Katon Wayne J, Rutter Carolyn, Simon Greg, Lin Elizabeth H B, Ludman Evette, Ciechanowski Paul, Kinder Leslie, Young Bessie, Von Korff Michael
Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, Seattle, WA 98195-6560, USA.
Diabetes Care. 2005 Nov;28(11):2668-72. doi: 10.2337/diacare.28.11.2668.
We assessed whether patients with comorbid minor and major depression and type 2 diabetes had a higher mortality rate over a 3-year period compared with patients with diabetes alone.
In a large health maintenance organization (HMO), 4,154 patients with type 2 diabetes were surveyed and followed for up to 3 years. Patients initially filled out a written questionnaire, and HMO-automated diagnostic, laboratory, and pharmacy data and Washington State mortality data were collected to assess diabetes complications and deaths. Cox proportional hazards regression models were used to calculate adjusted hazard ratios of death for each group compared with the reference group.
There were 275 (8.3%) deaths in 3,303 patients without depression compared with 48 (13.6%) deaths in 354 patients with minor depression and 59 (11.9%) deaths among 497 patients with major depression. A proportional hazards model with adjustment for age, sex, race/ethnicity, and educational attainment found that compared with the nondepressed group, minor depression was associated with a 1.67-fold increase in mortality (P = 0.003), and major depression was associated with a 2.30-fold increase (P < 0.0001). In a second model that controlled for multiple potential mediators, both minor and major depression remained significant predictors of mortality.
Among patients with diabetes, both minor and major depression are strongly associated with increased mortality. Further research will be necessary to disentangle causal relationships among depression, behavioral risk factors (adherence to medical regimens), diabetes complications, and mortality.
我们评估了合并轻度和重度抑郁症的2型糖尿病患者在3年期间的死亡率是否高于单纯糖尿病患者。
在一个大型健康维护组织（HMO）中，对4154例2型糖尿病患者进行了调查，并随访了长达3年。患者最初填写了一份书面问卷，并收集了HMO的自动诊断、实验室和药房数据以及华盛顿州的死亡率数据，以评估糖尿病并发症和死亡情况。使用Cox比例风险回归模型计算每组与参照组相比的调整后死亡风险比。
3303例无抑郁症患者中有275例（8.3%）死亡，而354例轻度抑郁症患者中有48例（13.6%）死亡，497例重度抑郁症患者中有59例（11.9%）死亡。一个对年龄、性别、种族/民族和教育程度进行调整的比例风险模型发现，与无抑郁症组相比，轻度抑郁症使死亡率增加1.67倍（P = 0.003），重度抑郁症使死亡率增加2.30倍（P < 0.0001）。在控制了多个潜在中介因素的第二个模型中，轻度和重度抑郁症仍然是死亡率的显著预测因素。
在糖尿病患者中，轻度和重度抑郁症均与死亡率增加密切相关。需要进一步研究以理清抑郁症、行为风险因素（对医疗方案的依从性）、糖尿病并发症和死亡率之间的因果关系。
