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Objective: To examine the associations between mental health and lifestyle in adults with type 1 and type 2 diabetes mellitus (T1DM and T2DM)., Methods: Online survey data from the cross-sectional Diabetes MILES - The Netherlands Study was analysed, including 270 adults with T1DM and 325 with T2DM. Mental health status (flourishing, moderate and languishing) in relation to diet, physical activity, alcohol consumption and smoking was analysed with ANCOVA and logistic regressions (adjusted for confounders)., Results: 47% of T1DM-, and 55% of T2DM participants reported flourishing mental health. Due to an insufficient number, participants with languishing mental health were excluded. In T2DM, participants with flourishing mental health had more optimal diet quality (mean ± SEM: 70 ± 1 vs 68 ± 1 diet quality score, p = 0.015), and physical activity levels (mean ± SEM: 3484 ± 269 vs 2404 ± 273 MET minutes/week, p = 0.001) than those with moderate mental health, but did not differ with respect to alcohol consumption and smoking. In T1DM, no significant associations were found., Conclusion: Only in T2DM, people with flourishing mental health had more optimal lifestyle behaviours compared to people with moderate mental health. Further research is needed to determine if mental health is more important for specific lifestyle behaviours, and if the mental health effect differs across diabetes types., (Copyright © 2022. Published by Elsevier Inc.)

Objective: This study aims to examine the associations between following of the Dutch dietary guidelines 2015 and elevated depressive and anxiety symptoms in adults with diabetes., Methods: Cross-sectional data of 3174 people (47% men, mean age 55 ± 14 years) with type 1 diabetes (n = 1369) and type 2 diabetes (n = 1805) participating in Diabetes MILES-The Netherlands were analysed. Following of the Dutch dietary guidelines 2015 was quantified using the Dutch Healthy Diet 2015 (DHD15)-index (12 food components; total score range 0-120 points), calculated from a 32-item food frequency questionnaire. Cases with elevated depressive and anxiety symptoms (cutoff ≥ 10) were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Cox regression models were used to estimate the prevalence ratios (PRs) adjusted for demographical, lifestyle related, clinical and biomedical factors., Results: Elevated depressive and anxiety symptoms were present in 167 (12%) and 89 (7%) of participants with type 1 diabetes and 215 (12%) and 97 (5%) of those with type 2 diabetes, respectively. In the total sample (n = 3174), a DHD15-index score in the highest quartile was associated with lower prevalence of elevated depressive symptoms, compared to the lowest quartile with an adjusted PR [95% CI] of 0.73 [0.55-0.98]. The inverse association was more pronounced among participants with type 2 diabetes and among non-smokers. There was no association with elevated anxiety symptoms (adjusted PR [95% CI]: 1.03 [0.68-1.55])., Conclusion: Closer following of the Dutch dietary guidelines 2015 was associated with a lower likelihood of elevated depressive symptoms in adults with type 2 diabetes., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Research has shown the effectiveness of mindfulness-based interventions for a variety of emotional problems in different samples, but it is unknown which factors influence this effectiveness. Therefore, the aim of the current study was: which factors (demographic, personality, and baseline levels of mindfulness skills) moderate the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT)?, Methods: Outpatients with diabetes (type 1 or type 2; N=139) and an elevated level of emotional distress participated in the Diabetes and Mindfulness (DiaMind) trial. They were randomized into MBCT (N=70) or a control group (N=69) that received treatment as usual and that was offered the intervention 6months later. Primary outcomes were anxiety, depressive symptoms, and perceived stress at post-intervention and at 6-month follow-up., Results: Mixed models analyses showed that sex, extraversion, and baseline acting with awareness were significant moderators of effectiveness. In the MBCT group, women showed larger decreases in anxiety and depression across time (large effects) compared to men (medium to small effects). For extraversion divided into quartiles, the three lowest quartiles generally exhibited large decreases in symptoms, whereas the high extraversion group showed medium (perceived stress) to small (depression) decreases., Conclusion: MBCT seems to be effective to decrease symptoms of anxiety, depression, and perceived stress for a broad range of person characteristics in patients with diabetes. However, men and those high in extraversion showed considerably lower effectiveness compared to the other groups. The small effect in high extraverts may be due to the large dropout in this subgroup., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: We examined (a) the demographic and clinical correlates of worries about hypoglycemia in adult family members of adults with diabetes, and (b) the association of these worries with measures of diabetes support., Methods: The second multinational Diabetes Attitudes, Wishes and Needs (DAWN2) study cross-sectionally surveyed 2057 family members from 17 countries. Participants completed questions about demographics, diabetes, and psychosocial functioning, including worry about overall and nocturnal hypoglycemia. Analyses included hierarchical ordinal and linear regression., Results: Eighty-five percent of family members (n=1661) were at least occasionally very worried about the risk of hypoglycemic events overall. Correlates of worries about hypoglycemia included female gender, higher age and lower education in the family member, younger age of the person with diabetes and this person being a parent or another adult (versus spouse or partner), insulin or non-insulin injectable treatment, severe or non-severe hypoglycemia in the past 12months, and family member recognition of hypoglycemia. Elevated worries about hypoglycemia had a significant independent association with increased odds of diabetes-related family arguments and family member frustration in providing helpful support (OR range 1.60-3.72). High levels of worries about hypoglycemia were associated with increased odds of attending diabetes-related health-care visits. Worries about hypoglycemia were not associated with family member involvement in diabetes care. Similar results were found for worries about nocturnal events., Conclusion: Worries about hypoglycemia were common in family members and were associated with suboptimal diabetes support. This issue therefore deserves increased clinician attention., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: There is increasing evidence that mindfulness-based interventions reduce psychological distress in various medical populations. However, it has hardly been studied if these effects are mediated by an increase in mindfulness. The aim of this study was to examine mediating effects of various mindfulness facets on effects of a Mindfulness Based Cognitive Therapy (MBCT) on perceived stress and mood., Methods: Outpatients with diabetes types 1 and 2 and low levels of emotional wellbeing were randomized into a group receiving MBCT (n=70) or a waiting-list control group (n=69). Primary outcomes were mood and perceived stress. Before, after and at follow-up (6months post intervention) relevant questionnaires were completed., Results: Mediation analysis using bootstrap resampling indicated that increases in total mindfulness and the facets observing and nonreactivity mediated the effects of the intervention on depressed and angry mood, anxiety (only observing), and perceived stress (only nonreactivity) from pre- to post-intervention. In contrast, from post-intervention to follow-up, besides total mindfulness the facets of acting with awareness and nonjudging mediated the effects on depressed, anxious, and angry mood, while only nonjudging mediated the effects on perceived stress., Discussion: The findings indicate that increases in levels of mindfulness mediate the effects of the Mindfulness-Based Cognitive Therapy in patients with diabetes. It is notable that different facets may be important for immediate change versus long-term outcome. These findings might be relevant for post-intervention care., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: The DiaMind trial showed beneficial immediate effects of mindfulness-based cognitive therapy (MBCT) on emotional distress, but not on diabetes distress and HbA1c. The aim of the present report was to examine if the effects would be sustained after six month follow-up., Methods: In the DiaMind trial, 139 outpatients with diabetes (type-I or type-II) and a lowered level of emotional well-being were randomized into MBCT (n=70) or a waiting list with treatment as usual (TAU: n=69). Primary outcomes were perceived stress, anxiety and depressive symptoms, and diabetes distress. Secondary outcomes were, among others, health status, and glycemic control (HbA1c)., Results: Compared to TAU, MBCT showed sustained reductions at follow-up in perceived stress (p<.001, d=.76), anxiety (p<.001, assessed by HADS d=.83; assessed by POMS d=.92), and HADS depressive symptoms (p=.004, d=.51), but not POMS depressive symptoms when using Bonferroni correction for multiple testing (p=.016, d=.48). No significant between-group effect was found on diabetes distress and HbA1c., Conclusion: This study showed sustained benefits of MBCT six months after the intervention on emotional distress in people with diabetes and a lowered level of emotional well-being., Trial Registration: Dutch Trial Register NTR2145, http://www.trialregister.nl., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: COPD-guidelines recommend regular evaluation of both the degree of airway obstruction and health-status to provide adequate treatment. Numerous health-status questionnaires have been developed of which the 'Clinical-COPD-Questionnaire' and the 'COPD-Assessment-Test' are best known; although highly recommended, both have several limitations regarding structure, content, and/or methodological qualities. In the present study a new COPD-specific instrument was developed to measure impairment: the 'Patient-centred-COPD-Questionnaire' (PCQ)., Methods: Six focus groups with COPD patients and (lung) health care providers from primary, secondary and tertiary (rehabilitation) care were formed to discuss aspects of COPD most relevant to patients' daily lives. Eighty candidate items were derived for explorative factor analyses (EFA) to test their psychometric properties (study I, n=541). These resulted in an 18-item scale that was further explored by confirmatory factor analyses (CFA) and construct and concurrent validity assessment (study II, n=412)., Results: EFA in study I suggested a reliable three component solution ('shortness of breath', 'acceptance of COPD' and 'confidence in care'). In study II this model was confirmed with CFA, and significant and clinically relevant correlations were found between the PCQ subscales, and other COPD specific and general health questionnaires. Furthermore, multivariate analyses of covariance revealed that more severely ill patients reported more impairment., Conclusions: The PCQ is a questionnaire with three dimensions to assess the impact of COPD on daily life that is easy to complete. For the first time, a dimension referring to 'confidence in care' is included in a tool that assesses COPD-related impairment., (© 2013.)

Objective: The metabolic syndrome is a cluster of risk factors for the development of cardiovascular disease and/or type 2 diabetes. Personality can be defined as a stable set of behavioral characteristics of a person. In this review we systematically reviewed whether different personality characteristics are associated with the risk of having or developing the metabolic syndrome., Methods: Systematic review., Results: In total 18 studies were included. Thirteen cross-sectional analyses, and ten longitudinal analyses were grouped according to personality constructs: hostility, anger, and Type A behavior, temperament, neuroticism, and Type D personality. Conflicting evidence was reported on persons with high hostility, neuroticism, or Type D personality scores to be associated with an increased metabolic syndrome prevalence and development. All significant findings do point in the same direction: a more negative, or hostile personality type is associated with an increased prevalence of metabolic syndrome and its development over time., Conclusion: There was no clear association between personality measures and the occurrence and development of the metabolic syndrome. There is, however, a cluster of risk factors that include the presence of the metabolic syndrome, as well as a more negative prone personality style, that both predispose to the development of coronary heart disease and diabetes. Future studies should investigate the role of personality measures in the development of these conditions, while taking into account metabolic syndrome, lifestyle and socio-demographic factors., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: In cardiovascular research, Type D personality (high negative affectivity and social inhibition) has been associated with a more than 3-fold increased risk of adverse health outcomes. This study examined the validity and clinical correlates of the Type D construct as assessed by the Type D Scale-14 (DS14) in type 2 diabetes patients., Methods: 1553 primary care patients with type 2 diabetes were assessed for demographic, clinical, lifestyle and psychological characteristics in 2007. A subgroup (n=1012) completed the DS14 again 1 year later., Results: The two-factor model of the Type D construct was confirmed in exploratory and confirmatory factor analyses; results were stable across gender. The Negative Affectivity (NA) and Social Inhibition (SI) subscales had adequate reliability in both men and women, as measured by Cronbach's alpha (NA=0.87, SI=0.83), lambda2 (NA=0.87/0.88, SI=0.84), corrected item-total correlations (NA 0.47-0.77, SI 0.34-0.72) and mean inter-item correlations (NA=0.50/0.51, SI=0.42). One year test-retest reliability using intraclass correlation coefficients was 0.64/0.63 for NA and 0.73/0.65 for SI. Type D and non-Type D patients did not differ in vascular history or physiological risk factors, but Type D women had a more sedentary lifestyle (p=.003). Type D patients experienced less social support and more stressful life events, loneliness, and more depressed mood, anhedonia and anxiety (p<.001 for most variables). These differences were clinically significant (Cohen's d>0.60 for most variables)., Conclusion: Type D personality can be reliably assessed in primary care patients with type 2 diabetes, and is associated with increased loneliness, stress and emotional distress in these patients., (Copyright © 2012 Elsevier Inc. All rights reserved.)