Norbert Schmitz

Centre de recherche du diabète de Montréal, Montréal, Quebec, Canada

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Publications (217)702.84 Total impact

  • Rachel J Burns · Sonya S Deschênes · Norbert Schmitz
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    ABSTRACT: Background Individuals with diabetes are at increased risk of elevated depressive symptoms, and social support has been identified as a key factor in the health of this population. Cross-sectional associations between depressive symptoms and social support have been demonstrated. Three classes of hypotheses differentially describe the direction of this association: (1) depressive symptoms influence social support, (2) social support influences depressive symptoms, and (3) reciprocal associations exist between depressive symptoms and social support. Purpose The aim of this study was to compare these hypotheses. Methods Depressive symptoms and social support were measured via telephone survey in a large cohort study of individuals with diabetes (n = 1754) in Quebec, Canada. After baseline, data were collected annually for 4 years. Path models depicting each hypothesis, as well as a stability model containing only autoregressive effects, were generated, and model fit was compared with Akaike’s Information Criterion (AIC). Results The reciprocal model was selected as the best fitting model because it had the lowest AIC. This model demonstrated that depressive symptoms predicted subsequent social support at all time points and that social support predicted subsequent depressive symptoms at most time points. Conclusions It appears that the association between depressive symptoms and social support in people with diabetes is best characterized as reciprocal. Results underscore the importance of directly comparing competing hypotheses and offer a more accurate depiction of the association between depressive symptoms and social support among people with diabetes.
    No preview · Article · Dec 2015 · Annals of Behavioral Medicine
  • Sonya S. Deschênes · Rachel J. Burns · Norbert Schmitz
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    ABSTRACT: Background: Type 2 diabetes is associated with limitations in day-to-day functioning and with symptoms of anxiety. Though cross-sectional associations between anxiety and functioning in individuals with type 2 diabetes have been reported, the temporal dynamics of these associations are unclear. This study examined the longitudinal cross-lagged associations between anxiety symptoms and functioning in a community sample of individuals with type 2 diabetes. Methods: Data were from the Evaluation of Diabetes Treatment Study, a community-based observational study of 1,691 adults with type 2 diabetes. Anxiety symptoms and functioning were assessed with the Generalized Anxiety Disorder Scale-7 and the World Health Organization Disability Assessment Schedule 2.0, respectively, at baseline and every following year for three years. A cross-lagged path analysis accounting for autoregressive effects, sociodemographic factors, and health-related covariates was conducted using structural equation modeling. Results: Our model demonstrated good fit with the data (comparative fit index > .99, χ(2) (6) = 11.44, p = .08, root mean square error of approximation = 0.02). Path coefficients indicated that elevated anxiety was associated with subsequent poor functioning (βs ranging from .05 to .16, ps < .04) and that poor functioning was associated with subsequent elevated anxiety (βs ranging from .13 to .19, ps < .001). The addition of depressive symptoms as a covariate did not affect model fit, though not all cross-lagged path coefficients remained statistically significant; paths were strongest and most consistent between poor functioning and subsequent elevated anxiety. Conclusions: Anxiety symptoms and functioning seem to be reciprocally related among individuals with type 2 diabetes, independently of depressive symptoms.
    No preview · Article · Dec 2015 · Journal of Diabetes
  • N Schmitz · S Deschênes · R Burns · K J Smith
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    ABSTRACT: Background: The aim of this study was to evaluate the dynamic association between depressive symptoms and glycated hemoglobin A1c (HbA1c) levels using data from the English Longitudinal Study of Ageing (ELSA). Method: The sample was comprised of 2886 participants aged ⩾50 years who participated in three clinical assessments over an 8-year period (21% with prediabetes and 7% with diabetes at baseline). Structural equation models were used to address reciprocal associations between depressive symptoms and HbA1c levels and to evaluate the mediating effects of lifestyle-related behaviors and cardiometabolic factors. Results: We found a reciprocal association between depressive symptoms and HbA1c levels: depressive symptoms at one assessment point predicted HbA1c levels at the next assessment point (standardized β = 0.052) which in turn predicted depressive symptoms at the following assessment point (standardized β = 0.051). Mediation analysis suggested that both lifestyle-related behaviors and cardiometabolic factors might mediate the association between depressive symptoms and HbA1c levels: depressive symptoms at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted HbA1c levels 4 years later. A similar association was observed for the other direction: HbA1c levels at baseline predicted lifestyle-related behaviors and cardiometabolic factors at the next assessment, which in turn predicted depressive symptoms 4 years later. Conclusions: Our results suggest a dynamic relationship between depressive symptoms and HbA1c which might be mediated by both lifestyle and cardiometabolic factors. This has important implications for investigating the pathways which could link depressive symptoms and increased risk of diabetes.
    No preview · Article · Dec 2015 · Psychological Medicine
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    ABSTRACT: Specialized Early Intervention services (SEI) for first episode psychosis are shown to be effective for the treatment of positive and negative symptoms, medication adherence, rates of relapse, substance abuse disorders, functional outcome and quality of life at two-year treatment follow up. However, it is also reported that these benefits are not maintained when SEI is not sustained. The objective of this trial is to test the efficacy of a 3-year extension of a SEI service (following 2 years of SEI prior to randomization) for the maintenance and consolidation of therapeutic gains as compared to regular care in the community. Following an initial 2 years of SEI, patients are randomized to receive either 3-years of continued SEI or regular care. SEI provided at three sites within the McGill network of SEI services, using a model of treatment comprised of: modified assertive case management; psycho education for families; multiple family intervention; cognitive behavioural therapy; and substance abuse treatment and monitoring. Blinded research assistants conduct ongoing evaluation of the outcome variables every three months. The primary outcome measure is remission status measured both as the proportion of patients in complete remission and the mean length of remission achieved following randomization during the additional three years of follow up. Based on preliminary data, it is determined that a total of 212 patients are needed to achieve adequate statistical power. Intent to treat with the last observation carried forward will be the primary method of statistical analysis. The "critical period" hypothesis posits that there is a five year window during which the effects of the nascent psychotic illness can be countered and the impact of the disorder on symptomatic and functional outcomes can be offset through active and sustained treatment. Providing SEI throughout this critical period may solidify the benefits of treatment such that gains may be more sustainable over time as compared to intervention delivered for a shorter period. Findings from this study will have implications for service provision in first episode psychosis. ISRCTN11889976.
    Full-text · Article · Dec 2015 · BMC Psychiatry
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    ABSTRACT: This study assessed predictors and changes in adequacy of help received (AHR), as perceived by 204 individuals with severe mental disorders (SMDs) transferred from a mental health institution to the community following a key healthcare reform. Adjusted perceived AHR remained stable after 2 years (T1), but decreased at 5-year follow-up (T2). Predictors of higher adjusted perceived AHR are age, severity of needs, help received from services and relatives, and number of health professionals consulted. Community mental health services need to address the two major predictors of adjusted perceived AHR: severity of needs among individuals with SMDs and level of help from services.
    No preview · Article · Oct 2015 · Administration and Policy in Mental Health and Mental Health Services Research
  • Carla Lipscombe · Rachel J Burns · Norbert Schmitz
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    ABSTRACT: Background: Moderate to severe diabetes distress (DD) is a common comorbidity among adults with type 2 diabetes. Cross-sectional studies find DD is strongly correlated with poor diabetes management, however little is known about the pattern of change of DD symptoms over long periods of time. We sought to identify and describe a set of distinct longitudinal trajectories of DD over 4 years of follow-up time. Methods: We used data derived from the Evaluation of Diabetes Treatment study (2011-2014), a longitudinal community-based survey of Canadian adults (40-75 years) with type 2 diabetes (n=1135). To determine the number and shape of trajectories, we used a latent class growth modeling approach. Results: Five distinct trajectories of DD were identified. Trajectories 1 and 2 comprised participants with persistently low (61%) or persistently low, but at risk (22%) levels of distress. Trajectory 3 (7.5%) included participants with decreasing moderate levels of distress. Trajectory 4 (6.5%) consisted of participants with increasing moderate levels of distress. Trajectory 5 (2.4%) included participants with persistently severe levels of distress. Limitations: Different populations may produce different DD trajectories and thus the generalizability of the strata identified in this report remains to be investigated. Future research is needed to determine the extent to which time-varying covariates might alter the path of DD trajectories. Conclusions: For most individuals, DD is a fairly stable condition over 4 years of follow-up time. However, for a subset of individuals, DD symptoms worsened over time. Medical health professionals might consider repeated screenings for DD in adults with type 2 diabetes.
    No preview · Article · Sep 2015 · Journal of Affective Disorders
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    ABSTRACT: With increasing age, youth with disabilities are at risk for decreased participation in leisure activities, a key component for physical and mental health. This prospective study describes changes in leisure participation and leisure preferences from school-age to adolescence in children with cerebral palsy (CP). Participants were recruited at school-age (6-12 years) for a study on participation and reassessed for a second study on adolescents (12-19 years) if >12 years. Thirty-eight children (24 males) with CP who could actively participate in the completion of the Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC) comprised the sample. Average time between assessments was 5.0±1.3 years. Most children were ambulatory (32/38 Gross Motor Function Classification System I-II). In addition to the CAPE and PAC, children were evaluated using the Gross Motor Function Measure-66 and parents completed a socio-demographic questionnaire. Paired t-tests revealed a significant decline in leisure participation diversity and intensity (CAPE) for recreation (p<.0001), skill-based (p<.0001) and self-improvement (p<.05) activities, whereas social participation remained stable (p>.05). Diversity of active-physical activities increased modestly (p=.06) although intensity of participation in this activity domain decreased (p=.003). There was also a decline in enjoyment of leisure activities. Preferences for these leisure activities remained unchanged between school-age and adolescence, except for recreational activities. Gender, maternal education, family income and gross motor ability were not related to differences in CAPE/PAC scores with increasing age. Findings suggest that over time, children with CP's participation in leisure activities diminishes, which is of concern to their functioning and well-being. Parents may be more involved in early childhood in facilitating participation whereas in adolescence, youth may be faced with more environmental barriers and a greater awareness of challenges to participation. Adolescents demonstrated a persisting desire to do these activities, challenging rehabilitation specialists to prioritize strategies to promote greater participation as children transition to adolescence. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Sep 2015 · Research in developmental disabilities
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    ABSTRACT: Aim: To investigate the effect of the neighbourhood built environment on trajectories of depression symptom episodes in adults from the general Canadian population. Research design and methods: We used 10 years of data collection (2000/01-2010/11) from the Canadian National Population Health Study (n = 7114). Episodes of depression symptoms were identified using the Composite International Diagnostic Interview Short-Form. We assessed the presence of local parks, healthy food stores, fast food restaurants, health services and cultural services using geospatial data. We used latent class growth modelling to identify different trajectories of depression symptom episodes in the sample and tested for the effect of neighbourhood variables on the trajectories over time. Results: We uncovered three distinct trajectories of depression symptom episodes: low prevalence (76.2% of the sample), moderate prevalence (19.2%) and high prevalence of depression symptom episodes (2.8%). The presence of any neighbourhood service (healthy food store, fast-food restaurant, health service, except for cultural service) was significantly associated with a lower probability of a depression symptom episode for those following a trajectory of low prevalence of depression symptom episodes. The presence of a local park was also a significant protective factor in trajectory groups with both low and moderate prevalence of depression symptom episodes. Neighbourhood characteristics did not significantly affect the trajectory of high prevalence of depression symptom episodes. Conclusions: For individuals following a trajectory of low and moderate prevalence of depression symptom episodes, the neighbourhood built environment was associated with a shift in the trajectory of depression symptom episodes. Future intervention studies are recommended to make policy recommendations.
    Full-text · Article · Jul 2015 · PLoS ONE
  • R J Burns · S S Deschênes · N Schmitz
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    ABSTRACT: To determine if longitudinal cyclical relationships exist between depressive symptoms and diabetes distress in people with Type 2 diabetes mellitus. Data were obtained from the Montreal Evaluation of Diabetes Treatment study, a cohort study of 1691 people with Type 2 diabetes mellitus. Depressive symptoms and diabetes distress, measured using the Patient Health Questionnaire and Diabetes Distress Scale, respectively, were assessed at baseline, 1 year and 2 years. A cross-lagged path model analysis with all autoregressive associations was used. Paths and indirect associations were examined. All paths in the model were significant. Depressive symptoms were positively associated with diabetes distress across consecutive time points and diabetes distress was positively associated with depressive symptoms across consecutive time points. The association between depressive symptoms at baseline on depressive symptoms at second follow-up was mediated by both depressive symptoms and diabetes distress at first follow-up. The association between diabetes distress at baseline on diabetes distress at second follow-up was also mediated by both depressive symptoms and diabetes distress. Depressive symptoms and diabetes distress are cyclically related; results suggest that depressive symptoms influence diabetes distress, which, in turn, influences depressive symptoms. Although many studies focus on the differences between depressive symptoms and diabetes distress, the present study is the first to provide longitudinal evidence that these constructs are cyclically related. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2015 · Diabetic Medicine
  • Rachel J Burns · Sonya S Deschênes · Norbert Schmitz
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    ABSTRACT: Individuals with type 2 diabetes are at greater risk of developing a number of mental health conditions, including depression, anxiety, and diabetes-related distress, than individuals without type 2 diabetes. Cross-sectional studies suggest that some coping strategies may increase the risk of mental health conditions in individuals with diabetes, whereas others may be protective. This study extends the cross-sectional evidence base with a prospective study. Data were collected annually for 2 years from a community sample of 1,742 adults with type 2 diabetes. Coping strategies were measured at baseline and mental health conditions were assessed at each time point with self-report symptom measures. For comparison, cross-sectional and prospective analyses were conducted. Cross-sectional analyses demonstrated that task-oriented coping was negatively associated with the likelihood of each of the mental health conditions, emotion-oriented coping was positively associated with the likelihood of each condition, and avoidance-oriented coping showed no association. Prospective analyses revealed that among individuals who did not have elevated depressive symptoms at baseline, only emotion-oriented coping predicted the likelihood of developing major depression syndrome during follow-up. Similar patterns of results were observed for elevated anxiety symptoms and diabetes-related distress. Cross-sectional results differed from prospective results. Only emotion-oriented coping appears to play a role in the development of depressive symptoms, anxiety symptoms, and diabetes-related distress. Results underscore the importance of examining prospective associations and suggest that interventions targeting specific coping strategies might alleviate mental health problems in individuals with type 2 diabetes. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    No preview · Article · Jul 2015 · Health Psychology
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    A Blair · G Gariépy · N Schmitz
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    ABSTRACT: The purpose of this study was to assess how longitudinal changes in neighbourhood material and social deprivation affect distress outcomes in adult Canadians. This study used a prospective cohort approach. We paired data from 2745 urban participants of Canada's National Population Health Survey-who completed the Kessler 6-Item psychological distress screening tool at baseline and follow-up-with neighbourhood social and material deprivation data from the census-based Pampalon Deprivation Index. Data were paired using participants' postal code. We conducted multiple linear regression models, which were stratified by baseline deprivation level and controlled for key confounders. Most participants lived in neighbourhoods that did not change drastically in social or material deprivation level during the six years between baseline and follow-up. We found that a worsening of material settings was significantly associated with worsening distress scores at follow-up. This finding is discussed in the context of existing literature, and made relevant for urban health research and policy. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
    Full-text · Article · Jun 2015 · Public health
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    ABSTRACT: To describe the demographic, lifestyle, and health characteristics of people with prediabetes compared to people with normal glucose levels or diabetes. Participants were from the English Longitudinal Study of Aging 2004-2005 (n=4168). Statistical analyses examined differences between people with prediabetes and 1) people with normal glucose levels and 2) people with diabetes. Design-based F-statistics and t-tests tested differences for each characteristic individually and multinomial logistic regression examined the adjusted associations. Survey weighting and cluster information was used to generalize to the older English population. Compared to people with normal glucose levels, people with prediabetes were older (RR=1.05 95% CI 1.04-1.07), more likely to be employed (RR=1.27 95% CI 1.01-1.60), more likely to smoke (RR=2.21 95% CI 1.74-2.80), and had higher BMIs (RR=1.08 95% CI 1.06-1.10). Compared to people with diabetes, people with prediabetes were more likely to be women (RR=2.12 95% CI 1.57-2.86), more likely to be employed (RR=1.54 95% CI 1.02-2.33), had lower BMIs (RR=0.95 95% CI 0.93-0.98), were less likely to have a cardiovascular condition (RR=0.34 95% CI 0.24-0.47), and had higher self-rated health (χ2=26.08, p<0.001). People with prediabetes have a unique set of characteristics that may inform prevention or intervention schemes. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · May 2015 · Preventive Medicine
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    ABSTRACT: Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increases the fetus' risk for a variety of disorders in adulthood. Animal studies testing the fetal programming hypothesis find that maternal glucocorticoids pass through the placenta and alter fetal brain development, particularly the hypothalamic-pituitary-adrenal axis. However, there are no prospective studies of pregnant women exposed to a sudden-onset independent stressor that elucidate the biopsychosocial mechanisms responsible for the wide variety of consequences of prenatal stress seen in human offspring. The aim of the QF2011 Queensland Flood Study is to fill this gap, and to test the buffering effects of Midwifery Group Practice, a form of continuity of maternity care. In January 2011 Queensland, Australia had its worst flooding in 30 years. Simultaneously, researchers in Brisbane were collecting psychosocial data on pregnant women for a randomized control trial (the M@NGO Trial) comparing Midwifery Group Practice to standard care. We invited these and other pregnant women to participate in a prospective, longitudinal study of the effects of prenatal maternal stress from the floods on maternal, perinatal and early childhood outcomes. Data collection included assessment of objective hardship and subjective distress from the floods at recruitment and again 12 months post-flood. Biological samples included maternal bloods at 36 weeks pregnancy, umbilical cord, cord blood, and placental tissues at birth. Questionnaires assessing maternal and child outcomes were sent to women at 6 weeks and 6 months postpartum. The protocol includes assessments at 16 months, 2½ and 4 years. Outcomes include maternal psychopathology, and the child's cognitive, behavioral, motor and physical development. Additional biological samples include maternal and child DNA, as well as child testosterone, diurnal and reactive cortisol. This prenatal stress study is the first of its kind, and will fill important gaps in the literature. Analyses will determine the extent to which flood exposure influences the maternal biological stress response which may then affect the maternal-placental-fetal axis at the biological, biochemical, and molecular levels, altering fetal development and influencing outcomes in the offspring. The role of Midwifery Group Practice in moderating effects of maternal stress will be tested.
    Full-text · Article · May 2015 · BMC Pregnancy and Childbirth
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    ABSTRACT: To examine the association between moderate and severe diabetes distress (DD) and lifestyle behaviors (physical activity, smoking, alcohol consumption) in a community sample of adults with type 2 diabetes mellitus. A total of 1, 971 adults with type 2 diabetes were recruited using mixed methods sampling. Participants were considered eligible if they had a doctor diagnosis of type 2 diabetes (≤10 years), were insulin-naïve, between 40 and 75 years of age and from Quebec, Canada. Participants provided information on DD, lifestyle behaviors, socio-demographic and diabetes related factors. A series of multinomial logistic regressions examined the association between moderate and severe DD and each lifestyle behavior, according to gender. Effect estimates can be interpreted as probability ratios (PR). The prevalence of moderate to severe DD was 23%. In females, physical inactivity was associated with an increased likelihood of moderate distress (PR: 2.2 (1.49-3.24)) and severe distress (PR: 1.80 (1.00-3.24)). In males, only severe distress was associated with physical inactivity (PR: 1.92 (1.00-3.66)). Current smoking was associated with a greater probability of severe distress in both males and females; however this effect was stronger in male smokers (PR: 3.0 (1.54-5.84) than female smokers (PR: 1.32 (0.67-2.60)). No association was found between alcohol consumption and DD in females, however, in males, frequent alcohol consumption was associated with a reduced probability of moderate (PR: 0.56 (0.34-0.91)) and severe distress (PR: 0.47 (0.21-1.06)). The findings in this report suggest important gender differences in the association between DD and lifestyle behaviors. This article is protected by copyright. All rights reserved.
    No preview · Article · Apr 2015 · Journal of Diabetes
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    ABSTRACT: Comorbid depression and cardiometabolic abnormalities might represent an important subgroup of depression. The aim of the present study was to evaluate lifestyle and health-related characteristics of individuals with both depressive symptoms and cardiometabolic abnormalities. Data were from the English Longitudinal Study of Ageing. The sample was comprised of 5365 adults aged 50-80 years. High depressive symptoms were based on the eight-item Center for Epidemiologic Studies - Depression scale. Cardiometabolic abnormalities were defined as having ≥3 cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, hypertriglyceridemia, and central obesity). Four groups were created based on Center for Epidemiologic Studies - Depression scores and cardiometabolic abnormalities: those with (i) comorbid depressive symptoms and cardiometabolic abnormalities (DCM); (ii) depressive symptoms only (DnoCM); (iii) cardiometabolic abnormalities only; and (iv) neither depressive symptoms nor cardiometabolic abnormalities. Lifestyle and health-related characteristics of the four groups were compared using chi-square tests. A modified Poisson regression analysis was performed to compare the DCM and the DnoCM groups with respect to lifestyle and health-related characteristics. Those in the DCM group were significantly less physically active (p = 0.003), had poorer self-rated health (p < 0.001), had lower income (p = 0.001), and were more likely to be retired (p < 0.001) than those in the DnoCM group. The pattern of results remained after controlling for other lifestyle and health-related factors. These results provide support for a cardiometabolic subgroup of depression that is associated with physical inactivity, poorer self-rated health, lower income, and retirement. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    No preview · Article · Apr 2015 · International Journal of Geriatric Psychiatry
  • Sonya S Deschênes · Rachel J Burns · Norbert Schmitz
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    ABSTRACT: Previous research has demonstrated that comorbid depression and chronic physical health conditions are associated with disability. The distinction between persistent and transient depression in the relationship between physical health conditions and disability, however, is poorly understood. The present study examined the interactive effects of major depressive disorder (MDD) and chronic physical health conditions on disability in a community sample; the effects of persistent or transient depression on disability were also examined. Participants were from the Epidemiological Catchment Area of Montreal South-West Study (total N=2202). Past 12-month MDD, chronic physical conditions, functional disability, and disability days experienced within the past month were concurrently assessed. A subsample (n=1226) was used to examine the persistence of depression across three waves of data collection over approximately six years. Individuals with comorbid MDD and chronic physical health conditions were approximately thirteen times more likely to have moderate to severe functional disability and had the highest mean number of disability days compared to those without MDD or a chronic physical health condition. Persistent MDD was most strongly associated with functional disability and disability days, and persistence of MDD interacted with physical health conditions to increase likelihood of concurrent disability. Our study is limited by a single assessment point for disability and chronic health conditions and by the use of self-report. Our findings suggest that MDD, particularly when persistent, is associated with disability among individuals with a broad range of chronic physical health conditions. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Mar 2015 · Journal of Affective Disorders
  • John Lyne · Ridha Joober · Norbert Schmitz · Martin Lepage · Ashok Malla
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    ABSTRACT: AimDuration of untreated psychosis (DUP) has been associated with negative symptoms in several studies; however, longitudinal findings have been inconsistent. No previous study has accounted for active psychosis after presentation, although this could impact on outcomes in a manner similar to DUP.Methods We measured Scale for the Assessment of Positive Symptoms at frequent intervals during the 12 months after initial presentation to determine the active psychosis duration for 230 individuals with first-episode psychosis. This duration was added to DUP prior to presentation to create a new variable, duration of active psychosis (DAP). Negative symptoms were divided into expressivity and motivation/pleasure domains as measured by Scale for the Assessment of Negative Symptoms (SANS). The relationship of DUP and DAP with negative symptoms at 24-month follow up was determined and confounders controlled for using regression analysis.ResultsWhen DUP and DAP were compared as binary variables with long and short groups, 25.2% of individuals had differing category membership. DAP had a significant uncorrected association with both expressivity domain and motivation/pleasure domains at 24 months; however, relationship with DUP was not significant. DAP remained a significant predictor of 24-month expressivity domain after controlling for potential confounders.Conclusions Active psychosis after presentation is substantial, which is a limitation of DUP studies if active psychosis is considered as the key factor within DUP. DAP is a better predictor of negative symptoms than DUP at 2-year follow up, which suggests this concept requires further research.
    No preview · Article · Feb 2015 · Early Intervention in Psychiatry

  • No preview · Article · Jan 2015 · Journal of Diabetes
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    Full-text · Article · Jan 2015 · Journal of Psychosomatic Research
  • B. Au · K. J. Smith · N. Schmitz
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    ABSTRACT: Introduction Depressive symptoms are associated with increased risk of incident diabetes. Inflammatory mechanisms have been suggested to be involved in depression and diabetes. Specifically, increased levels of C-reactive protein (CRP), a biomarker for inflammation, is associated with depression and have also been linked to risk of developing diabetes. Objective To assess the association of both CRP and depressive symptomatology with diabetes incidence in a representative sample of English people ≥50 years old. Methods Participants were 5475 community-dwelling men and women without diabetes at baseline from the English Longitudinal Study of Ageing (ELSA). Wave 2 of ELSA was used as baseline (first assessment of CRP), with assessment of diabetes incidence at waves 3, 4, and 5. Elevated depressive symptoms were based on a score ≥4 using the 8-item Center for Epidemiologic Studies Depression (CES-D) scale, and high CRP level was defined as >3 mg/L. Diabetes incidence was indicated by self-reported doctor diagnosis. Association of diabetes incidence with baseline CRP and depressive symptomatology groups was examined using multivariate logistic regression adjusted for socio-demographic, lifestyle, metabolic, and health variables. Results In comparison to participants with normal CRP levels and low depressive symptoms, those with both high CRP and elevated depressive symptoms were more likely to develop diabetes over 6 years of follow-up (adjusted OR: 1.90, 95% CI: 1.10–3.30). Individuals with high CRP and low depressive symptoms (adjusted OR: 1.26, 95% CI: 0.89–1.78) and those with normal CRP and elevated depressive symptoms (adjusted OR: 1.55, 95% CI: 0.88–2.73) were not associated with diabetes incidence. Conclusion People with high CRP and elevated depressive symptoms are more likely to develop diabetes. Further analyses will examine the possible interactions between CRP and depression with diabetes incidence.
    No preview · Article · Jan 2015 · Journal of Epidemiology & Community Health

Publication Stats

3k Citations
702.84 Total Impact Points


  • 2012-2015
    • Centre de recherche du diabète de Montréal
      Montréal, Quebec, Canada
    • McMaster University
      Hamilton, Ontario, Canada
    • McGill University Health Centre
      Montréal, Quebec, Canada
  • 2006-2015
    • McGill University
      • Department of Psychiatry
      Montréal, Quebec, Canada
    • University of Toronto
      • Department of Psychiatry
      Toronto, Ontario, Canada
  • 2009-2011
    • Douglas Mental Health University Institute
      • Psychiatry
      Montréal, Quebec, Canada
  • 1997-2010
    • Heinrich-Heine-Universität Düsseldorf
      • Clinical Institute of Psychosomatic Medicine and Psychotherapy
      Düsseldorf, North Rhine-Westphalia, Germany
    • Technische Universität Dortmund
      Dortmund, North Rhine-Westphalia, Germany
  • 1999
    • Martin Luther University of Halle-Wittenberg
      • Clinic for Psychiatry, Psychotherapy and Psychosomatics
      Halle, Saxony-Anhalt, Germany
  • 1993-1995
    • Ruhr-Universität Bochum
      • Abteilung für Medizinische Psychologie und Medizinische Soziologie
      Bochum, North Rhine-Westphalia, Germany