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Biomedical subjects

F Pouwer

Publications and source records attributed to F Pouwer.

At least 19 recordsLinked to original sources
PubMed2006

Associations between depressive symptoms and insulin resistance: the Hoorn Study.

AIMS/HYPOTHESIS: The association between depression and insulin resistance has been investigated in only a few studies, with contradictory results reported. The aim of this study was to determine whether the association between symptoms of depression and insulin resistance varies across glucose tolerance status and between men and women. SUBJECTS AND METHODS: Cross-sectional data from a population-based cohort study in Hoorn, a medium-sized town in the Netherlands, were analysed. The study sample consisted of 541 men and women aged 55-75 years, of whom 260 had NGT, 164 had IGT and 117 had established type 2 diabetes mellitus. Main outcome measures were insulin resistance defined by the homeostasis model assessment for insulin resistance (HOMA-IR) and symptoms of depression using the Centre for Epidemiologic Studies Depression Scale (CES-D). RESULTS: In the total sample, we found a weak positive correlation between the depressive symptoms CED-D scores and HOMA-IR scores (r (s) = 0.156, p < 0.001). Even weaker associations were found in subjects with NGT (r (s) = 0.041, p=0.509), in subjects with IGT (r (s) = 0.112, p = 0.160) and in subjects with type 2 diabetes (r (s) = 0.007, p = 0.942). The association between depressive symptoms and insulin resistance was similar for men and women. CONCLUSIONS/INTERPRETATION: We found only weak associations between depressive symptoms and insulin resistance, which did not differ among different glucose metabolism subgroups or between men and women.

Aged↗
PubMed2006

Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis.

AIMS/HYPOTHESIS: Evidence strongly suggests that depression and type 2 diabetes are associated, but the direction of the association is still unclear. Depression may occur as a consequence of having diabetes, but may also be a risk factor for the onset of type 2 diabetes. This study examined the latter association by reviewing the literature and conducting a meta-analysis of longitudinal studies on this topic. METHODS: Medline and PsycInfo were searched for articles published up to January 2005. All studies that examined the relationship between depression and the onset of type 2 diabetes were included. Pooled relative risks were calculated using fixed and random effects models. To explore sources of heterogeneity between studies, subgroup analyses and meta-regression analyses were performed. RESULTS: Nine studies met our inclusion criteria for this meta-analysis. The pooled relative risk was 1.26 (1.13-1.39) using the fixed effects model and 1.37 (1.14-1.63) using the random effects model. Heterogeneity between studies could not be explained by (1) whether studies controlled for undetected diabetes at baseline; (2) the method of diabetes assessment at follow-up; (3) the baseline overall risk of diabetes in the study population; and (4) follow-up duration. CONCLUSIONS/INTERPRETATION: Depressed adults have a 37% increased risk of developing type 2 diabetes mellitus. The pathophysiological mechanisms underlying this relationship are still unclear and warrant further research. A randomised controlled study is needed to test whether effective prevention or treatment of depression can reduce the incidence of type 2 diabetes and its health consequences.

Depression↗
PubMed2005

Fat food for a bad mood. Could we treat and prevent depression in Type 2 diabetes by means of omega-3 polyunsaturated fatty acids? A review of the evidence.

AIMS: Evidence strongly suggests that depression is a common complication of Type 2 diabetes mellitus. However, there is considerable room to improve the effectiveness of pharmacological antidepressant agents, as in only 50-60% of the depressed subjects with diabetes does pharmacotherapy lead to remission of depression. The aim of the present paper was to review whether polyunsaturated fatty acids (PUFA) of the omega-3 family could be used for the prevention and treatment of depression in Type 2 diabetes. METHODS: MEDLINE database and published reference lists were used to identify studies that examined the associations between omega-3 PUFA and depression. To examine potential side-effects, such as on glycaemic control, studies regarding the use of omega-3 supplements in Type 2 diabetes were also reviewed. RESULTS: Epidemiological and clinical studies suggest that a high intake of omega-3 PUFA protects against the development of depression. There is also some evidence that a low intake of omega-3 is associated with an increased risk of Type 2 diabetes, but the results are less conclusive. Results from randomized controlled trials in non-diabetic subjects with major depression show that eicosapentaenoic acid is an effective adjunct treatment of depression in diabetes, while docosahexanoic acid is not. Moreover, consumption of omega-3 PUFA reduces the risk of cardiovascular disease and may therefore indirectly decrease depression in Type 2 diabetes, via the reduction of cardiovascular complications. CONCLUSIONS: Supplementation with omega-3 PUFA, in particular eicosapentaenoic acid, may be a safe and helpful tool to reduce the incidence of depression and to treat depression in Type 2 diabetes. Further studies are now justified to test these hypotheses in patients with Type 2 diabetes.

Adult↗
PubMed2003

Rates and risks for co-morbid depression in patients with Type 2 diabetes mellitus: results from a community-based study.

AIMS/HYPOTHESIS: There is accumulating evidence that depression is common in people with Type 2 diabetes. However, most prevalence-studies are uncontrolled and could also be inaccurate from selection-bias, as they are conducted in specialized treatment settings. We studied the prevalence and risk factors of co-morbid depression in a community-based sample of older adults, comparing Type 2 diabetic patients with healthy control subjects. METHODS: A large (n=3107) community-based study in Dutch adults (55-85 years of age) was conducted. Pervasive depression was defined as a CES-D score greater than 15. Diagnosis of Type 2 diabetes was obtained from self-reports and data from general practitioners. RESULTS: A number of 216 patients (7%) were identified as having Type 2 diabetes. The prevalence of pervasive depression was increased in people with Type 2 diabetes and co-morbid chronic disease (20%) but not in patients with Type 2 diabetes only (8%), compared with the healthy control subjects (9%). Regression analyses in diabetic patients yielded that being single, being female, having functional limitations, receiving instrumental support and having an external locus of control were associated with higher levels of depression. CONCLUSIONS/INTERPRETATION: The Results suggest that the prevalence of pervasive depression is increased in patients with Type 2 diabetes and co-morbid disease(s), but not in patients with Type 2 diabetes only. Functional limitations that often accompany co-morbid chronic disease could play an essential role in the development of depression in Type 2 diabetes. These findings can enable clinicians and researchers to identify high-risk groups and set up prevention and treatment programs.

Aged↗
PubMed2002

Continuous intraperitoneal insulin infusion in patients with 'brittle' diabetes: favourable effects on glycaemic control and hospital stay.

AIMS: To evaluate the effects of continuous intraperitoneal insulin infusion (CIPII) using implantable pumps on glycaemic control and duration of hospital stay in poorly controlled 'brittle' Dutch diabetes patients, and to assess their current quality of life. METHODS: Thirty-three patients were included. Glycaemic control was retrospectively assessed with HbA(1c) levels acquired before implantation, 1 year later and at long-term follow up of 58 months. Duration of hospital stay the year before and the year following first implantation was extracted from hospital records. Determinants of long-term glycaemic response were sought. Self-report questionnaires were administered at 58 months follow-up only, to assess current psychopathology and quality of life. RESULTS: Mean HbA(1c) decreased from 10.0 +/- 2.3% to 9.0 +/- 1.8% (P = 0.039) 1 year after implantation and stabilized at 9.0 +/- 1.6% (P = 0.023) during long-term follow-up. Median number of hospital days in the 20 patients suffering from hospital admission before implantation decreased from 45 the year before implantation to 13 the year after (P = 0.005). Patients with a higher baseline HbA(1c) showed a larger long-term response (P < 0.001). Relatively low levels for quality of life were found, as well as a higher than expected number of patients with psychiatric symptoms. CONCLUSIONS: CIPII proved effective in complex patients with a history of poor control and hospital admission. Despite a substantial long-term improvement in glycaemic control and diminished hospital stay, normal levels of glycaemic control and quality of life were not attained.

Adult↗
PubMed2002

Patients' Evaluation of the Quality of Diabetes Care (PEQD): development and validation of a new instrument.

OBJECTIVES: To develop a brief measure of patients' evaluation of the quality of diabetes care and to study predictors of consumers' rating of the quality of diabetes care. DESIGN: A prospective design. SUBJECTS: 176 adults with type 1 (39%) or type 2 (61%) diabetes. MAIN MEASURES: Demographic variables, HbA1c, number of diabetes complications, satisfaction with diabetes care, diabetes related distress, and fear of hypoglycaemia were assessed by self-report. In addition, satisfaction with diabetes care and evaluations about quality of the care were measured at 16 month follow up. Statistical analysis comprised principal component analyses, Cronbach's alpha, t tests, Pearson's correlation, and linear regression analyses. RESULTS: Results in the literature were used to develop the 14 items of the Patients' Evaluation of the Quality of Diabetes Care (PEQD) scale, assessing the most important aspects of the quality of diabetes care as delivered by the specialist in internal medicine (internist) and the diabetes nurse specialist (DNS). Two principal components analyses (internist/DNS) both yielded one 14 item factor with a high internal consistency. Satisfaction with diabetes care, fewer diabetes related complications, fewer treatment related problems, and a low level of worries about hypoglycaemia were predictors of a more positive evaluation of diabetes care delivered by the internist. Sociodemographic variables were not related to the patients' evaluations of the quality of diabetes care. CONCLUSIONS: The PEQD comprises different aspects of quality of diabetes care and can be regarded as a suitable instrument for evaluating patients' judgements about the quality of their care.

Adult↗
PubMed2001

Association between symptoms of depression and glycaemic control may be unstable across gender.

AIMS: Lloyd and colleagues (Diabetic Med 2000; 17, 198-202) have described an association between poor glycaemic control and moderate to severe depression in male but not in female diabetes patients. However, the validity of this study may be limited by its small sample size and the influence of uncontrolled confounders. Therefore, we set out to replicate this study by investigating the associations between depression and glycaemic control in larger samples, while controlling for potential confounders. METHODS: Out-patients with diabetes (n = 174) and 1437 patient members of the Dutch Diabetes Association (DDA) completed the Hospital Anxiety and Depression Scale. Demographic and clinical characteristics were obtained using medical records (out-patients) or self-report (DDA). RESULTS: After controlling for number of complications, years of education and body mass index, depression showed significant, low positive correlations with HbA(1c) in three of the four female samples and in one of the four male samples. Only for out-patients with Type 2 diabetes was the correlation between HbA(1c) and depression significantly higher for women when compared with men (0.19 vs. 0.04; P = 0.02). CONCLUSIONS: The association between depression and HbA1c may be stronger in women with Type 2 diabetes. Oestrogen levels and self-care behaviours may play a mediating role in this association. Further research is required before we can conclude that the association between symptoms of depression and glycaemic control differs across gender. Diabet. Med. 18, 595-598 (2001)

Adult↗
PubMed2001

Monitoring of psychological well-being in outpatients with diabetes: effects on mood, HbA(1c), and the patient's evaluation of the quality of diabetes care: a randomized controlled trial.

OBJECTIVE: To investigate whether monitoring and discussing psychological well-being in outpatients with diabetes improves mood, glycemic control, and the patient's evaluation of the quality of diabetes care. RESEARCH DESIGN AND METHODS: This study was a randomized controlled trial of 461 outpatients with diabetes who were randomly assigned to standard care or to the monitoring condition. In the latter group, the diabetes nurse specialist assessed and discussed psychological well-being with the patient (with an interval of 6 months) in addition to standard care. The computerized Well-being Questionnaire was used for this purpose. Primary outcomes were mood, HbA(1c), and the patient's evaluation of the quality of diabetes care at 1-year follow-up. The number of referrals to the psychologist was analyzed as a secondary outcome. Intention-to-treat analysis was used. RESULTS: The monitoring group reported better mood compared with the standard care group, as indicated by significantly lower negative well-being and significantly higher levels of energy, higher general well-being, better mental health, and a more positive evaluation of the quality of the emotional support received from the diabetes nurse. The two groups did not differ for HbA(1c) or in their overall evaluation of the quality of diabetes care. In the monitoring condition, significantly more subjects were referred to the psychologist. CONCLUSIONS: Monitoring and discussing psychological well-being as part of routine diabetes outpatient care had favorable effects on the mood of patients but did not affect their HbA(1c). Our results support the recommendation to monitor psychological well-being in patients with diabetes.

Adult↗
PubMed2000

Psychological distress two years after diagnosis of breast cancer: frequency and prediction.

The present prospective study aimed at (1) investigating the frequency of high levels of psychological distress in women with early-stage breast cancer almost two years after diagnosis and (2) identifying characteristics associated with long-term distress. One hundred and seventy women participated on two occasions. Two months after surgery, patients completed questionnaires measuring psychosocial variables (e.g., stressful life-events, health complaints, sleep problems, social support, subjective distress, personality factors), demographic and biomedical variables (e.g., TNM status, type of surgery). At the second measurement, subjective distress was assessed for a second time by means of the Impact of Events Scale (IES). Almost two years after diagnosis, 16% of the women reported a high level of psychological distress as measured by the Intrusion scale (IES). Best predictors of a high level of distress were: intrusive thoughts about the disease, trait-anxiety, health complaints and problems with sleeping. No significant association was found between previous life-events, social support or biomedical variables and levels of distress.

Adult↗
PubMed2000

The well-being questionnaire: evidence for a three-factor structure with 12 items (W-BQ12).

BACKGROUND: The Well-being Questionnaire (W-BQ) has been designed to measure psychological well-being in people with a chronic somatic illness and is recommended by the World Health Organization for widespread use. However, studies into the factor structure of this instrument are still limited and their findings are inconsistent. This study aimed to investigate the factor structure of the Dutch version of the W-BQ. METHODS: A cross-validation design was used. A total of 1472 people with diabetes completed the W-BQ and were randomly assigned to group A or B. In group A (N = 736), exploratory factor analyses were conducted. Group B (N = 736) was split up into four subgroups of male or female patients with type 1 or type 2 diabetes. In these subgroups, confirmatory factor analyses were employed to test the model(s) developed in group A and the two models described in the literature (four-factor model with 22 items and a three-factor model with 12 items). RESULTS: Exploratory factor analyses yielded a three-factor model with 21 items (negative well-being, energy and positive well-being). In the subgroups of group B confirmatory factor analyses only accepted the three-factor model with 12 items. This factor solution was stable across gender, type of diabetes and level of education. CONCLUSIONS: The best description of the factor structure of the Dutch translation of the W-BQ was given by a three-factor solution with 12 items (W-BQ12), measuring positive well-being (four items), negative well-being (four items) and energy (four items).

Activities of Daily Living↗
PubMed2000

Diabetes Fear of Injecting and Self-Testing Questionnaire: a psychometric evaluation.

OBJECTIVE: To study the psychometric properties of the Diabetes Fear of Injecting and Self-Testing Questionnaire (D-FISQ). RESEARCH DESIGN AND METHODS: Two groups of patients were studied. Sample A consisted of 252 insulin-treated diabetes patients. Sample B incorporated 24 insulin-treated patients with high scores (> or = 95th percentile) on the D-FISQ. Test-retest correlations were assessed in both samples. Discriminant and convergent validity of the D-FISQ were assessed with questionnaires concerning fear of hypoglycemia, trait anxiety, and fear of bodily injury, illness, or death. To evaluate criterion-related validity, sample B participated in a behavioral avoidance test (BAT), in which the current level of avoidance of either self-injecting or self-testing was determined. Exploratory factor analysis (EFA) was performed to study whether 2 factors (fear of self-injecting [FSI] and fear of self-testing [FST]) could be detected. RESULTS: Test-retest correlations ranged from 0.50 to 0.68 (P < 0.001). Correlations between D-FISQ and fear of hypoglycemia, trait anxiety, and fear of bodily injury, illness, or death ranged from 0.28 to 0.45 (P < 0.001). Patients who refused to do a BAT for self-injecting or self-testing had higher scores on FSI (P = 0.095) and FST (P = 0.01). EFA yielded 2 separate factors, FSI and FST. CONCLUSIONS: Results from this study support reliability and validity of the D-FISQ, a self-report instrument that can be used for both clinical and research purposes.

Adult↗
PubMed2000

Diabetes-related emotional distress in Dutch and U.S. diabetic patients: cross-cultural validity of the problem areas in diabetes scale.

OBJECTIVE: To examine the cross-cultural validity of the Problem Areas in Diabetes Scale (PAID) in Dutch and U.S. diabetic patients. RESEARCH DESIGN AND METHODS: A total of 1,472 Dutch people with diabetes completed the PAID along with other self-report measures of affect. Statistics covered Cronbach's alpha, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA), Pearson's product-moment correlation, and t tests. Psychometric properties of PAID were compared for Dutch and U.S. diabetic patients. RESULTS: Internal consistency of the Dutch PAID was high and stable across sex and type of diabetes. Test-retest reliability was high. Principal component analyses confirmed 1 general 20-item factor, whereas EFA identified 4 new subdimensions: negative emotions, treatment problems, food-related problems, and lack of social support. These dimensions were confirmed with CFA and were replicated in the U.S. sample. The PAID and its subscales demonstrated moderate to high associations in the expected direction with other measures of affect. Dutch and U.S. subjects reported having the same problem areas, with U.S. patients reporting higher emotional distress levels both in type 1 and type 2 diabetes. CONCLUSIONS: The Dutch and U.S. 20-item PAID appeared to be psychometrically equivalent, which allowed for cross-cultural comparisons.

Anxiety↗
PubMed1999

Factor structure of the Disability and Impact Profile in patients with multiple sclerosis.

The Disability and Impact Profile (DIP) is used for the measurement of quality of life in multiple sclerosis (MS) patients. Data from 211 persons with definite MS from Belgium, Denmark and the Netherlands were used to address three questions. To what extent do the impairment ratings and their complementary weighted scores share common variance? What is the factor structure of the weighted scores? To what extent do disease-related information and information from psychological questionnaires offer concurrent validity for the factors? Correlations between impairment ratings and the weighted item scores were high; for most items the complementary ratings of impact do not supplement information provided by impairment ratings. The DIP weighted scores can be represented to some extent by three independent dimensions: a motor (skeletal movement) or displacement ability factor, a factor relating to sensory-cognitive intactness and a psychological well-being factor. A two-factor solution provides a first factor identical to that of the three-factor solution and a second factor representing psychological well-being. The two factors correlate well with instruments measuring disability and with satisfaction versus emotional distress. Provisional scales based on the factors were constructed.

Activities of Daily Living↗
PubMed1999

The 12-item well-being questionnaire. An evaluation of its validity and reliability in Dutch people with diabetes.

OBJECTIVE: The objective of this study was to investigate the validity and reliability of the short-form 12-Item Well-Being Questionnaire (W-BQ12). The 12 items were used to construct the three 4-item subscales Negative Well-Being (NWB), Energy (ENE), and Positive Well-Being (PWB), and the 12-item overall scale General Well-Being (GWB). RESEARCH DESIGN AND METHODS: A total of 1,472 patients with diabetes completed the W-BQ12, the Hospital Anxiety and Depression scale, and the State Trait Anxiety Inventory. Statistics covered Cronbach's alpha, Pearson's correlation, t tests, and logistic regression. Test-retest reliability was studied in a sample of 202 patients who twice completed the W-BQ12, which was supplemented with the Center for Epidemiological Studies Depression scale and the Short Form (SF)-36 Health Survey. RESULTS: Of the tested subjects, 739 were defined as having type 1 diabetes and 701 as having type 2 diabetes. Cronbach's alpha proved to be high and stable across sex and type of diabetes for all W-BQ12 scales. Test-retest reliability ranged from 0.66 (PWB) to 0.83 (GWB), with a mean interval of 66 +/- 14 days. Convergent validity of the W-BQ12 scales was supported by high correlations with other measures of affect. Of all scales of the first measurement, ENE proved to have the strongest association with self-reported chronic fatigue. NWB and trait anxiety both had the strongest associations with self-reported depression and current treatment by a psychologist/psychiatrist. CONCLUSIONS: The W-BQ12 appeared to be a reliable and valid measure of psychological well-being. This short instrument is easy to administer and may be considered a useful tool for both clinicians and researchers to assess the psychological well-being of patients with diabetes.

Adult↗
PubMed1998

[Straying in the methodology. II. Bias introduced by questionnaires].

Some characteristics of self-report questionnaires can result in bias in responding. When a test item or a questionnaire is biased, the observed scores form an imprecise measurement of reality as a consequence of systematic errors of measurement. Causes of such bias are: unclear instructions, vague wording of the test items, culture-bound item content, suggestive questions, framing of questions, social desirability of certain answers, faking good, faking bad and the recall bias.

Bias↗
PubMed1998

A comparison of the standard and the computerized versions of the Well-being Questionnaire (WBQ) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ).

In the present study, the equivalence of paper and pencil assessment versus computer assessment of two self-administered questionnaires was investigated by means of a randomized cross-over design. Therefore, 105 out-patients with diabetes were invited to participate; 76 patients completed both the computer and the paper and pencil version of the Well-being Questionnaire (WBQ) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) in a randomized order, with a mean interval of 7 days. The scales showed high test-retest correlations and the means, dispersions, kurtosis and skewness were found to be approximately the same in both versions. In both modes of assessment, the depression and the energy scale proved to be sensitive for carry-over effects, resulting in better well-being scores at the second measurement. Almost all subjects reported that using the personal computer in the realization of a questionnaire was easy. It is concluded that the paper and pencil and the computerized versions of the WBQ and DTSQ can be considered equivalent. Therefore, the norms and cut-off scores obtained from paper and pencil assessments can be used in computerized versions of the WBQ and DTSQ and vice versa.

Adaptation, Psychological↗