Annotated Bibliography Week 4 IN

Correspondence

www.thelancet.com Vol 388 August 6, 2016 561

sample of people with type 1 and type 2 diabetes was seven times higher (14·3%) than in the general p o p u l a t i o n ( 2 · 3 % ) . Pa r t i c i p a n t s with insulin-treated type 2 diabetes reported more frequent depressive symptoms (34.3%) and even more prevalent suicidal ideation (19%) than individuals with type 1 diabetes. Participants with diabetes and at least moderate depressive symptoms reported higher suicide ideation rates (>40%) than those with diabetes and no depressive symptoms (5·8%).3 The suicide rate in young men (ages 20–24 years) with type 1 diabetes is complex, understudied, and higher than the expectations of Kyvik and colleagues, 4 suggesting that the cause of death is often misclassifi ed as diabetes-related, rather than due to mental health issues or suicide. Depression is associated with increased mortality in diabetic populations. Similarly, depressive symptoms have been shown to increase mortality risk in people with diabetes but not in those without diabetes.5

These pieces emphasise the eff ect of mental health on diabetes, and further ignorance will only lead to increasing numbers of articles chronicling the ballooning costs of the diabetes epidemic. We declare no competing interests.

*Gemma C Macdonald, Lesley V Campbell [email protected]

Diabetes Centre, St Vincent’s Hospital, Sydney, NSW 2010, Australia

1 Krug EG. Trends in diabetes: sounding the alarm. Lancet 2016; 387: 1485–86.

2 Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry 2016; 3: 171–78.

3 Handley TE, Ventura AD, Browne JL, et al. Suicidal ideation reported by adults with Type 1 or Type 2 diabetes: results from Diabetes MILES-Australia. Diabet Med 2015; published online Nov 3, 2015. doi: 10.1111/dme.13022.

4 Kyvik KO, Stenager EN, Green A, Svendsen A. Suicides in men with IDDM. Diabetes Care 1994; 17: 210–12.

5 Zhang X, Norris SL, Gregg EW, Cheng YJ, Beckles G, Kahn HS. Depressive symptoms and mortality among persons with and without diabetes. Am J Epidemiol 2005; 161: 652–60.

Division of Neonatology, Erasmus University Medical Centre, Sophia Children’s Hospital, Rotterdam, the Netherlands (JVB); Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK (JVB, AS); and School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, Netherlands (JVB, AS)

1 GBD Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386: 2287–323.

2 Flenady V, Koopmans L, Middleton P, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011; 377: 1331–40.

3 Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311: 1536–46.

4 Amegah AK, Quansah R, Jaakkola JJ. Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: a systematic review and meta-analysis of the empirical evidence. PLoS One 2014; 9: e113920.

5 US Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, 2014.

Mental illness: the forgotten burden on diabetes populations?

In April, The Lancet discussed the high cost of diabetes and an urgent call for action. The Comment by Etienne Krug (April 9, p 1485)1 focuses on physical interventions without mentioning the burden of mental illness in diabetes, in which depression and diabetes distress are common. Depression also has a bidirectional relationship with type 2 diabetes, showing causative and consequential implications: mental health is an essential consideration in diabetes prevention and management.

The 2011 UN initiative aims to r e d u c e p r e m a t u r e d e a t h s f r o m non-communicable diseases. Vigo and colleagues 2 warned of large numbers of people with severe mental illness dying prematurely from non-communicable diseases. S u i c i d a l i d e a t i o n i n a l a r g e

Freedom of expression and health: is the association causal?

Article 19 of The Universal Declaration of Human Rights1 declares the right to freedom of opinion and expression as one of the fundamental human rights. The violation of human rights deserves condemnation by civilised society. Health-care workers are entrusted with the task of mitigating pain in all forms, and preventing premature death due to all causes. Clearly, homicide deserves the highest condemnation by physicians as members of civilised society. Physical or mental harming of individuals for their expression of contrary views by organised groups is the worst form of humanity; it refl ects the distortion of collective wisdom.

However, the condemnation of such events by The Lancet (May 7, p 1880)2 needs more caution. The scientific community is testing ways to study the relations between human rights and health at present,3 and evidence of an association between the two is under investigation. To upgrade one domain of human rights—ie, the right to freedom— to causal of health, is premature. The Lancet manifesto reads “Improving lives is the only end goal that matters”, but there is a fl ipside: the aim is to be achieved through scientific principles. We as professionals should not attempt to achieve our objectives through means other than evidence, delivered by robust research. In the long term it may be deleterious both for the science, and the success of the mission. I declare no competing interests.

Varun M Malhotra [email protected]

Department of Community Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana 508254, India

1 The Universal Declaration of Human Rights. UN. www.un.org/en/universal-declaration- human-rights/ (accessed May 8, 2016).

2 The Lancet. No free expression, no health. Lancet 2016; 387: 1880.

3 Hunt P, Yamin AE, Bustreo F. Making the case: what is the evidence of impact of applying human rights-based approaches to health? Health Hum Rights 2015; 17: 1–10.

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