Hislop A L, Fegan P G, Schlaeppi M J, Duck M, Yeap B B
Diabetes Education Unit, Fremantle Hospital, Fremantle, Western Australia, Australia.
Diabet Med. 2008 Jan;25(1):91-6. doi: 10.1111/j.1464-5491.2007.02310.x.
To determine the prevalence of psychological distress in young adults with Type 1 diabetes and to explore associated factors.
Ninety-two participants with Type 1 diabetes (46 male, 46 female) attending a young adult clinic completed two psychological self-report assessments; the Centre for Epidemiological Studies-Depression Scale (CES-D) and Adult Self-Report Scale (ASR). The mean age was 21.6 +/- 2.8 years (sd) and mean duration of diabetes was 9.3 +/- 5.4 years. A questionnaire identified the method of insulin delivery, the frequency of blood glucose monitoring and hypoglycaemia requiring third-party assistance. HbA(1c) was measured.
Of the participants, 35.2% reported depressive symptoms (CES-D > or = 16), 23.1% indicating severe depressive symptoms (CES-D > or = 24), and 32.2, 40.4 and 35.5% of participants reported significant distress (ASR > or = 60) on the ASR total problem scales, ASR internalizing and ASR externalizing scores, respectively. Mean HbA(1c) levels were higher in participants with depressive symptoms compared with those with normal scores (CES-D > or = 16, HbA(1c)= 9.4% vs. CES-D < 16, HbA(1c)= 8.4%, P = 0.01). Factors associated with psychological distress included use of continuous subcutaneous insulin infusion (CSII) (P = 0.02) and increased frequency of hypoglycaemic episodes (P = 0.03). CSII users had higher CES-D (21.3 vs. 11.9, P = 0.001) and ASR-Total (59.7 vs. 53.0, P = 0.02) scores than non-CSII users.
Approximately one-third of young adults with Type 1 diabetes experience psychological distress, which is associated with poorer glycaemic control. Psychological distress was related to frequency of hypoglycaemic episodes and method of insulin administration, with significantly greater distress being observed in those using CSII. These findings support inclusion of a psychologist in the diabetes team.
确定1型糖尿病青年患者心理困扰的患病率，并探究相关因素。
92名1型糖尿病患者（46名男性，46名女性）在青年门诊完成了两项心理自评评估；流行病学研究中心抑郁量表（CES-D）和成人自评量表（ASR）。平均年龄为21.6±2.8岁（标准差），糖尿病平均病程为9.3±5.4年。通过问卷调查确定胰岛素给药方式、血糖监测频率以及需要第三方协助的低血糖情况。测量糖化血红蛋白（HbA1c）。
参与者中，35.2%报告有抑郁症状（CES-D≥16），23.1%表明有严重抑郁症状（CES-D≥24），分别有32.2%、40.4%和35.5%的参与者在ASR总问题量表、ASR内化和ASR外化得分上报告有显著困扰（ASR≥60）。与得分正常者（CES-D＜16）相比，有抑郁症状的参与者平均HbA1c水平更高（CES-D≥16，HbA1c = 9.4% 对比 CES-D＜16，HbA1c = 8.4%，P = 0.01）。与心理困扰相关的因素包括使用持续皮下胰岛素输注（CSII）（P = 0.02）和低血糖发作频率增加（P = 0.03）。与非CSII使用者相比，CSII使用者的CES-D得分（21.3对比11.9，P = 0.001）和ASR总分（59.7对比53.0，P = 0.02）更高。
约三分之一的1型糖尿病青年患者存在心理困扰，这与血糖控制较差有关。心理困扰与低血糖发作频率和胰岛素给药方式有关，使用CSII者的困扰明显更大。这些研究结果支持在糖尿病治疗团队中纳入一名心理学家。
