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Objectives Current definitions of mental health are no longer limited to presence or absence of mental illness. Although dimensions of mental illness have been well studied among people with diabetes, little is known about positive mental health. Optimal positive mental health is referred to as “flourishing” and is characterized by happiness, psychological well-being and social well-being. Therefore, the purpose of this study was to examine the prevalence and correlates of flourishing mental health among Canadian adults diagnosed with diabetes. Methods Data came from participants >19 years of age in the Canadian Community Health Survey---Mental Health 2012, a national, cross-sectional survey. Positive mental health was measured with the Mental Health Continuum---Short Form, which categorizes individuals into flourishing, moderate and languishing mental health. Results Although the majority of participants with diabetes reported flourishing mental health (73.22%), flourishing mental health was more common among people without diabetes (76.56%). Among people with diabetes (n=2,024), those who were flourishing reported greater physical activity, better self-rated health, fewer comorbidities, less functional disability and were less likely to smoke compared with those who were not flourishing. Those who were flourishing were less likely to have a lifetime history of major depressive disorder or generalized anxiety disorder and were distinguished by some demographic characteristics. Conclusion Among people with diabetes, flourishing mental health was associated with distinct behavioural, health and sociodemographic correlates.

Background Elevated depressive symptoms are associated with an increased risk for diabetes. Depression is a heterogeneous and chronic condition in which symptoms may remit, emerge, lessen, or intensify over time. Purpose The purpose of this study was to determine if trajectories of depressive symptoms measured at five time points over 8 years predicted incident diabetes over an 8-year follow-up in middle-aged and older adults. A secondary aim was to determine if trajectories of depressive symptoms predict incident diabetes, above and beyond depressive symptoms measured at a single time point. Methods Data came from the Health and Retirement Study (n = 9,233). Depressive symptoms were measured biennially from 1998 to 2006. Self-reported incident diabetes was measured during an 8-year follow-up. Results Five trajectories of depressive symptoms were identified (no depressive symptoms, low depressive symptoms, low-moderate depressive symptoms, moderate depressive symptoms, elevated and increasing depressive symptoms). Compared to the no depressive symptoms trajectory group (referent), all other trajectory groups were at higher risk of developing diabetes after adjusting for covariates. In most cases, trajectory group membership was associated with incident diabetes after controlling for depressive symptoms at a single time point. Conclusions Patterns of depressive symptoms over time were associated with incident diabetes. Patterns of depressive symptoms may be more predictive of diabetes incidence than depressive symptoms measured at a single time point.

Physical activity and body mass index (BMI) are linked to the prevention and management of type 2 diabetes (T2D). Romantic partners influence each other’s health and the behavioral management of T2D often involves both partners. Therefore, this study examined dyadic associations between physical activity and BMI in couples in which one partner has T2D. Data came from the Lifelines cohort study. The actor-partner interdependence model was applied to cross-sectional data from 1,133 couples in which only one partner had T2D. The physical activity of the person with diabetes was inversely associated with his/her partner’s BMI. However, partner physical activity was not associated with the BMI of the person with diabetes. These results suggest that people with diabetes may influence the BMI of their partners. Future research should consider how people with diabetes influence the health outcomes of their partners, which is an area that is often overlooked in the literature.

Objectives This study describes associations between depressive symptoms and indices of obesity in a community sample of adults with prediabetes. The strengths of these associations were compared to those observed in individuals with normal blood glucose levels. Methods Cross-sectional data came from the baseline assessment of the Emotional Health and Wellbeing Study. Participants were classified as meeting the American Diabetes Association criteria for prediabetes (n=1,152) or normal blood glucose levels (n=1,567). Indices of obesity included body mass index, waist circumference and fat mass index. Results After adjusting for sociodemographic covariates, greater depressive symptoms were associated with greater body mass index, waist circumference and fat mass index. These associations were stronger in participants with prediabetes compared to participants with normal blood glucose levels. The pattern of results observed for body mass index and waist circumference held after controlling for self-reported fruit and vegetable consumption, physical activity and sedentary time, but the strength of the interaction was attenuated for fat mass index. Conclusions Depressive symptoms were more strongly associated with indices of obesity in people with prediabetes than in people with normal blood glucose levels. Depressive symptoms may be a barrier to weight management in people with prediabetes.

Background The prevalence and prognosis of post-acute stage SARS-CoV-2 infection fatigue symptoms remain largely unknown. Aims We performed a systematic review to evaluate the prevalence of fatigue in post-recovery from SARS-CoV-2 infection. Method Medline, Embase, PsycINFO, CINAHL, Web of Science, Scopus, trial registries, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for studies on fatigue in samples that recovered from polymerase chain reaction (PCR) diagnosed COVID-19. English, French, and Spanish studies were included. Meta-analyses were conducted separately for each recruitment setting. Results We identified 41 studies with 9,362 patients that recovered from COVID-19. Post-COVID-19 patients self-report of fatigue was higher compared to healthy controls (risk ratio (RR) = 3.688, 95%CI [2.502, 5.436], p < .001). Over 50% of patients discharged from inpatient care reported symptoms of fatigue during the first (event rate [ER] = 0.517, 95%CI [0.278, 0.749]) and second month following recovery (ER = 0.527, 95%CI [0.337, 0.709]). Ten percent of the community patients reported fatigue in the first-month post-recovery. Patient setting moderated the association between COVID-19 recovery and fatigue symptoms (R2 = 0.11, p < .001). Female patients recovering from COVID-19 had a greater self-report of fatigue (odds ratio [OR] = 1.782, 95%CI [1.531, 2.870]). Patients recruited through social media had fatigue above 90% across multiple time points. Fatigue was highest in studies from Europe. Conclusion Fatigue is a symptom associated with functional challenges which could have economic and social impacts. Developing long-term planning for fatigue management amongst patients beyond the acute stages of SARS-CoV-2 infection is essential to optimizing patient care and public health outcomes. Further studies should examine the impact of sociodemographic, pandemic-related restrictions and pre-existing conditions on fatigue.

Middle-aged and older adults with diabetes are at increased risk for loneliness and functional limitations. Cross-sectional and longitudinal associations between loneliness and functional limitations have been demonstrated among the general population, but have not been established among those with diabetes. The purpose of this study was to directly compare the following models describing the direction of the association between loneliness and functional limitations among people with diabetes: (1) loneliness leads to functional limitations, (2) functional limitations lead to loneliness, and (3) a bidirectional association between loneliness and functional limitations.Data came from the Health and Retirement Study. Participants were middle-aged and older individuals with diabetes in the United States (n = 2934). Loneliness and functional limitations were measured at baseline, 4-year follow-up, and 8-year follow-up. Path models for each of the three models, as well as a stability model, were created. Model fit was compared using Akaike's Information Criteria (AIC).Participants were 54.6% female, 74.98% White, had a mean age of 69.66 years, had an average of 1.48 comorbid chronic conditions, and had diabetes for an average of 10.40 years. The bidirectional model best fit the data as evidenced by the lowest AIC value (AIC = 171,162.81). ∆AIC between the bidirectional model and the next best fitting model was 16.19, indicating strong support for selecting the bidirectional model. Higher levels of loneliness were associated with subsequent higher levels of functional limitations at some time points (βs = 0.07, 0.02) and higher levels of functional limitations were associated with subsequent higher levels of loneliness (βs = 0.13, 0.06) at all time points.Results suggest that the association between loneliness and functional limitations among individuals with diabetes is bidirectional. This study demonstrates the value of directly comparing directional models.

Objective The goal of this study was to examine the independent and joint associations between anxiety and depression symptoms with the risk of heart disease. Methods A total of 30,635 participants from the CARTaGENE community cohort study in Quebec who did not have heart diseases at baseline were included in the study. Baseline anxiety and depression symptoms were assessed using validated questionnaires. Survey data were linked with diagnostic codes from a public insurance database to examine incident heart disease during a 7-year follow-up period. Cox regression analyses were conducted comparing groups with high anxiety only, high depression only, comorbid anxiety and depression, and no/low symptoms of both on the risk of heart disease. Additional analyses examined anxiety and depression using continuous questionnaire symptom scores, data-driven comorbidity groups, and diagnostic codes. Covariates included sociodemographic characteristics, health behaviors, diabetes, and hypertension. Results In the main analyses, we found that, although depression without anxiety symptoms was associated with an increased risk of heart disease (hazard ratio = 1.35, 95% confidence interval = 1.04-1.74), there was no significant association for anxiety without depression symptoms (hazard ratio = 1.00, 95% confidence interval = 0.71-1.41). High anxiety assessed with diagnostic codes or by examining latent classes was, however, associated with a higher risk of heart disease. Conclusions The association between anxiety and incident heart disease may be accounted for by comorbid depression, particularly when anxiety and depression symptoms are assessed using self-report questionnaires. Differing methods of assessment and analysis, and adjustment for comorbid depression may explain differences in findings across different studies on anxiety and the risk of heart disease.

Background Prior studies indicate that depression is a risk factor for type 2 diabetes (T2D), though there is considerable heterogeneity in reported estimates. Identifying homogeneous subgroups of depression strongly associated with T2D may be beneficial. This study examined associations between depression and anxiety comorbidity with the risk of T2D. Methods 78,025 participants from the Lifelines Cohort Study (age range = 30–75 years) without diabetes at baseline were included in this study. The Mini-International Neuropsychiatric Interview assessed depressive and anxiety symptoms at baseline. Incident T2D was assessed by self-report or hemoglobin A1c levels during an approximately 3.8-year follow-up period. Risk of T2D was compared across four groups (no depressive or anxiety symptoms, depressive symptoms alone, anxiety symptoms alone, comorbid depressive/anxiety symptoms) using mixed effects logistic regression analyses adjusted for sociodemographic, lifestyle, and cardiometabolic characteristics. Results 1,096 participants developed diabetes. Compared to those without depressive or anxiety symptoms (n = 74,467), those with comorbid depressive and anxiety symptoms (n = 743) were more likely to develop T2D (n = 28, OR = 2.12, 95% CI = 1.22–3.68). Depressive symptoms alone (n = 650) and anxiety symptoms alone (n = 2,165) were not significantly associated with T2D (n = 23 and n = 24, respectively, developed diabetes). Those with comorbid symptoms were also more likely to develop T2D compared to those with depressive symptoms alone (OR = 2.86, 95% CI = 1.25–6.54). Limitations Depressive and anxiety symptom assessments were based on a screening tool. Hemoglobin A1c data were only available for a subset of participants. Conclusions Depression with comorbid anxiety may be a subgroup of depression that is strongly associated with the risk of T2D.

BACKGROUND Offering people financial incentives to increase their physical activity is an increasingly prevalent intervention strategy. However, little is known about the relative effectiveness of different types of incentives. This study tested whether incentives based on specified reinforcement types and schedules differentially affected the likelihood of meeting a walking goal and explored if observed behavioural changes may have been attributable to the perceived value of the incentive. METHODS A 2 (reinforcement type: cash reward, deposit contract) × 2 (schedule: fixed, variable) between-subjects experiment with a hanging control condition was conducted over 8 weeks (n = 153). RESULTS Although walking was greater in the incentive conditions relative to the control condition, walking did not differ across incentive conditions. Exploratory analyses indicated that the perceived value of the incentive was associated with the likelihood of meeting the walking goal, but was not affected by reinforcement type or schedule. CONCLUSIONS The reinforcement type and schedule manipulations tested in this study did not differentially affect walking. Given that walking behaviour was associated with perceived value, designing incentive strategies that optimise the perceived value of the incentive may be a promising avenue for future research.

Background Trajectories of anxiety symptoms in people with type 2 diabetes (T2D) and their associations with diabetes health outcomes have not been investigated. This study examined latent longitudinal trajectories of anxiety symptoms in adults with T2D and their associations with incident cardiovascular disease (CVD). Methods Data were from the Evaluation of Diabetes Treatment Study, a community-based cohort study of adults aged 40–76 years with T2D. Anxiety and CVD were assessed by self-report at baseline and at four annual follow-up assessments. N = 832 participants without cardiovascular disease at baseline and 12-month follow-up were included in the present study. Group-based trajectories of anxiety at baseline, 12-month follow-up, and 24-month follow-up were modelled using latent class growth modeling. Associations between anxiety trajectories and CVD reported at 24-, 36-, or 48-month follow-ups were examined with logistic regression analysis adjusted for sociodemographic and lifestyle characteristics. Results Four distinct anxiety trajectories were identified, reflecting chronically low (39.4%), chronically moderate-low (47.4%), chronically moderate-high (11.1%), and chronically high (2.2%) anxiety. The likelihood of CVD was greater for the chronically moderate-low (OR = 2.23, 95% CI = 1.36–3.66), chronically moderate-high (OR = 3.05, 95% CI = 1.54–6.02), and chronically high (OR = 3.61, 95% CI = 1.09–12.00) anxiety trajectory groups compared to the chronically low anxiety group. Conclusion The identified latent trajectories reflected three groups with chronic courses of anxiety symptoms at different levels of severity and one group with chronically low levels of anxiety. Chronic anxiety, even at subthreshold levels, was associated with an increased risk of CVD among people with T2D.

Although heavy alcohol consumption is associated with diabetes-related complications, little is known about patterns of alcohol use among people with diabetes. Moreover, heavy drinking is more common among individuals with major depressive disorder (MDD), bipolar disorder (BD), and generalized anxiety disorder (GAD) than in the general population, and these disorders are often comorbid with diabetes. The present study tested the hypothesis that mental disorders moderate the association between diabetes status and alcohol consumption. A total of 14,302 adult participants aged 40-79 were included from the cross-sectional 2012 Canadian Community Health Survey-Mental Health (1,698 with diabetes). Data were analyzed using hierarchical linear regression models. MDD and BD, but not GAD, significantly moderated the association between diabetes status and alcohol quantity, such that the presence of diabetes was strongly and negatively associated with alcohol quantity if individuals had MDD or BD. There was no interaction between diabetes status and any of the mental disorders and alcohol frequency. This study suggests that among individuals with diabetes, those with comorbid MDD or BD drink less than those without MDD or BD. Further investigation of this association is needed and could help inform future alcohol-related interventions among individuals with diabetes.

OBJECTIVE Prospective studies testing the potential impact of diabetes complications on depression are limited. The present study examined the longitudinal associations between diabetes complications and the risk and recurrence/persistence of depressive symptoms. METHODS Data were from a prospective community cohort telephone survey of adults with diabetes (N = 1314). Diabetes complications and depressive symptoms were assessed via self-report (Diabetes Complications Index and Patient Health Questionnaire-9, respectively) at baseline and annually for 5 years. Statistical models adjusted for sociodemographic, lifestyle, and diabetes characteristics. RESULTS The number of diabetes complications at baseline was positively associated with a greater risk of elevated depressive symptoms, with the highest risk found for those with four to six complications at baseline (risk ratio = 2.73, 95% confidence interval = 1.64-4.56). Cerebrovascular disease was the complication most strongly associated with incident depressive symptoms (risk ratio = 2.22, 95% confidence interval = 1.59-3.10). Coronary artery disease, peripheral vascular disease, and neuropathy were also associated with the risk of depression, whereas foot problems and eye problems were not. In addition, a greater number of diabetes complications were associated with recurrent/persistent depression, though with a small effect size (Δr = .02). A parallel process latent growth curve model indicated that increases in diabetes complications were associated with increases in depressive symptoms during the course of the follow-up period (β = .74, p < .001). CONCLUSIONS This study demonstrates the temporal relation between diabetes complications and depressive symptoms and underscores the psychological burden of diabetes complications by prospectively demonstrating the increased risk and recurrence of depressive symptoms associated with diabetes complications.

Objectives Evidence suggests that symptoms of depression and anxiety predict lower exercise behaviour and, inversely, that less exercise predicts higher symptomatology. The present longitudinal study examined this reciprocal association in adults with type 2 diabetes mellitus. We predicted that symptoms of anxiety or depression would intensify over time as a consequence of lower exercise frequency and, similarly, that exercise frequency would decrease as a consequence of greater symptoms of anxiety or depression. Methods We studied 1691 adults with type 2 diabetes who provided baseline measures in 2011 and 2 subsequent annual assessments (Follow-up 1 and Follow-up 2). Symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, respectively. A single item assessed exercise frequency in the past month (in days). Results Separate 3-wave cross-lagged path models for symptoms of anxiety and depression tested the reciprocal associations. Contrary to our hypotheses, the reciprocal associations were not supported and, by extension, the predicted secondary associations were not tested. In sum, only depressive symptoms negatively predicted subsequent exercise frequency (Follow-up 1 and Follow-up 2). Conclusions Symptoms of depression were prospectively associated with lower exercise frequency, which is consistent with evidence from population-based studies that identify depressive symptoms as a barrier to exercise participation.

Depression is common among individuals with diabetes and contributes to poorer prognoses. Optimism is associated with enhanced mental health. Therefore, this study tested whether optimism buffered against increases in depressive symptoms following a diabetes diagnosis. Participants were drawn from the Health and Retirement Study ( n = 328, Mage = 65.8). Optimism, assessed before diagnosis, was inversely associated with depressive symptoms within 2 ( B = −.30, p = .004, Δ R2 = .02) and 6 ( B = −.29, p = .008, Δ R2 = .02) years of a diabetes diagnosis. Results suggest that optimism is a protective factor for comorbid depressive symptoms.

Background Body mass index (BMI) is linked to Type 2 diabetes (T2D). Although romantic partners influence each other's health outcomes, it is unclear if partner's BMI is related to the development of T2D. Purpose To test prospective, dyadic associations between BMI and the development of T2D in middle-aged and older adult couples over 8 years. Methods Data came from 950 couples in the Health and Retirement Study. Neither partner had diabetes at baseline (2006). The actor–partner interdependence model was used to examine dyadic associations between BMI at baseline and the development of T2D during the next 8 years. Results After adjusting for covariates, a significant actor effect was observed such that one's BMI at baseline was positively associated with one's own odds of developing T2D during follow-up (odds ratio [OR] = 1.08, p < .001). A significant partner effect was also observed such that the BMI of one's partner at baseline was positively associated with one's own odds of developing T2D during follow-up above and beyond one's own baseline BMI (OR = 1.04, p = .003). These associations were not moderated by sex. This pattern of results held when BMI was coded categorically (not overweight/obese; overweight; obese). Conclusions Partner's BMI was prospectively associated with the likelihood of developing T2D. Future research should consider interpersonal risk factors for chronic health conditions, such as T2D. There is an opportunity to develop theoretical models that specify how and when partner characteristics are linked to physical morbidity.

AimsThe goals of the present study were to examine the associations between depressive symptoms, sleep problems and the risk of developing heart disease in a Canadian community sample.MethodsBaseline data were from the CARTaGENE study, a community health survey of adults aged 40–69 years in Quebec, Canada. Incidence of heart disease was examined inN= 33 455 participants by linking survey data with administrative health insurance data. Incident heart disease was identified using the World Health Organization's International Classification of Diseases, 9th or 10th edition (ICD-9 and ICD-10) diagnostic codes for heart disease. Sleep problems were assessed with diagnostic codes for sleep disorders within the 2 years preceding the baseline assessment. Average sleep duration was assessed by self-report. Depressive symptoms were assessed with the nine-item Patient Health Questionnaire.ResultsIn total, 2448 (7.3%) participants developed heart disease over an average follow-up period of 4.6 years. Compared to those without depressive symptoms and with no sleep disorders, those with elevated depressive symptoms and a sleep disorder (HR = 2.60, 95% CI 1.83–3.69), those with depressive symptoms alone (HR = 1.40, 95% CI 1.25–1.57) and those with sleep disorders alone (HR = 1.33, 95% CI 1.03–1.73) were more likely to develop heart disease. Test of additive interaction suggested a synergistic interaction between depressive symptoms and sleep disorders (synergy index = 2.17 [95% CI 1.01–4.64]). When sleep duration was considered, those with long sleep duration and elevated depressive symptoms were more likely to develop heart disease than those with long sleep alone (HR = 1.77, 95% CI 1.37–2.28; and HR = 1.16, 95% CI 0.99–1.36, respectively).ConclusionsDepression and diagnosed sleep disorders or long sleep duration are independent risk factors for heart disease and are associated with a stronger risk of heart disease when occurring together.

Though research has demonstrated that people generally perceive fruits to be healthy foods, little is known about how people think about the health benefits associated with eating increasing quantities of fruit. The purpose of this paper is to examine how evaluations of healthiness change as participants consider eating increasing quantities of fruit, and to explore how additional contextual features (i.e., variety and timing) can be leveraged to improve evaluations. In two within-subjects experiments, participants rated how good or bad for one’s health it would be to eat increasing quantities of either the same fruit or a variety of fruits. In study 1, all participants were instructed to imagine eating the fruit over the course of the day. In study 2, the temporal distribution of the fruit (throughout the day, during a single meal) was manipulated. In general, both studies demonstrated that evaluations of overall healthiness for eating increasing quantities of the same fruit tended to diminish beyond two pieces of fruit, whereas the overall healthiness of eating increasing quantities of a variety of fruit remained stable. Study 2 demonstrated that evaluations of healthiness increased as additional fruit was considered when a variety of fruit was imagined to be eaten throughout the day. Thus, the health benefits that people assign to eating increasing quantities of fruit seem to increase, but only if eating a variety of fruits throughout the day is considered. This study suggests that evaluations of the healthiness of fruit are not made in isolation; evaluations of healthiness are contextualized by what has been eaten previously and when it was eaten.

Objective To examine the potential synergistic associations between prediabetes, depressive and anxiety symptoms, and the risk of incident type 2 diabetes. Methods Data were from the Emotional Well-Being, Metabolic Factors and Health Status (EMHS) study and included 2486 adults between 40 and 69 years without diabetes at baseline. Hemoglobin A1c levels and measures of depressive and anxiety symptoms were collected at baseline and mutually exclusive groups were formed based on the presence/absence of prediabetes and high/low depressive and anxiety symptoms. A follow-up telephone interview conducted approximately 4.6 years later inquired about new diabetes diagnoses. Results 86 participants developed diabetes during the follow-up period. After accounting for sociodemographic, lifestyle, and metabolic characteristics, participants with prediabetes and elevated depressive symptoms had an increased risk of developing diabetes compared to those without prediabetes and with low depressive symptoms (OR = 10.65, 95% CI = 4.60, 24.66). The joint effect of prediabetes and depressive symptoms on diabetes risk was synergistic (Synergy Index = 2.57, 95% CI = 1.02, 6.49). Similar results were found for participants with prediabetes and high symptoms of anxiety (OR = 8.95, 95% CI = 3.54, 22.63), however the joint effect of prediabetes and anxiety symptoms did not significantly exceed additive risk after adjusting for covariates (Synergy Index = 2.39, 95% CI = 0.83, 6.87). Conclusion The combination of prediabetes and depressive or anxiety symptoms was associated with an increased risk of developing diabetes. This study underscores the importance of mental health in the progression from prediabetes to type 2 diabetes.

Individuals with diabetes are at increased risk of elevated depressive symptoms, and social support has been identified as a key factor in the health of this population. Cross-sectional associations between depressive symptoms and social support have been demonstrated. Three classes of hypotheses differentially describe the direction of this association: (1) depressive symptoms influence social support, (2) social support influences depressive symptoms, and (3) reciprocal associations exist between depressive symptoms and social support. The aim of this study was to compare these hypotheses. Depressive symptoms and social support were measured via telephone survey in a large cohort study of individuals with diabetes (n = 1754) in Quebec, Canada. After baseline, data were collected annually for 4 years. Path models depicting each hypothesis, as well as a stability model containing only autoregressive effects, were generated, and model fit was compared with Akaike’s Information Criterion (AIC). The reciprocal model was selected as the best fitting model because it had the lowest AIC. This model demonstrated that depressive symptoms predicted subsequent social support at all time points and that social support predicted subsequent depressive symptoms at most time points. It appears that the association between depressive symptoms and social support in people with diabetes is best characterized as reciprocal. Results underscore the importance of directly comparing competing hypotheses and offer a more accurate depiction of the association between depressive symptoms and social support among people with diabetes.

Background Moderate to severe diabetes distress (DD) is a common comorbidity among adults with type 2 diabetes. Cross-sectional studies find DD is strongly correlated with poor diabetes management, however little is known about the pattern of change of DD symptoms over long periods of time. We sought to identify and describe a set of distinct longitudinal trajectories of DD over 4 years of follow-up time. Methods We used data derived from the Evaluation of Diabetes Treatment study (2011–2014), a longitudinal community-based survey of Canadian adults (40–75 years) with type 2 diabetes (n=1135). To determine the number and shape of trajectories, we used a latent class growth modeling approach. Results Five distinct trajectories of DD were identified. Trajectories 1 and 2 comprised participants with persistently low (61%) or persistently low, but at risk (22%) levels of distress. Trajectory 3 (7.5%) included participants with decreasing moderate levels of distress. Trajectory 4 (6.5%) consisted of participants with increasing moderate levels of distress. Trajectory 5 (2.4%) included participants with persistently severe levels of distress. Limitations Different populations may produce different DD trajectories and thus the generalizability of the strata identified in this report remains to be investigated. Future research is needed to determine the extent to which time-varying covariates might alter the path of DD trajectories. Conclusions For most individuals, DD is a fairly stable condition over 4 years of follow-up time. However, for a subset of individuals, DD symptoms worsened over time. Medical health professionals might consider repeated screenings for DD in adults with type 2 diabetes.

Objectives Little is known about temporal trajectories of social support in adults with type 2 diabetes (T2D) and how they are associated with diabetes-related outcomes. This study identified and explored different trajectories of social support in a community sample of adults with T2D, as well as the extent to which different trajectories were prospectively associated with depressive symptoms and functional disability. Methods Data came from five annual waves of the Evaluation of Diabetes Treatment study (N = 1077). Social support, depressive symptoms, and functional disability were assessed via self-report. Separate analyses were conducted to examine the associations between social support trajectories, depressive symptoms, and functional disability, adjusting for demographic characteristics, diabetes-related covariates, and baseline depressive symptoms and functional disability. Results Latent class growth modeling identified four distinct social support trajectories. Trajectory Groups 1 and 2 comprised participants with persistently low and persistently moderate-low social support, respectively. Trajectory Groups 3 and 4 included participants with persistently moderate-high and persistently high social support, respectively. People with persistently low social support reported higher functional disability relative to those with persistently moderate-high and persistently high social support. Conclusions The findings of the present study indicate that temporal patterns of social support are a predictor of future functional disability among adults with T2D.

BackgroundPrevious studies have examined associations of cardiometabolic factors with depression and cognition separately.AimsTo determine if depressive symptoms mediate the association between cardiometabolic factors and cognitive decline in two community studies.MethodData for the analyses were drawn from the Rotterdam Study, the Netherlands (n = 2940) and the Whitehall II study, UK (n = 4469).ResultsMediation analyses suggested a direct association between cardiometabolic factors and cognitive decline and an indirect association through depression: poorer cardiometabolic status at time 1 was associated with a higher level of depressive symptoms at time 2 (standardised regression coefficient 0.07 and 0.06, respectively), which, in turn, was associated with greater cognitive decline between time 2 and time 3 (standardised regression coefficient of −0.15 and −0.41, respectively).ConclusionsEvidence from two independent cohort studies suggest an association between cardiometabolic dysregulation and cognitive decline and that depressive symptoms tend to precede this decline.Declaration of interestNone.

The Tobacco Longitudinal Care study was a randomized controlled trial for smoking cessation. It demonstrated that longitudinal care for smoking cessation, in which telephone-based counseling and nicotine replacement therapy were offered for 12 months, was more effective than the standard 8-week treatment. This study aims to identify for whom and how longitudinal care increased the likelihood of abstinence. Mediated moderation analyses were utilized across three time points. There was a trend towards smokers who did not respond to treatment (i.e., were still smoking) by 21 days being more likely to be abstinent at 6 months if they received longitudinal care rather than usual care. Similarly, those who did not respond to treatment by 3 months were more likely to be abstinent at 12 months if they received longitudinal care. At both time points, the likelihood of abstinence did not differ across treatment conditions among participants who responded to treatment (i.e., quit smoking). The effect on 6-month outcomes was mediated by satisfaction and readiness to quit. Cessation self-efficacy, satisfaction, and readiness to quit mediated the effect on 12-month outcomes. The effect of treatment condition on the likelihood of abstinence at 18 months was not moderated by response to treatment at 6 months. Smokers who did not respond to initial treatment benefited from longitudinal care. Differential effects of treatment condition were not observed among those who responded to early treatment. Conditional assignment to longitudinal care may be useful. Determining for whom and how interventions work over time will advance theory and practice.

Aims To determine if longitudinal cyclical relationships exist between depressive symptoms and diabetes distress in people with Type 2 diabetes mellitus. Methods Data were obtained from the Montreal Evaluation of Diabetes Treatment study, a cohort study of 1691 people with Type 2 diabetes mellitus. Depressive symptoms and diabetes distress, measured with the Patient Health Questionnaire and Diabetes Distress Scale, respectively, were assessed at baseline, 1 year and 2 years. A cross-lagged path model analysis with all autoregressive associations was used. Paths and indirect associations were examined. Results All paths in the model were significant. Depressive symptoms were positively associated with diabetes distress across consecutive time points and diabetes distress was positively associated with depressive symptoms across consecutive time points. The association between depressive symptoms at baseline and depressive symptoms at 2 years was mediated by both depressive symptoms and diabetes distress at 1 year. The association between diabetes distress at baseline and diabetes distress at 2 years was also mediated by both depressive symptoms and diabetes distress. Conclusions Depressive symptoms and diabetes distress are cyclically related; results suggest that depressive symptoms influence diabetes distress, which, in turn, influences depressive symptoms. Although many studies focus on the differences between depressive symptoms and diabetes distress, the present study is the first to provide longitudinal evidence that these constructs are cyclically related.

Background Previous research has demonstrated that comorbid depression and chronic physical health conditions are associated with disability. The distinction between persistent and transient depression in the relationship between physical health conditions and disability, however, is poorly understood. The present study examined the interactive effects of major depressive disorder (MDD) and chronic physical health conditions on disability in a community sample; the effects of persistent or transient depression on disability were also examined. Methods Participants were from the Epidemiological Catchment Area of Montreal South-West Study (total N =2202). Past 12-month MDD, chronic physical conditions, functional disability, and disability days experienced within the past month were concurrently assessed. A subsample ( n =1226) was used to examine the persistence of depression across three waves of data collection over approximately six years. Results Individuals with comorbid MDD and chronic physical health conditions were approximately thirteen times more likely to have moderate to severe functional disability and had the highest mean number of disability days compared to those without MDD or a chronic physical health condition. Persistent MDD was most strongly associated with functional disability and disability days, and persistence of MDD interacted with physical health conditions to increase likelihood of concurrent disability. Limitations Our study is limited by a single assessment point for disability and chronic health conditions and by the use of self-report. Conclusions Our findings suggest that MDD, particularly when persistent, is associated with disability among individuals with a broad range of chronic physical health conditions.

This study tested if habit strength for taking oral hypoglycemic medication moderated the association between poor mental health symptoms (i.e. depressive symptoms, diabetes distress) and unintentional non-adherence in 790 adults with type 2 diabetes. Data were cross-sectional. A habit strength × depressive symptom interaction was observed. Depressive symptoms were negatively associated with adherence if habit was weak or of average strength; no association was observed if habit was strong. A similar interaction emerged when diabetes distress was examined. Results suggest that habit strength might operate as a buffer in the association between poor mental health symptoms and medication adherence.

Background Diabetes requires complex self-management routines to prevent the development of functional disability. Relative to people without diabetes, those with diabetes are more likely to have comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD), which also increase the likelihood of functional disability. Social support is associated with positive health outcomes in people with comorbid diabetes and mental disorders and may serve as a buffer against functional disability, though this possibility has yet to be examined. Objectives This study examined whether social support moderates the association between MDD or GAD and functional disability in adults with diabetes. Adults with MDD or GAD were expected to report greater disability than those without MDD or GAD. This association was expected to be stronger in people reporting lower social support relative to those reporting higher social support. Methods Data came from the cross-sectional 2012 Canadian Community Health Survey-Mental Health ( n = 1764). Diabetes status, social support, and functional disability were assessed via self-report; past-year MDD and GAD were assessed with structured diagnostic interviews. Results Linear regression analyses, conducted separately for MDD and GAD, indicated main effects of past-year MDD and GAD, such that those with a mental disorder reported greater functional disability than those without a mental disorder. Social support did not moderate the associations between either MDD and functional disability or GAD and functional disability. Conclusions In this nationally representative population study, both MDD and GAD predicted greater functional disability in adults with diabetes. Social support, however, did not moderate these associations.

Providing material incentives for weight loss is a class of intervention strategies that has received considerable attention; however, the effectiveness of this class of strategies is uncertain. Attending to distinctions among incentive strategies may clarify our understanding of prior work and inform the design of future interventions.A theoretical framework is proposed that distinguishes between four classes of incentive strategies and is used to organize randomized controlled trials of material incentives for weight loss.A systematic literature review was conducted.Findings were mixed with regards to the overall efficacy of material incentives for weight loss. Three of the four proposed incentive categories are represented in the literature. Heterogeneous methods were used across studies rendering comparisons between studies difficult.Definitive conclusions about the usefulness of material incentives for weight loss could not be drawn. A theoretically grounded approach to designing and testing incentive strategies is encouraged.

Background The aim of this study was to evaluate the dynamic association between depressive symptoms and glycated hemoglobin A1c (HbA1c) levels using data from the English Longitudinal Study of Ageing (ELSA). Method The sample was comprised of 2886 participants aged ≥50 years who participated in three clinical assessments over an 8-year period (21% with prediabetes and 7% with diabetes at baseline). Structural equation models were used to address reciprocal associations between depressive symptoms and HbA1c levels and to evaluate the mediating effects of lifestyle-related behaviors and cardiometabolic factors. Results We found a reciprocal association between depressive symptoms and HbA1c levels: depressive symptoms at one assessment point predicted HbA1c levels at the next assessment point (standardized β = 0.052) which in turn predicted depressive symptoms at the following assessment point (standardized β = 0.051). Mediation analysis suggested that both lifestyle-related behaviors and cardiometabolic factors might mediate the association between depressive symptoms and HbA1c levels: depressive symptoms at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted HbA1c levels 4 years later. A similar association was observed for the other direction: HbA1c levels at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted depressive symptoms 4 years later. Conclusions Our results suggest a dynamic relationship between depressive symptoms and HbA1c which might be mediated by both lifestyle and cardiometabolic factors. This has important implications for investigating the pathways which could link depressive symptoms and increased risk of diabetes. ELSA is funded by the US National Institute on Aging (NIA) and a consortium of UK Government departments. N.S. was supported by grants from the Canadian Institutes of Health Research (MOP-84574 and MOP-130552). S.D. is supported by a fellowship from the Fonds de recherche du Québec – Santé, Canada and R.B. is supported by a fellowship from the Canadian Institutes of Health Research. ELSA is funded by the US National Institute on Aging (NIA) and a consortium of UK Government departments. N.S. was supported by grants from the Canadian Institutes of Health Research (MOP-84574 and MOP-130552). S.D. is supported by a fellowship from the Fonds de recherche du Québec – Santé, Canada and R.B. is supported by a fellowship from the Canadian Institutes of Health Research.

The aim of the present study was to evaluate the interaction between depressive symptoms and metabolic dysregulations as risk factors for type 2 diabetes. The sample comprised of 2525 adults who participated in a baseline and a follow-up assessment over a 4.5-year period in the Emotional Health and Wellbeing Study (EMHS) in Quebec, Canada. A two-way stratified sampling design was used, on the basis of the presence of depressive symptoms and metabolic dysregulation (obesity, elevated blood sugar, high blood pressure, high levels of triglycerides and decreased high-density lipoprotein). A total of 87 (3.5%) individuals developed diabetes. Participants with both depressive symptoms and metabolic dysregulation had the highest risk of diabetes (adjusted odds ratio=6.61, 95% confidence interval (CI): 4.86–9.01), compared with those without depressive symptoms and metabolic dysregulation (reference group). The risk of diabetes in individuals with depressive symptoms and without metabolic dysregulation did not differ from the reference group (adjusted odds ratio=1.28, 95% CI: 0.81–2.03), whereas the adjusted odds ratio for those with metabolic dysregulation and without depressive symptoms was 4.40 (95% CI: 3.42–5.67). The Synergy Index (SI=1.52; 95% CI: 1.07–2.17) suggested that the combined effect of depressive symptoms and metabolic dysregulation was greater than the sum of individual effects. An interaction between depression and metabolic dysregulation was also suggested by a structural equation model. Our study highlights the interaction between depressive symptoms and metabolic dysregulation as a risk factor for type 2 diabetes. Early identification, monitoring and a comprehensive management approach of both conditions might be an important diabetes prevention strategy.

Objective Individuals with type 2 diabetes are at greater risk of developing a number of mental health conditions, including depression, anxiety, and diabetes-related distress, than individuals without type 2 diabetes. Cross-sectional studies suggest that some coping strategies may increase the risk of mental health conditions in individuals with diabetes, whereas others may be protective. This study extends the cross-sectional evidence base with a prospective study. Methods Data were collected annually for 2 years from a community sample of 1,742 adults with type 2 diabetes. Coping strategies were measured at baseline and mental health conditions were assessed at each time point with self-report symptom measures. For comparison, cross-sectional and prospective analyses were conducted. Results Cross-sectional analyses demonstrated that task-oriented coping was negatively associated with the likelihood of each of the mental health conditions, emotion-oriented coping was positively associated with the likelihood of each condition, and avoidance-oriented coping showed no association. Prospective analyses revealed that among individuals who did not have elevated depressive symptoms at baseline, only emotion-oriented coping predicted the likelihood of developing major depression syndrome during follow-up. Similar patterns of results were observed for elevated anxiety symptoms and diabetes-related distress. Conclusions Cross-sectional results differed from prospective results. Only emotion-oriented coping appears to play a role in the development of depressive symptoms, anxiety symptoms, and diabetes-related distress. Results underscore the importance of examining prospective associations and suggest that interventions targeting specific coping strategies might alleviate mental health problems in individuals with type 2 diabetes.

Type 2 diabetes (T2D) is associated with limitations in day-to-day functioning and with symptoms of anxiety. Although cross-sectional associations between anxiety and functioning in individuals with T2D have been reported, the temporal dynamics of these associations are unclear. The present study examined the longitudinal cross-lagged associations between anxiety symptoms and functioning in a community sample of individuals with T2D.Data were from the Evaluation of Diabetes Treatment Study, a community-based observational study of 1691 adults with T2D. Anxiety symptoms and functioning were assessed with the Generalized Anxiety Disorder Scale-7 and the World Health Organization Disability Assessment Schedule 2.0, respectively, at baseline and every following year for 3 years. A cross-lagged path analysis accounting for autoregressive effects, sociodemographic factors, and health-related covariates was conducted using structural equation modeling.The model demonstrated good fit with the data (comparative fit index0.99, χ62 = 11.44, P = 0.08, root mean square error of approximation = 0.02). Path coefficients indicated that elevated anxiety was associated with subsequent poor functioning (β-values ranging from 0.05 to 0.16; P-values0.04) and that poor functioning was associated with subsequent elevated anxiety (β-values ranging from 0.13 to 0.19; P-values0.001). The addition of depressive symptoms as a covariate did not affect model fit, although not all cross-lagged path coefficients remained statistically significant; paths were strongest and most consistent between poor functioning and subsequent elevated anxiety.Anxiety symptoms and functioning seem to be reciprocally related among individuals with T2D, independent of depressive symptoms.

OBJECTIVE Providing a variety of food generally increases consumption and enjoyment. This effect is typically associated with unhealthy behavior (e.g., overindulgence at a buffet) and studied during a single meal. Two studies tested whether this effect can be leveraged in a subtle, simple manipulation to promote healthy food choices over the course of a day. METHOD In Studies 1 and 2, 188 and 187 participants, respectively, chose between a sweet and a piece of fruit in the afternoon. The fruit was either the same as or different from fruit that was selected in the morning; choice was not given in the morning. Study 1 tested this effect in the domain of expressed preferences and Study 2 examined actual choice. RESULTS In both studies, a second piece of fruit was more likely to be selected in the afternoon if it was different from fruit that was selected in the morning. CONCLUSIONS These results illustrate how a robust effect that is typically associated with unhealthy outcomes can be harnessed to promote healthy food choices and underscore the importance of conceptualizing eating as a series of interrelated behavioral decisions. This work has implications for applied settings, such as cafeterias, and is distinguished from other simple structural manipulations by its focus on sustaining healthy food choice over the course of the day. (PsycINFO Database Record

Objective To examine the associations between diabetes, disability, and the likelihood of comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD). Methods Data were obtained from the 2012 Canadian Community Health Survey — Mental Health ( N = 17 623). Diabetes assessment consisted of a self-reported diagnosis of diabetes made by a health care professional. Disability was assessed via self-report. 12-Month and lifetime MDD and GAD were assessed with the Composite International Diagnostic Interview 3.0. Results In multinomial logistic regression models adjusted for sociodemographic and health-related factors, having diabetes was associated with a greater likelihood of 12-month comorbid MDD and GAD (OR = 1.99, 95% CI [1.22, 3.25], p = .006), compared with those with neither MDD nor GAD. No significant associations were found for MDD without GAD or GAD without MDD. This pattern of effects held when lifetime diagnoses of MDD and GAD were considered. For individuals with diabetes ( n = 1730), adjusted binary logistic regression models demonstrated that with 12-month diagnoses, MDD without GAD (OR = 2.79, 95% CI [1.39–5.62], p = .004), GAD without MDD (OR = 3.69, 95% CI [1.34–10.11], p = .01), and comorbid MDD and GAD (OR = 4.17, 95% CI [1.66–10.51], p = .002) were associated with greater disability than the control group. Only comorbid MDD and GAD were associated with disability when lifetime diagnoses of MDD and GAD were considered. Conclusions Individuals with diabetes may be particularly vulnerable to comorbid MDD and GAD, and MDD-GAD comorbidity may exacerbate disability in persons with diabetes.