How Does Change in Depressive Symptomatology Influence Trajectories

How Does Change in Depressive Symptomatology Influence Trajectories in Weight, Cognitive Function and Behaviors in Patients with Diabetes? Ching-Ju 1 Chiu , Feng-Hwa 12 Lu , Linda, A. 3 Wray , Elizabeth A. 4 Beverly , Siao-Ling 1 Lee 1 Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan 2 Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan 3 Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States 4 Joslin Diabetes Medical Center, Harvard Medical School, Boston, MA, United States Sample Members of diabetes participants who completed CES-D scale on both 1996 and 2003 (N=292). Background Diabetes is a prevalent chronic disease. Currently, about one in ten people of all ages and more than 20% of older adults aged 65 and above, are living with diabetes in Taiwan. Figure 1. Memory function (m-RAVLT) after 1996 by Depressive Symptom Group Measures Depressive symptoms. 10 -item version of the Center for Epidemiologic Studies Depression Scale (CES-D) Weight. Self-reported weight (kg) divided by height in meters squared (m 2) BMI. Cognitive Function. 9 -item Short Portable Mental Status Questionnaire (SPMSQ) and the modified Rey Auditory Verbal Learning Test (m. RAVLT). Covariates. Demographic variables (age, gender, race/ethnicity, education), behavioral (smoking and drinking status), and clinical variables (years with diabetes, number of comorbidity, disability, using hypnotics or sedatives. It is estimated that 15 -40% of individuals with diabetes have comorbid depression. If improvements in depression are associated with preferable weight, behavioral and cognitive trajectories in adults with diabetes, perhaps proactively and optimally treating depression in diabetes patients could ultimately reduce the complications attendant to poor weight control, exercise behavior or cognitive functions. Objectives To investigate the associations between longitudinal changes in depressive symptoms and trajectories in weight, cognitive function and health behaviors in adults with diabetes in Taiwan. Figure 3. Exercise Score after 1996 by Depressive Symptom Group Conclusion Results Table 1. Baseline Characteristics of Participants by Baseline and 7 -Year CESD scores Data 1996 -2007 Survey of Health and Living Status of the Elderly in Taiwan (a. k. a. , Taiwan Longitudinal Study of Aging, TLSA). Figure 2. BMI Change after 1996 by Depressive Symptom Group Analyses Growth Curve Modeling with SAS Proc Mixed. Methods Design Compared a) patients with persistently low depressive symptoms with those whose depressive symptoms increased (at least 5 points on CES-D) over 7 years from 1996 to 2003 and b) patients with persistently high depressive symptoms with those whose symptoms decreased (at least 5 points on CES-D) on the same period on their levels of and rates of change in weight, exercise, and cognitive function during 1999, 2003 and 2007. Compared to those with persistently low depressive symptoms, those whose depressive symptoms increased did not differ in their patterns of cognitive function, but they had a significantly faster increase in BMI and decrease in amount of exercise they participated in. Total sample (N=292) 65. 09 (7. 75) Age(y), M(SD) Gender %Women Education(y), M(SD) Ethnicity %Fuchien %Mainlander %Hakka and others Years with diabetes, M(SD) #of comorbidity, M(SD) #of disability, M(SD) %Using hypnotics/ sedatives %current smoker %current drinker Baseline CESD<10(n=216) Persistently low Worsening depression symptoms (n=159) (n=57) Statistical test (X 2 or t) Baseline CESD>=10(n=76) Persistently Improving high depression Statistical test symptoms (n=36) (n=40) (X 2 or t) 64. 43 (7. 71) 66. 00 (8. 04) 1. 28 66. 67 (7. 46) 64. 98 (7. 70) -0. 97 58. 90 4. 41(4. 58) 50. 94 5. 25 (4. 45) 61. 40 4. 63(5. 17) 86. 11 2. 19 (3. 57) 62. 50 2. 73 (3. 96) 66. 44 16. 78 66. 04 18. 24 15. 72 64. 91 15. 79 19. 30 1. 85 -0. 80 0. 47 63. 89 16. 67 19. 44 72. 50 15. 00 5. 45* 0. 61 0. 65 6. 58 (6. 35) 2. 16(1. 31) 1. 63(2. 65) 6. 06 (6. 34) 1. 96(1. 14) 1. 09(1. 99) 8. 21 (7. 10) 2. 04(1. 13) 1. 37(2. 56) 2. 01* 0. 45 0. 73 7. 53 (6. 30) 2. 92 (1. 90) 2. 86(3. 01) 5. 43 (4. 80) 2. 50 (1. 26) 3. 05(3. 76) -1. 62 -1. 11 0. 24 10. 27 19. 86 17. 81 5. 03 21. 38 22. 01 8. 77 21. 05 17. 54 1. 04 0. 0027 0. 51 25. 00 5. 56 8. 33 20. 00 25. 00 18. 42 0. 27 5. 39* 0. 06 Table 2. Fixed Effect Coefficients from Mixed Models Baseline CESD<10 (n=216) Recall(m-RAVLT) Concurren t Prospective Baseline CESD≧ 10 (n=76) BMI Concurren t Exercise Recall(m-RAVLT) Prospective Concurrent Prospective Concurren t Prospective BMI Concurren t Exercise Prospective Concurren t Prospective 1. Weight management and maintain of healthy behaviors may be jeopardized by increment in depressive symptoms even for those with low depressive symptoms at baseline. 2. In persons with diabetes who have high score of depressive symptoms, improvement in depressive symptomatology may guard against cognitive deterioration. Intercep t 4. 71*** 4. 84*** - 24. 04*** 1. 48*** 1. 51*** 4. 44*** 3. 64*** - 26. 14*** 0. 79** 0. 60 -0. 15*** - -0. 09* 0. 08*** 0. 04* -0. 26*** -0. 13^ - 0. 022 0. 04 0. 10** -0. 21 -0. 36 - -1. 00 -0. 07 -0. 11 -0. 37 0. 69 - -1. 77* 0. 23 0. 29 0. 01 0. 048 - 0. 25* -0. 06^ -0. 06 0. 17^ -0. 03 - 0. 02 -0. 02 Year I/W Year* I/W Although the groups had almost identical cognitive function at baseline, those whose depressive symptoms decreased had a significantly lower rate of decline in cognitive function compared to those with persistently high depressive symptoms. 3. The management of psychological burden in adults with diabetes cannot be overemphasized. Acknowledgements/ Contacts Grant 2012 -2013, National Science Council, Taiwan. Grant 2011 -2012, Research Center for Humanities and Social Sciences (CHASS), National Cheng Kung University. For more information : Ching-Ju Chiu Email: cjchiu@mail. ncku. edu. tw 65 th of the Gerontological Society of America (GSA), San Diego, CA. 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