Stages of hyperglycemia and common mental disorders in adults – The Brazilian Study of Adult Health (ELSA-Brasil)
Keywords:
Diabetes mellitus, Prediabetic state, Hemoglobin A, glycosylated, Depressive disorder, Mental disordersAbstract
CONTEXT AND OBJECTIVE: Diabetes mellitus and depressive disorders frequently coexist. However, this relationship has been little evaluated across stages of hyperglycemia and for a broad range of common mental disorders (CMDs). The objective here was to investigate the association between CMDs and stages of glycemia. DESIGN AND SETTING: Cross-sectional study conducted among civil servants aged 35-74 years participating in the ELSA-Brasil cohort. METHODS: CMDs were classified using the Clinical Interview Schedule – Revised (CIS-R). Glycemia was classified in stages as normal, intermediate hyperglycemia, newly classified diabetes or previously known diabetes, based on oral glucose tolerance testing, glycated hemoglobin (HbA1c), self-reported diabetes and medication use. Blood glucose control was assessed according to HbA1c. RESULTS: CMDs were most prevalent in individuals with previously known diabetes. After adjustments, associations weakened considerably and remained significant only for those with a CIS-R score ≥ 12 (prevalence ratio, PR: 1.15; 95% confidence interval, CI: 1.03-1.29). Intermediate hyperglycemia did not show any association with CMDs. For individuals with previously known diabetes and newly classified diabetes, for every 1% increase in HbA1c, the prevalence of depressive disorders became, respectively, 12% and 23% greater (PR: 1.12; 95% CI: 1.00-1.26; and PR: 1.23; 95% CI: 1.04-1.44). CONCLUSION: Individuals with previously known diabetes had higher CIS-R scores. Among all individuals with diabetes, worse blood glucose control was correlated with depressive disorder. No relationship between intermediate hyperglycemia and CMDs was observed, thus suggesting that causal processes relating to CMDs, if present, must act more proximally to diabetes onset.
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References
World Health Organization (WHO). Noncommunicable diseases country profiles 2011 [Internet]. WHO. 2011. Available from: http://www.who.int/nmh/publications/ncd_profiles2011/en/index.html. Accessed in 2016 (Aug 22).
Schmidt MI, Duncan BB, Azevedo e Silva G, et al. Chronic non- communicable diseases in Brazil: burden and current challenges. Lancet. 2011;377(9781):1949-61.
International Diabetes Federation. IDF diabetes atlas, 7th edition. Available from: http://www.diabetesatlas.org/. Accessed in 2016 (Aug 22).
Institute for Health Metrics and Evaluation. Brazil. Available from: http://www.healthdata.org/brazil. Accessed in 2016 (Aug 22).
Golden SH, Lazo M, Carnethon M, et al. Examining a bidirectional association between depressive symptoms and diabetes. JAMA. 2008;299(23):2751-9.
Kivimaki M, Tabak AG, Batty GD, et al. Hyperglycemia, type 2 diabetes, and depressive symptoms: the British Whitehall II study. Diabetes Care. 2009;32(10):1867-9.
Golden SH, Lee HB, Schreiner PJ, et al. Depression and type 2 diabetes mellitus: the multiethnic study of atherosclerosis. Psychosom Med. 2007;69(6):529-36.
Knol MJ, Twisk JW, Beekman AT, et al. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia. 2006;49(5):837-45.
Nouwen A, Winkley K, Twisk J, et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta- analysis. Diabetologia. 2010;53(12):2480-6.
Sumita NM, Andriolo A. Importância da hemoglobina glicada no controle do diabetes mellitus e na avaliação de risco das complicações crônicas: (revisão) [Glycohemoglobin importance in the diabetes mellitus control and in the risk evaluation of chronic complications: (review)]. J Bras Patol Med Lab. 2008;44(3):169-74.
Schmidt MI, Duncan BB, Mill JG, et al. Cohort Profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol. 2015;44(1):68-75.
Aquino EM, Barreto SM, Bensenor IM, et al. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol. 2012;175(4):315-24.
Lewis G, Pelosi AJ, Araya R, Dunn G. Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med. 1992;22(2):465-86.
World Health Organization. International Classification of Diseases and Related Health Problemas 10th Revision. Available from: http://apps.who.int/classifications/icd10/browse/2016/en. Accessed in 2016 (Aug 22).
Skapinakis P, Anagnostopoulos F, Bellos S, et al. An empirical investigation of the structure of anxiety and depressive symptoms in late adolescence: cross-sectional study using the Greek version of the revised Clinical Interview Schedule. Psychiatry Res. 2011;186(2- 3):419-26.
Office for National Statistics. Psychiatric Morbidity Among Adults Living In Private Households, 2000: Available from: http://www.ons.gov.uk/ons/rel/psychiatric-morbidity/psychiatric-morbidity-among-adults-living-in-private-households/2000/index.html. Accessed in 2016 (Aug 22).
Das-Munshi J, Stewart R, Ismail K, et al. Diabetes, common mental disorders, and disability: findings from the UK National Psychiatric Morbidity Survey. Psychosom Med. 2007;69(6):543-50.
Lustman PJ, Anderson RJ, Freedland KE, et al. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000;23(7):934-42.
Knol MJ, Heerdink ER, Egberts ACG, et al. Depressive symptoms in subjects with diagnosed and undiagnosed type 2 diabetes. Psychosom Med. 2007;69(4):300-5.
Stuart MJ, Baune BT. Depression and type 2 diabetes: inflammatory mechanisms of a psychoneuroendocrine co-morbidity. Neurosci Biobehav Rev. 2012;36(1):658-76.
Schmidt MI, Duncan BB. Diabesity: an inflammatory metabolic condition. Clin Chem Lab Med. 2003;41(9):1120-30.
Duncan BB, Schmidt MI. Chronic activation of the innate immune system may underlie the metabolic syndrome. Sao Paulo Med J. 2001;119(3):122-7.
Schmidt MI, Duncan BB, Sharrett AR, et al. Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet. 1999;353(9165):1649-52.
Duncan BB, Schmidt MI, Pankow JS, et al. Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes. 2003;52(7):1799-805.
Duncan BB, Schmidt MI, Pankow JS, et al. Adiponectin and the development of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes. 2004;53(9):2473-8.
Schmidt MI, Duncan BB, Vigo A, et al. Leptin and incident type 2 diabetes: risk or protection? Diabetologia. 2006;49(9):2086-96.
Luft VC, Schmidt MI, Pankow JS, et al. Chronic inflammation role in the obesity-diabetes association: a case-cohort study. Diabetol Metab Syndr. 2013;5(1):31.
Papelbaum M, Moreira RO, Coutinho W, et al. Depression, glycemic control and type 2 diabetes. Diabetol Metab Syndr. 2011;3(1):26.
Diabetes.co.uk. Common diabetes drugs could combat depression. Available from: http://www.diabetes.co.uk/News/2012/Nov/common-diabetes-drugs-could-combat-depression-99654992.html. Accessed in 2016 (Jun 29).
Wahlqvist ML, Lee MS, Chuang SY, et al. Increased risk of affective disorders in type 2 diabetes is minimized by sulfonylurea and metformin combination: a population-based cohort study. BMC Med. 2012;10:150.
