Diabetes distress, depressive, and anxiety symptoms in people with type 2 diabetes: a network analysis approach to understanding comorbidity

Article

McInerney, A., Lindekilde, N., Nouwen, A., Schmitz, N. and Deschenes, S. 2022. Diabetes distress, depressive, and anxiety symptoms in people with type 2 diabetes: a network analysis approach to understanding comorbidity. Diabetes Care. 45 (8), pp. 1715-1723. https://doi.org/10.2337/dc21-2297
TypeArticle
TitleDiabetes distress, depressive, and anxiety symptoms in people with type 2 diabetes: a network analysis approach to understanding comorbidity
AuthorsMcInerney, A., Lindekilde, N., Nouwen, A., Schmitz, N. and Deschenes, S.
Abstract

Objective
This study aimed to explore interactions between diabetes distress, depressive, 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 Evaluation of Diabetes Insulin Treatment (EDIT) study from Quebec, Canada. A network of diabetes distress symptoms was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the 17 items of the DDS-17, the 9 depressive items of the Patient Health Questionnaire (PHQ-9), and the 7 anxiety items of the Generalized Anxiety Disorder Assessment (GAD-7). Network analysis was used to identify central symptoms, clusters of symptoms, and symptoms that may bridge between diabetes distress, depressive, and anxiety symptoms.
Results
Regimen-related and physician-related diabetes distress symptoms were amongst the most influential (most positive connections to others) in the diabetes distress network. Feeling like a failure (depression) was identified as a potential bridge between depression and diabetes distress, being highly connected to symptoms of diabetes distress. The anxiety symptoms of worrying too much and being unable to stop worrying were found to be bridge symptoms between both anxiety and depression symptoms, and anxiety and diabetes distress symptoms, respectively.
Conclusions
These findings suggest individual symptoms that might be influential to the development and maintenance of diabetes distress and mental health comorbidity in diabetes and warrant further investigation. Study limitations and potential for clinical applicability are discussed.

Keywordsanxiety; comorbidity; depressive disorders; diabetes mellitus; type 2; mental health
PublisherAmerican Diabetes Association (ADA)
JournalDiabetes Care
ISSN0149-5992
Electronic1935-5548
Publication dates
Online26 Jul 2022
PrintAug 2022
Publication process dates
Deposited19 May 2022
Accepted17 Apr 2022
Submitted05 Nov 2021
Output statusPublished
Accepted author manuscript
Copyright Statement

This is an author-created, uncopyedited electronic version of an article accepted for publication in Diabetes Care on April 17 2022. The American Diabetes Association (ADA), publisher of Diabetes Care, is not responsible for any errors or omissions in this version of the manuscript or any version derived from it by third parties. The definitive publisher-authenticated version is available in in Diabetes Care 2022;45(8):1715–1723 online at https://doi.org/10.2337/dc21-2297

Additional information

This article contains supplementary material online at https://doi.org/10.2337/figshare.19692721

Digital Object Identifier (DOI)https://doi.org/10.2337/dc21-2297
PubMed ID35704532
Web of Science identifierWOS:000843954800007
Related Output
Is supplemented byhttps://doi.org/10.2337/figshare.19692721
LanguageEnglish
Permalink -

https://repository.mdx.ac.uk/item/89w75

Log in to edit

Download files

Accepted author manuscript
McInnery et al 2022 accepted paper EDIT_DiabetesCare_manuscript_revision_finaldraft_am[37].docx
McInnery et al 2022 accepted paper EDIT_DiabetesCare_manuscript_revision_finaldraft_am[37].pdf

  • 104
    total views
  • 70
    total downloads
  • 4
    views this month
  • 11
    downloads this month

Export as

Related outputs

Mendelian randomization analysis identifies inverse causal relationship between external eating and metabolic phenotypes
Timasheva, Y., Balkhiyarova, Z., Avzaletdinova, D., Morugova, T., Korytina, G., Nouwen, A., Prokopenko, I. and Kochetova, O. 2024. Mendelian randomization analysis identifies inverse causal relationship between external eating and metabolic phenotypes. Nutrients. 16 (8). https://doi.org/10.3390/nu16081166
Associations between HbA1c reduction and change in depressive symptoms following glucose-lowering treatment in adults: A systematic review of intervention studies
Schmitt, A., Beran, M., Geraets, A., Iversen, M., Nefs, G., Nouwen, A., Pouwer, F., Huber, J. and T Schram, M. 2024. Associations between HbA1c reduction and change in depressive symptoms following glucose-lowering treatment in adults: A systematic review of intervention studies. Current Diabetes Reviews. 20 (3), pp. 66-83. https://doi.org/10.2174/1573399820666230602124223
Prediabetes and the risk of type 2 diabetes: investigating the roles of depressive and anxiety symptoms in the Lifelines cohort study
Deschênes, S., McInerney, A., Nearchou, F., Byrne, B., Nouwen, A. and Schmitz, N. 2023. Prediabetes and the risk of type 2 diabetes: investigating the roles of depressive and anxiety symptoms in the Lifelines cohort study. Diabetic Medicine. 40 (7). https://doi.org/10.1111/dme.15061
The bidirectional longitudinal association between depressive symptoms and HbA1c : a systematic review and meta‐analysis
Beran, M., Muzambi, R., Geraets, A., Albertorio-Diaz, J., Adriaanse, M., Iversen, M., Kokoszka, A., Nefs, G., Nouwen, A., Pouwer, F., Huber, J., Schmitt, A. and Schram, M. 2022. The bidirectional longitudinal association between depressive symptoms and HbA1c : a systematic review and meta‐analysis. Diabetic Medicine. 39 (2), pp. 1-11. https://doi.org/10.1111/dme.14671
Data on diabetes-specific distress are needed to improve the quality of diabetes care [Correspondence]
Speight, J., Hermanns, N., Ehrmann, D., Anarte Ortiz, M., Asimakopoulou, K., Baig, A., Cooke, D., Deschênes, S., de Wit, M., Garrett, C., Goethals, E., Hendrieckx, C., Holmes-Truscott, E., Holt, R., Huber, J., Ismail, K., Kalra, S., Kubiak, T., Messina, R., Mezuk, B., Nefs, G., Newson, L., Nouwen, A., Petrak, F., Pouwer, F., Saleh-Stattin, N., Skinner, T., Snoek, F., Sturt, J. and Vallis, M. 2021. Data on diabetes-specific distress are needed to improve the quality of diabetes care [Correspondence]. The Lancet. 397 (10290), p. p2149. https://doi.org/10.1016/S0140-6736(21)00633-4
Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EHMS and UK Biobank datasets
Nouwen, A., Deschenes, S., Balkhiyarova, Z., Albertorio-Diaz, J., Prokopenko, I. and Schmitz, N. 2021. Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EHMS and UK Biobank datasets. Journal of Affective Disorders. 292, pp. 311-318. https://doi.org/10.1016/j.jad.2021.05.031
Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: systematic review and meta-analysis
van der Feltz-Cornelis, C., Allen, S., Holt, R., Roberts, R., Nouwen, A. and Sortorius, N. 2021. Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: systematic review and meta-analysis. Brain and Behavior. 11 (2), pp. 1-26. https://doi.org/10.1002/brb3.1981
The mediating role of comorbid conditions in the association between type 2 diabetes and cognition: a cross-sectional observational study using the UK Biobank cohort
Whitelock, V., Rutters, F., Rijnhart, J., Nouwen, A. and Higgs, S. 2021. The mediating role of comorbid conditions in the association between type 2 diabetes and cognition: a cross-sectional observational study using the UK Biobank cohort. Psychoneuroendocrinology. 123. https://doi.org/10.1016/j.psyneuen.2020.104902
Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries; results from the INTERPRET-DD prospective study
Lloyd, C., Sartorius, N., Ahmed, H., Alvarez, A., Bahendeka, S., Bobrov, A., Burti, L., Chaturvedi, S., Gaebel, W., de Girolamo, G., Gondek, T., Guinzbourg, M., Heinze, M., Khan, A., Kiejna, A., Kokoszka, A., Lalic, N., Lecic-Tosevski, D., Mannucci, E., Mankovsky, B., Müssig, K., Mutiso, V., Ndetei, D., Nouwen, A., Rabbani, G., Srikanta, S., Starostina, E., Shevchuk, M., Taj, R., Valentini, U., van Dam, K., Vukovic, O. and Wölwer, W. 2020. Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries; results from the INTERPRET-DD prospective study. Epidemiology and Psychiatric sciences. 29, pp. 1-9. https://doi.org/10.1017/S2045796020000438
Spousal support and relationship happiness in adults with type 2 diabetes and their spouses
Lafontaine, M., Bélanger, C., Jolin, S., Sabourin, S. and Nouwen, A. 2020. Spousal support and relationship happiness in adults with type 2 diabetes and their spouses. Canadian Journal of Diabetes. 44 (6), pp. 481-486. https://doi.org/10.1016/j.jcjd.2020.05.006
Motivation: key to a healthy lifestyle in people with diabetes? Current and emerging knowledge and applications
Lakerveld, J., Palmeira, A., van Duinkerken, E., Whitelock, V., Peyrot, M. and Nouwen, A. 2020. Motivation: key to a healthy lifestyle in people with diabetes? Current and emerging knowledge and applications. Diabetic Medicine. 37 (3), pp. 464-472. https://doi.org/10.1111/dme.14228
How 25 years of psychosocial research has contributed to a better understanding of the links between depression and diabetes
Pouwer, F., Schram, M., Iversen, M., Nouwen, A. and Holt, R. 2020. How 25 years of psychosocial research has contributed to a better understanding of the links between depression and diabetes. Diabetic Medicine. 37 (3), pp. 383-392. https://doi.org/10.1111/dme.14227
More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus
Chaturvedi, S., Manche Gowda, S., Ahmed, H., Alosaimi, F., Andreone, N., Bobrov, A., Bulgari, V., Carrà, G., Castelnuovo, G., de Girolamo, G., Gondek, T., Jovanovic, N., Kamala, T., Kiejna, A., Lalic, N., Lecic-Tosevski, D., Minhas, F., Mutiso, V., Ndetei, D., Rabbani, G., Somruk, S., Srikanta, S., Taj, R., Valentini, U., Vukovic, O., Wölwer, W., Cimino, L., Nouwen, A., Lloyd, C. and Sartorius, N. 2019. More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus. General Psychiatry. 32 (4), pp. 1-9. https://doi.org/10.1136/gpsych-2019-100076
Comment on the consensus report on the management of hyperglycaemia in Type 2 diabetes by the American Diabetes Association and the European Association for the Study of Diabetes
Skinner, T., Byrne, M., Dickinson, J., Fisher, L., Funnell, M., Guzman, S., Hendrieckx, C., Hermanns, N., Kanc, K., Lloyd, C., Mocan, A., Nouwen, A., Pouwer, F., Saleh‐Stattin, N., Snoek, F., Speight, J., Sturt, J., Vallis, M., Wagner, J., Willaing, I., Young‐Hyman, D. and Zoffmann, V. 2019. Comment on the consensus report on the management of hyperglycaemia in Type 2 diabetes by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetic Medicine. 36 (7), pp. 911-912. https://doi.org/10.1111/dme.13934
Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis
Nouwen, A., Adriaanse, M., van Dam, K., Iversen, M., Viechtbauer, W., Peyrot, M., Caramlau, I., Kokoszka, A., Kanc, K., de Groot, M., Nefs, G. and Pouwer, F. 2019. Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis. Diabetic Medicine. 36 (12), pp. 1562-1572. https://doi.org/10.1111/dme.14054
Sex differences in the association of psychological status with measures of physical activity and sedentary behaviour in adults with type 2 diabetes
Indelicato, L., Dauriz, M., Bacchi, E., Donà, S., Santi, L., Negri, C., Cacciatori, V., Bonora, E., Nouwen, A. and Moghetti, P. 2018. Sex differences in the association of psychological status with measures of physical activity and sedentary behaviour in adults with type 2 diabetes. Acta Diabetologica. 55 (6), pp. 627-635. https://doi.org/10.1007/s00592-018-1132-0
Does working memory training improve dietary self-care in type 2 diabetes mellitus? Results of a double blind randomised controlled trial
Whitelock, V., Nouwen, A., Houben, K., van den Akker, O., Rosenthal, M. and Higgs, S. 2018. Does working memory training improve dietary self-care in type 2 diabetes mellitus? Results of a double blind randomised controlled trial. Diabetes Research and Clinical Practice. 143, pp. 204-214. https://doi.org/10.1016/j.diabres.2018.07.005
Comment on Young-Hyman et al. Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016;39:2126–2140
Snoek, F., Hermanns, N., de Wit, M., Huber, J., Sturt, J., Pouwer, F., Lloyd, C., Willaing, I. and Nouwen, A. 2018. Comment on Young-Hyman et al. Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016;39:2126–2140. Diabetes Care. 41 (3), pp. e31-e32. https://doi.org/10.2337/dc17-1102
Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the international prevalence and treatment of diabetes and depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries
Lloyd, C., Nouwen, A., Sartorius, N., Ahmed, H., Alvarez, A., Bahendeka, S., Basangwa, D., Bobrov, A., Boden, S., Bulgari, V., Burti, L., Chaturvedi, S., Cimino, L., Gaebel, W., de Girolamo, G., Gondek, T., de Braude, M., Guntupalli, A., Heinze, M., Ji, L., Hong, X., Khan, A., Kiejna, A., Kokoszka, A., Kamala, T., Lalic, N., Lecic Tosevski, D., Mankovsky, B., Li, M., Musau, A., Müssig, K., Ndetei, D., Rabbani, G., Srikanta, S., Starostina, E., Shevchuk, M., Taj, R., Vukovic, O., Wölwer, W. and Xin, Y. 2018. Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the international prevalence and treatment of diabetes and depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries. Diabetic Medicine. 35 (6), pp. 760-769. https://doi.org/10.1111/dme.13611
Exercise to preserve β-cell function in recent-onset Type 1 diabetes mellitus (EXTOD) - a randomized controlled pilot trial
Narendran, P., Jackson, N., Daley, A., Thompson, D., Stokes, K., Greenfield, S., Charlton, M., Curran, M., Solomon, T., Nouwen, A., Lee, S., Cooper, A., Mostazir, M., Taylor, R., Kennedy, A. and Andrews, R. 2017. Exercise to preserve β-cell function in recent-onset Type 1 diabetes mellitus (EXTOD) - a randomized controlled pilot trial. Diabetic Medicine. 34 (11), pp. 1521-1531. https://doi.org/10.1111/dme.13439
The role of working memory sub-components in food choice and dieting success
Whitelock, V., Nouwen, A., van den Akker, O. and Higgs, S. 2018. The role of working memory sub-components in food choice and dieting success. Appetite. 124, pp. 24-32. https://doi.org/10.1016/j.appet.2017.05.043
Microstructural abnormalities in white and gray matter in obese adolescents with and without type 2 diabetes
Nouwen, A., Chambers, A., Chechlacz, M., Higgs, S., Blissett, J., Barrett, T. and Allen, H. 2017. Microstructural abnormalities in white and gray matter in obese adolescents with and without type 2 diabetes. NeuroImage: Clinical. 16, pp. 43-51. https://doi.org/10.1016/j.nicl.2017.07.004
Type 2 diabetes, depressive symptoms and trajectories of cognitive decline in a national sample of community-dwellers: a prospective cohort study
Demakakos, P., Muniz-Terrera, G. and Nouwen, A. 2017. Type 2 diabetes, depressive symptoms and trajectories of cognitive decline in a national sample of community-dwellers: a prospective cohort study. PLoS ONE. 12 (4), pp. 1-14. https://doi.org/10.1371/journal.pone.0175827
Relationship between parental feeding practices and neural responses to food cues in adolescents
Allen, H., Chambers, A., Blissett, J., Chechlacz, M., Barrett, T., Higgs, S. and Nouwen, A. 2016. Relationship between parental feeding practices and neural responses to food cues in adolescents. PLoS ONE. 11 (8), pp. 1-19. https://doi.org/10.1371/journal.pone.0157037
A cross-sectional study of depressive symptoms and diabetes self-care in African Americans and Hispanics/Latinos with diabetes: the role of self-efficacy
Hernandez, R., Ruggiero, L., Prohaska, T., Chavez, N., Boughton, S., Peacock, N., Zhao, W. and Nouwen, A. 2016. A cross-sectional study of depressive symptoms and diabetes self-care in African Americans and Hispanics/Latinos with diabetes: the role of self-efficacy. Diabetes Educator. 42 (4), pp. 452-461. https://doi.org/10.1177/0145721716654008
Improving management and effectiveness of home blood pressure monitoring: a qualitative UK primary care study
Grant, S., Greenfield, S., Nouwen, A. and McManus, R. 2015. Improving management and effectiveness of home blood pressure monitoring: a qualitative UK primary care study. British Journal of General Practice. 65, pp. e776-e783. https://doi.org/10.3399/bjgp15X687433
Depression and diabetes distress
Nouwen, A. 2015. Depression and diabetes distress. Diabetic Medicine. 32 (10), pp. 1261-1263. https://doi.org/10.1111/dme.12863
Does neurocognitive training have the potential to improve dietary self-care in type 2 diabetes? Study protocol of a double blind randomised controlled trial
Whitelock, V., Nouwen, A., Houben, K., van den Akker, O. and Higgs, S. 2015. Does neurocognitive training have the potential to improve dietary self-care in type 2 diabetes? Study protocol of a double blind randomised controlled trial. BMC Nutrition. 1, pp. 1-8. https://doi.org/10.1186/s40795-015-0006-x
Examining evidence for behavioural mimicry of parental eating by adolescent females. An observational study
Sharps, M., Higgs, S., Blissett, J., Nouwen, A., Chechlacz, M., Allen, H. and Robinson, E. 2015. Examining evidence for behavioural mimicry of parental eating by adolescent females. An observational study. Appetite. 89, pp. 55-61. https://doi.org/10.1016/j.appet.2015.01.015
Is the association between depressive symptoms and glucose metabolism bidirectional? Evidence from the English Longitudinal Study of Ageing
Demakakos, P., Zaninotto, P. and Nouwen, A. 2014. Is the association between depressive symptoms and glucose metabolism bidirectional? Evidence from the English Longitudinal Study of Ageing. Psychosomatic Medicine: Journal of Biobehavioral Medicine. 76 (7), pp. 555-561. https://doi.org/10.1097/PSY.0000000000000082
Adverse effects of depression on glycemic control and health outcomes in people with diabetes: a review
Pouwer, F., Nefs, G. and Nouwen, A. 2013. Adverse effects of depression on glycemic control and health outcomes in people with diabetes: a review. Endocrinology and metabolism clinics of North America. 42 (3), pp. 529-544. https://doi.org/10.1016/j.ecl.2013.05.002
Longitudinal testing of a dietary self-care motivational model in adolescents with diabetes.
Austin, S., Guay, F., Senécal, C., Fernet, C. and Nouwen, A. 2013. Longitudinal testing of a dietary self-care motivational model in adolescents with diabetes. Journal of Psychosomatic Research. 75 (2), pp. 153-159. https://doi.org/10.1016/j.jpsychores.2013.04.013
Adolescent and parent diabetes distress in type 1 diabetes: the role of self-efficacy, perceived consequences, family responsibility and adolescent-parent discrepancies
Law, G., Walsh, J., Queralt, V. and Nouwen, A. 2013. Adolescent and parent diabetes distress in type 1 diabetes: the role of self-efficacy, perceived consequences, family responsibility and adolescent-parent discrepancies. Journal of Psychosomatic Research. 74 (4), pp. 334-339. https://doi.org/10.1016/j.jpsychores.2012.12.009
Longitudinal motivational predictors of dietary self-care and diabetes control in adults with newly diagnosed type 2 diabetes mellitus
Nouwen, A., Ford, T., Balan, A., Twisk, J., Ruggiero, L. and White, D. 2011. Longitudinal motivational predictors of dietary self-care and diabetes control in adults with newly diagnosed type 2 diabetes mellitus. Health Psychology. 30 (6), pp. 771-779. https://doi.org/10.1037/a0024500
Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: a systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium
Nouwen, A., Nefs, G., Caramlau, I., Connock, M., Winkley, K., Lloyd, C., Peyrot, M., Pouwer, F. and European Depression in Diabetes (EDID) Research Consortium 2011. Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: a systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium. Diabetes Care. 34 (3), pp. 752-762. https://doi.org/10.2337/dc10-1414
Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis
Nouwen, A., Winkley, K., Twisk, J., Lloyd, C., Peyrot, M., Ismail, K. and Pouwer, F. 2010. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 53 (12), pp. 2480-2486. https://doi.org/10.1007/s00125-010-1874-x
Diabetes dietary management alters responses to food pictures in brain regions associated with motivation and emotion: a functional magnetic resonance imaging study
Chechlacz, M., Rotshtein, P., Klamer, S., Porubská, K., Higgs, S., Booth, D., Fritsche, A., Preissl, H., Abele, H., Birbaumer, N. and Nouwen, A. 2009. Diabetes dietary management alters responses to food pictures in brain regions associated with motivation and emotion: a functional magnetic resonance imaging study. Diabetologia. 52 (3), pp. 524-533. https://doi.org/10.1007/S00125-008-1253-Z