Diabetes, depressive symptoms, and functional disability in African Americans: the Jackson Heart Study
Rita Rastogi Kalyani1, Nan Ji2, Mercedes Carnethon3
1Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 East Monument Street, Suite 333, Baltimore, MD 21287, USA.
Insights
In African Americans, comorbid depression significantly contributes to functional disability in those with diabetes. Depressive symptoms, not diabetes alone, were the stronger predictor of disability.
Area of Science:
- Public Health
- Epidemiology
- Clinical Medicine
Background:
- African Americans (AAs) face a high risk of diabetes complications.
- Comorbid depression is a growing concern in chronic disease management.
- Understanding factors contributing to functional disability is crucial for this population.
Purpose of the Study:
- To determine the extent to which depression exacerbates the link between diabetes and functional disability in African Americans.
- To identify the independent and combined effects of diabetes and depressive symptoms on functional disability.
Main Methods:
- Analysis of 2989 African Americans from the Jackson Heart Study.
- Assessment of diabetes status and depressive symptoms (CES-D) at baseline.
- Logistic regression models to evaluate associations with overall functional disability.
Main Results:
- Functional disability was most prevalent in individuals with both diabetes and depression (54%).
- Depressive symptoms alone (OR=2.30) and combined with diabetes (OR=2.75) showed significant associations with functional disability.
- Diabetes alone was not significantly associated with functional disability after adjustments.
Conclusions:
- Depressive symptoms are a stronger contributor to functional disability in African Americans with diabetes than diabetes alone.
- The interplay between depression and diabetes warrants further investigation to understand underlying mechanisms.
- Targeting depression may be key to mitigating functional disability in this high-risk group.
Aims:
To investigate the degree to which comorbid depression contributes to the relationship of diabetes with functional disability in African Americans (AAs), a population at high-risk for complications.
Methods:
We examined 2989 African Americans (AAs) in the Jackson Heart Study who had diabetes and depressive symptoms (CES-D) assessed at baseline. Overall functional disability was defined as the inability to perform at least one task of daily living. Multivariable logistic regression models explored the association of diabetes and depressive symptoms with functional disability.
Results:
Prevalence of overall functional disability was highest with both diabetes and depressive symptoms (54%), similar with diabetes alone (31%) or depressive symptoms alone (33%), and lowest with neither (15%). Adjusting for demographics, smoking, BMI, cardiovascular comorbidities, and hsCRP, the association of depressive symptoms alone (OR=2.30,95% CI 1.75-3.03) and both diabetes and depressive symptoms (OR=2.75,1.88-4.04) with overall functional disability was significant, but not for diabetes alone (OR=1.26,0.95-1.67), compared to neither. In regression analyses including any diabetes and any depressive symptoms together in models, the main effect of depressive symptoms but not diabetes was associated with overall functional disability, and the interaction term was not significant (p-value=0.84).
Conclusions:
Functional disability was highest among AAs who have both diabetes and depressive symptoms; the latter was a stronger contributor. Future studies should explore mechanisms underlying functional disability in diabetes, particularly the role of depression.
More Related Videos
Related Concept Videos
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:22Diabetes Mellitus: Type 2 and Gestational
01:22Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
01:19Psychoneuroimmunology: Diabetes and Cancer
01:20Pathophysiology of Diabetes
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
01:15Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...