Delineating and diagnosing depression and anxiety in the presence of a medical condition, such as diabetes, is complicated by the presence of overlapping symptoms that, therefore, are etiologically ambiguous. These overlapping symptoms include feelings of fatigue, concentration difficulties, restlessness, changes in appetite, irritability and autonomic arousal. The difficulty in understanding these overlapping symptoms has been proposed to lead to an underdiagnosis of depression and anxiety disorders among adults with diabetes, which is problematic given that such disorders are associated with poorer health outcomes. The goal of the current study is to test whether or not these overlapping symptoms are affected by the presence of diabetes by comparing structural models of these symptoms in adults with diabetes versus those free of major medical conditions. Participants include 226 adults with diabetes and 379 adults free of diabetes who completed a series of questionnaires assessing symptoms of depression, anxiety and health status. In addition, for adults with diabetes, the most recent hemoglobin A1c lab result was collected from patient medical records. Results indicate that overlapping symptoms were strongly related to mood for adults with and without diabetes. In conclusion, it is recommended that when these overlapping symptoms are present in adults with diabetes, depression and anxiety should be considered as possible contributors to their presence.

No description available.

This study responds to the globally increasing rate of caesarean section, and specifically to the very high rate of elective caesarean section among Taiwanese mothers as evidence suggests that such elective caesareans pose potential health risks for mothers and babies. The purpose of this study was to develop and evaluate a multi-component instrument based on the theory of planned behavior (TPB) to better understand Taiwanese pregnant women's decisions regarding their childbirth delivery options (spontaneous vaginal delivery or elective caesarean section). The study was a four-phased mixed method design. First, the TPB guided item development and instrument drafting. Second, pretesting and instrument refinement used cognitive interviewing with a small sample of Taiwanese pregnant women. Third, the instrument was administered to 310 such women to examine psychometric properties of the component scales. Fourth, the phase 3 instrument was re-administered to 30 women to estimate item stability. Confirmatory factor analyses (CFA) were used to assess construct validity of the multi-item, multi-component measurement model with LISREL 9.1. Based on the TPB, the 52-item self-administered Childbirth Delivery Options Questionnaire (CDOQ) was developed to measure three components: intention regarding delivery options, attitudes toward delivery options, and perceptions of significant others' (partner, mother, and mother-in-law) feelings about delivery options. Respondents from phase two thought that the items on the CDOQ were easy to read and comprehend; they reported favorably on the wording and formatting. Preliminary item analysis revealed that the items referring to dangerousness of delivery options did not function as intended and were dropped because they did not differentiate between the two delivery options, leaving 36 items. Test-retest reliability indicated that responses to each item were positively correlated and those referring to spontaneous vaginal delivery were more stable than those referring to elective caesarean section. Corrected item-to-total correlations and expected change in Cronbach's alpha if item deleted revealed that four items might form a measure of general social norms associated with the Taiwanese culture. The Cronbach's alphas for the components of the CDOQ ranged from .55 to .89. The measurement model incorporating the design features of the CDOQ fitted the data well using the CFA. Because serious problems with multicollinearity and suppression were revealed, Beckstead's (2012) criterion-irrelevant-variance-omitted (CIVO) regression method was used to untangle the suppressor effects when predicting intention from the other components of the CDOQ. The results indicated that attitude and partner's feelings were significant and explained the bulk of the variance in intentions. The TPB-based instrument developed here will be of considerable use to maternal-child health researchers. The findings of this study suggest that decisions regarding delivery options may be modified by interventions geared toward pregnant women's attitudes within family- and cultural-centered prenatal programs.