Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
Gen Hosp Psychiatry. 2011 Sep-Oct;33(5):429-35. doi: 10.1016/j.genhosppsych.2011.05.021. Epub 2011 Jul 16.
This study examined whether depression is associated with a higher incidence of diabetic retinopathy among adults with type 2 diabetes after controlling for sociodemographic factors, health risk behaviors and clinical characteristics.
This study included 2359 patients enrolled in Pathways Epidemiologic Follow-Up Study, a prospective cohort study investigating the impact of depression in primary care patients with type 2 diabetes. The predictor of interest was baseline severity of depressive symptoms assessed with the Patient Health Questionnaire-9 (PHQ-9). The outcome was incident diabetic retinopathy. Risk of diabetic retinopathy was assessed using logistic regression, and time to incident diabetic retinopathy was examined using Cox proportional hazard models.
Over a 5-year follow-up period, severity of depression was associated with an increased risk of incident retinopathy [odds ratio =1.026; 95% confidence interval (CI) 1.002-1.051] as well as time to incident retinopathy (hazard ratio=1.025; 95% CI 1.009-1.041). The risk of incident diabetic retinopathy was estimated to increase by up to 15% for every significant increase in depressive symptoms severity (5-point increase on the PHQ-9 score).
Diabetic patients with comorbid depression have a significantly higher risk of developing diabetic retinopathy. Improving depression treatment in patients with diabetes could contribute to diabetic retinopathy prevention.
本研究旨在探讨在控制社会人口统计学因素、健康风险行为和临床特征后，抑郁是否与 2 型糖尿病成人的糖尿病视网膜病变发生率升高有关。
本研究纳入了 2359 名参加 Pathways 流行病学随访研究的患者，该前瞻性队列研究旨在调查 2 型糖尿病初级保健患者中抑郁的影响。感兴趣的预测因素是使用患者健康问卷-9（PHQ-9）评估的基线抑郁症状严重程度。结果是新发糖尿病视网膜病变。使用逻辑回归评估糖尿病视网膜病变的风险，使用 Cox 比例风险模型检查新发糖尿病视网膜病变的时间。
在 5 年的随访期间，抑郁严重程度与新发视网膜病变的风险增加相关[比值比=1.026；95%置信区间（CI）1.002-1.051]以及新发视网膜病变的时间（风险比=1.025；95%CI 1.009-1.041）。抑郁症状严重程度每增加一个显著单位（PHQ-9 评分增加 5 分），新发糖尿病视网膜病变的风险估计会增加高达 15%。
患有合并症抑郁的糖尿病患者发生糖尿病视网膜病变的风险显著增加。改善糖尿病患者的抑郁治疗可能有助于预防糖尿病视网膜病变。
