MindBody Connection

Web site to connect researchers, patients






The Center for Mind/Body Research
is a new online resource that serves as a gallery for investigations into mind/body interactions.




More rapid communication of research findings across disciplines could result in a faster translation of those findings into patient treatment.



Depression is a risk factor for diabetes

Depressed patients with diabetes are twice as likely to develop serious complications, including heart attacks

Depressed heart attack patients are more likely to have a second heart attack and to die from their disease

Findings like these come as no surprise to researchers Ray E. Clouse, MD, and Patrick J. Lustman, PhD, longtime collaborators who have focused their careers on defining the connections between mental and physical health.

“Ten to 15 years ago, we had to sit on the fact that we had already observed that depression, when we took medical histories, preceded the onset of diabetes,” says Clouse, professor of medicine and of psychiatry. “At that time, many physicians would say, ‘You’d be depressed too if you had diabetes.’ We began to write about the issue and eventually, more studies confirmed that depression is indeed a risk for the development of diabetes.”

And it’s not just diabetes. Ongoing investigations at Washington University are studying how mental health can affect outcomes for patients with heart disease, chronic pain, gastrointestinal disorders, neurologic diseases, and even AIDS and cancer.To raise awareness about the scope and volume of mind/body research under way at Washington University, Clouse and Lustman, professor of psychiatry, have created and are co-directors of the Center for Mind/Body Research, a new online resource designed to connect scientists involved in this research.

Together with Kenneth E. Freedland, PhD, and Robert M. Carney, PhD, both professors of psychiatry, the investigators form the core of a group that has been studying the interaction of psychiatric and medical disorders for more than two decades.

Patrick J. Lustman, PhD, talks with a patient.

According to the duo, the idea for the center arose from the need for better interdisciplinary exposure of biobehavioral research. Individual investigators within departments at the School of Medicine are interested in mind/body research, he says, but they often are so involved in their specific departments that they are unaware of the synergy that could occur with other scholars.

“We realized that even in our own area of study, there was research going on at Washington University that was difficult for us to tap into or to share,” Clouse says. “We wanted to be able to more fully explore the successes people were having.”

The new center will serve its constituents through a web site showcasing ongoing mind/body research and functioning as a communication network between investigators. The site, sponsored by the School of Medicine’s Department of Psychiatry, can be accessed online at mindbody.wustl.edu.

Body of evidence

“When we first started working together, there was an agreement that I would help Ray work on the psychological aspects of functional GI disorders if he would help me with the physician end of depression and diabetes studies,” says Lustman. “So we launched a series of investigations in both of these areas, particularly looking at the prevalence and effect of depression on outcomes of medical illness.”

Their cumulative research has demonstrated that conditions such as stress, depression and other types of mental problems tend to exacerbate medical illnesses.

“The scientific literature demonstrates that mental health can have a major impact on physical health,” says Lustman. “In one study, we showed that depressed patients with diabetes are twice as likely to develop serious complications as those who aren’t depressed. Clearly, there is a relationship between depression and diabetes, an interaction that alters the course of both diseases.”

Depression also increases the risk of heart attack
and death from heart disease, and in women who are both depressed and diabetic, the risk of heart complications is more than twice that seen in women with diabetes who are not depressed, the researchers say.

“Those women lose the protective effect of their gender,” explains Clouse. “Prior to menopause, women tend to have a lower risk for heart attack than men, but in depressed women with diabetes, that protective effect disappears.”

Clouse says it appears that although diabetes itself is a risk factor for heart disease, the increased risk they observed in a 10-year study of depressed women with diabetes was related more to depression than to diabetes.

“We looked at the other, traditional risk factors to see whether they also were predictive of poor outcomes, because we know that depression might be associated with the other factors,” says Clouse. “But when we examined those — obesity, high blood pressure, smoking, high cholesterol — we found that only a woman’s age and depression were significant predictors of the increased risk of heart disease that we observed.”

Clouse and Lustman wanted to see just how strong a risk depression was, so they analyzed the scientific literature, looking at every available study of diabetes and depression. They found that being depressed doubled the risk of diabetic complications, and in their study of depressed women with diabetes, they found that the risk of heart problems more than doubled.

“It could be that people with complications are just more likely to get depressed,” says Lustman. “But
by following the depressed, diabetic women and comparing them to women who had diabetes but weren’t depressed, we were able to establish that depression was, in fact, predicting an accelerated presentation of coronary heart disease in women with diabetes.”

That increased risk is particularly important, because women with diabetes are 1.5 times more likely to be de-pressed than diabetic men. Clouse says that fact, combined with their findings, demonstrates that it’s important to look more closely at how depression and other mental disorders can negatively affect physical health.

Now the researchers are trying to determine whether treatment for depression can reverse some of these physiological factors. “Our research shows that depression is a potentially modifiable risk,” says Lustman, “one that, if treated, might improve patient outcomes.”

Meeting of minds

This type of inquiry is just what the researchers hope to share with colleagues from both Washington University and other institutions on the Center for Mind/Body Research web site. Already, faculty members are exchanging ideas on grant funding, study design and statistical analyses to study biobehavioral issues.

Lustman notes that the new site will be particularly helpful in supporting junior faculty and trainees with an interest in mind/body research. “The center will enable anyone with an interest in biobehavioral research to step in and work with other like-minded researchers,” he says.

The site also serves as a point of entry for various funding agencies, showcasing not only the volume of research being done across departments at Washington University, but also the expertise of its faculty.

Ray E. Clouse, MD, takes a patient’s blood pressure.

“The NIH is increasingly emphasizing the dissemination of research findings; it would like to know that there’s a plan in place for how these advances will be communicated,” Lustman says.
“The Center for Mind/Body Research provides a ready vehicle for doing that.”

Ultimately, patients have the most to gain. More rapid communication of research findings across disciplines could result in faster translation of those findings into effective treatment. In addition, patients who log on to the site will learn about ongoing clinical trials and perhaps find information about treatment for conditions to which they might not otherwise have access.

Clouse is gratified to see the growing interest in the connection between mental and physical health.

“There’s a new excitement about mind/body research because there is a general sense that this
is an area that’s been undertapped,” he says. “Consequently, it holds new promise for research and, ultimately, for patient care.”