Ludman Evette J, Katon Wayne, Russo Joan, Von Korff Michael, Simon Gregory, Ciechanowski Paul, Lin Elizabeth, Bush Terry, Walker Edward, Young Bessie
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA.
Gen Hosp Psychiatry. 2004 Nov-Dec;26(6):430-6. doi: 10.1016/j.genhosppsych.2004.08.010.
To examine the relationship among patient-reported diabetes symptoms, severity of depressive illness and objective measures of diabetes control and severity among a population-based sample of patients with diabetes.
A mailed survey was sent to all patients with diabetes from nine primary care clinics of a Health Maintenance Organization. The Patient Health Questionnaire (PHQ-9) was used to diagnose major depression, the Self-Completion Patient Outcome instrument assessed diabetes symptoms and automated medical record data were used to measure diabetes treatment intensity, HbA(1c) levels, diabetes complications and medical comorbidity. Analysis of covariance (ANCOVA) was used to determine if the number of diabetes symptoms was related to having major depression and to number of depressive symptoms. Logistic regression analyses determined the relative strengths of the associations between each individual diabetic symptom and presence of major depression, HbA(1c) levels above 8.0% and two or more diabetes complications.
Among 4168 patients with diabetes, those with major depression (N=487) reported significantly more diabetes symptoms (mean=4.40) than participants without depression (mean=2.46) after adjusting for demographic characteristics, objective measures of diabetes severity and medical comorbidity [F(1,4029)=339.31, P<.0001]. The overall number of diabetes symptoms was related to the number of depressive symptoms (from 0 to 9) endorsed by participants [F(9,4021)=110.05, P<.0001]. Logistic regression analyses found that depression was significantly related to each of the 10 diabetes symptoms (all P<.001).
The depression-diabetes symptom association is stronger than the association of diabetes symptoms with measures of glycemic control and diabetes complications.
在一个基于人群的糖尿病患者样本中，研究患者报告的糖尿病症状、抑郁疾病严重程度与糖尿病控制及严重程度的客观指标之间的关系。
向一家健康维护组织的9家初级保健诊所的所有糖尿病患者发送了邮寄调查问卷。使用患者健康问卷（PHQ - 9）诊断重度抑郁症，自我完成患者结局工具评估糖尿病症状，自动化医疗记录数据用于测量糖尿病治疗强度、糖化血红蛋白（HbA1c）水平、糖尿病并发症和医疗合并症。采用协方差分析（ANCOVA）来确定糖尿病症状的数量是否与重度抑郁症以及抑郁症状的数量相关。逻辑回归分析确定了每种个体糖尿病症状与重度抑郁症的存在、HbA1c水平高于8.0%以及两种或更多糖尿病并发症之间关联的相对强度。
在4168名糖尿病患者中，在调整了人口统计学特征、糖尿病严重程度的客观指标和医疗合并症后，患有重度抑郁症的患者（N = 487）报告的糖尿病症状（平均值 = 4.40）明显多于无抑郁症的参与者（平均值 = 2.46）[F(1,4029)=339.31，P <.0001]。糖尿病症状的总数与参与者认可的抑郁症状数量（从0到9）相关[F(9,4021)=110.05，P <.0001]。逻辑回归分析发现，抑郁症与10种糖尿病症状中的每一种都显著相关（所有P <.001）。
抑郁症与糖尿病症状之间的关联比糖尿病症状与血糖控制及糖尿病并发症指标之间的关联更强。
