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Peripheral neuropathy and depressive symptoms: examining the association in a primary health care setting among persons with and without diabetes mellitus

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Abstract

Purpose

The purpose of this study was to measure the association between peripheral neuropathy symptoms and depressive symptoms among a sample of patients with and without diabetes mellitus (DM).

Methods

Patients were administered the 15-item Michigan Neuropathy Screening Instrument (MNSI) and the patient health questionnaire depression scale (PHQ-8). Patients with an MNSI score ≥ 4 were categorized as having PN and patients with a PHQ-8 score ≥ 10 were considered to have current depression. Log-binomial regression was used to analyze the relationship between PN and depressive symptoms.

Results

406 patients were included in the final analysis. There were no statistically significant differences by diabetes status in PN symptoms (Diabetes = 61.8%; No diabetes = 55.4%; p = .20) or in depression status (Diabetes = 37.6%; No diabetes = 36.6%; p =  .83). After adjustment for covariates, PN was associated with depression (aRR = 4.46; 95% CI 2.91,6.85) independent of diabetes status.

Conclusions

PN symptoms may be common among aging persons even in the absence of DM. Past literature and our study demonstrate that PN and depression are closely associated. More work is needed to understand the etiology and potential utility of intervention for depression symptoms among patients with neuropathy.

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Data availability

Data used for this study was not deidentified because it was analyzed on-site at a medical facility. Data for this study are not allowed to be analyzed outside of the Waco Family Health Center.

Code availability

SAS code will be made available upon request.

References

  1. Juster-Switlyk, K., & Smith, A. G. (2016). Updates in diabetic peripheral neuropathy. F1000 Research. https://doi.org/10.12688/f1000research.7898.1.

    Article  PubMed  Google Scholar 

  2. Gregg, E. W., Sorlie, P., Paulose-Ram, R., et al. (2004). Prevalence of lower-extremity disease in the US adult population ≥40 years of age with and without diabetes: 1999–2000 National Health and Nutrition Examination Survey. Diabetes Care, 27(7), 1591–1597. https://doi.org/10.2337/diacare.27.7.1591.

    Article  PubMed  Google Scholar 

  3. Stino, A. M., & Smith, A. G. (2017). Peripheral neuropathy in prediabetes and the metabolic syndrome. Journal of Diabetes Investigation, 8(5), 646–655. https://doi.org/10.1111/jdi.12650.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ylitalo, K. R., Sowers, M., & Heeringa, S. (2011). Peripheral vascular disease and peripheral neuropathy in individuals with cardiometabolic clustering and obesity. Diabetes Care, 34(7), 1642–1647. https://doi.org/10.2337/dc10-2150.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Miscio, G., Guastamacchia, G., Brunani, A., Priano, L., Baudo, S., & Mauro, A. (2005). Obesity and peripheral neuropathy risk: a dangerous liaison. Journal of the Peripheral Nervous System, 10(4), 354–358. https://doi.org/10.1111/j.1085-9489.2005.00047.x.

    Article  PubMed  Google Scholar 

  6. Farhad, K., Traub, R., Ruzhansky, K. M., & Brannagan, T. H. (2016). Causes of neuropathy in patients referred as “idiopathic neuropathy”: Causes of Neuropathy. Muscle and Nerve, 53(6), 856–861. https://doi.org/10.1002/mus.24969.

    Article  PubMed  Google Scholar 

  7. Gordon Smith, A., & Robinson, S. J. (2006). Idiopathic neuropathy, prediabetes and the metabolic syndrome. Journal of the Neurological Sciences, 242(1–2), 9–14. https://doi.org/10.1016/j.jns.2005.11.020.

    Article  CAS  PubMed  Google Scholar 

  8. Baron, R., Binder, A., & Wasner, G. (2010). Review neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. The Lancet Neurology, 9(8), 807–819.

    Article  Google Scholar 

  9. Boulton, A. J. M. (2005). Management of diabetic peripheral neuropathy. Clinical Diabetes, 23(1), 9–15. https://doi.org/10.2337/diaclin.23.1.9.

    Article  Google Scholar 

  10. Vileikyte, L., Leventhal, H., Gonzalez, J. S., et al. (2005). Diabetic peripheral neuropathy and depressive symptoms: The association revisited. Diabetes Care, 28(10), 2378–2383. https://doi.org/10.2337/diacare.28.10.2378.

    Article  PubMed  Google Scholar 

  11. Vileikyte, L., Peyrot, M., Gonzalez, J. S., et al. (2009). Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: A longitudinal study. Diabetologia, 52(7), 1265–1273. https://doi.org/10.1007/s00125-009-1363-2.

    Article  CAS  PubMed  Google Scholar 

  12. Bai, J.-W., Lovblom, L. E., Cardinez, M., et al. (2017). Neuropathy and presence of emotional distress and depression in longstanding diabetes: Results from the Canadian study of longevity in type 1 diabetes. Journal of Diabetes and Its Complications, 31(8), 1318–1324. https://doi.org/10.1016/j.jdiacomp.2017.05.002.

    Article  PubMed  Google Scholar 

  13. Gormsen, L., Rosenberg, R., Bach, F., & Jensen, T. (2010). Depression, anxiety, health-related quality of life and pain in patients with chronic fibromyalgia and neuropathic pain. European Journal of Pain, 14(2), 127.e1–127.e8. https://doi.org/10.1016/j.ejpain.2009.03.010.

    Article  Google Scholar 

  14. Yoshida, S., Hirai, M., Suzuki, S., Awata, S., & Oka, Y. (2009). Neuropathy is associated with depression independently of health-related quality of life in Japanese patients with diabetes. Psychiatry and Clinical Neurosciences, 63(1), 65–72. https://doi.org/10.1111/j.1440-1819.2008.01889.x.

    Article  PubMed  Google Scholar 

  15. Pan, S., Liu, Z.-W., Shi, S., et al. (2017). Hamilton rating scale for depression-24 (HAM-D 24) as a novel predictor for diabetic microvascular complications in type 2 diabetes mellitus patients. Psychiatry Research, 258, 177–183. https://doi.org/10.1016/j.psychres.2017.07.050.

    Article  CAS  PubMed  Google Scholar 

  16. Feldman, E. L., Stevens, M. J., Thomas, P. K., Brown, M. B., Canal, N., & Greene, D. A. (1994). A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care, 17(11), 1281–1289. https://doi.org/10.2337/diacare.17.11.1281.

    Article  CAS  PubMed  Google Scholar 

  17. Herman, W. H., Pop-Busui, R., Braffett, B. H., et al. (2012). Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: Results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. Diabetic Medicine, 29(7), 937–944. https://doi.org/10.1111/j.1464-5491.2012.03644.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B. W., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1–3), 163–173. https://doi.org/10.1016/j.jad.2008.06.026.

    Article  PubMed  Google Scholar 

  20. Wells, T. S., Horton, J. L., LeardMann, C. A., Jacobson, I. G., & Boyko, E. J. (2013). A comparison of the PRIME-MD PHQ-9 and PHQ-8 in a large military prospective study, the Millennium Cohort Study. Journal of Affective Disorders, 148(1), 77–83. https://doi.org/10.1016/j.jad.2012.11.052.

    Article  PubMed  Google Scholar 

  21. Dhingra, S. S., Kroenke, K., Zack, M. M., Strine, T. W., & Balluz, L. S. (2011). PHQ-8 Days: A measurement option for DSM-5 major depressive disorder (MDD) severity. Population Health Metrics. https://doi.org/10.1186/1478-7954-9-11.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Spiegelman, D., & Easy, S. A. S. (2005). Calculations for risk or prevalence ratios and differences. American Journal of Epidemiology, 162(3), 199–200. https://doi.org/10.1093/aje/kwi188.

    Article  PubMed  Google Scholar 

  23. D’Amato, C., Morganti, R., Greco, C., et al. (2016). Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities. Diabetes & Vascular Disease Research, 13(6), 418–428. https://doi.org/10.1177/1479164116653240.

    Article  Google Scholar 

  24. Rekleiti, M., Sarafis, P., Saridi, M., et al. (2013). Investigation of depression in greek patients with diabetic peripheral neuropathy. Global Journal of Health Science, 5(5), 107–114. https://doi.org/10.5539/gjhs.v5n5p107.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Raval, A., Dhanaraj, E., Bhansali, A., Grover, S., & Tiwari, P. (2010). Prevalence & determinants of depression in type 2 diabetes patients. Indian Journal of Medical Research, 132(2), 195.

    PubMed  Google Scholar 

  26. Stankovik, Ž. (2010). Psychosocial and clinical variables associated with depression in patients with type 2 diabetes. Psychiatria Danubina, 23(1), 11.

    Google Scholar 

  27. Ishizawa, K., Babazono, T., Horiba, Y., et al. (2016). The relationship between depressive symptoms and diabetic complications in elderly patients with diabetes: Analysis using the Diabetes Study from the Center of Tokyo Women’s Medical University (DIACET). Journal of Diabetes and Its Complications, 30(4), 597–602. https://doi.org/10.1016/j.jdiacomp.2016.02.004.

    Article  PubMed  Google Scholar 

  28. Rodda, J., Walker, Z., & Carter, J. (2011). Depression in older adults. BMJ, 343, d5219. https://doi.org/10.1136/bmj.d5219.

    Article  PubMed  Google Scholar 

  29. Cuijpers, P., de Graaf, R., & van Dorsselaer, S. (2004). Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. Journal of Affective Disorders, 79(1–3), 71–79. https://doi.org/10.1016/S0165-0327(02)00348-8.

    Article  PubMed  Google Scholar 

  30. Lewis Brown, R., & Turner, R. J. (2010). Physical disability and depression: Clarifying racial/ethnic contrasts. Journal of Aging and Health, 22(7), 977–1000. https://doi.org/10.1177/0898264309360573.

    Article  PubMed  Google Scholar 

  31. Verbrugge, L. M., & Jette, A. M. (1994). The disablement process. Social Science & Medicine, 38(1), 1–14.

    Article  CAS  Google Scholar 

  32. Resnick, H. E., Vinik, A. I., Schwartz, A. V., et al. (2000). Independent effects of peripheral nerve dysfunction on lower-extremity physical function in old age: The Women’s Health and Aging Study. Diabetes Care, 23(11), 1642–1647. https://doi.org/10.2337/diacare.23.11.1642.

    Article  CAS  PubMed  Google Scholar 

  33. Karvonen-Gutierrez, C. A., & Ylitalo, K. R. (2013). Prevalence and correlates of disability in a late middle-aged population of women. Journal of Aging and Health, 25(4), 701–717. https://doi.org/10.1177/0898264313488165.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Tesfaye, S. (2019). Neuropathy in diabetes. Medicine (Baltimore), 47(2), 92–99. https://doi.org/10.1016/j.mpmed.2018.11.009.

    Article  Google Scholar 

  35. Iqbal, Z., Azmi, S., Yadav, R., et al. (2018). Diabetic peripheral neuropathy: Epidemiology, diagnosis, and pharmacotherapy. Clinical Therapeutics, 40(6), 828–849. https://doi.org/10.1016/j.clinthera.2018.04.001.

    Article  PubMed  Google Scholar 

  36. England, J. D., Gronseth, G. S., Franklin, G., et al. (2009). Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review): Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology., 72(2), 177–184. https://doi.org/10.1212/01.wnl.0000336345.70511.0f.

    Article  CAS  PubMed  Google Scholar 

  37. U.S. Preventive Services Task Force. Published Recommendations-US Preventive Services Task Force. Published June 2019. Accessed June 20, 2019. https://www.uspreventiveservicestaskforce.org/BrowseRec/Index.

  38. Pop-Busui, R., Boulton, A. J. M., Feldman, E. L., et al. (2017). Diabetic neuropathy: A position statement by the american diabetes association. Diabetes Care, 40(1), 136–154. https://doi.org/10.2337/dc16-2042.

    Article  CAS  PubMed  Google Scholar 

  39. Watson, J. C., & Dyck, P. J. B. (2015). Peripheral neuropathy: A practical approach to diagnosis and symptom management. Mayo Clinic Proceedings, 90(7), 940–951. https://doi.org/10.1016/j.mayocp.2015.05.004.

    Article  PubMed  Google Scholar 

  40. Abresch, R. T., Jensen, M. P., & Carter, G. T. (2001). Health-related quality of life in peripheral neuropathy. Physical Medicine and Rehabilitation Clinics of North America, 12(2), 461–472.

    Article  CAS  Google Scholar 

  41. Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015). Depression and quality of life in older persons: A review. Dementia and Geriatric Cognitive Disorders, 40(5–6), 311–339. https://doi.org/10.1159/000437299.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors of this study would like to thank the Waco Family Health Center for their continued partnership with the Baylor University Department of Public Health that made this study possible.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Public Health, Baylor University, One Bear Place #97343, Waco, TX, 76798, USA

    Gabriel A. Benavidez, Kelly R. Ylitalo, Beth Lanning & Matt Asare

  2. Department of Health, Human Performance, and Recreation, Baylor University, One Bear Place #97313, Waco, TX, 76798, USA

    Andrew Meyer

  3. Waco Family Health Center, 1600 Providence Dr, Waco, TX, 76707, USA

    Jackson O. Griggs

Authors
  1. Gabriel A. Benavidez
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  2. Kelly R. Ylitalo
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Correspondence to Gabriel A. Benavidez.

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Dr. Jackson Griggs currently serves as the Chief Executive Officer of the Waco Family Health Center. Besides this employment, no authors have any conflicts of interest to report.

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Benavidez, G.A., Ylitalo, K.R., Lanning, B. et al. Peripheral neuropathy and depressive symptoms: examining the association in a primary health care setting among persons with and without diabetes mellitus. Qual Life Res 29, 3297–3304 (2020). https://doi.org/10.1007/s11136-020-02579-2

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