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Biomedical subjects

Gregory Simon

Publications and source records attributed to Gregory Simon.

23 records · Page 2Linked to original sources
PubMedDate not supplied

Panic episodes among patients with diabetes.

OBJECTIVE: The objective of this study was to examine the prevalence of panic episodes in persons with diabetes and the demographic, behavioral and clinical characteristics associated with panic symptoms in persons with diabetes. METHOD: A survey mailed to 4385 patients with diabetes assessed recent experiences of panic episodes, depression, diabetes symptoms, quality of life, disability, smoking status and body mass index. Automated medical record data were used to measure diabetes treatment, hemoglobin A1c (Hb(A1c)) levels, diabetes complications and medical comorbidity. RESULTS: One hundred ninety-three (4.4%) participants reported recent panic episodes, among whom 54.5% also met criteria for major depression. After accounting for the effects of depression, panic episodes were associated with higher Hb(A1c) values, increased diabetic complications and symptoms, greater disability and lower self-rated health and functioning. CONCLUSION: Panic is strongly associated with decrements in disease status and functioning. Since panic is often comorbid with depression, efforts to address psychological disorders among persons with diabetes may need to pay increased attention to anxiety and mood disorders.

Anxiety Disorders↗
PubMedDate not supplied

Influence of patient attachment style on self-care and outcomes in diabetes.

OBJECTIVE: Difficulties collaborating with providers and important others may adversely influence self-management in patients with diabetes. We predicted that dismissing attachment style, characterized by high interpersonal self-reliance and low trust of others, would be associated with poorer self-management in patients with diabetes. METHODS: A population-based mail survey was sent to all patients with diabetes from nine primary care clinics of a health maintenance organization. We collected data on attachment style, self-care behaviors, the patient provider relationship and depression status and accessed automated diagnostic, pharmacy, and laboratory data to measure diabetes treatment intensity, medical comorbidity, glycosylated hemoglobin levels, and diabetes complications. We used logistic regression to determine whether dismissing attachment style was associated with poorer diabetes self-care behaviors, adherence to medication, smoking status, and higher glycosylated hemoglobin. RESULTS: In 4095 primary care patients with diabetes, prevalence rates for secure, dismissing, preoccupied, and fearful attachment styles were 44.2%, 35.8%, 7.9%, and 12.1%, respectively. When compared with secure attachment style, dismissing attachment style was associated with significantly lower levels of exercise (p =.005), foot care (p <.05), diet (p =.001), and adherence to oral hypoglycemic medications (p <.05), and with higher rates of smoking (p <.05), and these associations were mediated through the patient-provider relationship. Preoccupied attachment style, characterized by overreliance on others, was associated with a significantly lower risk of having glycosylated hemoglobin levels >8%, compared with secure attachment style. CONCLUSION: Attachment style is significantly associated with diabetes self-management and outcomes.

Adult↗
PubMedDate not supplied

An international study of the effect of physical ill health on psychiatric recovery in primary care.

OBJECTIVE: The aim of this study was to determine the association between physical morbidity and recovery from psychiatric illness in primary care. METHODS: A total of 1252 psychiatric cases were recruited using a 2-stage design from 5447 subjects presenting for primary care in 14 countries. Cases were assessed at the time of screening and 1 year subsequently. Information on physical, psychiatric, and social status was obtained using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI-PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from the patients' family practitioners. RESULTS: Medically explained somatic symptoms were strongly related to psychiatric outcome 1 year later. Whereas just over one half of patients (614 of 1078) with 4 or less medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 38% (67 of 174) in those with 5 or more medically explained symptoms. Patients with 5 or more medically explained symptoms had a 70% increase in risk of remaining a psychiatric case 1 year later after controlling for demographics, country, initial severity of psychiatric disorder, medically unexplained somatic symptoms, and social disability. CONCLUSION: Physical ill health is independently associated with psychologic outcome 1 year after a patient has been seen. The needs of these patients should receive greater attention.

Comorbidity↗
PubMedDate not supplied

Potentially modifiable factors associated with disability among people with diabetes.

OBJECTIVE: This article seeks to identify potentially modifiable factors associated with disability among people with diabetes. STUDY DESIGN AND SETTING: Among people with diabetes (N = 4357) in a large health maintenance organization, disease severity, psychologic and behavioral risk factors for disability were assessed. Disability was evaluated by the WHO Disability Assessment Scale (WHO-DAS-II), the SF-36 Social Functioning scale, and days of reduced household work. RESULTS: Depression was associated with a tenfold increase in elevated WHO-DAS-II and low SF-36 Social Functioning scores, and a fourfold increase in 20+ days of reduced household work. Minor depression and the presence of three or more diabetic complications were associated with approximately a twofold increase in disability risk. Diabetic symptoms, chronic disease comorbidity, and reduced exercise were also associated with disability. CONCLUSION: Among people with diabetes, depression, diabetic complications, and exercise are potentially modifiable factors associated with disability. This suggests that integrated, biopsychosocial approaches may be needed to understand and to ameliorate disability among people with diabetes.

Activities of Daily Living↗