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The eating disorder clinical and scientific community advocates for the use of a shared approach to healthcare that actively involves patients and carers. A systematic review of the literature on guided self-help or self-help in anorexia nervosa (targeting either the individual affected by the illness or their carers) and meta-analyses of studies using randomised controlled designs for the evaluation of the outcomes: (1) drop-out from end-of-treatment assessment, (2) body mass index (BMI), (3) anxiety, (4) depression and (5) quality of life, were undertaken. Guided self-help was directed to patients in 15 studies and to carers in seven studies. The interventions were based on a variety of theoretical models, used different formats (books and digital materials), and were delivered by individuals with a range of experiences and expertise (e.g. individuals with lived experience of the illness, graduate students, or clinically trained professionals). Guided self-help was associated with significantly lower drop-out from the completion of end-of-treatment assessments compared to a control condition. There was an improvement in carers' wellbeing from skill-sharing interventions. Guided self-help may facilitate patients' treatment engagement and also improve carers' wellbeing. [ABSTRACT FROM AUTHOR]

Importance: The association between major depressive disorder (MDD) and obesity may stem from shared immunometabolic mechanisms particularly evident in MDD with atypical features, characterized by increased appetite and/or weight (A/W) during an active episode.Objective: To determine whether subgroups of patients with MDD stratified according to the A/W criterion had a different degree of genetic overlap with obesity-related traits (body mass index [BMI] and levels of C-reactive protein [CRP] and leptin).Design, Setting, and Patients: This multicenter study assembled genome-wide genotypic and phenotypic measures from 14 data sets of the Psychiatric Genomics Consortium. Data sets were drawn from case-control, cohort, and population-based studies, including 26 628 participants with established psychiatric diagnoses and genome-wide genotype data. Data on BMI were available for 15 237 participants. Data were retrieved and analyzed from September 28, 2015, through May 20, 2017.Main Outcomes and Measures: Lifetime DSM-IV MDD was diagnosed using structured diagnostic instruments. Patients with MDD were stratified into subgroups according to change in the DSM-IV A/W symptoms as decreased or increased.Results: Data included 11 837 participants with MDD and 14 791 control individuals, for a total of 26 628 participants (59.1% female and 40.9% male). Among participants with MDD, 5347 (45.2%) were classified in the decreased A/W and 1871 (15.8%) in the increased A/W subgroups. Common genetic variants explained approximately 10% of the heritability in the 2 subgroups. The increased A/W subgroup showed a strong and positive genetic correlation (SE) with BMI (0.53 [0.15]; P = 6.3 × 10-4), whereas the decreased A/W subgroup showed an inverse correlation (-0.28 [0.14]; P = .06). Furthermore, the decreased A/W subgroup had a higher polygenic risk for increased BMI (odds ratio [OR], 1.18; 95% CI, 1.12-1.25; P = 1.6 × 10-10) and levels of CRP (OR, 1.08; 95% CI, 1.02-1.13; P = 7.3 × 10-3) and leptin (OR, 1.09; 95% CI, 1.06-1.12; P = 1.7 × 10-3).Conclusions and Relevance: The phenotypic associations between atypical depressive symptoms and obesity-related traits may arise from shared pathophysiologic mechanisms in patients with MDD. Development of treatments effectively targeting immunometabolic dysregulations may benefit patients with depression and obesity, both syndromes with important disability. [ABSTRACT FROM AUTHOR]

OBJECTIVE--Depression is associated with the onset of type 2 diabetes. A systematic review and meta-analysis of observational studies, controlled trials, and unpublished data was conducted to examine the association between depression and insulin resistance (IR). RESEARCH DESIGN AND METHODS-Medline, EMBASE, and PsycINFO were searched for studies published up to September 2011. Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria (study design and measure of depression and IR, excluding prevalent cases of diabetes). Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size using random effects. Subgroup analyses and meta-regression were conducted to explore any potential source of heterogeneity between studies. RESULTS-Of 967 abstracts reviewed, 21 studies met the inclusion criteria of which 18 studies had appropriate data for the meta-analysis (n = 25,847). The pooled effect size (95% CI) was 0.19 (0.11-0.27) with marked heterogeneity (I² = 82.2%) using the random-effects model. Heterogeneity between studies was not explained by age or sex, but could be partly explained by the methods of depression and IR assessments. CONCLUSIONS--A small but significant cross-sectional association was observed between depression and IR, despite heterogeneity between studies. The pathophysiology mechanisms and direction of this association need further study using a purposively designed prospective or intervention study in samples at high risk for diabetes. [ABSTRACT FROM AUTHOR]

The association between Type 2 Diabetes (T2DM) and depression has been consistently reported in epidemiological studies. The T2DM-depression link may be symptom-specific. We therefore examined whether polygenic risk scores for T2DM predict specific depressive symptoms in the Psychiatric Genomics Consortium Major Depressive Disorder Phase 2 (PGC-MDD-29) dataset. T2DM-polygenic scores were constructed from the association summary statistics of Diabetes Genetic Replication And Meta-analysis Consortium (DIAGRAM; 12,171 cases and 56,862 controls) at association p-value threshold of 0.5 (PT<0. 0.5). Stepwise regression was used to test for association between T2DM-polygenic scores at PT<0.5 and nine specific depressive symptoms in PGC-MDD-29 dataset, adjusting for ancestry principal components and study. The four cohorts from PGC-MDD-29 dataset included in this study were: i) CoFaMS, ii) PsyCoLaus, iii) NESDA/NTR and iv) SHP0. The combined data consists of 6542 participants of European ancestry, with 2,360 cases of depression and 4,182 controls. Feelings of guilt/worthlessness is the only significant depressive symptom predictor for T2DM-polygenic scores (β=-0.0041; p=0.0037). It is present in 1,771 (75%) cases and 120 (3%) controls. This effect came primarily from depression cases (β=-0.0058; p=0.0002), with limited information from controls (β=-0.0003; p=0.7903). This study provides the first evidence of a shared genetic aetiology between T2DM and feelings of guilt/worthlessness, particularly in people with depression. No association was found between T2DM-polygenic scores and depressive symptoms which are more related to T2DM, such as changes in appetite/weight. Previous studies have reported an association between appetite/weight and inflammatory markers but not with glucose-related measures. Longitudinal prospective studies examining the association between specific symptoms of T2DM and depression are needed to clarify the underlying mechanism. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A Systematic Review and Meta-Analysis of the Association Between Depression and Insulin Resistance" by C. Kan and colleagues in a 2013 issue.