Black Sandra A, Markides Kyriakos S, Ray Laura A
Department of Epidemiology and Preventive Medicine, University of Maryland Baltimore, Baltimore, Maryland 21201, USA.
Diabetes Care. 2003 Oct;26(10):2822-8. doi: 10.2337/diacare.26.10.2822.
To examine the separate and combined effects of depression and diabetes on the incidence of adverse health outcomes among older Mexican Americans.
Longitudinal data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey were used to examine the main effects and interaction effects of diabetes and depressive symptoms (measured with the Center for Epidemiologic Study of Depression) or clinical diagnostic criteria (measured with the Composite International Diagnostic Interview Depression Module) on the development of macrovascular complications (including cardiovascular disease, stroke, and kidney disease), microvascular complications (including nephropathy, neuropathy, retinopathy, and amputations), functional disability, and mortality over 7 years in a sample of 2,830 Mexican Americans aged >or=65 years.
The interaction of diabetes and depression was found to be synergistic, predicting greater mortality, greater incidence of both macro- and microvascular complications, and greater incidence of disability in activities of daily living, even when controlling for sociodemographic characteristics such as sex, age, education, acculturation, and marital status. Importantly, this interaction was found to predict not only greater incidence but also earlier incidence of adverse events in older adults.
Whether a marker for underlying disease severity, an indicator of diminished self-care motivation, or the result of physiologic changes, the interaction of depression and diabetes has a synergistic effect on the health of older Mexican Americans, increasing the risk for poor outcomes. This is of particular clinical importance because although depression is often underrecognized in older adults, effective treatment is available and can result in improved medical outcomes.
研究抑郁症和糖尿病对老年墨西哥裔美国人不良健康结局发生率的单独及联合影响。
利用西班牙裔老年人流行病学研究的既定人群（EPESE）调查的纵向数据，在2830名年龄≥65岁的墨西哥裔美国人样本中，研究糖尿病与抑郁症状（用流行病学研究中心抑郁量表测量）或临床诊断标准（用复合国际诊断访谈抑郁模块测量）对大血管并发症（包括心血管疾病、中风和肾脏疾病）、微血管并发症（包括肾病、神经病变、视网膜病变和截肢）、功能残疾和7年死亡率的主要影响及交互作用。
发现糖尿病与抑郁症之间存在协同作用，即使在控制了性别、年龄、教育程度、文化适应程度和婚姻状况等社会人口学特征后，仍能预测更高的死亡率、更高的大血管和微血管并发症发生率以及更高的日常生活活动残疾发生率。重要的是，这种交互作用不仅能预测不良事件发生率更高，还能预测老年人不良事件更早发生。
无论抑郁症是潜在疾病严重程度的标志、自我护理动机减弱的指标，还是生理变化的结果，抑郁症与糖尿病之间的交互作用对老年墨西哥裔美国人的健康具有协同效应，增加了不良结局的风险。这具有特别的临床重要性——尽管抑郁症在老年人中常常未得到充分认识，但有效的治疗方法是可用的，且可以改善医疗结局。
