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Depressive symptoms mediate the longitudinal association between diabetes and subjective cognitive decline. Findings from a semirural multi-ethnic older population in Malaysia

Johar H, Schaefer A, Su TT

Prev Med, 2023 Feb;167:107390.
PMID: 36528114 DOI: 10.1016/j.ypmed.2022.107390

The potential role of psychological distress as the pathway linking diabetes and subjective cognitive decline (SCD) is still unclear. This study aims to investigate whether depressive symptoms mediate the relationship between diabetes and SCD in older adults. Baseline data from 3428 adults (55-94 years) of the South East Asia Community Observatory (SEACO), Malaysia were utilized. Subjective cognitive complaints (SCC) were recorded at baseline and five years later. Mediation analyses with non-parametric bootstrapping methods were employed. A proportion of 20% of participants without SCC at baseline reported a decline in SCC after 5 years of follow-up. Known diabetes (β = -0.13, SE = 0.05, p = 0.02) and depressive symptoms (ß = -0.18, SE = 0.05, p = 0.001) were independently associated with SCD. Previously diagnosed diabetes was associated with depressive symptoms at baseline (ß = 0.04, SE = 0.02, p = 0.01), and greater SCD at follow-up (β = -0.19, SE = 0.06, p = 0.001). Mediation analyses revealed that 9% of the association between diabetes and SCD was attributable to an indirect effect through depressive symptoms (ß = -0.01, 95% CI 0.02-0.001, p
In Search for a Sustainable and Equitable Long-Term Care for Malaysia

Yunus RM, Johar H, Katiman D

J Aging Soc Policy, 2023 Nov 02;35(6):743-755.
PMID: 35290173 DOI: 10.1080/08959420.2022.2049575

Like many other countries across the globe, Malaysia is rapidly graying. It is projected that older adults will comprise 10-15% of the country's total population in the next decade. Despite the surge in chronic diseases and a rise in dependency in daily living activities among Malaysian elders, formal support and long-term care services (LTC) have not been adequately developed. The existing tax-funded health care system - currently under huge financial strain - has no systematic or comprehensive LTC provision in place. This paper highlights the need for sustainable and equitable LTC services in Malaysia while drawing insight from existing LTC provision and financing arrangements in neighboring countries. It offers several recommendations to move forward in LTC planning using an approach that is unique to the Malaysian context.
Covid-19 pandemic induced traumatizing medical job contents and mental health distortions of physicians working in private practices and in hospitals

Ladwig KH, Johar H, Miller I, Atasoy S, Goette A

Sci Rep, 2023 Mar 31;13(1):5284.
PMID: 37002346 DOI: 10.1038/s41598-023-32412-y

The Covid-19 pandemic during its early phases posed significant psychological threats particularly for medical frontline personal. It is unclear whether the medical workforce with the passage of time has adapted to these threats or have generalized to wider medical settings. An online survey was conducted reaching 1476 physicians in Germany with valid data from 1327 participants. Depression and anxiety were screened with the PHQ-2 and the GAD-2. Among a subtotal of 1139 (86.6%) physicians reporting personal treatment experiences with Covid-19 patients, 553 (84.8%) worked in a private practice (PP) and 586 (88.3%) in a hospital (HP). Covid-19 provoked profound conflicts between professional and ethical values: more physicians in PPs than HPs reported external constraints on their medical care being in conflict with the code of medical ethics (39.1 vs. 34.4%, p
Fulltext Diabetes Treatment and Mental Illness: A Call for an Integrated Health Care System in Underserved Semi-Rural Malaysia

Thangiah G, Johar H, Ismail R, Reininghaus U, Bärnighausen T, Thurairajasingam S, et al.

Int J Environ Res Public Health, 2022 Aug 14;19(16).
PMID: 36011650 DOI: 10.3390/ijerph191610015

Diabetes mellitus (DM) management imposes a tremendous psychological burden on patients. The study investigates the association between DM treatment with blood glucose (BG) control and common mental health conditions. A cross-sectional study was conducted among 1821 individuals with DM in a community-based survey conducted in 2013. Information on respondents’ sociodemographic, mental health, DM treatment, and BG levels was collected. Multinomial logistic regression was employed to examine the association of diabetes treatment with controlled BG levels (<11.1 mmol/L) (42.5%, n = 774) or uncontrolled BG levels (34.3%, n = 625) compared with those not undergoing treatment (23.2%, n = 422) on depression anxiety, and stress. Having DM treatment and controlled BG was associated with high depressive symptoms (Relative Risk Ratio, RRR: 2.42; 95% CI 1.33−4.41) and high anxiety symptoms (1.66; 1.08−2.56) but not with perceived stress. However, treated DM with uncontrolled BG was associated with anxiety (high: 1.64; 1.05−2.56; low: 2.59; 1.10−6.09) but not depression or perceived stress. Our results suggest that being treated for DM, regardless of glucose control status, was associated with anxiety symptoms, whereas being treated with controlled BG was associated with high depressive symptoms. This situation highlights the need for integrative, multidisciplinary care for DM patients with mental health comorbidities.
Author Correction: Gender specific somatic symptom burden and mortality risk in the general population

Atasoy S, Hausteiner-Wiehle C, Sattel H, Johar H, Roenneberg C, Peters A, et al.

Sci Rep, 2022 Nov 29;12(1):20593.
PMID: 36447016 DOI: 10.1038/s41598-022-25157-7
Fulltext Gender specific somatic symptom burden and mortality risk in the general population

Atasoy S, Hausteiner-Wiehle C, Sattel H, Johar H, Roenneberg C, Peters A, et al.

Sci Rep, 2022 Sep 05;12(1):15049.
PMID: 36065007 DOI: 10.1038/s41598-022-18814-4

Gender specific all-cause mortality risk associated with a high somatic symptom burden (SSB) in a population-based cohort was investigated. The study population included 5679 women and 5861 men aged 25-74 years from the population-based MONICA/KORA Cohort. SSB was assessed following the Somatic Symptom Scale-8 and categorized as very high (≥ 95th percentile), high (60-95th percentile), moderate (30-60th percentile), and low (≤ 30th percentile). The impact of SSB on all-cause mortality risk within a mean follow-up period of 22.6 years (SD 7.1; 267,278 person years) was estimated by gender-specific Cox regression models adjusted for sociodemographic, lifestyle, somatic and psychosocial risk factors, as well as pre-existing medical conditions. Approximately 5.7% of men and 7.3% of women had very high SSB. During follow-up, 3638 (30.6%) mortality cases were observed. Men with a very-high SSB had 48% increased relative risk of mortality in comparison to men with a low SSB after adjustment for concurrent risk factors (1.48, 95% CI 1.20-1.81, p < .0001), corresponding to 2% increased risk of mortality for each 1-point increment in SSB (1.02; 95% CI 1.01-1.03; p = 0.03). In contrast, women with a very high SSB had a 22% lower risk of mortality (0.78, 95% CI 0.61-1.00, p = 0.05) and women with high SSB had an 18% lower risk of mortality (0.82; 95% CI 0.68-0.98, p = 0.03) following adjustment for concurrent risk factors. The current findings indicate that an increasing SSB is an independent risk factor for mortality in men but not in women, pointing in the direction of critical gender differences in the management of SSB, including women's earlier health care utilization than men.
The Association of Social Connectivity and Body Weight With the Onset of Type 2 Diabetes: Findings From the Population-Based Prospective MONICA/KORA Cohort

Atasoy S, Johar H, Kruse J, Lukaschek K, Peters A, Ladwig KH

Psychosom Med, 2022 10 13;84(9):1050-1055.
PMID: 36162072 DOI: 10.1097/PSY.0000000000001135

OBJECTIVE: Low levels of social connectivity are related to the onset of type 2 diabetes mellitus (T2D), and this study investigates the role of body weight in this association.
METHODS: In a sample of 9448 participants followed for a mean of 15.3 years (186,158.5 person-years) from the Monitoring of Trends and Determinants in Cardiovascular Disease Augsburg/Cooperative Health Research in the Region of Augsburg population-based cohort conducted in Germany, we investigated the association of social connectivity, measured by the Social Network Index, and body mass index (BMI) with the risk of clinically validated T2D incidence using stratified Cox proportional hazards regression models adjusted for sociodemographic, life-style, cardiometabolic, and psychosocial risk factors.
RESULTS: During a mean follow-up of 14.1 years (186,158.5 person-years), 975 (10.3%) participants developed T2D. Participants with low social connectivity developed T2D at a higher rate than socially connected participants (10.0 versus 8.0 cases/10,000 person-years); however, BMI played a significant role in the association of social connectivity with T2D ( p < .001). In comparison to their socially connected counterparts, low social connectivity was associated with a higher rate of T2D incidence in normal-weight (6.0 versus 2.0 cases/10,000 person-years), but not overweight (13.0 versus 13.0 cases/10,000 person-years) or obese participants (32.0 versus 30.0 cases/10,000 person-years). Correspondingly, Cox regression analysis showed that 5-unit increments in BMI increased the risk of T2D in socially connected participants (hazard ratio = 3.03, 95% confidence interval = 2.48-3.79, p < .001) at a substantially higher rate than in low socially connected participants (hazard ratio = 1.77, 95% confidence interval = 1.45-2.16, p < .001).
CONCLUSION: The detrimental link between low social connectivity and increased risk of T2D is substantially stronger in participants with a lower BMI.
Hypertension in the first blood pressure reading and the risk of cardiovascular disease mortality in the general population: findings from the prospective KORA study

Atasoy S, Henningsen P, Johar H, Middeke M, Sattel H, Linkohr B, et al.

J Hypertens, 2024 Mar 01;42(3):521-529.
PMID: 38088424 DOI: 10.1097/HJH.0000000000003629

BACKGROUND: The risk of cardiovascular disease (CVD) mortality in individuals with an alerting reaction, assessed by hypertension in the first blood pressure (BP) reading but normal BP in further readings, remains unknown in the general population.
METHODS AND RESULTS: In a sample of 11 146 adults (51.5% men and 48.5% women) with a mean age of 47.1 years (SD ± 12.3) from a German population-based cohort, we analyzed risk factors and CVD mortality risk associated with an alerting reaction. An alerting reaction was prevalent in 10.2% of the population and associated with sociodemographic, lifestyle, and somatic CVD risk factors. Within a mean follow-up period of 22.7 years (SD ± 7.05 years; max: 32 years; 253 201 person years), 1420 (12.7%) CVD mortality cases were observed. The CVD mortality rate associated with an alerting reaction was significantly higher than in normotension (64 vs. 32 cases/10 000 person-years), but lower than hypertension (118 cases/10 000 person-years). Correspondingly, the alerting reaction was associated with a 23% higher hazard ratio of CVD mortality than normal blood pressure [hazard ratio 1.23 (95% confidence interval 1.02-1.49), P = 0.04]. However, adjustment for antihypertensive medication use attenuated this association [1.19 (0.99-1.44), P = 0.06].
CONCLUSION: The results may warrant monitoring of an alerting reaction as a preventive measure of CVD mortality in untreated individuals with elevated first BP readings, as well as optimized treatment in treated individuals.
[Sex- and Regionalspecific Differences in Child Abuse and Violence Before the German Reunification. Results from GESA, a Multi-Cohort Study]

Fleischer T, Ulke C, Ladwig KH, Linkohr B, Johar H, Atasoy S, et al.

Psychother Psychosom Med Psychol, 2022 Dec;72(12):550-557.
PMID: 36195099 DOI: 10.1055/a-1926-7428

Results from a population-based study suggest sex-specific patterns of self-reported child maltreatment, more frequently reported in former West than East Germany. Aim of the current study was to examine these patterns in two regional samples of the former East- (SHIP, 2008 - 2012) and West German (KORA, 2013 - 2014) population. Child maltreatment was assessed using the Childhood Trauma Screener (CTS). Overall, child maltreatment was less often reported in the East German sample, compared to the West German sample. The most prominent differences were identified in self-rated emotional violence (east 6.1%, west 8.7%), physical violence (east 5.7%, west 10.3%) and physical neglect (east 10.0%, west 19.2%). However, we could not find differences in sex-specific patterns between the East and West German samples. Results were discussed within a historical context, since the events took place before the German reunification in two oppose political systems.