Dr Kimberley Smith

This code includes the data preparation and curation for my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The scripts are written in SPSS version 27 and include the code and procedures for data preparation, curation and harmonisation across three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

This repository includes three curated datasets used in my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The datasets are in SAV (SPSS) format and contain curated and harmonised data from three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS). Permission for access may be granted on request to panagiota.kontari@gmail.com or p.kontari@surrey.ac.uk or kimberley.j.smith@surrey.ac.uk.

This code includes the statistical analysis for my study on “Independent and combined effects of depressive symptoms and cardiometabolic risk factors on dementia incidence”. It was created as part of my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The analysis was performed in Stata version 16 and contains code Cox proportional hazards regression. The code is created using three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

This code includes the statistical analysis for my study on “Mediating effects of depressive symptoms and cardiometabolic health on dementia development”. It was created as part of my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The analysis was performed in Stata version 16 and Mplus version 8 and contains code on mediation analysis using structural-equation modelling (SEM). The code is created using three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

This code includes the statistical analysis for my study on “Trajectories of depressive symptoms and their relationship with dementia incidence”. It was created as part of my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The analysis was performed in Stata version 16 and contains code on latent class growth curve analysis (LCGA), logistic regression, and Cox proportional hazards regression.The code is created using three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

This code includes the statistical analysis for my study on “Clustering of cardiometabolic risk factors and dementia incidence”. It was created as part of my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The analysis was performed in Stata version 16 and contains code on latent class analysis (LCA) and Cox proportional hazards regression. The code is created using three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

OBJECTIVES: Ascertain the association of elevated co-occurring anxiety and depression symptoms, elevated anxiety symptoms alone or elevated depression symptoms alone with indicators of self-care behaviours in people with type 2 diabetes. METHODS: Data from a community sample of 1,990 people diagnosed with type 2 diabetes for less than 10 years were assessed. All participants took part in a telephone interview. Questionnaires examined depression, anxiety, health, and indicators of self-care (physical activity, blood glucose monitoring, diet and smoking). Data were assessed with cross tabulations, ANOVA and logistic regression. RESULTS: Groups who met criteria for elevated co-occurring anxiety and depression symptoms, elevated anxiety symptoms and elevated depression symptoms were more likely to report poor eating habits. Meeting criteria for either elevated depression symptoms (with and without anxiety) was also associated with an increased likelihood of not meeting physical activity recommendations. Those people with elevated depression and anxiety scores were more likely to be a current smoker. CONCLUSIONS: Those people who meet criteria for elevated anxiety and/or depression symptoms are less likely to report adhering to self-care recommendations. These associations are particularly marked in those people with elevated depression symptoms with or without co-occurring anxiety symptoms. There is a lot of evidence emphasising the importance of monitoring depressive symptoms in people with diabetes. Our results add to this, indicating that adherence to self-care recommendations should be carefully monitored in people with depression and anxiety symptoms.

•IFN-α treatment induced a temporal memory impairment in rat.•Animals treated with IFN-α did not have an object recognition memory impairment.•Chronic exercise prevented IFN-α induced temporal order memory impairments. Patients receiving cytokine immunotherapy with IFN-α frequently present with neuropsychiatric consequences and cognitive impairments, including a profound depressive-like symptomatology. While the neurobiological substrates of the dysfunction that leads to adverse events in IFN-α-treated patients remains ill-defined, dysfunctions of the hippocampus and prefrontal cortex (PFC) are strong possibilities. To date, hippocampal deficits have been well-characterised; there does however remain a lack of insight into the nature of prefrontal participation. Here, we used a PFC-supported temporal order memory paradigm to examine if IFN-α treatment induced deficits in performance; additionally, we used an object recognition task to assess the integrity of the perirhinal cortex (PRH). Finally, the utility of exercise as an ameliorative strategy to recover temporal order deficits in rats was also explored. We found that IFN-α-treatment impaired temporal order memory discriminations, whereas recognition memory remained intact, reflecting a possible dissociation between recognition and temporal order memory processing. Further characterisation of temporal order memory impairments using a longitudinal design revealed that deficits persisted for 10 weeks following cessation of IFN-α-treatment. Finally, a 6 week forced exercise regime reversed IFN-α-induced deficits in temporal order memory. These data provide further insight into the circuitry involved in cognitive impairments arising from IFN-α-treatment. Here we suggest that PFC (or the hippocampo-prefrontal pathway) may be compromised whilst the function of the PRH is preserved. Deficits may persist after cessation of IFN-α-treatment which suggests that extended patient monitoring is required. Aerobic exercise may be restorative and could prove beneficial for patients treated with IFN-α.

Comorbid depression and cardiometabolic abnormalities might represent an important subgroup of depression. The aim of the present study was to evaluate lifestyle and health-related characteristics of individuals with both depressive symptoms and cardiometabolic abnormalities. Data were from the English Longitudinal Study of Ageing. The sample was comprised of 5365 adults aged 50-80 years. High depressive symptoms were based on the eight-item Center for Epidemiologic Studies - Depression scale. Cardiometabolic abnormalities were defined as having ≥3 cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, hypertriglyceridemia, and central obesity). Four groups were created based on Center for Epidemiologic Studies - Depression scores and cardiometabolic abnormalities: those with (i) comorbid depressive symptoms and cardiometabolic abnormalities (DCM); (ii) depressive symptoms only (DnoCM); (iii) cardiometabolic abnormalities only; and (iv) neither depressive symptoms nor cardiometabolic abnormalities. Lifestyle and health-related characteristics of the four groups were compared using chi-square tests. A modified Poisson regression analysis was performed to compare the DCM and the DnoCM groups with respect to lifestyle and health-related characteristics. Those in the DCM group were significantly less physically active (p = 0.003), had poorer self-rated health (p 

Background: Self-rated health (SRH) is a single-item measure that is one of the most widely used measures of general health in population health research. Relatively little is known about changes and the trajectories of SRH in people with chronic medical conditions. The aims of the present study were to identify and describe longitudinal trajectories of self-rated health (SRH) status in people with diabetes. Methods: A prospective community study was carried out between 2008 and 2011. SRH was assessed at baseline and yearly at follow-ups (n=1288). Analysis was carried out through trajectory modeling. The trajectory groups were subsequently compared at 4 years follow-up with respect to functioning. Results: Four distinct trajectories of SRH were identified: 1) 72.2% of the participants were assigned to a persistently good SRH trajectory; 2) 10.1% were assigned to a persistently poor SRH trajectory; 3) mean SRH scores changed from good to poor for one group (7.3%); while 4) mean SRH scores changed from poor to medium/good for another group (10.4%). Those with a persistently poor perception of health status were at higher risk for poor functioning at 4 years follow-up than those whose SRH scores decreased from good to poor. Conclusions: SRH is an important predictor for poor functioning in diabetes, but the trajectory of SRH seems to be even more important. Health professionals should pay attention to not only SRH per se, but also changes in SRH over time.

Background The aim of this study was to evaluate the dynamic association between depressive symptoms and glycated hemoglobin A1c (HbA1c) levels using data from the English Longitudinal Study of Ageing (ELSA). Method The sample was comprised of 2886 participants aged 50 years who participated in three clinical assessments over an 8-year period (21% with prediabetes and 7% with diabetes at baseline). Structural equation models were used to address reciprocal associations between depressive symptoms and HbA1c levels and to evaluate the mediating effects of lifestyle-related behaviors and cardiometabolic factors. Results We found a reciprocal association between depressive symptoms and HbA1c levels: depressive symptoms at one assessment point predicted HbA1c levels at the next assessment point (standardized = 0.052) which in turn predicted depressive symptoms at the following assessment point (standardized = 0.051). Mediation analysis suggested that both lifestyle-related behaviors and cardiometabolic factors might mediate the association between depressive symptoms and HbA1c levels: depressive symptoms at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted HbA1c levels 4 years later. A similar association was observed for the other direction: HbA1c levels at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted depressive symptoms 4 years later. Conclusions Our results suggest a dynamic relationship between depressive symptoms and HbA1c which might be mediated by both lifestyle and cardiometabolic factors. This has important implications for investigating the pathways which could link depressive symptoms and increased risk of diabetes.

Raised levels of C-reactive protein (CRP), an inflammatory biomarker, and depressive symptoms are both independently linked to risk of diabetes. The purpose of this study was to assess the joint association of CRP and depressive symptomatology with diabetes incidence in a representative sample of English people ≥50years old. Data were from the English Longitudinal Study of Ageing, a prospective study of community-dwelling older adults. The sample was comprised of 4955 participants without self-reported doctor-diagnosed diabetes at baseline. High CRP level was dichotomized as >3mg/L. Elevated depressive symptomatology was defined as ≥4 using the 8-item Center for Epidemiologic Studies Depression Scale. Incident diabetes was determined based on newly self-reported doctor-diagnosed diabetes. Cox proportional hazard regressions were used to examine the association between CRP and depressive symptoms with incidence of type 2 diabetes. During approximately 63.2months of follow-up, 194 participants reported diabetes diagnosis. After adjustment for socio-demographics, lifestyle behaviors, clinical factors, and BMI, the hazard ratio for diabetes was 1.63 (95% CI 0.88–3.01) for people with elevated depressive symptoms only, 1.43 (95% CI 0.99–2.07) for people with high CRP only, and 2.03 (95% CI 1.14–3.61) for people with both high CRP and elevated depressive symptoms. The presence of both high CRP levels and elevated depressive symptoms was associated with risk of diabetes. Further investigation into this relationship could aid in understanding the mechanisms underlying inflammation, depression, and diabetes. •This is the first study to examine CRP and depressive symptoms with diabetes risk.•High CRP alone was not associated with diabetes risk.•Elevated depressive symptomatology alone was not associated with diabetes risk.•Having both high CRP and elevated depressive symptoms was linked to diabetes risk.•The relation between CRP, depression, and diabetes needs to be further explored.

The most investigated adverse event associated with interferon-alpha (IFN-α) treatment is depressed mood, with many studies finding a significant increase in depression scale scores from baseline to treatment. This paper is concerned with exploring discrete categories of depressive symptoms (somatic, behavioral, negative cognitions and depressed mood) in order to explore the behavioral syndrome associated with IFN-α. Thirty-five Hepatitis C patients due to commence IFN-α treatment were assessed using the Structured Clinical Interview (SCID), and the 24-item Hamilton Depression Inventory (HAM-D) at 0 and 8 weeks. Somatic symptoms comprised the significant majority of scores across all weeks for patients taking IFN-α. Patients who developed a depression had significantly more somatic and mood symptoms at Week 8 than those patients who did not develop a depression. These exploratory results indicate that the increase in raw depression scores is due to an increase in somatic and mood symptoms, rather than negative cognitions. However, this increase does not correspond to a proportional increase in a particular subscale. These results also indicate that development of an IFN-α-induced depression is due to mood symptoms rather than negative cognitions.

Diabetes control is a multifaceted process involving successful adherence to a self-care regimen as indicated by improved health outcomes. The aim of this study was to ascertain the construct validity of self-reported diabetes control in a population-based survey. This study assessed 1848 participants with type 2 diabetes who took part in the Montreal Diabetes Health and Wellbeing Study in Quebec, Canada. Participants were administered the diabetes complications index as well as sociodemographic and health questions. Fair/poor diabetes control was associated with being less likely to check blood glucose weekly, being less likely to drink alcohol, being more likely to report being physically inactive, reporting fair/poor eating habits, being obese and having 1 or more diabetes complications. When all variables were included in a regression model the two variables most strongly associated with poor fair/poor diabetes control were reporting fair/poor eating habits (odds ratio 1.36, 95% CI 1.00–1.85) and having 2 or more diabetes complications (odds ratio 1.60, 95% CI 1.06–2.40). Results from this study indicate that self-rated diabetes control has associations with diabetes-specific self-care behaviours and outcomes, and is a general indicator of self-care and diabetes-related complications in a population-based survey.

Objectives: Anxiety has been shown to be associated with poor outcomes in people with diabetes. However, there has been little research which has specifically examined whether diabetes mellitus is associated with an increased likelihood of co-morbid anxiety. The aim of this systematic review and meta-analysis was to determine whether people with diabetes are more likely to have anxiety disorders or elevated anxiety symptoms than people who do not have diabetes. Methods: A systematic review was performed by three independent reviewers who searched for articles that examined the association between anxiety and diabetes in adults 16 or older. Those studies that met eligibility criteria were put forward for meta-analysis using a random-effects model. Results: A total of twelve studies with data for 12,626 people with diabetes were eligible for inclusion in the systematic review and meta-analysis. Significant and positive associations were found for diabetes with both anxiety disorders, 1.20 (1.10-131), and elevated anxiety symptoms, 1.48 (1.02-1.93). The pooled OR for all studies that assessed anxiety was 1.25 (1.10-1.39). Conclusions: Results from this meta-analysis provide support that diabetes is associated with an increased likelihood of having anxiety disorders and elevated anxiety symptoms. Crown Copyright (C) 2012 Published by Elsevier Inc. All rights reserved.

There is a well-documented association between depression and disability in people with diabetes. However, less is known about the possible association of co-occurring anxiety on these associations. The objective of this study was to assess the association of elevated anxiety or depression symptoms or both with functional disability and frequent disability days in a community sample with type 2 diabetes. The participants were 1999 people with diabetes who completed the baseline portion of the Evaluation of Diabetes Treatment study. Functional disability was assessed using the World Health Organization Disability Assessment Schedule II. Frequent disability days were assessed using a cutoff score ≥14 on a question assessing functional disability in the past month from the Healthy Days Core Module. Depression and anxiety were assessed with the Patient Health Questionnaire and General Anxiety Questionnaire with cutoff scores ≥10 applied to create groups. Additional questions examined diabetes complications, chronic conditions, and sociodemographic characteristics. Fully adjusted logistic regression analyses demonstrated an increased likelihood of reporting functional disability for all groups with high anxiety or depressive symptoms or both. Groups with high depressive symptoms with and without high anxiety symptoms were also more likely to report frequent disability days. Results indicate that elevated anxiety and depression symptoms are important factors associated with increased functional disability and frequent disability days in people with diabetes.

Existing literature highlights notable health and social inequalities for people aging with a lifelong disability and the need for research to better understand how we can support this group to age well. This scoping review mapped existing literature related to "aging well" in people with lifelong disabilities. Five scientific databases and gray literature sources were searched for studies related to "aging well" and "lifelong disability" (defined as a disability that a person had lived with since birth or early childhood). We identified 81 studies that discussed aging well with a lifelong disability, with most (70%) focusing on intellectual disabilities. Two themes captured existing research on aging well with a lifelong disability: (1) framing aging well with a lifelong disability, which included the ways that people with lifelong disability, their supporters, and existing research frame aging well for this group and (2) supporting people to age well with a lifelong disability, which involves the micro-, meso-, and macro-level factors where research suggests interventions to facilitate aging well could be situated. This synthesis highlights how aging well is currently framed in the literature and where interventions to improve aging well in this group could be situated. Literature highlights the importance of considering multilevel interventions to improve aging well. Evidence gaps include the lack of research conducted with groups other than those with intellectual disabilities and the need for more research examining aging well interventions.

BackgroundThe aim of the present study was to investigate the stability and longitudinal association between depression and smoking status within a community sample with type 2 diabetes (T2D) while controlling for sociodemographic and disease-related variables. MethodsAdults with T2D were recruited and agreed to be followed-up via random digit dialing for the Montreal Diabetes Health Study. At baseline, 1614 individuals were classified as never (n=592), former (n=690), light (10 cigarettes a day; n=128) and moderate-heavy (11+ cigarettes a day; n=204) smokers. Depression was assessed using the Patient Health Questionnaire-9 and individuals were classified as either none or having depression syndrome. Generalized estimating equations were used to test the association between depression syndrome and current smoking status while controlling for other demographic and health-related variables. ResultsPrevalence rates of smoking and depression showed mild to substantial agreement over time. Depression syndrome was significantly associated with moderate-heavy smoking in the fully adjusted model using cross-sectional (all four waves; odds ratio [OR] 1.46; 95% confidence interval [CI] 1.08-1.99; P < 0.05) and longitudinal (controlling for depression at baseline; OR 1.54; 95% CI 1.02-2.31; P < 0.05) data. ConclusionsSmoking and depression prevalence rates appear to be stable over time in our community sample with T2D. Moderate-heavy smoking is strongly associated with elevated depression, both in cross-sectional and longitudinal models. Persistent moderate-heavy smokers may be at increased risk of both physical and mental health complications. This burden is even greater for those with T2D.

To determine whether self-rated health was a predictor for the three year incidence of major depression in people with Type II diabetes. Data was collected as part a population-based telephone survey of adults with diabetes, in Québec, Canada (2008–2011). Adults with Type II diabetes who did not have major depression at baseline were assessed at three follow-up interviews conducted 12, 24 and 36 months after baseline. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Self-rated health status was determined by asking participants to rate their health on a scale from excellent to poor. The sample consisted of 1265 adults with Type II diabetes who did not have major depression at baseline. 36% of individuals who had developed major depression at follow up rated their health as fair or poor at baseline compared to 14.4% of those who had not developed major depression. Logistic regression analyses indicated fair or poor self-rated health at baseline to be predictive of a twofold increased risk for major depression at follow-up, even after adjusting for socio-demographic characteristics, lifestyle-related behaviors, disability and diabetes characteristics (OR=2.05, 95% CI 1.20–3.48). We have focused on current depression (last two weeks) and we have used a questionnaire (PHQ-9) rather than a clinical interview for the assessment of depression. Self-rated health status might be a predictor for developing major depression in people with diabetes in addition to well established risk factors.

High depressive symptoms and cardiometabolic abnormalities are independently associated with an increased risk of diabetes. The purpose of this study was to assess the association of co-occurring depressive symptoms and cardiometabolic abnormalities on risk of diabetes in a representative sample of the English population aged 50 years and older. Data were from the English Longitudinal Study of Ageing. The sample comprised of 4454 participants without diabetes at baseline. High depressive symptoms were based on a score of 4 or more on the 8-item binary Centre for Epidemiologic Studies-Depression scale. Cardiometabolic abnormalities were defined as 3 or more cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, high triglycerides, and central obesity). Cox proportional hazards regressions assessed the association between co-occurring depressive symptoms and cardiometabolic abnormalities with incidence of diabetes. Multiple imputation by chained equations was performed to account for missing data. Covariates included age, sex, education, income, smoking status, physical activity, alcohol consumption, and cardiovascular comorbidity. The follow-up period consisted of 106 months, during which 193 participants reported a diagnosis of diabetes. Diabetes incidence rates were compared across the following four groups: 1) no or low depressive symptoms and no cardiometabolic abnormalities (reference group, n = 2717); 2) high depressive symptoms only (n = 338); 3) cardiometabolic abnormalities only (n = 1180); and 4) high depressive symptoms and cardiometabolic abnormalities (n = 219). Compared to the reference group, the hazard ratio for diabetes was 1.29 (95% CI 0.63, 2.64) for those with high depressive symptoms only, 3.88 (95% CI 2.77, 5.44) for those with cardiometabolic abnormalities only, and 5.56 (95% CI 3.45, 8.94) for those with both high depressive symptoms and cardiometabolic abnormalities, after adjusting for socio-demographic, lifestyle and clinical variables. These findings suggest that those with high depressive symptoms and cardiometabolic abnormalities are at a particularly increased risk of type 2 diabetes.

The aim of this study was to assess differences in cardiovascular risk and performance of self-care activities in people who rated their diabetes control as good or poor. A sub-sample of 77 participants who took part in the Evaluation of Diabetes Treatment telephone interview were invited into a clinic to complete a series of laboratory examinations. Self-rated diabetes control was validated using the following laboratory markers: HbA1c, total cholesterol/HDL cholesterol ratio and LDL cholesterol. Differences in blood pressure and BMI were also assessed. Finally, all participants also completed the Summary of Self-Care activities questionnaire. Those people who rated their diabetes control as fair or poor had a significantly higher BMI, HbA1c levels, total cholesterol/HDL-cholesterol ratio and systolic blood pressure. When asked about self-care activities in the past week, those people who reported their diabetes control was fair/poor had spent significantly fewer days following a general diet and exercising. People with poor self-rated diabetes control have unfavourable cardiovascular risk and decreased performance of self-care activities.

The reciprocal relationship between depression and functioning in people with chronic conditions is poorly understood. The aim of the present study was to analyze the dynamic relationship between depression and functioning in a community sample of people with diabetes. Participants with diabetes were assessed at baseline and three yearly follow-up assessments (n = 1,403). Depression was assessed using the Patient Health Questionnaire. Global functioning was assessed using the World Health Organization Disability Assessment Schedule II. Path analysis suggested a reciprocal relationship between depression and functioning. Baseline depression was associated with functioning at 3 years follow-up through depression and functioning at 1 and 2 years follow-up assessments. Depression and functioning might interact with each other in a dynamic way: depression at one assessment point might predict poor functioning at the next assessment point, which in turn might predict depression at the next assessment point. This should be taken into account in both treatment and research programs.

Interferon-alpha, currently used for the treatment of hepatitis C, is associated with a substantially elevated risk of depression. However, not everyone who takes this drug becomes depressed, so it is important to understand what particular factors may make some individuals more 'at risk' of developing depression than others. Currently there is no consensus as to why interferon-induced depression occurs and the range of putative risk factors is wide and diverse. The identification of risk factors prior to treatment may allow identification of patients who will become depressed on interferon, allowing the possibility of improved treatment support and rates of treatment adherence. Here, we consolidate and review the literature on risk factors, and we discuss the potential confounds within the research examined in order to better isolate the risk factors that may be important in the development of depression in these patients and which might help predict patients likely to become depressed on treatment. We suggest that interactions between psychobehavioral, genetic, and biological risk factors are of particular importance in the occurrence of depression in patients with hepatitis C taking interferon-alpha.

Objective: The aim of the present study was to identify and describe longitudinal patterns of depression in a community sample of people with type 2 diabetes in Quebec, Canada. Methods: A prospective community based study in Quebec, Canada, was carried out between 2008 and 2011. Participants with diabetes were assessed at baseline and at 1,2 and 3 years follow-up (n = 1388). Depression was assessed using the Patient Health Questionnaire (PHQ-9). Results: Longitudinal latent class analysis yielded four clusters representing different longitudinal patterns of depression: Cluster 1 ("no depression"; 67%): participants had neither minor nor major depression over time. Cluster 2 ("slowly increasing prevalence of minor and major depression over time"; 20%): participants had low levels of depression at baseline but increasing levels of minor and major depression over time; while most of the Cluster 3 ("increasing major depression"; 6%) participants had high and increasing levels of major depression over time. Participants in Cluster 4 ("improved depression"; 7%) started with high levels of depression but progressed to low levels of depression. Conclusions: Our results provide important evidence of different longitudinal patterns of depression in people with type 2 diabetes. Identification of four distinct groups of participants might improve our understanding of the course of depression and may provide a basis of classification for intervention. (C) 2012 Elsevier Inc. All rights reserved.

Objective: To investigate the association between depression and smoking status within a community-based sample with type 2 diabetes mellitus, while controlling for socio-demographic, diabetes-related characteristics and complications, disability, other chronic illness and other health-related variables. Method: A total of 1868 adults with type 2 diabetes were recruited via random digit dialing for the Montreal Health and Well Being Study (DHS). Smoking was classified as never, former, light (

Objectives: To ascertain the impact of minor and major depression on self-reported use of and access to diabetes healthcare services, and the care components received in a community-based Quebec sample with type 2 diabetes. Study design: Adults with type 2 diabetes who took part in baseline and 1-year follow-up telephone interviews for the Diabetes Health Study were assessed (n = 1175). Methods: Information was collected regarding depression status (i.e. minor or major depression), use of and access to diabetes healthcare services, sociodemographic and diabetes characteristics, treatment, diabetes complications, disability, body mass index, residential area and depression. Results: People with major depression were more likely to be high users or non-users of diabetes healthcare services. The high users reported more diabetes complications. People with major depression also reported more problems with accessing diabetes healthcare services, specifically having to wait too long between making their appointment and their visit, specialist care not being available in their area, general health deterioration, being unable to leave their house due to their health and problems with transportation. People with major depression were less likely to report having their feet checked by their doctor, and were more likely to report problems with getting advice from their doctor. Conclusions: People with diabetes need to use healthcare services in order to receive recommended care components. People with major depression and no complications are less likely to report using healthcare services; conversely, people with major depression and complications are more likely to be high users of healthcare services. People with major depression perceive more problems with the health care they receive. Crown Copyright (C) 2013 Published by Elsevier Ltd on behalf of The Royal Society for Public Health. All rights reserved.

Aims: There is an increasing interest in single-item self-rated indicators of perceived health and control status in people with chronic illnesses such as diabetes. However, self-rated measures can be associated with indicators of psychological status. The aim of this paper is to explore the association of anxiety, depression, and diabetes distress with self-rated diabetes control. Methods: Telephone interviews were conducted with 1,787 people with type 2 diabetes taking oral hypoglycemic medication. Diabetes control, health behaviors, and outcomes, anxiety, depression, and diabetes distress were assessed by standardized questionnaires. Self-reported diabetes control was modeled using logistic regression. Results: The best fit logistic regression model for self-rated poor diabetes control was a model that incorporated diabetes distress. When adjusted for age, sex, and all other health behaviors and outcomes, poor diabetes control was most associated with diabetes distress, physical inactivity, being overweight, and poor eating habits. Conclusions: Results from this study indicate that poor self-rated diabetes control shares the strongest associations with diabetes-specific distress along with perceptions of diabetes-specific healthcare behaviors and outcomes. (Psychosomatics 2013; 54:35-43)

Objectives: The inflammatory marker C-reactive protein (CRP) is associated with depression. We examined the directional relations between CRP and symptoms of depression among older adults. Method: The sample consisted of 3397 participants from the English Longitudinal Study of Ageing, a prospective study of community-dwelling older adults. CRP and depressive symptoms were measured at baseline and follow-up. A high CRP level was dichotomized as >3 mg/L. Elevated depressive symptomatology was defined as >= 4 using the 8-item Center for Epidemiologic Studies Depression Scale. Logistic regressions computed the association between high CRP levels at baseline with elevated depressive symptoms at follow-up, and vice versa. Results: After adjusting for baseline depressive symptoms, baseline high CRP levels were associated with subsequent elevated symptoms of depression (OR=1.49; 95% CI, 1.19-1.88). This relationship was no longer significant after simultaneous adjustments for metabolic and health variables. In the other direction, after adjusting for baseline CRP levels, baseline elevated depressive symptoms was not associated with subsequent high CRP levels (OR=1.12; 95% CI, 0.88-1.42). Conclusion: High CRP levels at baseline are related to elevated depressive symptomatology at follow-up due to clinical factors. No association was found in the opposite direction. Copyright (C) 2014 John Wiley & Sons, Ltd.

Objective: To examine the association between physical inactivity and anxiety symptoms in a community-based sample of men and women with type 2 diabetes mellitus. Methods: Eligibility criteria included residents of Quebec, Canada aged between 40 and 75 years, having a diagnosis of type 2 diabetes (

Major depression can be associated with neurocognitive deficits which are believed in part to be related to medial temporal lobe pathology. The purpose of this study was to investigate this impairment using a hippocampal-dependent neuropsychological task. The face-name pairs task was used to assess associative memory functioning in 19 patients with major depression. When compared to age-sex-and-education matched controls, patients with depression showed impaired learning, delayed cued-recall, and delayed free-recall. However, they also showed preserved recognition of the verbal and nonverbal components of this task. Results indicate that the face-name pairs task is sensitive to neurocognitive deficits in major depression.

BackgroundThe present study examined the association between moderate and severe diabetes distress (DD) and lifestyle behaviors (physical activity, smoking, alcohol consumption) in a community sample of adults with type 2 diabetes mellitus (T2DM). MethodsA total of 1971 adults with T2DM were recruited using mixed methods sampling. Participants were considered eligible if they had a doctor diagnosis of T2DM (10 years), were insulin naive, aged 40-75 years, and were from Quebec, Canada. Participants provided information on DD, lifestyle behaviors, sociodemographic, and diabetes-related factors. Multinomial logistic regressions examined the association between moderate and severe DD and each lifestyle behavior, according to gender. Effect estimates can be interpreted as probability ratios (PR). ResultsIn females, physical inactivity was associated with an increased likelihood of moderate distress (PR 2.2; 95% confidence interval [CI] 1.49-3.24) and severe distress (PR 1.80; 95% CI 1.00-3.24). In males, only severe distress was associated with physical inactivity (PR 1.92; 95% CI 1.00-3.66). Current smoking was associated with a greater probability of severe distress in males (PR 3.0; 95% CI 1.54-5.84) and females (PR 1.32; 95% CI 0.67-2.60); however this effect was stronger in males. No association was found between alcohol consumption and DD in females. In males, frequent alcohol consumption was associated with a reduced probability of moderate (PR 0.56; 95% CI 0.34-0.91) and severe distress (PR 0.47; 95% CI 0.21-1.06). ConclusionsThe findings of this study suggest important gender differences in the association between DD and lifestyle behaviors.

Objective: Diabetes-specific distress is an important psychological issue in people with diabetes. The neighborhood environment has the potential to be an important factor for diabetes distress. This study investigates the associations between neighborhood characteristics and diabetes distress in adults with type 2 diabetes. Methods: We used cross-sectional data from a community-based sample of 578 adults with type 2 diabetes from Quebec, Canada. Information on perceived neighborhood characteristics and diabetes distress was collected from phone interviews. We used factor analysis to combine questionnaire items into neighborhood factors. Information on neighborhood deprivation was derived from census data. We performed linear regressions for diabetes distress and specific domains of diabetes distress (emotional, regimen-related, physician-related and interpersonal distress), adjusting for individual-level variables. Results: Factorial analysis uncovered 3 important neighborhood constructs: perceived order (social and physical order), culture (social and cultural environment) and access (access to services and facilities). After adjusting for individual-level confounders, neighborhood order was significantly associated with diabetes distress and all specific domains of distress; neighborhood culture was specifically associated with regimen-related distress; and neighborhood access was specifically associated with physician-related distress. The objective measure of neighborhood material deprivation was associated with regimen-related distress. Conclusions: Neighborhood characteristics are associated with diabetes distress in people with type 2 diabetes. Clinicians should consider the neighborhood environment reported by their patients with diabetes when assessing and addressing diabetes-specific distress. (C) 2013 Elsevier Inc. All rights reserved.

Background Current literature highlights higher prevalence rates of sleep difficulties amongst adults with an intellectual disability. However, no synthesis has been conducted to assess the effectiveness of existing interventions in this population. Thus, the aim of this review was to assess the effectiveness of sleep interventions in adults with an intellectual disability (ID). Method Eight databases were searched to identify interventions for sleep difficulties amongst adults with an ID. The study quality was assessed with the Risk Of Bias In Non‐randomised Studies – of Interventions. Nine studies (n = 97) were eligible for inclusion in the review. Results There was a notable study on heterogeneity in terms of the population, study design, intervention studied, sleep assessment and outcome assessments used. Eight of the nine studies reported improvement in sleep following intervention. However, these findings need additional support as only 97 participants involving a variety of interventions and measurement systems were used across all studies. Furthermore, eight of the nine studies had serious to critical risk of bias. The only study identified as having low risk of bias was a placebo‐controlled randomised controlled trial for the use of melatonin. Conclusions This review highlights the need for objective measures such as actigraphy and studies with greater experimental control investigating sleep interventions in adults with ID.

In the article by Kontari and Smith,1 the authors found that Table 3 was published in its incomplete form. The complete table is as follows: TABLE 3. Hazard ratio HR (95% confidence interval CI) of Dementia across Depressive Symptoms and Individual Indicators of Cardiometabolic abnormalities The authors have carefully checked the statistical results and this correction does not change the description, interpretation, or the original conclusion of the article. The authors apologise for any inconvenience caused.

OBJECTIVE To evaluate the association between recurrent subthreshold depressive episodes and functioning in a prospective community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS A prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n = 1,064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (Patient Health Questionnaire [PHQ]-9). Functioning (World Health Organization Disability Assessment Schedule II [WHODAS-II]) and health-related quality of life (Centers for Disease Control and Prevention [CDC] unhealthy days) at 4- and 5-year follow-up assessments were the outcome measures. RESULTS Nearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/impaired health–related quality of life was nearly three times higher (relative risk = 2.86) for participants with four subthreshold depressive episodes compared with participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/impaired health–related quality of life increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, P < 0.001). CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring, and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.

Importance: Cerebral palsy (CP) is considered a paediatric condition despite most people living into adulthood. Due to this we lack evidence in adults with CP, this includes a paucity of research examining mental health in this population. Objectives: Determine the risk of depression and anxiety in adults with a diagnosis of CP compared with an age-, sex-, and practice-matched reference group of adults without CP, using primary care data. Design, setting and participants: Retrospective longitudinal cohort study set in UK primary care. Data were analysed using Cox proportional hazards regression analyses adjusted for chronic conditions and visits to their physician. The study period ran from 1987 to 2015. Data for 1,705 adults aged 18 or older with CP and 5,115 matched adults who did not have CP were extracted. CP was identified using diagnostic codes, and each person with CP was compared with 3 age, sex and practice matched controls. Exposure: Diagnosis of CP, with a second analysis accounting for co-morbidity of intellectual disability (ID). Main outcomes: Time to diagnosis for depression or anxiety following the date of entry into the study in adults with CP (with and without ID) when compared with matched controls. Results: The mean age of the CP and matched group was 33.3 and 46.8% (n=798) were female. People with CP had an increased adjusted hazard of depression (HR 1.28, 95% CI: 1.09-1.51) and anxiety (HR 1.40, 95% CI: 1.21-1.63) when compared with the matched reference group. When we accounted for ID co-morbidity there were 363 adults with CP who also had ID (mean age 32.1, 47.6% (n=159) female) and 1342 adults with CP who did not have ID (mean age 33.6, 43.8% (n=639) female). Only those people with CP and no co-morbid ID had a higher risk of incident depression (HR 1.44: 95% CI 1.20-1.72) and anxiety (HR 1.55: 95% CI 1.28-1.87) than their matched controls. Conclusions: The results demonstrate that adults with CP have an increased risk of depression or anxiety. In particular, our results indicate that this association is driven largely by those individuals with CP with no co-occurring ID. Future work is needed in community-based samples in order to fully elucidate the causal mechanisms driving these associations.

Aim To compare the rate of falls between adults with and without cerebral palsy (CP). Method We used primary care data on 1705 adults with CP and 5115 adults without CP matched for age, sex, and general practice attended. We compared odds of experiencing a fall between adults with and without CP using conditional logistic regression. We compared the rate of falls using a negative binomial model. Results Participants were 3628 males (53%) and 3192 females (47%) (median age 29y, interquartile range 20–42y) at the start of follow‐up. Follow‐up was 14 617 person‐years for adults with CP and 56 816 person‐years for adults without CP. Of adults with CP, 15.3% experienced at least one fall compared to 5.7% of adults without CP. Adults with CP had 3.64 times (95% confidence interval [CI] 2.98–4.45) the odds of experiencing a fall compared to adults without CP. The rate of falls was 30.5 per 1000 person‐years and 6.7 per 1000 person‐years for adults with and without CP respectively (rate ratio 5.83, 95% CI 4.84–7.02) Interpretation Adults with CP are more likely to fall, and fall more often, than adults without CP. The causes and consequences of falls in adults with CP need examination.

Aim: To compare mortality rates for cardiovascular disease, cancer, and respiratory disease between adults with cerebral palsy (CP) and the general population. Method: A cohort study was conducted using data from adults with CP in England, identified through a primary care dataset (the Clinical Practice Research Datalink), with linked data on death registrations from the Office for National Statistics. Cause of death was categorised according to ICD codes. Standardised mortality ratios were calculated to compare mortality rates between adults with CP and the general population, adjusted for age, sex, and calendar-year. Results: 958 adults with CP were identified (median age at start of follow-up 31 yr; 52.5% males) and followed for a total of 7693 person-years. 142 patients (15%) died during follow-up. Adults with CP had an increased risk of death due to cardiovascular disease (SMR: 3.19, 95% CI 2.20 to 4.62) and respiratory disease (SMR: 13.59, 95% CI to 18.67), but not from malignant neoplasms (SMR: 1.42, 95% CI 0.83 to 2.45). Interpretation: We found that adults with CP in England have increased risk of death due to diseases of the circulatory and respiratory systems, supporting findings from two studies that compared cause-specific mortality rates between adults with CP in the US and the general population. Further research is required into primary and secondary prevention of cardiovascular and respiratory disease in people with CP worldwide.

Background: There is mixed evidence for an association between cardiometabolic risk factors and dementia incidence. This study aimed to determine whether different latent classes of cardiometabolic conditions were associated with dementia risk in older adults across England, the USA and China. Methods: A total of 4511 participants aged 50 and older were drawn from the English Longitudinal Study of Ageing (ELSA), 5112 from Health and Retirement Study (HRS) and 9022 from China Health and Retirement Longitudinal Study (CHARLS). Latent class analyses were performed across each dataset utilising seven baseline cardiometabolic conditions: obesity, low high‐density-lipoprotein (HDL) cholesterol, systolic and diastolic blood pressure (BP), hyperglycemia, diabetes, and inflammation. Confounder-adjusted Cox proportional hazards regressions were conducted to estimate dementia incidence by cardiometabolic latent classes. Results: Three similar cardiometabolic classes were identified across all countries: 1) ‘relatively healthy/healthy obesity’, 2) ‘obesity-hypertension’ and 3) ‘complex cardiometabolic’. Across the three samples, a total of 1,230 individuals developed dementia over a median of 6.8-12.2 years. Among ELSA and HRS participants, the ‘complex cardiometabolic’ group had a higher dementia risk when compared to the ‘healthy obesity’ groups (England: AdjHR=1.62 [95%CI=1.11–2.37]; USA: AdjHR=1.31 [95%CI=1.02–1.68]). However, in CHARLS participants, the ‘obesity-hypertension’ group had a greater risk of dementia when compared to the ‘relatively healthy’ group (AdjHR=1.28 [95%CI=1.04–1.57]). Conclusion: This study provides evidence that in western populations, complex cardiometabolic clusters are associated with higher rates of dementia incidence, whereas in a Chinese sample, a different cardiometabolic profile seems to be linked to an increased risk of dementia.

The relationship between living alone, loneliness and social isolation and how they are associated with health remains contentious. We sought to explore typologies based on shared experiences of loneliness, social isolation and living alone using Latent Class Analysis and determine how these groups may differ in terms of their physical and mental health. We used Wave 7 of the English Longitudinal Study of Ageing (n=7032, mean age 67.3) and responses to the UCLA loneliness scale, household composition, participation in social/societal activities plus frequency of contact with friends, family and relatives for the Latent Class Analysis. The optimal number of groups were identified using model fit criteria. The sociodemographic characteristics of groups and health outcomes were explored using descriptive statistics and logistic regression. We identified a 6-cluster typology: 1.) No loneliness or isolation; 2.) Moderate loneliness 3.) Living alone; 4.) Moderate isolation; 5.) Moderate loneliness, living alone 6.) High loneliness, moderate isolation (with high likelihood of living alone). Groups experiencing loneliness and/or isolation were more likely to report poorer physical and mental health even after adjusting for sociodemographic confounders, this was particularly notable for group 6. Our results indicate that different typologies of living alone, loneliness and isolation can be identified using data-driven techniques, and can be differentiated by the number and severity of issues they experience.

Background and objective: Loneliness is proposed to be linked with increased service use. This review examined the proposed association between loneliness and health and social care utilisation (HSCU) in older adults from the general population. Methods: Four databases were screened for studies that examined the association between loneliness (predictor) with HSCU (outcome) in older adults (defined as majority of sample 60 or older). Study quality was assessed with the NIH scale for observational cohorts and cross-sectional studies. Results: We identified 32 studies, of which 9 prospective studies were evaluated as being of good or good-fair quality. Two good-fair quality studies suggested that loneliness at baseline was associated with subsequent admission to a residential care home. There was emerging evidence that loneliness was associated with emergency department use (n=1), and CVD-specific hospitalisation (n=1). Once adjusted for confounders the highest quality studies found no association between baseline loneliness with physician utilisation, outpatient service utilisation, skilled nursing facility use, and planned or unplanned hospital admissions. The remaining, studies were cross-sectional, or of fair to poor quality, and inadequate to reliably determine whether loneliness was associated with a subsequent change in HSCU. Discussion and implications: There was heterogeneity in study design, measurement, and study quality. This generated an inconsistent evidence base where we cannot determine clear inferences about the relationship between loneliness and HSCU. Only one consistent finding was observed between two good-fair quality studies regarding care home admission. To determine clinical implications and make reliable inferences additional good quality longitudinal research is needed.

Objectives: To determine whether psychosocial wellbeing is associated with the health-related quality of life (HRQOL) of people with Usher syndrome. Setting: The survey was advertised online and through deafblind-related charities, support groups and social groups throughout the UK. Participants: 90 people with Usher syndrome took part in the survey. Inclusion criteria are having a diagnosis of Usher syndrome, being 18 or older and being a UK resident. Primary and secondary outcome measures: All participants took part in a survey that measured depressive symptoms, loneliness and social support ( predictors) and their physical and mental HRQOL (outcomes). Measured confounders included agerelated, sex-related and health-related characteristics. Hierarchical multiple linear regression analyses examined the association of each psychosocial wellbeing predictor with the physical and mental HRQOL outcomes while controlling for confounders in a stepwise manner. Results: After adjusting for all confounders, psychosocial well-being was shown to predict physical and mental HRQOL in our population with Usher syndrome. Increasing depressive symptoms were predictive of poorer physical (β=−0.36, p

This qualitative study evaluated a co-designed nature conservation intervention for older adults living in a retirement village. It explored if and how the intervention could support autonomous motivation to engage with nature. Participants were invited to “spot, count and record things in nature” for 6 weeks, tailoring (i.e., personalizing) this nature activity to their motivations, needs and abilities, and using resources provided (e.g., logbook). Following the intervention, semi-structured interviews were conducted with 30 participants. These interviews highlighted the wide range of barriers to engaging with the natural environment among older adults, even if it is easily accessible. Findings revealed that co-designing an intervention, tailored to different motivations, needs and abilities, providing a sense of purpose and connection, and supporting discovery and learning, can inspire older adults to spend more time engaging with nature.

Objectives: Depression and cardiometabolic abnormalities are independently associated with a high risk of dementia. This study aimed to examine the association of comorbid depressive symptoms and cardiometabolic abnormalities with risk of dementia. Methods: The sample comprised 4859 participants aged 50 or older without baseline dementia who took part in the English Longitudinal Study of Ageing (Waves 2-7). Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression tool. Cardiometabolic abnormalities were defined as three or more cardiometabolic risk factors (inflammation, central obesity, raised triglycerides, low high-density lipoprotein (HDL) cholesterol, hypertension and hyperglycaemia or diabetes). Participants were classified into four groups based on presence of depressive symptoms and cardiometabolic abnormalities. Results were analysed using Cox Proportional Hazards Regression adjusted for covariates. Results: A total of 216 cases of incident dementia were reported over 10 years of follow-up. The group with high depressive symptoms only had an increased hazard of developing incident dementia during follow-up (HR 2.68, 95% CI [1.70 - 4.23]) which was attenuated after adjustment for baseline cognition. No evidence was found for an association of overall cardiometabolic abnormalities with incident dementia, though hyperglycaemia, hypertension and abdominal obesity with depressive symptoms had an unadjusted association with incident dementia. Only low-HDL cholesterol with depressive symptoms had an adjusted association with incident dementia (HR 0.18: 95% CI [0.04 – 0.75]). Conclusions: This work confirms depressive symptoms as a risk factor for incident dementia. However, low HDL-cholesterol with depressive symptoms may be protective against dementia, though more work is required to confirm this association.

Aims: Diabetes self-care outcomes are positively impacted by social support. Understanding the mechanisms involved can inform more effective interventions. This study tested potential cross-sectional mediation of social support through self-efficacy and diabetes distress for self-care and clinical outcomes (diet, physical activity, blood glucose monitoring, HbA(1c)). Method: We analysed a sub-sample of the Australian Diabetes MILES-2 cross-sectional online survey (N =1727). Measures were: Diabetes Social Support Scale, Confidence in Diabetes Self-care Scale, Problem Areas In Diabetes scale, diet and physical activity subscales of the Summary of Diabetes Self-Care Activities, and self-reported HbA(1c). Separate mediation path models were tested for each of the four self-care/clinical outcomes in groups with type 1 and type 2 (insulinand non-insulin-treated) diabetes. Results: Social support was associated with more optimal self-care and self-reported HbA(1c) outcomes. When diabetes-specific self-efficacy and distress were included as mediators, the direct path from social support became non-significant. Conversely, the indirect effects of social support through diabetes-specific self-efficacy and distress were significant across all diabetes groups and outcomes. Conclusion: Diabetes-specific self-efficacy and distress may be important mechanisms link ing social support with diabetes self-care and clinical outcomes. Social support interventions could explore whether improving diabetes self-efficacy and decreasing diabetes distress could help improve self-care. (C) 2020 Elsevier B.V. All rights reserved.

Objectives: Determine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls.DesignRetrospective cohort study.SettingUK GPs linked into the Clinical Practice Research Datalink (CPRD). Participants:CPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with CP and 5109 matched controls were included in the analysis. The mean baseline age of participants was 33.30 years (SD: 15.48 years) and 46.8% of the sample were female. Primary outcome: New diagnosis of dementia during the follow-up period (earliest date of 1987 to latest date of 2015). Results:During the follow-up, 72 people were identified with a new diagnosis of dementia. The overall proportion of people with and without CP who developed dementia was similar (CP: n=19, 1.1%; matched controls n=54, 10.0%). The unadjusted HR suggested that people with CP had an increased hazard of being diagnosed with dementia when compared with matched controls (HR 2.69, 95% CI 1.44 to 5.00). This association was attenuated when CP comorbidities (sensory impairment, intellectual disability and epilepsy) were accounted for (HR 1.92, 95% CI 0.92 to 4.02). Conclusions: There was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia during the follow-up. Furthermore, while there was evidence for an increased hazard of dementia among people with CP, the fact that this association was attenuated after controlling for comorbidities indicates that this association may be explained by comorbidities rather than being a direct result of CP. Findings should be interpreted with caution due to the low number of incident cases of dementia.

Previous research indicates there may be an association between inflammation and depression in older adults but results are inconsistent. Therefore, the aim of this review was to determine the cross-sectional and longitudinal associations of two inflammatory markers C-reactive protein (CRP) and Interleukin-6 (IL-6) with depression in older adults. We searched five databases for cross-sectional and longitudinal studies reporting an association between CRP or IL-6 with depression among adults sampled from the community aged 50 or older. We found 32 studies (23 cross-sectional, 7 longitudinal, and 2 assessing both cross-sectional and longitudinal associations) that met eligibility criteria. These studies were entered into a random-effects meta-analysis to determine the cross-sectional association and longitudinal direction of association between both IL-6 and CRP with depression. Results indicated a cross-sectional and longitudinal association between both CRP and IL-6 with depression in older adults, with inflammation leading to depression in longitudinal studies rather than depression to inflammation. However, there was notable heterogeneity between studies as results differed based on adjusting for confounders and on how inflammation and depression were measured. These sources of heterogeneity could explain differences in study results.

Background People with cerebral palsy (CP) may be at increased risk of musculoskeletal conditions due to various factors including malnutrition and abnormal levels of skeletal loading. This study aimed to compare the incidence of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases between adults with and without CP. Methods A population based cohort study was conducted using data from the Clinical Practice Research Datalink collected between 1987 and 2015. Adults with CP were matched to adults without CP for age, sex and general practice. Cox models, stratified by matched set and adjusted for potential confounders, were fitted to compare the risk of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases. Results 1705 adults with CP were matched to 5115 adults without CP. Adults with CP had an increased risk of osteoporosis in unadjusted (Hazard Ratio (HR) 3.67, 95% Confidence Interval (CI) 2.32 to 5.80, p ˂ 0.001) and adjusted (HR 6.19, 95% CI 3.37 to 11.39, p ˂ 0.001) analyses. No evidence of increased risk of inflammatory musculoskeletal diseases was observed in unadjusted or adjusted analyses. For osteoarthritis no evidence of increased risk was seen in the unadjusted analysis, but evidence of an increased risk was seen when the analysis was adjusted for alcohol consumption, smoking status, and mean yearly general practice (GP) visits (HR 1.54, 95% CI 1.17 to 2.02, p ˂ 0.001). Conclusions After accounting for potential confounding variables, we found that CP is associated with increased risk of osteoporosis and osteoarthritis. These findings provide the strongest epidemiological evidence to date for increased risk of osteoporosis and osteoarthritis in people with CP, and highlight need for clinical awareness of such conditions in this population.

The large response to our 2017 patient survey, 2,000 in all, speaks to the need for people living with haemochromatosis to have a voice. Whilst our knowledge of the biological mechanisms at work in haemochromatosis continues to develop, little research is published on the impact of the condition on people’s lives. This report is the result of an independent expert analysis of the 2017 survey responses. It highlights the wide array of symptoms experienced by people with haemochromatosis. You will read that most of the people who responded reported debilitating symptoms including fatigue and pain, particularly those for whom diagnosis was delayed. Yet, treatment is relatively simple. The report provides support for its effectiveness in reducing some of the symptoms although for some patients, treatment is a difficult and unpleasant experience. In the report you will read about haemochromatosis patients’ experiences of healthcare. Whilst most patients are satisfied with the information and support provided by medical specialists, this is not the case with regard to their GPs. Greater awareness of recent guidelines for screening for haemochromatosis is recommended by the report authors, and we strongly support implementation of these guidelines in order to avoid delays in treatment and prevent irreversible tissue damage. At HUK, our aims are to support those with haemochromatosis and those at risk, to educate patients, families, the wider public and healthcare community about the condition in order to raise awareness of haemochromatosis, and to stimulate research into the condition and its impact on people’s lives. We hope that this report will contribute to all of these aims and, in particular, that it will encourage earlier diagnosis and stimulate much needed new research.

Background and objectives: Existing literature highlights notable health and social inequalities for people ageing with a lifelong disability and the need for research to better understand how we can support this group to age well. This scoping review mapped existing literature related to ‘ageing well’ in people with lifelong disabilities.Methods: Five scientific databases and grey literature sources were searched for studies related to ‘ageing well’ and ‘lifelong disability’ (defined as a disability that a person had lived with since birth or early childhood). Results: We identified 81 studies that discussed ageing well with a lifelong disability, with most (70%) focusing on intellectual disabilities. Two themes captured existing research on ageing well with a lifelong disability: 1.) Framing ageing well with a lifelong disability, which included the ways that people with lifelong disability, their supporters and existing research frame ageing well for this group and 2.) Supporting people to age well with a lifelong disability, which involves the micro, meso and macro-level factors where research suggests interventions to facilitate ageing well could be situated.Discussion and implications: This synthesis highlights how ageing well is currently framed in the literature and where interventions to improve ageing well in this group could be situated. Literature highlights the importance of considering multi-level interventions to improve ageing well. Evidence gaps include the lack of research conducted with groups other than those with intellectual disabilities and the need for more research examining ageing well interventions.

Objective: This study aimed to compare the incidence of non-communicable diseases between adults with and without cerebral palsy (CP). Methods: A cohort study was conducted using primary care data from the Clinical Practice Research Datalink. Cox models, stratified by matched set and adjusted for potential confounders, were fitted to compare the risk of any non-communicable disease, cancer, cardiovascular disease, type 2 diabetes, and respiratory disease between adults with and without CP. Results: The analysis included 1,705 adults with CP and 5,115 age-, sex-, and general practice matched adults without CP. There was evidence from adjusted analyses that adults with CP had 75% increased risk of developing any non-communicable disease compared to adults without CP (HR: 1·75, 95% CI 1·58 to 1·94). Specifically, they had increased risk of cardiovascular disease (HR: 1.76, 95% CI 1.48 to 2.11) and respiratory disease (HR: 2.61, 95% CI 2.14 to 3.19). There was no evidence of increased risk of cancer or type 2 diabetes. Conclusions: Adults with CP had increased risk of non-communicable disease, specifically cardiovascular and respiratory disease. These findings highlight the need for clinical vigilance regarding identification of non-communicable disease in people with CP, and further research into the etiology and management of non-communicable disease in this population.

The aim of the present study was to evaluate the interaction between depressive symptoms and metabolic dysregulations as risk factors for type 2 diabetes. The sample comprised of 2525 adults who participated in a baseline and a follow-up assessment over a 4.5-year period in the Emotional Health and Wellbeing Study (EMHS) in Quebec, Canada. A two-way stratified sampling design was used, on the basis of the presence of depressive symptoms and metabolic dysregulation (obesity, elevated blood sugar, high blood pressure, high levels of triglycerides and decreased high-density lipoprotein). A total of 87 (3.5%) individuals developed diabetes. Participants with both depressive symptoms and metabolic dysregulation had the highest risk of diabetes (adjusted odds ratio=6.61, 95% confidence interval (CI): 4.86–9.01), compared with those without depressive symptoms and metabolic dysregulation (reference group). The risk of diabetes in individuals with depressive symptoms and without metabolic dysregulation did not differ from the reference group (adjusted odds ratio=1.28, 95% CI: 0.81–2.03), whereas the adjusted odds ratio for those with metabolic dysregulation and without depressive symptoms was 4.40 (95% CI: 3.42–5.67). The Synergy Index (SI=1.52; 95% CI: 1.07–2.17) suggested that the combined effect of depressive symptoms and metabolic dysregulation was greater than the sum of individual effects. An interaction between depression and metabolic dysregulation was also suggested by a structural equation model. Our study highlights the interaction between depressive symptoms and metabolic dysregulation as a risk factor for type 2 diabetes. Early identification, monitoring and a comprehensive management approach of both conditions might be an important diabetes prevention strategy.

Research has shown that high blood glucose levels are important predictors of incident diabetes. However, they are also strongly associated with other cardiometabolic risk factors such as high blood pressure, adiposity, and cholesterol, which are also highly correlated with one another. The aim of this analysis was to ascertain how these highly correlated cardiometabolic risk factors might be associated with high levels of blood glucose in older adults aged 50 or older from wave 2 of the English Longitudinal Study of Ageing (ELSA). Due to the high collinearity of predictor variables and our interest in extreme values of blood glucose we proposed a new method, called quantile profile regression, to answer this question. Profile regression, a Bayesian nonparametric model for clustering responses and covariates simultaneously, is a powerful tool to model the relationship between a response variable and covariates, but the standard approach of using a mixture of Gaussian distributions for the response model will not identify the underlying clusters correctly, particularly with outliers in the data or heavy tail distribution of the response. Therefore, we propose quantile profile regression to model the response variable with an asymmetric Laplace distribution, allowing us to model more accurately clusters that are asymmetric and predict more accurately for extreme values of the response variable and/or outliers. Our new method performs more accurately in simulations when compared to Normal profile regression approach as well as robustly when outliers are present in the data. We conclude with an analysis of the ELSA.

This paper highlights experiences and perceptions of older gay males living with Human Immunodeficiency Virus (HIV) in relation to age, sexual orientation, HIV status and how they perceive health. Participants were gay males aged 50 and over living in England, diagnosed with HIV for longer than 2 years. In total, 19 interviews were conducted between March 2020 and March 2021. Data were analysed using thematic analysis. Three major themes were generated: 1.) Health as holistic and as a balance; 2.) The impact of HIV on people’s lives; 3.) The Intersectionality of stigma: a lifetime of discrimination. Participants highlighted the changing nature of the concept of health through their lifespan while the intersectionality of stigma in different contexts is examined considering the personal journey of living with HIV. The implications of health as a complex concept and intersectional stigma on the planning and delivering of care in this population are discussed

The review synthesised evidence examining the association between a.) loneliness with inflammation and b.) social isolation with inflammation in adults aged 16 or older from the general population. From an initial 7,400 articles we identified 14 papers that examined loneliness, and 16 that examined social isolation. Qualitative syntheses indicated mixed results, variable study quality, and methodological heterogeneity. Most studies provided associations for C-reactive protein (CRP), fibrinogen and Interleukin-6 (IL-6), and these results were synthesised using random-effects meta-analyses. There was no association between loneliness with CRP or fibrinogen, but there was a significant association between loneliness and IL-6 for most-adjusted (but not least-adjusted) analyses. There was also a significant least-adjusted association between social isolation with CRP and fibrinogen, which remained significant for fibrinogen in most-adjusted analyses. There was no association between social isolation with IL-6. Sensitivity analyses indicated that methodological heterogeneity impacted on results. Results indicate that social isolation and loneliness could be linked with systemic inflammation, but more robust methodology is needed to confirm these associations and unpack mechanisms.

Objectives: Previous research has indicated that there is an association between diabetes and anxiety. However, no synthesis has determined the direction of this association. Therefore, the aim of this study was to determine the longitudinal relationship between anxiety and diabetes. Method: We searched seven databases for studies examining the longitudinal relationship between anxiety and diabetes. Two independent reviewers screened studies from a population aged 16 or older that either a) examined anxiety as a risk factor for incident diabetes or b) examined diabetes as a risk factor for incident anxiety. Studies that met eligibility criteria were put forward for data extraction and meta-analysis. Results: In total 14 studies (n=1,760,800) that examined anxiety as a risk factor for incident diabetes and 2 studies (n=88,109) that examined diabetes as a risk factor for incident anxiety were eligible for inclusion in the review. Only studies examining anxiety as a risk factor for incident diabetes were put forward for the meta-analysis. The least adjusted (unadjusted or adjusted for age only) estimate indicated a significant association between baseline anxiety with incident diabetes (OR 1.47: 1.23-1.75). Furthermore, most-adjusted analyses indicated a significant association between baseline anxiety and incident diabetes. Included studies that examined diabetes to incident anxiety found no association. Conclusions: There was an association between baseline anxiety with incident diabetes. Results also indicate the need for more research to examine the direction of association from diabetes to incident anxiety. This work adds to the growing body of evidence that poor mental health increases the risk of developing diabetes.

Background Previous research indicated a high prevalence of disordered sleep among adults with learning disabilities, however issues with design impacted findings. The current systematic review aims to: (a) present how disordered sleep and sleep disorders amongst adults with learning disabilities are described in the literature, and (b) report on the prevalence of disordered sleep and sleep disorders among adults with learning disabilities. Methods Five databases (EMBASE, MEDLINE, PsycARTICLES, PsycINFO and PubMed) were searched for articles published from 1900 to October 2021 that examined the prevalence of disordered sleep and/or sleep disorders in adults aged 18 or older with learning disabilities. The Joanna Briggs Institute critical appraisal checklist for prevalence studies was used to assess study quality and prevalence is described and reported as ranges. The study was registered on PROSPERO (ID: CRD42019134550). Findings A total of 27 studies were selected. Twenty studies (n = 8043 participants) examined the prevalence of disordered sleep and identified prevalence ranging from 6.1% to 74.2% across a range of sleep parameters. Twelve studies examined sleep-related breathing disorders (n = 2558 participants) and identified prevalence which ranged from 0.5% to 100%. There was notable heterogeneity between studies in terms of quality, definition of disordered sleep, measurement of sleep, and study design. Conclusion There was a variable prevalence of disordered sleep among people living with learning disabilities. There were problems in meaningfully synthesising results due to heterogeneity in measurement, diagnosis, study design and study quality. Based on these limitations, we suggest that future studies should seek to utilise objective, replicable and consistent measures of sleep in this population and control for physical health factors which could influence prevalence such as epilepsy and iatrogenic effects.