral disorders were not associated with T2D-risk. For all psychiatric disorders significantly associated with T2D, the use of antidepressant medication had the largest proportional mediating effect on the association (13-32 %). CONCLUSIONS: Use of antidepressant medication had the largest contribution to the associations between psychiatric disorders and incident T2D. Future epidemiological studies and prevention studies should focus on optimizing the use of antidepressant medication with minimal side effects, and the promotion of health behaviors in individuals with a psychiatric disorder to prevent T2D.

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.

Anxiety and depression as risk factors for ICD shocks and mortality in patients with an implantable cardioverter defibrillator - A systematic review.

OBJECTIVE: To examine associations between baseline anxiety and depression and occurrence of ICD shocks and risk of mortality in patients with an implantable cardioverter defibrillator (ICD). METHOD: We systematically searched EMBASE, PubMed, PsycINFO, and CINAHL for eligible studies fulfilling the predefined criteria. RESULTS: We included 37 studies based on 25 different cohorts following 35,003 participants for up to seven years. We observed no association between baseline anxiety nor depression and the occurrence of ICD shocks. More than half of the identified studies (respectively 56% and 60%) indicated a significant association between baseline anxiety or depression and increased risk of mortality (anxiety: n = 5, ranging from Hazard ratios (HR):1.02 [Confidence intervals (CI) 95% 1.00-1.03] to HR:3.45 [CI 95% 1.57-7.60]; depression: n = 6, ranging from HR:1.03 [CI 95% 1.00-1.06] to HR:2.10 [CI 95% 1.44-3.05]). We found a significant association between high methodological quality of the primary study and the detection of a significant association (p < 0.01). CONCLUSIONS: Baseline anxiety and depression are associated with increased risk of mortality in patients with an ICD, but not with occurrence of ICD shocks. Inclusion of baseline anxiety and depression in risk stratification of mortality may be warranted.

Severe Mental Illness and the Risk of Diabetes Complications: A Nationwide, Register-based Cohort Study.

CONTEXT: Individuals with severe mental illness (SMI) are at increased risk of developing type 2 diabetes. OBJECTIVE: This work explores whether individuals with diabetes and SMI are also at increased risk of diabetes complications and the potential age-specific differences in development of these. METHODS: Using nationwide registry data, we followed the entire Danish population with type 2 diabetes from January 1, 1996 to December 31, 2018. Exposure was SMI (schizophrenia, bipolar, or depression disorders). Outcome was diabetes complications (nephropathy, retinopathy, lower limp amputations, and cardiovascular disease). We applied Poisson regression models to estimate overall incidence rate ratios (IRRs) and age-specific incidence rates (IRs) and IRRs of the first event of each complication in individuals with SMI compared to individuals without SMI. The models were adjusted for sex, age, diabetes duration, calendar year, education, and migration status. RESULTS: We followed 371 625 individuals with type 2 diabetes, of whom 30 102 had coexisting diagnosed SMI. Individuals with SMI had a higher IR of nephropathy (IRR: 1.15; 95% CI, 1.12-1.18), amputations (IRR: 1.15; 95% CI, 1.04-1.28), and cardiovascular disease (men: IRR: 1.10; 95% CI, 1.05-1.15, women: IRR: 1.18; 95% CI, 1.13-1.22) but a lower IR of retinopathy (IRR: 0.75; 95% CI, 0.70-0.81) when compared to individuals without SMI, after adjustment for confounders. For all complications except amputations, the difference in IR was highest in the younger age groups. CONCLUSION: Individuals with type 2 diabetes and SMI had a higher risk and an earlier onset of several diabetes complications diagnoses, emphasizing focusing on improving diabetes management in younger age groups with SMI.

Risk of Developing Type 2 Diabetes in Individuals With a Psychiatric Disorder: A Nationwide Register-Based Cohort Study.

OBJECTIVE: Previous studies have investigated the incidence of type 2 diabetes in individuals with psychiatric disorders, but most studies have focused on a specific psychiatric disorder or a selected sample. More population-based studies are needed to determine these associations in representative samples. We therefore aimed to determine these associations in a nationwide, register-based dynamic cohort study. RESEARCH DESIGN AND METHODS: We analyzed data from 5,005,612 adults living in Denmark between 1995 and 2018, without prior diabetes. We investigated 10 different categories of psychiatric disorders and a composite group with any psychiatric disorder. Individuals with a psychiatric disorder were compared with individuals without using multivariable-adjusted Poisson regression to estimate incidence rate ratios (IRR) of type 2 diabetes. We modeled age-specific incidence rates (IR) for individuals with and without the specific psychiatric disorder. All models were stratified by sex. RESULTS: In total, 334,739 individuals developed type 2 diabetes during follow-up. For all investigated categories of psychiatric disorders, we found increased IR of type 2 diabetes for individuals with versus those without a psychiatric disorder (IRR: men, 1.47 [95% CI 1.45-1.50]; women, 1.65 [95% CI 1.62-1.68]). When we examined age-specific IR, the largest differences were found in the younger population (<50 years). CONCLUSIONS: We found that the IR of type 2 diabetes was higher in individuals with a psychiatric disorder compared with individuals without a psychiatric disorder and particularly high in the younger people with a psychiatric disorder. New studies into the prevention and early detection of type 2 diabetes in these groups are warranted.

Psychiatric disorders as risk factors for type 2 diabetes: An umbrella review of systematic reviews with and without meta-analyses.

Having a psychiatric disorder may increase the risk of developing type 2 diabetes[T2D] and this umbrella review aims to determine whether people with a psychiatric disorder have an increased risk of developing T2D and to investigate potential underlying mechanisms. A literature search was performed to identify systematic reviews of longitudinal studies investigating different psychiatric disorders as risk factors for incident T2D in humans (≥18 years). A total of 8612 abstracts were identified, 180 full-text articles were read, and 25 systematic reviews were included. Six categories of psychiatric disorders were identified. Except for eating disorders, all psychiatric disorders were associated with increased risk of incident T2D ranging from RR = 1.18 [95% CI 1.12-1.24] to RR = 1.60 [95% CI 1.37-1.88] for depression; from RR = 1.27 [95% CI 1.19-1.35] to OR = 1.50 [95% CI 1.08-2.10] for use of antidepressant medication; from OR = 1.93 [1.37-2.73] to OR = 1.94 [1.34-2.80] for use of antipsychotic medication; from RR = 1.55 [95% CI 1.21-1.99] to RR = 1.74 [95% CI 1.30-2.34] for insomnia, and finally showed OR = 1.47 [95% CI 1.23-1.75] for anxiety disorders. Plausible underlying mechanisms were discussed, but in most reviews corrections for mechanisms did not explain the association. Notable, only 16% of the systematic reviews had a high methodological quality.

Psychiatric disorders as risk factors for the development of type 2 diabetes mellitus: an umbrella review protocol.

INTRODUCTION: Numerous longitudinal studies, systematic reviews and meta-analyses have examined psychiatric disorders as risk factors for the development of type 2 diabetes mellitus. A more comprehensive overview of the area is warranted to summarise current evidence and discuss strengths and weaknesses to guide future research. AIM: The aim of this umbrella review is to determine whether and to what extent different psychiatric disorders are associated with the development of type 2 diabetes mellitus. Furthermore, the umbrella review also assesses the evidence on potential mediating mechanisms. METHODS AND ANALYSIS: The present umbrella review will consist of a comprehensive systematic search of published systematic reviews and meta-analyses of observational longitudinal studies investigating whether a psychiatric disorder is associated with the risk of developing type 2 diabetes. PubMed, Embase, PsychINFO and the Cochrane Database of Systematic Reviews will be searched, and the results will be screened for inclusion by two independent reviewers. Furthermore, the reference lists of included publications will be manually searched. Two independent reviewers will extract data and assess the methodological quality in the included systematic reviews and meta-analyses. Evidence on potential mediating mechanisms included in the systematic reviews and meta-analyses will also be reviewed. The implications of the overview will be discussed in light of the quality of the included studies, and suggestions for clinical practice and future research will be made. ETHICS AND DISSEMINATION: Ethical approval is not required for this umbrella review. Our review will be submitted for publication in a peer-reviewed international journal using open access option if available. The results will also be disseminated at international conferences. PROSPERO REGISTRATION NUMBER: CRD42018096362.

Identity formation and evaluation in adolescence and emerging adulthood: How is it associated with depressive symptoms and loneliness?

BACKGROUND: Developing a personal identity is a challenging task throughout adolescence and emerging adulthood. In 2006, Luyckx and colleagues developed an identity model differentiating identity formation into exploration and commitment dimensions. Previous studies have documented associations between the identity dimensions and different aspects of mental health. OBJECTIVE: Based on Luyckx and colleagues five-dimensional identity model, the present study investigated associations between identity dimensions and intra- and interpersonal aspects of mental health. METHOD: In total, 524 high school students (65 % female; mean age = 18.27; SD = 1.15) participated in a cross-sectional study measuring five identity dimensions and intra- and interpersonal aspects of mental health (depressive symptoms and loneliness). Correlation coefficients were calculated and hierarchical regression analyses were performed. RESULTS: Only two of the five identity dimensions: Identification with Commitment and Ruminative Exploration, were significantly associated with depression. None of the five identity dimensions were associated with loneliness. CONCLUSIONS: The findings suggest that the identity dimensions are not specifically associated with feelings of loneliness but that Identification with Commitment and Ruminative Exploration may be key components in the development of depressive symptoms. Future studies exploring the associations of identity dimensions and multiple intra- and interpersonal aspects of mental health are recommended.

Patterns of victimization: A person-centered approach to physical and sexual violence in a representative sample of Danish youth.

Professionals and policy makers have only recently begun to recognize the extent to which different types of victimization are interconnected. To enhance our knowledge of the co-occurrence of physical and sexual violence across childhood and adolescence/early adulthood, the present study investigated distinct typologies of victimization in a sample of adolescents and young adults and explored the relationship between victimization typologies and gender, age, and mental health. Data from the Danish 2013 National Health Survey ("How are you?") were used. Latent class analysis (i.e., a person-centered approach) was used to identify typologies of physical and sexual victimization in a representative sample of 3812 adolescents and young adults aged 16-24 years. Five distinct victimization typologies emerged: a normative, non-victimization group (76%), a physical victimization in adolescence/early adulthood group (13%), a physical revictimization group (5%), a poly-victimization group (4%), and a physical victimization in childhood group (2%). Physical revictimization, poly-victimization, and physical victimization in childhood were highly associated with poor mental health status. Using a latent variable modeling approach, we identified meaningful subgroups of the victimized population. Two subgroups (i.e., physical revictimization and poly-victimization), which comprised a third of all individuals in the victimization subgroups, had a high probability of exposure to multiple traumatic events and poor mental health. These study findings underscore the need to promote interventions addressing the co-occurrence of physical and sexual victimization and the persistence of victimization over time.

Motivational interventions in the management of HbA1c levels: a systematic review and meta-analysis.

AIMS: To review the diabetes literature in order to examine the effect of motivational interventions on treatment outcome as measured by changes in glycated haemoglobin. METHODS: Relevant databases were systematically searched for randomised controlled trials in which motivational interventions were examined in relation to treatment outcome in people with type 1 and type 2 diabetes mellitus. RESULTS: The 13 studies identified for review included 1223 participants diagnosed with type 1 diabetes and 1895 participants diagnosed with type 2 diabetes. The analysis showed a 0.17% (95% CI: -0.09, 0.43%) improvement in glycemic control in people who received a motivational intervention compared to a control group, however, the effect was not statistically significant. CONCLUSIONS: The impact of motivational interventions in the management of blood glucose levels appears to be limited. However, due to the small number of studies and issues of heterogeneity caution in interpreting the present findings is advised. Moreover, the unique contribution of motivational interventions may be better assessed by outcomes such as behaviour change and other intermediate outcomes. Further research examining the delivery and focus of motivational interventions in helping people manage their diabetes is recommended. The clinical implications of the present findings are therefore uncertain pending further research.