Clinic of Psychiatry, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia.
Psychiatr Danub. 2011 Mar;23(1):34-44.
Type 2 diabetes (T2DM) doubles the odds of comorbid depression. Depression is a strong predictor of developing T2DM. The aim of the study was to compare depressed patients with T2DM to non-depressed ones with respect to demographic, psycho-social, clinical, anthropometric and metabolic characteristics; to examine the relationship between glycemic control and depression severity in depressed patients; to estimate the risk factors of depression.
A group of depressed diabetic patients comprising those with a Major depressive episode, first or repeated (ICD-10; 1992) and endocrinologist-diagnosed T2DM, duration ≥5 years on oral, insulin therapy or both (N=46) and non-depressed ones (N=44) (90 in total) of both genders (<65 years) were included in this cross-sectional study. Laboratory and non-laboratory measures were performed.. The patient Health Questionnaire (PHQ-9) and a structured interview (MINI) were used to establish diagnosis, while the Beck Depression Inventory (BDI; cut off ≥16) was used to assess the severity ofdepression. Scaling of Life Events (SLE) for self-assessment of life events and Problem in Areas in Diabetes (PAID) for self-assessment of diabetes distress were also performed.
Statistically significant higher rates of psychiatric heredity, neuropathy, higher level of diabetes related distress and a greater number of life events in depressed patients compared to non-depressed ones were found. There was a statistically significant positive correlation between BDI somatic subscore and the HbA1c level (r=0.343; p=0.020). The level of diabetes related distress (OR=1.084; p=0.000), total number of life events (OR=4.528; p=0.001) and neuropathy (OR=8.699; p=0.039) were statistically significant predictors of depression using logistic regression.
The results obtained showed that depression in diabetic patients was predicted by both psychological (diabetes related distress, life events) and disease-specific variables (neuropathy). The severity of self-reported somatic depressive symptoms significantly correlated with the HbA1c level in depressed diabetic patients.
2 型糖尿病（T2DM）使合并抑郁的几率增加一倍。抑郁是发生 T2DM 的强有力预测因子。本研究的目的是比较患有 T2DM 的抑郁患者与无抑郁的 T2DM 患者在人口统计学、心理社会、临床、人体测量和代谢特征方面的差异；研究抑郁患者的血糖控制与抑郁严重程度之间的关系；评估抑郁的危险因素。
本横断面研究纳入了一组患有 T2DM 的抑郁患者，这些患者符合以下标准：（1）存在 1992 年 ICD-10 诊断的首次或反复发作的重性抑郁障碍；（2）内分泌科诊断的 T2DM，病程≥5 年，接受口服药物、胰岛素或两者联合治疗；（3）年龄<65 岁，性别不限。共纳入 90 例患者（46 例抑郁患者和 44 例非抑郁患者），分别评估其实验室和非实验室指标。采用患者健康问卷（PHQ-9）和定式临床访谈（MINI）进行诊断，采用贝克抑郁量表（BDI；临界值≥16）评估抑郁严重程度。还采用生活事件量表（SLE）自评生活事件，采用糖尿病困扰量表（PAID）自评糖尿病困扰。
与非抑郁患者相比，抑郁患者有更高的精神遗传率、神经病变率、更高的糖尿病相关困扰水平和更多的生活事件。BDI 的躯体因子得分与糖化血红蛋白（HbA1c）水平呈正相关（r=0.343；p=0.020）。使用 logistic 回归分析发现，糖尿病相关困扰程度（OR=1.084；p=0.000）、生活事件总数（OR=4.528；p=0.001）和神经病变（OR=8.699；p=0.039）是抑郁的统计学显著预测因子。
研究结果表明，糖尿病患者的抑郁是由心理（糖尿病相关困扰、生活事件）和疾病特异性因素（神经病变）共同预测的。抑郁糖尿病患者自我报告的躯体性抑郁症状严重程度与 HbA1c 水平显著相关。
