Affective Temperament and Glycemic Control – The Psychological Aspect of Obesity and Diabetes Mellitus

Abstract

Purpose Affective temperament shows innate predisposition to affective disorders and has been studied in patients with type 2 diabetes mellitus (T2DM) and obesity. Studies describing connections between depressive disorders, obesity and T2DM, show a bidirectional way in which these disorders affect each other. Given that obesity, depression, and T2DM are still growing health problems of our times, the improvement of therapeutic strategies is required. The aim of our study was to evaluate affective temperament in obese individuals with T2DM and pre-diabetes and to investigate the correlations between affective temperaments and glycemic control. Materials and Methods The study enrolled 185 obese individuals (146 females; 39 males) who were diagnosed with pre-diabetes, diabetes or without any carbohydrate disorder. For affective temperament evaluation, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) was utilized; for glycemic control, the assessment of hemoglobin A1c (HbA1c) was performed. Results We did not observe any significant differences of affective temperament between studied groups. In the group of patients with diabetes, depressive, cyclothymic and anxious temperaments positively correlated with HbA1c values indicating worse glycemic control. Inversly, hyperthymic dimension showed negative correlation with HbA1c values. Conclusion Affective temperaments may affect glycemic control in obese individuals with carbohydrate disorders. Individuals with stronger expression of cyclothymic, depressive and anxious temperaments may need more medical aid for better self-management. Hence, TEMPS-A is an easy and useful tool which may significantly improve the compliance in obese patients with carbohydrate disorders.

A bitter pill to swallow? Impact of affective temperaments on treatment adherence: a systematic review and meta-analysis

“…Though void of any pathological value per se, affective temperaments may nonetheless represent vulnerability factors towards the development of various configurations of mood [ 4 ] as well as other psychiatric disorders [ 5 ] and specific somatic conditions [ 6 – 17 ]. Affective temperaments may also affect the long-term course and treatment outcome of various conditions, although evidence modeling the relationship between affective temperaments and the prognosis of somatic diseases is tentative [ 13 , 15 , 18 , 19 ].…”

Affective temperaments show stronger impact on infertility treatment success compared to somatic factors, highlighting the role of personality focused interventions

“…Regarding the relationship between psychology and infertility, different models have evolved since the 1940s [39], starting with the since outdated psychogenetic model, which considered psychopathology and unconscious psychological processes as the sole causes of biologically unexplained infertility [40], followed by various psychosomatic models, which likewise focus on the psychological contributors of the development of infertility [39], the most intensively researched of which is the stress hypothesis, which examines the association between neuroendocrine sequalae of chronic stress and fertility problems [41]. Stress was found to be associated with uctuations in blood sugar levels, insulin resistance, obesity, hypothyroidism or hyperprolactinemia, all of which may complicate achieving pregnancy [42,43], and some of which somatic conditions have already been associated with affective temperaments [25,26,34,[44][45][46]. More recent results also suggest that the effects of stress may not be mediated by the abovementioned hormonal-biological factors, but instead operate through deterioration of health behaviours, some of which are also associated with affective temperaments [47,48], such as smoking, alcohol intake, drug use and lack of physical activity [24].…”

“…But what is even more important from clinical perspective, is that among women with infertility problems, affective temperament pro le robustly in uences the chance of getting pregnant, which implies that our results may have direct clinical consequences regarding fertility treatment. Although affective temperaments are relatively stable during the lifespan, they in uence several modi able risk factors of infertility, such as depression and anxiety [7], weight, nutrition, exercise, smoking and other self-harm behaviours [25,27], or adherence to the treatment protocol, medication, and lifestyle changes advised by the doctor [51]. Further studies are needed to understand what mediates this affective temperament-infertility treatment outcome relationship for different temperament pro les, considering psychological pathways and processes such as emotional stability and reactivity, cognitions, and behaviours.…”

“…Infertility is a disease of the reproductive system, which, according to the World Health Organization is de ned by the failure to achieve pregnancy after 12 months or more of regular, unprotected sexual intercourse [23]. Infertility has been associated with psychological factors and has also been found to be underlied by various physiological conditions, somatic diseases [23] and various lifestyle-related factors [24], some of which may also be associated with affective temperaments [25][26][27][28] which may thus directly or indirectly be involved in their development. On the other hand, via partially overlapping mechanisms, affective temperaments may also profoundly be involved in the success of infertility treatment by contributing to psychological status, compliance with infertility treatment and required lifestyle adjustments, and several other behaviours and cognitions which may in uence treatment success in general and particularly in case of assisted reproduction.…”

Adherence to dietary recommendations mediates the effect of affective temperaments on infertility treatment outcomes

“…Affective temperaments (depressive, cyclothymic, hyperthymic, irritable, and anxious) represent vulnerability factors towards the development of various psychiatric 17,18 and somatic diseases [19][20][21][22][23][24][25][26][27][28][29][30] and affect the long-term course and treatment outcome of several of these conditions 17,26,28,31 . In a previous study, we reported that affective temperaments also affect infertility treatment success 32 , and we discussed that the necessary next step is to identify the processes and factors through which they exert their in uence, and which may be modi able with psychological interventions and patient-centered, targeted therapy.…”