Browsing by Author "Schwartz, Frank"

Now showing 1 - 4 of 4
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    Depression Among Adults With Diabetes: Prevalence, Impact, and Treatment Options
    (2010-01) de Groot, Mary; Kushnick, Michael; Doyle, Todd; Merrill, Jennifer; McGlynn, Mark; Shubrook, Jay; Schwartz, Frank
    Patients with type 1 or type 2 diabetes are two times more likely to experience depression than their peers without diabetes. Comorbid depression results in deleterious effects on glycemic control, worsened diabetes complications, functional disability, and premature mortality. Once identified, depression can be effectively treated with antidepressant medications, psychotherapy, or a combination of both. Patients and providers should monitor depressive symptoms to identify their recurrence and work collaboratively to address barriers to care that exist in both urban and rural areas.
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    Depression Among Type 2 Diabetes Rural Appalachian Clinic Attendees
    (2007-06) de Groot, Mary; Doyle, Todd; Hockman, Erin; Wheeler, Charles; Pinkerman, Brenda; Shubrook, Jay; Gotfried, Robert; Schwartz, Frank
    The prevalence and impact of type 2 diabetes in Appalachia is understudied despite the presence of high-risk socioeconomic conditions (e.g., low levels of education and income). Appalachian counties experience greater burdens of poverty, income inequality, unemployment (1), and diabetes compared with non-Appalachian counties (2–5). Rates of comorbid depression have not been documented in this region. Patients with type 2 diabetes are two times more likely to experience depressive symptoms than their peers without diabetes (6). Depression prevalence in studies using self-report depression inventories was found to be 32.9%, with lower rates (28.5%) observed in studies using diagnostic interview schedules (6,7). Depressive symptoms are associated with worsened blood glucose levels (8), diabetes complications (9), increased functional disability (10), worsened adherence to diabetes regimen (11), higher ambulatory care costs (12), and increased mortality (13). The current study was conducted to identify rates of self-reported depression and to identify the socioeconomic and medical correlates of depression among type 2 diabetic patients attending family medicine and endocrinology appointments from rural Appalachian counties of southeastern Ohio and West Virginia. It was hypothesized that poverty would increase the risk of comorbid depression in this region.
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    Depressive Symptoms, Antidepressant Medication Use, and Inflammatory Markers in the Diabetes Prevention Program
    (Wolters Kluwer, 2018-02) de Groot, Mary; Marrero, David; Mele, Lisa Mele; Doyle, Todd; Schwartz, Frank; Mather, Kieren J.; Goldberg, Ronald; Price, David W.; Ma, Yong; Knowler, William C.; Medicine, School of Medicine
    OBJECTIVE: Antidepressant medication use (ADM) has been shown to predict diabetes. This article assessed the role of inflammatory markers in this relationship within the Diabetes Prevention Program (DPP). METHODS: DPP participants randomized to metformin (MET), life-style intervention (ILS), or placebo (PLB) were assessed for depression (Beck Depression Inventory [BDI]) annually, ADM use semiannually, serum inflammatory markers (C-reactive protein [CRP], interleukin 6 [IL-6]) at baseline and year 1, and diagnosis of type 2 diabetes mellitus (T2DM) semiannually (for 3.2 years). RESULTS: At baseline (N = 3187), M (SD) body mass index was 34 (6) kg/m and the median (interquartile range) BDI score was 3 (1-7). One hundred eighty-one (5.7%) reported ADM use and 328 (10%) had BDI scores of 11 or higher. CRP and IL-6 levels did not differ by treatment group. Baseline ADM, but not BDI score, was associated with higher levels of baseline CRP adjusted for demographic, anthropometric variables, and other medications (20% higher, p = .01). Year 1 CRP decreased for non-ADM users in the MET (-13.2%) and ILS (-34%) groups and ADM users in the ILS group (-29%). No associations were found with IL-6. CRP and continuous use of ADM predicted incident T2DM in the PLB group. In the ILS group, continuous and intermittent ADM, but not CRP, predicted T2DM. In the MET group, CRP predicted incident T2DM. CRP did not mediate the risk of T2DM with ADM use in any group. CONCLUSIONS: ADM was significantly associated with elevated CRP and incident T2DM. In the PLB group, ADM and CRP independently predicted onset of T2DM; however, CRP did not significantly mediate the effect of ADM.
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    Program ACTIVE II: Design and Methods for a Multi-Center Community-Based Depression Treatment for Rural and Urban Adults with Type 2 Diabetes
    (Hindawi, 2015-08) de Grogg, Mary; Shubrook, Jay; Schwartz, Frank; Hornsby Jr., W. Guyton; Pillay, Yegan; Saha, Chandan; Department of Medicine, IU School of Medicine
    OBJECTIVE: Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to conduct a cost-effectiveness analysis of predicted incidence of cardiovascular complications across groups. METHODS: The study is a 2-by-2 factorial randomized controlled trial consisting of 4 treatment groups: CBT alone, EXER alone, combination of CBT and EXER, and UC. Adults with T2DM for > 1 year and who meet DSM-IVTR criteria for Major Depressive Disorder (MDD) are eligible to participate at two rural Appalachian sites (southeastern Ohio and West Virginia) and one urban site (Indianapolis). This type II behavioral translation study uses a community-engaged research (CEnR) approach by incorporating community fitness centers and mental health practices as interventionists. CONCLUSIONS: This is the first study to evaluate the comparative effectiveness of combined CBT and exercise in the treatment of depression using community-based intervention delivery. This approach may serve as a national model for expanding depression treatment for patients with T2DM.