Abstract
Objectives
Type 2 diabetes mellitus (DM) is associated with substantial impairments in workplace
function; however, the mediators of workplace performance in DM are not well characterized.
Herein, we investigate depressive symptomatology and cognitive dysfunction as mediators
of workplace productivity and hypothesize that workplace impairment is mediated principally
by cognitive dysfunction in DM.
Methods
The Motivaction study screened individuals employed across Canada for diabetes. Subjects
with impairments in glucose regulation indicative of risk for (i.e. glycated hemoglobin
[A1C] levels 5.5% to 5.9%) or the presence of (i.e. A1C≥6.0%) DM were assessed on
measures of depressive symptom severity [Patient Health Questionnaire, 9-item (PHQ-9)],
self-rated cognitive impairment [Perceived Deficits Questionnaire, 5-item (PDQ-5)],
and workplace impairment [Endicott Work Productivity Scale (EWPS)]. Multivariate regression
and mediational analyses assessed for correlations between PHQ-9, PDQ-5 and EWPS total
scores and the mediational role of self-reported cognitive dysfunction on the effect
of depressive symptom severity on workplace impairment, respectively.
Results
A total of 3627 individuals were screened, 1738 met eligibility criteria and 724 consented
to the Motivaction study; 205 subjects with impaired glucose regulation were included
in the analysis. Self-rated depressive and cognitive symptoms were positively correlated
with workplace impairment among subjects with or at risk for DM. The deleterious effects
of depressive symptomatology on workplace effectiveness was mediated principally by
cognitive dysfunction in subjects with impaired glucose tolerance.
Conclusions
Among employed Canadians, impaired glucose tolerance is highly associated with impaired
workplace performance. We report a novel finding insofar as the association between
depressive symptoms and workplace impairment in individuals with impaired glucose
regulation is mediated principally by self-rated cognitive dysfunction.
Résumé
Objectifs
Le diabète sucré de type 2 (DS) est associé à une diminution importante des capacités
reliées au travail. Toutefois, les rôles médiateurs de la performance au travail lors
de DS ne sont pas bien définis. Ci-après, nous examinons le rôle médiateur de la symptomatologie
dépressive et du dysfonctionnement cognitif dans la productivité au travail lors de
DS et posons l'hypothèse que la diminution des capacités reliées au travail est principalement
influencée par le dysfonctionnement cognitif lors de DS.
Méthodes
L'étude Motivaction a permis de faire subir un test de dépistage du diabète à des
individus occupant un emploi au Canada. Les sujets ayant des anomalies de la régulation
de la glycémie révélatrices d'un risque (c.-à-d. des concentrations d'hémoglobine
glyquée [A1c] de 5,5 % à 5,9 %) ou de la présence de DS (c.-à-d. A1c≥6,0 %) ont fait
l'objet d'une évaluation à partir des mesures de la gravité des symptômes dépressifs
[Patient Health Questionnaire, 9-item (PHQ-9)], de l’auto-évaluation des troubles
cognitifs [Perceived Deficits Questionnaire, 5-item (PDQ-5)] et des mesures de la
productivité au travail [Endicott Work Productivity Scale (EWPS)]. Les analyses de régression multiple et les analyses de médiation ont permis d'évaluer
les corrélations entre les scores globaux obtenus au PHQ-9, au PDQ-5 et à l'échelle
EWPS et le rôle médiateur du dysfonctionnement cognitif autorapporté sur l'effet de
la gravité des symptômes dépressifs sur la diminution des capacités reliées au travail,
et ce, de manière respective.
Résultats
Parmi les 3627 individus ayant subi le dépistage, 1738 ont répondu aux critères d'admissibilité
et 724 ont accepté de faire partie de l'étude Motivaction ; 205 sujets ayant des anomalies
de la régulation de la glycémie ont fait partie de l'analyse. Les symptômes dépressifs
et cognitifs auto-évalués corrélaient de manière positive avec la diminution des capacités
reliées au travail chez les sujets diabétiques ou exposés au risque de DS. Les effets
délétères de la symptomatologie dépressive sur l'efficacité au travail étaient principalement
influencés par le dysfonctionnement cognitif chez les patients ayant une diminution
de la tolérance au glucose.
Conclusions
Chez les Canadiens occupant un emploi, la diminution de la tolérance au glucose est
fortement associée à la diminution de la performance au travail. Nous rapportons une
nouvelle constatation dans la mesure où l'association entre les symptômes dépressifs
et la diminution des capacités reliées au travail chez les individus ayant des anomalies
de la régulation de la glycémie est principalement influencée par le dysfonctionnement
cognitif auto-évalué.
Keywords
Mots clés
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Article info
Publication history
Published online: September 25, 2017
Accepted:
June 27,
2017
Received in revised form:
June 26,
2017
Received:
May 12,
2017
Footnotes
The Canadian Diabetes Association is the registered owner of the name Diabetes Canada.
Identification
Copyright
© 2017 Canadian Diabetes Association.
