Diabetes distress, depressive, and anxiety symptoms in people with type 2 diabetes: a network analysis approach to understanding comorbidity

Objective This study aimed to explore interactions between diabetes distress, depressive, and anxiety symptoms in a cohort of adults with type 2 diabetes using network analysis. Research design and methods Participants (N = 1,796) were from the Evaluation of Diabetes Insulin Treatment (EDIT) study from Quebec, Canada. A network of diabetes distress symptoms was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the 17 items of the DDS-17, the 9 depressive items of the Patient Health Questionnaire (PHQ-9), and the 7 anxiety items of the Generalized Anxiety Disorder Assessment (GAD-7). Network analysis was used to identify central symptoms, clusters of symptoms, and symptoms that may bridge between diabetes distress, depressive, and anxiety symptoms. Results Regimen-related and physician-related diabetes distress symptoms were amongst the most influential (most positive connections to others) in the diabetes distress network. Feeling like a failure (depression) was identified as a potential bridge between depression and diabetes distress, being highly connected to symptoms of diabetes distress. The anxiety symptoms of worrying too much and being unable to stop worrying were found to be bridge symptoms between both anxiety and depression symptoms, and anxiety and diabetes distress symptoms, respectively. Conclusions These findings suggest individual symptoms that might be influential to the development and maintenance of diabetes distress and mental health comorbidity in diabetes and warrant further investigation. Study limitations and potential for clinical applicability are discussed

Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews

Aims/hypothesis: Estimates of the global prevalence of type 2 diabetes vary between 6% and 9%. The prevalence of type 2 diabetes has been investigated in psychiatric populations but a critical appraisal of the existing evidence is lacking, and an overview is needed. This umbrella review summarises existing systematic reviews of observational studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder. / Methods: We searched PubMed, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews from inception to 17 January 2021 and screened reference lists of included systematic reviews. On the basis of prespecified criteria, we included systematic reviews investigating the prevalence of type 2 diabetes in adults (aged ≥18 years) with a psychiatric disorder. Titles and abstracts of 5155 identified records and full texts of 431 selected studies were screened by two independent reviewers, based on predefined eligibility criteria and an a priori developed extraction form, following the PRISMA and MOOSE guidelines. Risk of bias was assessed with the ROBIS instrument. Data extracted from primary studies were synthesised using random-effects meta-analyses. / Results: A total of 32 systematic reviews with 245 unique primary studies were identified and met inclusion criteria. Twelve had low risk of bias. They reported type 2 diabetes prevalence estimates ranging from 5% to 22% depending on the specific psychiatric disorder. We meta-analysed data for ten categories of psychiatric disorders and found the following prevalence estimates of type 2 diabetes: in people with a sleep disorder: 40%; binge eating disorder: 21%; substance use disorder: 16%; anxiety disorder: 14%; bipolar disorder: 11%; psychosis: 11%; schizophrenia: 10%; a mixed group of psychiatric disorders: 10%; depression: 9%; and in people with an intellectual disability 8%. All meta-analyses revealed high levels of heterogeneity. / Conclusions/interpretation: Type 2 diabetes is a common comorbidity in people with a psychiatric disorder. Future research should investigate whether routine screening for type 2 diabetes and subsequent prevention initiatives for these people are warranted

End of the Lone Wolf: The Typology that Should Not Have Been

This research note argues that the “lone wolf” typology should be fundamentally reconsidered. Based on a three-year empirical research project, two key points are made to support this argument. First, the authors found that ties to online and offline radical milieus are critical to lone actors' adoption and maintenance of both the motive and capability to commit acts of terrorism. Second, in terms of pre-attack behaviors, the majority of lone actors are not the stealthy and highly capable terrorists the “lone wolf” moniker alludes to. These findings not only urge a reconsideration of the utility of the lone-wolf concept, they are also particularly relevant for counterterrorism professionals, whose conceptions of this threat may have closed off avenues for detection and interdiction that do, in fact, exist

Psychiatric disorders as risk factors for the development of type 2 diabetes mellitus: An umbrella review protocol

Introduction: Numerous longitudinal studies, systematic reviews and meta-analyses have examined psychiatric disorders as risk factors for the development of type 2 diabetes mellitus. A more comprehensive overview of the area is warranted to summarise current evidence and discuss strengths and weaknesses to guide future research. / Aim: The aim of this umbrella review is to determine whether and to what extent different psychiatric disorders are associated with the development of type 2 diabetes mellitus. Furthermore, the umbrella review also assesses the evidence on potential mediating mechanisms. / Methods and analysis: The present umbrella review will consist of a comprehensive systematic search of published systematic reviews and meta-analyses of observational longitudinal studies investigating whether a psychiatric disorder is associated with the risk of developing type 2 diabetes. PubMed, Embase, PsychINFO and the Cochrane Database of Systematic Reviews will be searched, and the results will be screened for inclusion by two independent reviewers. Furthermore, the reference lists of included publications will be manually searched. Two independent reviewers will extract data and assess the methodological quality in the included systematic reviews and meta-analyses. Evidence on potential mediating mechanisms included in the systematic reviews and meta-analyses will also be reviewed. The implications of the overview will be discussed in light of the quality of the included studies, and suggestions for clinical practice and future research will be made. / Ethics and dissemination: Ethical approval is not required for this umbrella review. Our review will be submitted for publication in a peer-reviewed international journal using open access option if available. The results will also be disseminated at international conferences. / PROSPERO registration number: CRD4201809636

Investigating the DSM-5 and the ICD-11 PTSD symptoms using network analysis across two distinct samples

Objective: Posttraumatic stress disorder (PTSD) has long been debated with a recent focus on the consequences of having two different diagnostic descriptions of PTSD (i.e., the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition [DSM-5] and the International Classification of Diseases-11th Edition [ICD-11]). Research has modeled PTSD as a network of interacting symptoms according to both diagnostic systems, but the relations between the two systems remain unclear regarding which symptoms are more central or interconnected. To answer this question, the present study is the first study to investigate the combined network structure of PTSD symptoms according to both systems using validated measurements (i.e., the International Trauma Questionnaire [ITQ] and the Posttraumatic Stress Disorder Checklist 5 [PCL-5] across two distinct trauma samples [a community sample, N = 2,367], and a military sample, N = 657). Method: We estimated two Gaussian Graphical Models of the combined ICD-11 and DSM-5 PTSD symptoms across the two samples. Results: Five of the six most central symptoms were the same across both samples. Conclusions: The results underline that a combination of five symptoms representing both diagnostic systems may hold central positions and potentially be important for treatment. However, the implications depend on if the different diagnostic descriptions can be reconciled in an indexical rather than constitutive perspective.Clinical Impact Statement Five identical posttraumatic stress disorder (PTSD) symptoms representing both diagnostic systems were identified across two distinct trauma exposed samples using network analysis. These symptoms may hold important positions compared with the remaining symptoms of the network and potentially be central for treatment. However, the implications depend on whether the results can be reconciled by viewing the two diagnostic descriptions of PTSD as indexical.Stress and Psychopatholog

Encouraging public reporting of suspicious behaviour on rail networks

Ongoing targeting of mass transit networks and the challenges associated with policing these large open systems means that encouraging public vigilance and reporting on railways is a counter-terrorism priority. There is, however, surprisingly little research on motivations and barriers to cooperating with the police in this context. This paper contributes to this under-researched field by presenting the findings of a survey experiment which examined (1) the role of uncertainty as a barrier for reporting suspicious behaviour on rail networks, (2) whether drivers for cooperation established in the context of traditional crime hold for reporting suspicious behaviour at train stations, and (3) whether the UK ‘See it. Say it. Sorted’ campaign is effective in encouraging reporting. Data was collected in the UK and Denmark, national contexts with differing baseline attitudes towards the police and experiences of transit terrorist attacks, to assess the extent to which public vigilance campaigns need to be adapted to address local concerns. Results suggest that future public vigilance campaigns should address differences in lay and official definitions of suspicious behaviour to reduce uncertainty as a barrier to reporting. They also demonstrate that the influence of procedural justice on cooperation via its influence on social identification with the police holds beyond the context of community policing and reporting of traditional crime. However, other drivers are likely to be more important for determining reporting suspicious behaviour on rail networks, including perceived benefits of reporting. Theoretical and practical implications of cross-national differences and similarities in responses are discussed

End of the lone wolf: the typology that should not have been

This research note argues that the ‘lone wolf’ typology should be fundamentally reconsidered. Based on a three-year empirical research project, two key points are made to support this argument. First, the authors found that ties to online and offline radical milieus are critical to lone actors’ adoption and maintenance of both the motive and capability to commits acts of terrorism. Secondly, in terms of pre-attack behaviors, the majority of lone actors are not the stealthy and highly capable terrorists the ‘lone wolf’ moniker alludes to. These findings not only urge a reconsideration of the utility of the lone-wolf concept, they are also particularly relevant for counterterrorism professional, whose conceptions of this threat may have closed off avenues for detection and interdiction that do, in fact, exist.Seventh Framework Programme (FP7)608354 (PRIME) FP7-SEC-2013-1Security and Global Affair

Motivational Interventions in the Management of HbA1c Levels: a Systematic Review and Meta-analysis

IMS: To review the diabetes literature in order to examine the effect of motivational interventions on treatment outcome as measured by changes in glycated haemoglobin. METHODS: Relevant databases were systematically searched for randomised controlled trials in which motivational interventions were examined in relation to treatment outcome in people with type 1 and type 2 diabetes mellitus. RESULTS: The 13 studies identified for review included 1223 participants diagnosed with type 1 diabetes and 1895 participants diagnosed with type 2 diabetes. The analysis showed a 0.17% (95% CI: -0.09, 0.43%) improvement in glycemic control in people who received a motivational intervention compared to a control group, however, the effect was not statistically significant. CONCLUSIONS: The impact of motivational interventions in the management of blood glucose levels appears to be limited. However, due to the small number of studies and issues of heterogeneity caution in interpreting the present findings is advised. Moreover, the unique contribution of motivational interventions may be better assessed by outcomes such as behaviour change and other intermediate outcomes. Further research examining the delivery and focus of motivational interventions in helping people manage their diabetes is recommended. The clinical implications of the present findings are therefore uncertain pending further research

PRIME Deliverable D3.1: PReventing, Interdicting and Mitigating Extremist events: Defending against lone actor extremism

Led by UCL, the purpose of this deliverable is to set out an analytical framework, which will 1) guide and motivate the project's data collection activities; and 2) provide the 'bare frame' around which to build LAEE scripts by identifying key categories of indicators associated with LAEEs, which are theorised to signposts opportunities for the prevention, disruption or mitigation of these events. The theoretical model described herein, based on prior work by the first author (Bouhana, UCL) is intended for use as a risk analysis framework (i.e. a model which sets out the relationships between categories of risk factors and indicators at different analytical levels)

Psychiatric disorders as risk factors for the development of type 2 diabetes mellitus: an umbrella review protocol

Contains fulltext : 205521.pdf (publisher's version ) (Open Access)INTRODUCTION: Numerous longitudinal studies, systematic reviews and meta-analyses have examined psychiatric disorders as risk factors for the development of type 2 diabetes mellitus. A more comprehensive overview of the area is warranted to summarise current evidence and discuss strengths and weaknesses to guide future research. AIM: The aim of this umbrella review is to determine whether and to what extent different psychiatric disorders are associated with the development of type 2 diabetes mellitus. Furthermore, the umbrella review also assesses the evidence on potential mediating mechanisms. METHODS AND ANALYSIS: The present umbrella review will consist of a comprehensive systematic search of published systematic reviews and meta-analyses of observational longitudinal studies investigating whether a psychiatric disorder is associated with the risk of developing type 2 diabetes. PubMed, Embase, PsychINFO and the Cochrane Database of Systematic Reviews will be searched, and the results will be screened for inclusion by two independent reviewers. Furthermore, the reference lists of included publications will be manually searched. Two independent reviewers will extract data and assess the methodological quality in the included systematic reviews and meta-analyses. Evidence on potential mediating mechanisms included in the systematic reviews and meta-analyses will also be reviewed. The implications of the overview will be discussed in light of the quality of the included studies, and suggestions for clinical practice and future research will be made. ETHICS AND DISSEMINATION: Ethical approval is not required for this umbrella review. Our review will be submitted for publication in a peer-reviewed international journal using open access option if available. The results will also be disseminated at international conferences. PROSPERO REGISTRATION NUMBER: CRD42018096362