Anxiety, depression and timing of insulin treatment among people with type 2 diabetes

Nine-year follow-up of the Nord-Trondelag Health Study, Norway

M. M. Iversen, G.M. Nefs, G. S. Tell, B. Espehaug, K. Midthjell, M. Graue, F. Pouwer

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background
Depression and anxiety have been found to be predictors of poor health outcomes in diabetes, but mechanisms are still unclear.
Aims
To examine whether symptoms of anxiety and depression were associated with timing of initiating insulin therapy.
Methods
A cohort study of insulin-naive particpants with type 2 dabetes completed the Hospital Anxiey and Depression Scale, HADS-A (n = 731) and/or the HADS-D (n = 768) in the communy-based Nord-Trøndelag Health Study (1995-1997). Information on insulin initiation was retrieved from the Norwegian Prescription Database from January 1, 2004 to November 21, 2012. Cox regression analyses were used to estimate the association between symptoms of anxiety, depression and time to insulin initiation.
Results
At baseline, 19% reported anxiety symptoms (score ≥ 8) and 18% depressive symptoms (score ≥ 8). After a mean follow-up of 4.4 (SD 3.6) years, 337 (40%) participants had started insulin therapy. After adjustment for sociodemographic and clinical variables, anxiety symptoms were associated with later initiation of insulin therapy (HR 0.70, 95% CI 0.49–0.99), while depressive symptoms were not. Considering groups simultaneously, having both elevated depressive and elevated anxiety symptoms was associated with later time to insulin initiation (HR 0.62, 95% CI 0.39–0.99), while having only anxiety symptoms (without depressive) HR 0.81, 95% CI 0.50–1.32) or only depressive symptoms (without anxiety) (HR 1.08, 95% CI 0.68–1.72) were not.
Conclusions
Anxiety was associated with a later initiation of insulin, while depressive symptoms were not. Persons with both elevated levels of anxiety and depression were also less likely to start insulin therapy. These results need further testing in other prospective studies.
Keywords: Anxiety, Depression, Insulin therapy, Insulin-naive people, Type 2 diabetes, Prospective study
Original languageEnglish
Pages (from-to)309-315
JournalJournal of Psychosomatic Research
Volume79
Issue number4
DOIs
Publication statusPublished - Oct 2015

Keywords

  • Anxiety
  • Depression
  • Insulin therapy
  • Insulin-naive people
  • Type 2 diabetes
  • Prospective study

Cite this

@article{5de41dd533a7499a915de397f45de2a0,
title = "Anxiety, depression and timing of insulin treatment among people with type 2 diabetes: Nine-year follow-up of the Nord-Trondelag Health Study, Norway",
abstract = "BackgroundDepression and anxiety have been found to be predictors of poor health outcomes in diabetes, but mechanisms are still unclear.AimsTo examine whether symptoms of anxiety and depression were associated with timing of initiating insulin therapy.MethodsA cohort study of insulin-naive particpants with type 2 dabetes completed the Hospital Anxiey and Depression Scale, HADS-A (n = 731) and/or the HADS-D (n = 768) in the communy-based Nord-Tr{\o}ndelag Health Study (1995-1997). Information on insulin initiation was retrieved from the Norwegian Prescription Database from January 1, 2004 to November 21, 2012. Cox regression analyses were used to estimate the association between symptoms of anxiety, depression and time to insulin initiation.ResultsAt baseline, 19{\%} reported anxiety symptoms (score ≥ 8) and 18{\%} depressive symptoms (score ≥ 8). After a mean follow-up of 4.4 (SD 3.6) years, 337 (40{\%}) participants had started insulin therapy. After adjustment for sociodemographic and clinical variables, anxiety symptoms were associated with later initiation of insulin therapy (HR 0.70, 95{\%} CI 0.49–0.99), while depressive symptoms were not. Considering groups simultaneously, having both elevated depressive and elevated anxiety symptoms was associated with later time to insulin initiation (HR 0.62, 95{\%} CI 0.39–0.99), while having only anxiety symptoms (without depressive) HR 0.81, 95{\%} CI 0.50–1.32) or only depressive symptoms (without anxiety) (HR 1.08, 95{\%} CI 0.68–1.72) were not.ConclusionsAnxiety was associated with a later initiation of insulin, while depressive symptoms were not. Persons with both elevated levels of anxiety and depression were also less likely to start insulin therapy. These results need further testing in other prospective studies.Keywords: Anxiety, Depression, Insulin therapy, Insulin-naive people, Type 2 diabetes, Prospective study",
keywords = "Anxiety, Depression, Insulin therapy, Insulin-naive people, Type 2 diabetes, Prospective study",
author = "Iversen, {M. M.} and G.M. Nefs and Tell, {G. S.} and B. Espehaug and K. Midthjell and M. Graue and F. Pouwer",
year = "2015",
month = "10",
doi = "10.1016/j.jpsychores.2015.07.004",
language = "English",
volume = "79",
pages = "309--315",
journal = "Journal of Psychosomatic Research",
issn = "0022-3999",
publisher = "PERGAMON-ELSEVIER SCIENCE LTD",
number = "4",

}

Anxiety, depression and timing of insulin treatment among people with type 2 diabetes : Nine-year follow-up of the Nord-Trondelag Health Study, Norway. / Iversen, M. M.; Nefs, G.M.; Tell, G. S.; Espehaug, B.; Midthjell, K.; Graue, M.; Pouwer, F.

In: Journal of Psychosomatic Research, Vol. 79, No. 4, 10.2015, p. 309-315.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Anxiety, depression and timing of insulin treatment among people with type 2 diabetes

T2 - Nine-year follow-up of the Nord-Trondelag Health Study, Norway

AU - Iversen, M. M.

AU - Nefs, G.M.

AU - Tell, G. S.

AU - Espehaug, B.

AU - Midthjell, K.

AU - Graue, M.

AU - Pouwer, F.

PY - 2015/10

Y1 - 2015/10

N2 - BackgroundDepression and anxiety have been found to be predictors of poor health outcomes in diabetes, but mechanisms are still unclear.AimsTo examine whether symptoms of anxiety and depression were associated with timing of initiating insulin therapy.MethodsA cohort study of insulin-naive particpants with type 2 dabetes completed the Hospital Anxiey and Depression Scale, HADS-A (n = 731) and/or the HADS-D (n = 768) in the communy-based Nord-Trøndelag Health Study (1995-1997). Information on insulin initiation was retrieved from the Norwegian Prescription Database from January 1, 2004 to November 21, 2012. Cox regression analyses were used to estimate the association between symptoms of anxiety, depression and time to insulin initiation.ResultsAt baseline, 19% reported anxiety symptoms (score ≥ 8) and 18% depressive symptoms (score ≥ 8). After a mean follow-up of 4.4 (SD 3.6) years, 337 (40%) participants had started insulin therapy. After adjustment for sociodemographic and clinical variables, anxiety symptoms were associated with later initiation of insulin therapy (HR 0.70, 95% CI 0.49–0.99), while depressive symptoms were not. Considering groups simultaneously, having both elevated depressive and elevated anxiety symptoms was associated with later time to insulin initiation (HR 0.62, 95% CI 0.39–0.99), while having only anxiety symptoms (without depressive) HR 0.81, 95% CI 0.50–1.32) or only depressive symptoms (without anxiety) (HR 1.08, 95% CI 0.68–1.72) were not.ConclusionsAnxiety was associated with a later initiation of insulin, while depressive symptoms were not. Persons with both elevated levels of anxiety and depression were also less likely to start insulin therapy. These results need further testing in other prospective studies.Keywords: Anxiety, Depression, Insulin therapy, Insulin-naive people, Type 2 diabetes, Prospective study

AB - BackgroundDepression and anxiety have been found to be predictors of poor health outcomes in diabetes, but mechanisms are still unclear.AimsTo examine whether symptoms of anxiety and depression were associated with timing of initiating insulin therapy.MethodsA cohort study of insulin-naive particpants with type 2 dabetes completed the Hospital Anxiey and Depression Scale, HADS-A (n = 731) and/or the HADS-D (n = 768) in the communy-based Nord-Trøndelag Health Study (1995-1997). Information on insulin initiation was retrieved from the Norwegian Prescription Database from January 1, 2004 to November 21, 2012. Cox regression analyses were used to estimate the association between symptoms of anxiety, depression and time to insulin initiation.ResultsAt baseline, 19% reported anxiety symptoms (score ≥ 8) and 18% depressive symptoms (score ≥ 8). After a mean follow-up of 4.4 (SD 3.6) years, 337 (40%) participants had started insulin therapy. After adjustment for sociodemographic and clinical variables, anxiety symptoms were associated with later initiation of insulin therapy (HR 0.70, 95% CI 0.49–0.99), while depressive symptoms were not. Considering groups simultaneously, having both elevated depressive and elevated anxiety symptoms was associated with later time to insulin initiation (HR 0.62, 95% CI 0.39–0.99), while having only anxiety symptoms (without depressive) HR 0.81, 95% CI 0.50–1.32) or only depressive symptoms (without anxiety) (HR 1.08, 95% CI 0.68–1.72) were not.ConclusionsAnxiety was associated with a later initiation of insulin, while depressive symptoms were not. Persons with both elevated levels of anxiety and depression were also less likely to start insulin therapy. These results need further testing in other prospective studies.Keywords: Anxiety, Depression, Insulin therapy, Insulin-naive people, Type 2 diabetes, Prospective study

KW - Anxiety

KW - Depression

KW - Insulin therapy

KW - Insulin-naive people

KW - Type 2 diabetes

KW - Prospective study

U2 - 10.1016/j.jpsychores.2015.07.004

DO - 10.1016/j.jpsychores.2015.07.004

M3 - Article

VL - 79

SP - 309

EP - 315

JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

SN - 0022-3999

IS - 4

ER -