Obesity Mediates the Effect of Past and Current Mental Health on Diabetes Treatment Outcomes
-
Fatemeh Amini
,
Afsaneh Khajevand Khoshli
,
Javanshir Asadi
,
Adeleh Bahar
,
Hamid Najafipour
,
Ali Mirzazadeh
Abstract
Background: Anxiety and depression (A&D) are common among patients with diabetes (DM). We assessed the mediatory effect of obesity on the pathway between past and current mental health (as measured by A&D) on self-care DM treatment adherence and DM treatment failure.
Methods: We used data collected in two rounds (2009-12, 2014-2018) of a population-based cohort study in Kerman, Iran (KERCADRS). By a random cluster sampling approach, 5900 residents of Kerman aged 15 to 75 yr were recruited to the study to measure demographic characteristics, body measures (to calculate BMI), adherence to DM treatment, and symptoms for A&D (Beck questionnaires). Fasting blood also collected for biochemical tests and glycemic control (as an indicator for treatment failure). We used path analysis and Structural Equation Modeling (SEM) for analysis.
Results: We analyzed data for 264 patients with diabetes who attended in both study rounds. While only 5.7% reported not adherence to DM treatment, 67.9% had diabetes treatment failure. Past mental health had a significant positive association with HbA1c (standard beta coefficient for total effect =0.148, P=0.044), of which 42% was indirect effect through obesity. Current mental health had a positive association with current no adherence to diabetes treatment (standard beta coefficient for total effect=0.077, P=0.001).
Conclusion: Our study showed an important indirect path from A&D to diabetes treatment failure outcome which mediated by obesity. Screening for A&D symptoms and treating those as well as obesity among patients with diabetes may improve glycemic control.
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15. Nanayakkara N, Pease A, Ranasinha S, Wischer N, Andrikopoulos S, Speight J, et al. Depression and diabetes distress in adults with type 2 diabetes: results from the Australian National Diabetes Audit (ANDA) 2016. Sci Rep. 2018;8(1):7846.
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17. Barnacle M, Strand MA, Werremeyer A, Maack B, Petry N. Depression Screening in Diabetes Care to Improve Outcomes: Are We Meeting the Challenge? Diabetes Educ. 2016;42(5):646-51.
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19. Rajan TM, Menon V. Psychiatric disorders and obesity: A review of association studies. J Postgrad Med. 2017;63(3):182-90.
20. Markowitz S, Friedman MA, Arent SM. Understanding the Relation Between Obesity and Depression: Causal Mechanisms and Implications for Treatment. Clinical Psychology: Science and Practice. 2008;15(1):1-20.
21. Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obes Rev. 2001;2(4):219-29.
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23. Barnes M, Abhyankar P, Dimova E, Best C. Associations between body dissatisfaction and self-reported anxiety and depression in otherwise healthy men: A systematic review and meta-analysis. PLoS One. 2020;15(2):e0229268.
24. Jacquet P, Schutz Y, Montani JP, Dulloo A. How dieting might make some fatter: modeling weight cycling toward obesity from a perspective of body composition autoregulation. Int J Obes (Lond). 2020;44(6):1243-53.
25. Pasquali R, Vicennati V, Gambineri A. Adrenal and gonadal function in obesity. J Endocrinol Invest. 2002;25(10):893-8.
26. Faulconbridge LF, Bechtel CF. Depression and Disordered Eating in the Obese Person. Curr Obes Rep. 2014;3(1):127-36.
27. Herzer M, Zeller MH, Rausch JR, Modi AC. Perceived social support and its association with obesity-specific health-related quality of life. J Dev Behav Pediatr. 2011;32(3):188-95.
28. Zhang J, Xu CP, Wu HX, Xue XJ, Xu ZJ, Li Y, et al. Comparative study of the influence of diabetes distress and depression on treatment adherence in Chinese patients with type 2 diabetes: a cross-sectional survey in the People's Republic of China. Neuropsychiatr Dis Treat. 2013;9:1289-94.
29. Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154-60.
30. Nefs G, Hendrieckx C, Reddy P, Browne JL, Bot M, Dixon J, et al. Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study. J Diabetes Complications. 2019;33(8):523-9.
31. Mendes R, Martins S, Fernandes L. Adherence to Medication, Physical Activity and Diet in Older Adults With Diabetes: Its Association With Cognition, Anxiety and Depression. J Clin Med Res. 2019;11(8):583-92.
2. Haghdoost AA, Rezazadeh Kermani M, Sadghirad B, Baradaran HR. Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis. 2009.
3. Mirzaei M, Rahmaninan M, Mirzaei M, Nadjarzadeh A, Dehghani Tafti AA. Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes in Central Iran: results from Yazd health study. BMC Public Health. 2020;20(1):166.
4. Najafipour H, Sanjari M, Shokoohi M, Haghdoost AA, Afshari M, Shadkam M, et al. Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes and its predictors in general population aged 15 to 75 years: A community-based study (KERCADRS) in southeastern Iran. J Diabetes. 2015;7(5):613-21.
5. Moradi Y, Baradaran HR, Djalalinia S, Chinekesh A, Khamseh ME, Dastoorpoor M, et al. Complications of type 2 diabetes in Iranian population: An updated systematic review and meta-analysis. Diabetes Metab Syndr. 2019;13(3):2300-12.
6. Esteghamati A, Larijani B, Aghajani MH, Ghaemi F, Kermanchi J, Shahrami A, et al. Diabetes in Iran: Prospective Analysis from First Nationwide Diabetes Report of National Program for Prevention and Control of Diabetes (NPPCD-2016). Sci Rep. 2017;7(1):13461.
7. Najafipour H, Banivaheb G, Sabahi A, Naderi N, Nasirian M, Mirzazadeh A. Prevalence of anxiety and depression symptoms and their relationship with other coronary artery disease risk factors: A population-based study on 5900 residents in Southeast Iran. Asian J Psychiatr. 2016;20:55-60.
8. Dehesh T, Dehesh P, Shojaei S. Prevalence and Associated Factors of Anxiety and Depression Among Patients with Type 2 Diabetes in Kerman, Southern Iran. Diabetes Metab Syndr Obes. 2020;13:1509-17.
9. Najafipour H, Mirzazadeh A, Haghdoost A, Shadkam M, Afshari M, Moazenzadeh M, et al. Coronary Artery Disease Risk Factors in an Urban and Peri-urban Setting, Kerman, Southeastern Iran (KERCADR Study): Methodology and Preliminary Report. Iran J Public Health. 2012;41(9):86-92.
10. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21(4):185-92.
11. Hossein Kaviani H, Mousavi A S. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran University Medical Journal. 2008;66(2):136-40.
12. Kline RB. Principles and Practice of Structural Equation Modeling. 4th ed. New York: Guilford Press.2016.
13. Tripathy JP, Thakur JS, Jeet G, Jain S. Structural equation modeling to identify the risk factors of diabetes in the adult population of North India. Trop Med Health. 2018;46:23.
14. Golden SH, Shah N, Naqibuddin M, Payne JL, Hill-Briggs F, Wand GS, et al. The Prevalence and Specificity of Depression Diagnosis in a Clinic-Based Population of Adults With Type 2 Diabetes Mellitus. Psychosomatics. 2017;58(1):28-37.
15. Nanayakkara N, Pease A, Ranasinha S, Wischer N, Andrikopoulos S, Speight J, et al. Depression and diabetes distress in adults with type 2 diabetes: results from the Australian National Diabetes Audit (ANDA) 2016. Sci Rep. 2018;8(1):7846.
16. Liu X, Haagsma J, Sijbrands E, Buijks H, Boogaard L, Mackenbach JP, et al. Anxiety and depression in diabetes care: longitudinal associations with health-related quality of life. Sci Rep. 2020;10(1):8307.
17. Barnacle M, Strand MA, Werremeyer A, Maack B, Petry N. Depression Screening in Diabetes Care to Improve Outcomes: Are We Meeting the Challenge? Diabetes Educ. 2016;42(5):646-51.
18. Agarwal SM, Venkatasubramanian G. Metabolic syndrome in schizophrenia: theoretical, clinical and translational perspectives. Indian J Psychol Med. 2013;35(2):117-20.
19. Rajan TM, Menon V. Psychiatric disorders and obesity: A review of association studies. J Postgrad Med. 2017;63(3):182-90.
20. Markowitz S, Friedman MA, Arent SM. Understanding the Relation Between Obesity and Depression: Causal Mechanisms and Implications for Treatment. Clinical Psychology: Science and Practice. 2008;15(1):1-20.
21. Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obes Rev. 2001;2(4):219-29.
22. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. Jama. 2003;289(2):187-93.
23. Barnes M, Abhyankar P, Dimova E, Best C. Associations between body dissatisfaction and self-reported anxiety and depression in otherwise healthy men: A systematic review and meta-analysis. PLoS One. 2020;15(2):e0229268.
24. Jacquet P, Schutz Y, Montani JP, Dulloo A. How dieting might make some fatter: modeling weight cycling toward obesity from a perspective of body composition autoregulation. Int J Obes (Lond). 2020;44(6):1243-53.
25. Pasquali R, Vicennati V, Gambineri A. Adrenal and gonadal function in obesity. J Endocrinol Invest. 2002;25(10):893-8.
26. Faulconbridge LF, Bechtel CF. Depression and Disordered Eating in the Obese Person. Curr Obes Rep. 2014;3(1):127-36.
27. Herzer M, Zeller MH, Rausch JR, Modi AC. Perceived social support and its association with obesity-specific health-related quality of life. J Dev Behav Pediatr. 2011;32(3):188-95.
28. Zhang J, Xu CP, Wu HX, Xue XJ, Xu ZJ, Li Y, et al. Comparative study of the influence of diabetes distress and depression on treatment adherence in Chinese patients with type 2 diabetes: a cross-sectional survey in the People's Republic of China. Neuropsychiatr Dis Treat. 2013;9:1289-94.
29. Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154-60.
30. Nefs G, Hendrieckx C, Reddy P, Browne JL, Bot M, Dixon J, et al. Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study. J Diabetes Complications. 2019;33(8):523-9.
31. Mendes R, Martins S, Fernandes L. Adherence to Medication, Physical Activity and Diet in Older Adults With Diabetes: Its Association With Cognition, Anxiety and Depression. J Clin Med Res. 2019;11(8):583-92.
| Files | ||
| Issue | Vol 51 No 11 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i11.11180 | |
| Keywords | ||
| Obesity Mental health Diabetes mellitus Treatment outcomes | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Amini F, Khajevand Khoshli A, Asadi J, Bahar A, Najafipour H, Mirzazadeh A. Obesity Mediates the Effect of Past and Current Mental Health on Diabetes Treatment Outcomes. Iran J Public Health. 2022;51(11):2608-2618.
