The Impact of Integrated Behavioral Healthcare on Glycemic Control.

Integrated behavioral healthcare (IBH) is the "standard of care" to address psychosocial factors impacting diabetes outcomes; it is not standard in practice. This longitudinal, retrospective, chart-review examines IBH impact on glycemic control in an adult diabetes clinic. Adults (n = 374) with ≥ 1 behavioral health encounter, ≥ 2 hemoglobin A1c (HbA1c) values, and HbA1c value > 8% at initial IBH visit were included. Mixed effects linear piecewise models examined differences in slope trajectories for 365 days pre- and post-IBH intervention. Pre-intervention slope was not significant (z = - 1.09, p = 0.28). The post-intervention slope was significant (z = - 6.44, p < 0.001), indicating a significant linear decrease in HbA1c values. Results demonstrated that prior to engaging with behavioral health, there was no change in HbA1c. After initial IBH visit, there was a predicted reduction of > 1% in HbA1c over the following year. These results suggest that IBH significantly improves patients' metabolic status. Next steps for IBH research are offered.

Special Considerations in the Systematic Psychosocial Screening of Youth with Type 1 Diabetes.

OBJECTIVE: The American Diabetes Association recommends psychosocial screening for individuals with type 1 diabetes (T1D). The purpose of this study is to present (a) several high priority decisions that program developers may encounter when building a new psychosocial screening program and (b) both the screening development process and results of one mental health screening program within a multidisciplinary pediatric diabetes clinic, with particular emphasis on parent-youth screening agreement and changes to elevation status over time. METHODS: Youth with T1D ages 12-17 and parents of youth with T1D ages 8-17 were administered mental health screeners as a part of outpatient diabetes visits over a 1-year period. Youth depression and anxiety were screened using self- and parent proxy-report versions of the Patient-Reported Outcomes Measurement Information System (PROMIS). RESULTS: Youth (n = 154) and parents (n = 211) completed mental health screening measures, such that 228 youth were screened. Intraclass correlation coefficients (ICCs) between youth- and parent proxy-report agreement were good for the measures of depression (ICC = .787) and anxiety (ICC = .781), with parent proxy-reports significantly higher than youth self-reports of anxiety (p < .01). Of the 93 youth with follow-up screening data and no youth- or parent proxy-reported elevation on the initial screener, 16.1% had at least one elevated screener within 1 year. CONCLUSIONS: Findings indicate that questions of who to screen and how often to screen may deserve increased scrutiny, as this screening program's data suggest that there may be benefit to obtaining both youth- and parent report more often than annually.

Binge eating behavior among a national sample of overweight and obese veterans.

OBJECTIVE: Despite the high prevalence of overweight and obesity in US military veterans, binge eating has not been examined in this population. Using a secondary data analysis approach, we examined the prevalence and correlates of self-reported binge eating among 45,477 overweight or obese veterans receiving care in Veterans Health Administration (VHA) facilities. Participants completed a 23-item survey that assessed demographics, weight history, physical and mental health comorbidities, and eating habits during routine medical clinic visits. Chi square and logistic regression analyses were used to examine relationships among binge eating and demographic variables and medical and psychiatric comorbidities. Nearly three-quarters of the sample reported any binge eating. Binge-eaters were more likely to report higher BMI,depression, anxiety, and type 2 diabetes (p<.0001). After controlling for potentially confounding variables, male veterans were significantly more likely to report any binge eating than female veterans (p<.001). These results have important implications for modifying weight management programs and highlight the need for assessment and treatment to address binge eating, particularly among men and patients with type 2 diabetes [corrected].

Evaluation of the PHQ-9 Item 3 as a screen for sleep disturbance in primary care.

BACKGROUND: Sleep disturbance is a significant problem for adults presenting to primary care. Though it is recommended that primary care providers screen for sleep problems, a brief, effective screening tool is not available. OBJECTIVE: The aim of this preliminary study was to test the utility of item three of the Patient Health Questionnaire-9-item (PHQ-9) as a self-report screening test for sleep disturbance in primary care. DESIGN: This was a cross-sectional survey of male VA primary care patients in Syracuse and Rochester, NY. Sensitivity and specificity statistics were calculated as well as positive and negative predictive value to determine both whether the PHQ-9 item-3 can be used as an effective sleep screen in primary care and at what PHQ item-3 cut score patients should be further assessed for sleep disturbance. PARTICIPANTS: One hundred and eleven male, VA primary care patients over the age of 18 and without gross neurological impairment participated in this one-session, in-person study. MEASURES: During the research session, patients completed several questionnaires, including a basic demographic questionnaire, the PHQ-9, and the Insomnia Severity Index (ISI). KEY RESULTS: PHQ-9 item 3 significantly correlated with the total score on the ISI (r = 0.75, p < 0.0001). A cut score of 1 on the PHQ-9 item 3, indicating sleep disturbance at least several days in the last two weeks, showed the best balance of sensitivity (82.5%) and specificity (84.5%) as well as positive (78.4%) and negative (91%) predictive value. CONCLUSIONS: Item 3 of the PHQ-9 shows promise as a screener for sleep problems in primary care. Using this one-item of a popular screening measure for depression in primary care allows providers to easily screen for two important issues without unnecessarily adding significant burden.

Subcortical hyperintensities impact cognitive function among a select subset of healthy elderly.

Previous studies have examined the impact of subcortical hyperintensities (SH), a proxy measure of cerebrovascular disease, on the cognitive abilities of otherwise healthy older adults. However, there remains a limited understanding as to what extent this MRI marker of pathological processes explains the decline in specific cognitive functions that occur nearly ubiquitously with advanced age, especially in relation to other age-related imaging markers. In the present study we compared cognitive abilities between a sample of 53 older healthy adults (age range=50-79) and a sample of 53 younger adults (age range=21-40). As expected, the older group performed significantly worse on most cognitive measures compared to the younger group. Frontal volume and total grey matter volume were also significantly reduced among the older individuals compared to the younger individuals. SH volume was consistently associated with cognitive function in older adults, though, this relationship was evident only for a relatively small subset of older individuals with the most severe SH. These data suggest that the relationship between SH and cognition in the elderly is driven by a subset of individuals who may be in the earliest stages of vascular cognitive impairment. Further, the findings suggest that cognitive aging is largely determined by factors other than SH for most older adults.

Category and letter verbal fluency across the adult lifespan: relationship to EEG theta power.

The purpose of this study was to examine the impact of age, sex, and education on category and letter verbal fluency task performance. A secondary goal was to examine whether resting EEG theta power in bilateral frontal and temporal lobes impacts age-associated decline in verbal fluency task performance. A large sample (N = 471) of healthy, normal participants, age 21-82, was assessed for letter fluency (i.e., FAS), and for category fluency (i.e., Animal Naming), and with a 32-channel EEG system for 'eyes-open' resting theta power. The effects of age, sex, and education were examined using analyses of variance. Correlation analyses were used to test the impact of theta power on age and fluency performance by controlling for the effects of theta when examining the relationship between the other two variables. The results indicated that performance on both fluency tests declined linearly with age, but that the rate of decline was greater for category fluency. These age changes were not associated with education level, and there were no sex differences. While theta power was negatively associated with age and positively associated with Animal Naming performance, it did not moderate the relationship between the two. The differential age-associated decline between category and letter fluency suggests separate neurobiological substrates underlying the two domains of performance, which is not related to theta activity.

Blood pressure variability and white matter hyperintensities in older adults with cardiovascular disease.

The present study examined the relationship between multiple blood pressure (BP) indices and white matter hyperintensities (WMH) in a sample of 39 older adults with cardiovascular disease (CVD). Resting BP was measured using an automated monitor every 10 min for 2 h. WMH were quantified on FLAIR images and separate indices were generated for neocortical, periventricular and subcortical brain regions. Correlation analyses revealed systolic BP variability was related to neocortical and total WMH. A function of systolic BP variability and average diastolic pressure showed the strongest relationships, including significant correlation to neocortical, subcortical and total WMH. No BP index was related to WMH in periventricular regions. Exploratory analyses showed only the function of systolic BP variability and average diastolic pressure predicted total WMH, whereas as age, CVD conditions and psychosocial factors did not. These findings demonstrate BP variability is an important contributor to WMH in older adults with CVD and suggests it may have differential relationships to WMH in different brain regions. Additional studies are needed to examine the role of autoregulatory systems in the development of WMH, particularly those using beat-to-beat measures of BP.