智障老年人中焦虑和抑郁症状与糖尿病及心血管危险因素的关联。
Associations of symptoms of anxiety and depression with diabetes and cardiovascular risk factors in older people with intellectual disability.
作者信息
de Winter C F, Hermans H, Evenhuis H M, Echteld M A
机构信息
Intellectual Disability Medicine, Erasmus Medical Center Rotterdam, Department of General Practice, Rotterdam, The Netherlands; Reinaerde, Den Dolder, The Netherlands.
出版信息
J Intellect Disabil Res. 2015 Feb;59(2):176-85. doi: 10.1111/jir.12049. Epub 2013 Apr 30.
BACKGROUND
Depression, anxiety, diabetes and cardiovascular risk factors are frequent health problems among older people with intellectual disability (ID). These conditions may be bidirectionally related. Depression and anxiety may have biological effects causing glucose intolerance, fat accumulation and also lifestyle changes causing metabolic syndrome. But also the effects of diabetes, metabolic syndrome and subsequent cardiovascular disease may affect mood and anxiety. This study investigated the association between depression, anxiety and diabetes and cardiovascular risk factors in older people with ID.
METHODS
The healthy ageing in intellectual disability-study (HA-ID study) is a cross-sectional study among people aged 50 years and over with ID, receiving formal ID care. Screening instruments for symptoms of anxiety and depression were completed and physical examination and vena-puncture were performed to establish components of the metabolic syndrome, peripheral arterial disease and c-reactive protein.
RESULTS
Of the 990 people who participated, 17% had symptoms of depression and 16% had symptoms of anxiety. Type I diabetes was present in 1%, type II diabetes in 13% of the study population. Metabolic syndrome, central obesity, hypercholesterolemia and hypertension were present in 45%, 48%, 23% and 53% respectively. In a multivariate logistic regression analysis a significant association was found between increased anxiety symptoms and diabetes only (OR 2.4, 95%CI 1.2-4.9).
CONCLUSIONS
Increased anxiety symptoms and diabetes are related in older people with ID. This association may be bidirectional. No other associations of depression and anxiety symptoms with cardiovascular risk factors could be proven to be significant. Therefore, more research is needed to unravel the mechanisms of stress, mood disorders and cardiovascular disease in older people with ID. To provide comprehensive care for older people with ID, screening for diabetes and components of the metabolic syndrome in people with anxiety or mood disorders, and screening for symptoms of anxiety or depression in people with diabetes is warranted.
背景
抑郁症、焦虑症、糖尿病和心血管危险因素是老年智障人士常见的健康问题。这些情况可能存在双向关联。抑郁和焦虑可能产生生物学效应，导致葡萄糖不耐受、脂肪堆积，还会引起生活方式改变，进而导致代谢综合征。但糖尿病、代谢综合征及后续心血管疾病的影响也可能影响情绪和焦虑。本研究调查了老年智障人士中抑郁、焦虑与糖尿病及心血管危险因素之间的关联。
方法
智障人士健康老龄化研究（HA-ID研究）是一项针对50岁及以上接受正规智障护理的智障人士的横断面研究。完成了焦虑和抑郁症状的筛查工具，并进行了体格检查和静脉穿刺，以确定代谢综合征、外周动脉疾病和C反应蛋白的组成部分。
结果
在参与研究的990人中，17%有抑郁症状，16%有焦虑症状。1%的研究人群患有I型糖尿病，13%患有II型糖尿病。代谢综合征、中心性肥胖、高胆固醇血症和高血压的发生率分别为45%、48%、23%和53%。在多因素逻辑回归分析中，仅发现焦虑症状增加与糖尿病之间存在显著关联（比值比2.4，95%置信区间1.2 - 4.9）。
结论
老年智障人士中焦虑症状增加与糖尿病有关。这种关联可能是双向的。抑郁和焦虑症状与心血管危险因素之间的其他关联未被证明具有显著性。因此，需要更多研究来阐明老年智障人士压力、情绪障碍和心血管疾病的机制。为了为老年智障人士提供全面护理，对患有焦虑或情绪障碍的人群进行糖尿病和代谢综合征组成部分的筛查，以及对患有糖尿病的人群进行焦虑或抑郁症状的筛查是必要的。
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