Mary de Groot

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https://hdl.handle.net/1805/11673

One in four patients with diabetes will experience depression in their lifetime which is associated with poorer outcomes, greater functional disability, and early mortality. Dr. Mary de Groot is a clinical psychologist whose research is focused on examining the mechanisms that link diabetes and depression as well as the development of accessible interventions to treat depression among adults and socio-economically and culturally diverse populations with diabetes.

Dr. de Groot’s Program ACTIVE (Adults Coming Together to Increase Vital Exercise) is a research study funded by the National Institute of Diabetes, Digestive Diseases and Kidneys within the National Institutes of Health. The study looks at a combination of cognitive behavioral therapy and exercise for individuals with type 2 diabetes to be used as a model of an interdisciplinary approach to the treatment of depression in diabetes.

Dr. de Groot has contributed more than 80 articles and presentations on the psychosocial aspects of type 1 and type 2 diabetes.

Dr. de Groot’s work on treatment of depression for those with diabetes is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.

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5-OR: Health Disparities in People with and without Diabetes during the COVID-19 Pandemic
(American Diabetes Association, 2021-06-01) Myers, Barbara A.; Klingensmith, Rachel; de Groot, Mary; Medicine, School of Medicine
Purpose: To characterize the psychosocial experiences of adults with (PWD) and without diabetes (ND) during the COVID-19 pandemic. US adults (2176) completed a web-based survey in May-June, 2020 and November-December, 2020, including demographics, COVID-19 exposure, diabetes-related distress (DDS-17), depressive symptoms (PHQ-8) and anxiety (GAD-7). At baseline, mean age was 49.6 years (S.D. = 16.9), 80% female, 88.3% White, with an annual household income of ≥ $60,000 (57.6%), type 2 diabetes (T2D; 301,13.9%), 145 prediabetes (145, 6.6%) and type 1 (T1D, 100, 4.6%). One-third (29.7%) reported decreased income due to the pandemic. T2Ds had more medical comorbidities and COVID risk factors than T1Ds and NDs (all p < 0.01). Mean PHQ-8 scores were 7.1 (S.D. = 5.8; mild), with the T2Ds (M = 7.7; S.D. = 5.9) exceeding NDs (M = 6.9; S.D. = 5.7; p<.001). Mean DDS-17 and GAD-7 scores were comparable for T1Ds and T2Ds (moderate level; p=NS). At 6 months (6MFU), 1,345 (62.6%) completed follow up surveys. Completers were more likely to be older, male, White, married, with higher education levels, and homeowners, with a greater proportion of medical comorbidities and lower A1cs at baseline than non-completers (all p<.05). 6MFU completers had lower baseline depressive symptoms and diabetes distress, lower household COVID-19 rates and less difficulty paying bills than non-completers (all p<.05). At 6MFU for all groups, depressive symptoms decreased (p<.0001) and financial strain improved (p<.001), while COVID exposure increased (personal and household, p<.001). Diabetes distress remained at a moderate level for T1Ds and T2Ds. T1Ds and T2Ds showed comparable levels of depressive symptoms to NDs but were more likely to report financial hardship (p<.05) and difficulty paying bills than NDs (p<.001). Health outcomes were worse for PWDs compared to NDs during the COVID-19 pandemic despite high SES protective factors. Persistent financial strain and diabetes distress increase the risk for future poor health outcomes.
50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future
(ADA, 2021) de Groot, Mary; Medicine, School of Medicine
Associations between immigrant status and pharmacological treatments for diabetes in U.S. adults
(APA, 2018) Hsueh, Loretta; Vrany, Elizabeth A.; Patel, Jay S.; Hollingshead, Nicole A.; Hirsh, Adam T.; de Groot, Mary; Stewart, Jesse C.; Psychology, School of Science
Objectives: Although treatment disparities in diabetes have been documented along racial/ethnic lines, it is unclear if immigrant groups in the United States experience similar treatment disparities. Our objective was to determine whether immigrant status is associated with differences in pharmacological treatment of diabetes in a nationally representative sample of adults with diabetes. We were specifically interested in differences in treatment with oral hypoglycemic agents (OHA) and insulin. Method: Respondents were 2,260 adults from National Health and Nutritional Examination Survey (NHANES) 2003–2012 with a self-reported diabetes diagnosis. Immigrant status was indicated by birth within (U.S.-born) or outside (foreign-born) the 50 U.S. States or Washington, DC. Multinomial logistic regression analyses examined associations between immigrant status and (a) treatment with OHAs only and (b) treatment with insulin only or insulin and OHA combination therapy, using no treatment as the reference group. Results: Adjusting for demographics, diabetes severity and duration, cardiovascular disease (CVD), and CVD risk factors, being foreign-born versus U.S.-born was not associated with treatment with OHAs only (odds ratio [OR] = 1.59; 95% confidence interval [CI] [0.97, 2.60]). However, being foreign-born was associated with decreased odds (OR = 0.53; 95% CI [0.28, 0.99]) of treatment with insulin. Conclusions: Pharmacological treatment of diabetes differs along immigrant status lines. To understand these findings, studies capturing the processes underlying treatment differences in diabetes among immigrants are needed. Findings raise the possibility that integrating information about a patient’s immigrant status, in addition to racial/ethnic identity, may be an important component of culturally sensitive diabetes care.
COVID-19 and Type 1 Diabetes: Addressing Concerns and Maintaining Control
(ADA, 2021-09) DiMeglio, Linda A.; Pediatrics, School of Medicine
The worldwide outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been an unprecedented pandemic. Early on, even as the signs and symptoms of coronavirus disease 2019 (COVID-19) were first characterized, significant concerns were articulated regarding its potential impact on people with chronic disease, including type 1 diabetes. Information about the basic and clinical interrelationships between COVID-19 and diabetes has rapidly emerged. Initial rapid reports were useful to provide alerts and guide health care responses and initial policies. Some of these have proven subsequently to have durable findings, whereas others lacked scientific rigor/reproducibility. Many publications that report on COVID-19 and “diabetes” also have not distinguished between type 1 and type 2 (1). Available evidence now demonstrates that people with type 1 diabetes have been acutely affected by COVID-19 in multiple ways. This includes effects from limited access to health care, particularly during lockdown periods, and increased morbidity/mortality in infected adults with type 1 diabetes compared with peers without diabetes.
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.
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.
Depression and poverty among African American women at risk for type 2 diabetes
(2003-06) de Groot, Mary; Auslanden, Wendy; Williams, James Herbert; Sherraden, Michael; Haire-Joshu, Debra
Poverty is associated with negative health outcomes, including depression. Little is known about the specific elements of poverty that contribute to depression, particularly among African American women at risk for type 2 diabetes. This study examined the relationships of economic and social resources to depression among African American women at high risk for the development of type 2 diabetes (N = 181) using the Conservation of Resources theory as a conceptual framework. Women were assessed at 3 time points in conjunction with a dietary change intervention. At baseline, 40% of women reported clinically significant depression, and 43.3% were below the poverty line. Depressed women reported fewer economic assets and greater economic distress than nondepressed peers. Multivariate logistic regression analyses indicated that nonwork status, lack of home ownership, low appraisal of one’s economic situation, low self-esteem, and increased life events were significantly associated with depression at baseline. Longitudinal multivariate logistic regression models indicated that income, home ownership, future economic appraisal, life events, and self-esteem predicted depression trajectories at Time 3. These results speak to the multifaceted sources of stress in the lives of poor African American women. Interventions that address the economic and social factors associated with depression are needed.
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.
Diabetes and Depression
(Springer US, 2014-06) Holt, Richard I. G.; de Groot, Mary; Golden, Sherita Hill; Department of Medicine, IU School of Medicine
Diabetes and depression occur together approximately twice as frequently as would be predicted by chance alone. Comorbid diabetes and depression are a major clinical challenge as the outcomes of both conditions are worsened by the other. Although the psychological burden of diabetes may contribute to depression, this explanation does not fully explain the relationship between these 2 conditions. Both conditions may be driven by shared underlying biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors. Depression is frequently missed in people with diabetes despite effective screening tools being available. Both psychological interventions and antidepressants are effective in treating depressive symptoms in people with diabetes but have mixed effects on glycemic control. Clear care pathways involving a multidisciplinary team are needed to obtain optimal medical and psychiatric outcomes for people with comorbid diabetes and depression.
Diabetes Risk Perception Among Immigrant and Racial/Ethnic Minority Adults in the United States
(Sage, 2019) Hsueh, Loretta; Peña, Juan M.; Hirsh, Adam T.; de Groot, Mary; Stewart, Jesse C.; Psychology, School of Science
Purpose The purpose of the study was to examine associations of immigrant and racial/ethnic status with diabetes risk perception among a population-based sample of US adults without diabetes. Racial/ethnic minorities are at increased risk of developing diabetes. Emerging research shows that immigrant (foreign born) individuals are also at increased risk, but less is understood about risk perception in this group. Methods Respondents were 11,569 adults from the NHANES (2011-2016; National Health and Nutrition Examination Survey) reporting no diabetes or prediabetes. Immigrant status was coded as foreign born or US born and analyses used NHANES racial/ethnic categories: white, black, Mexican American, other Hispanic, Asian, and other/multiracial. Immigrant status and variables comparing each minority group with whites were simultaneously entered into models predicting risk perception (yes/no), adjusting for demographic and diabetes risk factors. Results Being foreign born was associated with decreased odds of perceived risk, while being Mexican American, Asian, and other/multiracial were associated with increased odds of perceived risk. Discussion Foreign-born adults are less likely than US-born adults to report perceived risk for diabetes. Lower diabetes risk perception among immigrants could result in poorer preventative behaviors and later diabetes detection.

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