Intellectual Disabilities Research

de Winter, C. F., Hermans, H., Evenhuis, H. M., & Echteld, M. A. (2015). Associations of symptoms of anxiety and depression with diabetes and cardiovascular risk factors in older people with intellectual disabilities. Journal of Intellectual Disabilities Research, 59, 176-185.

Depression, anxiety, diabetes, and cardiovascular disease risks have been shown to be related in the general older population.  Furthermore, they are bidirectionally related.  Though these health problems are also common among older people with ID, these relationships had not been previously studied in this population.  This study looked at the association between symptoms of depression and anxiety and cardiovascular risk factors in older people with ID.

This study encompassed 990 participants aged 50 years and older with ID, receiving formal ID care.  Screening instruments were used to identify symptoms of anxiety and depression.  Physical examinations and blood draws were used to establish components of the metabolic syndrome, peripheral arterial disease, and c-reactive protein.

Key findings / “takeaways”

The only significant association found in the study was between anxiety and diabetes in older people with ID.  This association may be bidirectional.  No other associations of depression and anxiety symptoms with cardiovascular risk factors could be proven to be significant.

It was interesting to note that etiology may also affect the relationships studied.  People with Down syndrome are often more obese and have higher body fat percentages but have fewer other cardiovascular disease risk factors than people with other causes of ID.  However, older people with Down syndrome are more prone to early dementia, the symptoms of which can resemble those of depression.  In this study, people with Down syndrome were almost three times more likely to have symptoms of depression.

What do the findings mean for students with an ID?

Cardiovascular disease risk factors increase with age.  “Students” implies being of school-age, a demographic which this study did not address.  However, the following background information was shared in the article:

  • Adolescents with ID and obesity were more likely to experience depression than those with a healthy weight, and
  • The prevalence of depression and low self-esteem seemed to be higher among overweight adolescents.

A different study found no association between depression and obesity in adults with ID and this study similarly did not find an association between depression and cardiovascular disease risk factors in seniors with ID.  However, the findings referenced in the background information suggest the need for future study, as the relationships between mood disorders and cardiovascular disease risk factors may be applicable to younger people with ID and perhaps even experienced differently than in adulthood.

What are potential implications for practice / educational programming?

In practical application, the association between anxiety and diabetes suggests that when one disorder is present in older people with ID, the other should also be screened for so preventative measures can be implemented.  Explanations of the bidirectional relationship between the conditions include:

  • People with diabetes may encounter a lot of stress and medical visits in their lives (ex: finger pricking, monitoring blood sugars, regular blood draws, hospitalization due to complications) that lead to anxiety;
  • Disturbed glucose homeostasis, elevated inflammatory cytokines, and vascular damage may cause symptoms of anxiety; and
  • Anxiety may contribute to impaired glucose tolerance.

Key definitions

Bidirectional:  functioning in two directions

Cardiovascular risk factors:  obesity, body fat percentage, diabetes, hypercholesterolemia, hypertension, metabolic syndrome, smoking, c-reactive protein, and peripheral arterial disease

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