低收入西班牙裔人群中的抑郁症与糖尿病：一项社会文化适应性协作护理模式随机对照试验的设计要素
Depression and diabetes among low-income Hispanics: design elements of a socioculturally adapted collaborative care model randomized controlled trial.
作者信息
Ell Kathleen, Katon Wayne, Cabassa Leopoldo J, Xie Bin, Lee Pey-Jiuan, Kapetanovic Suad, Guterman Jeffry
机构信息
School of Social Work, University of Southern California, Los Angeles, CA 90089-0411, USA.
出版信息
Int J Psychiatry Med. 2009;39(2):113-32. doi: 10.2190/PM.39.2.a.
OBJECTIVE
This article describes design elements of the Multifaceted Depression and Diabetes Program (MDDP) randomized clinical trial. The MDDP trial hypothesizes that a socioculturally adapted collaborative care depression management intervention will reduce depressive symptoms and improve patient adherence to diabetes self-care regimens, glycemic control, and quality-of-life. In addition, baseline data of 387 low-income, 96% Hispanic, enrolled patients with major depression and diabetes are examined to identify study population characteristics consistent with trial design adaptations.
METHODS
The PHQ-9 depression scale was used to identify patients meeting criteria for major depressive disorder (1 cardinal depression symptom + a PHQ-9 score of > or = 10) from two community safety net clinics. Design elements included sociocultural adaptations in recruitment and efforts to reduce attrition and collaborative depression care management.
RESULTS
Of 1,803 diabetes patients screened, 30.2% met criteria for major depressive disorder. Of 387 patients enrolled in the clinical trial, 98% had Type 2 diabetes, and 83% had glycated hemoglobin (HbA1c) levels > or = 7%. Study recruitment rates and baseline data analyses identified socioeconomic and clinical factors that support trial design and intervention adaptations. Depression severity was significantly associated with diabetes complications, medical comorbidity, greater anxiety, dysthymia, financial worries, social stress, and poorer quality-of-life.
CONCLUSION
Low-income Hispanic patients with diabetes experience high prevalence of depressive disorder and depression severity is associated with socioeconomic stressors and clinical severity. Improving depression care management among Hispanic patients in public sector clinics should include intervention components that address self-care of diabetes and socioeconomic stressors.
目的
本文描述了多方面抑郁症与糖尿病项目（MDDP）随机临床试验的设计要素。MDDP试验假设，一种经过社会文化调适的协作式抑郁症护理管理干预措施将减轻抑郁症状，提高患者对糖尿病自我护理方案的依从性、血糖控制水平及生活质量。此外，还对387名低收入、96%为西班牙裔的重度抑郁症合并糖尿病患者的基线数据进行了研究，以确定与试验设计调适相符的研究人群特征。
方法
使用患者健康问卷-9（PHQ-9）抑郁量表，从两家社区安全网诊所中识别出符合重度抑郁症诊断标准（1项主要抑郁症状+PHQ-9得分≥10）的患者。设计要素包括招募过程中的社会文化调适、减少失访的措施以及协作式抑郁症护理管理。
结果
在筛查的1803名糖尿病患者中，30.2%符合重度抑郁症诊断标准。在参与临床试验的387名患者中，98%患有2型糖尿病，83%的糖化血红蛋白（HbA1c）水平≥7%。研究招募率和基线数据分析确定了支持试验设计和干预调适的社会经济及临床因素。抑郁严重程度与糖尿病并发症、合并症、更严重的焦虑症、心境恶劣、经济担忧、社会压力及较差的生活质量显著相关。
结论
低收入西班牙裔糖尿病患者抑郁症患病率较高，抑郁严重程度与社会经济压力源及临床严重程度相关。改善公共部门诊所中西班牙裔患者的抑郁症护理管理应包括针对糖尿病自我护理及社会经济压力源的干预措施。
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