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Publications

Journal Article Ahead of print

PubMed: 42576788 DOI: 10.1177/10998004261476233

Depression, Systemic Inflammation, and Prevalent Diabetes: A Counterfactual Mediation Analysis.

Biol Res Nurs

Authors: Samuel Akyirem, Joshua Okyere, Jonathan Bayuo, Livingstone Aduse-Poku, Emmanuel Ekpor, Precious Adade Duodu

Affiliations

  • University of Kentucky College of Nursing, Lexington, KY, USA.
  • School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, UK.
  • School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD, Australia.
  • Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
  • School of Psychology, Deakin University, Geelong, VIC, Australia.
  • The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, VIC, Australia.
  • Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, UK.

Abstract

Depression and diabetes frequently co-occur, and chronic low-grade systemic inflammation has been proposed as one of many potential factors that may account for the association between these two conditions. This study aimed to empirically examine systemic inflammation as a potential mediator of the association between depression and prevalent diabetes. This study analyzed 2015-2018 NHANES data (N = 7,583) using a counterfactual causal mediation approach. Depression was assessed via the Patient Health Questionnaire, systemic inflammation via high-sensitivity C-reactive protein, neutrophils-to-lymphocytes ratio, and platelet-to-lymphocytes ratio, and diabetes via HbA1c or self-report. Mediation effects were decomposed into natural direct effect (NDE), natural indirect effect (NIE), and total effect. Percentile bootstrapping with 1000 resampling was used to generate confidence intervals (CI). Depression was associated with 62% greater odds of prevalent diabetes (total effect: OR = 1.62, 95% CI: 1.20 - 2.24). There was a significant positive natural direct effect regarding the association between depression and prevalent diabetes (NDE: OR = 1.60, 95% CI: 1.18 - 2.19), and a positive but small natural indirect effect through systemic inflammation (NIE: OR = 1.02, 95% CI: 1.01 - 1.04). Similar findings were observed in the multiple imputed datasets. Depression is associated with greater odds of prevalent diabetes, with systemic inflammation contributing to a small but significant proportion of the observed association. Further research should assess other potential physiological or behavioral mediators that may account for the association between depression and prevalent diabetes.

MeSH

Diabetes Mellitus, Depression, Lymphocytes, C-Reactive Protein, Mediation Analysis, Nursing Research, Negotiating