Fisher L, Gonzalez J S, Polonsky W H
University of California, San Francisco, San Francisco, CA.
Diabet Med. 2014 Jul;31(7):764-72. doi: 10.1111/dme.12428.
Studies have identified significant linkages between depression and diabetes, with depression associated with poor self-management behaviour, poor clinical outcomes and high rates of mortality. However, findings are not consistent across studies, yielding confusing and contradictory results about these relationships. We suggest that there has been a failure to define and measure 'depression' in a consistent manner. Because the diagnosis of depression is symptom-based only, without reference to source or content, the context of diabetes is not considered when addressing the emotional distress experienced by individuals struggling with diabetes. To reduce this confusion, we suggest that an underlying construct of 'emotional distress' be considered as a core construct to link diabetes-related distress, subclinical depression, elevated depression symptoms and major depressive disorder (MDD). We view emotional distress as a single, continuous dimension that has two primary characteristics: content and severity; that the primary content of emotional distress among these individuals include diabetes and its management, other life stresses and other contributors; and that both the content and severity of distress be addressed directly in clinical care. We suggest further that all patients, even those whose emotional distress rises to the level of MDD or anxiety disorders, can benefit from consideration of the content of distress to direct care effectively, and we suggest strategies for integrating the emotional side of diabetes into regular diabetes care. This approach can reduce confusion between depression and distress so that appropriate and targeted patient-centred interventions can occur.
研究已确定抑郁症与糖尿病之间存在显著关联，抑郁症与自我管理行为不佳、临床预后不良及高死亡率相关。然而，各研究结果并不一致，在这些关系上产生了令人困惑和矛盾的结果。我们认为，一直未能以一致的方式定义和衡量“抑郁症”。由于抑郁症的诊断仅基于症状，而不涉及病因或内容，在处理糖尿病患者所经历的情绪困扰时，未考虑糖尿病这一背景情况。为减少这种混乱，我们建议将“情绪困扰”这一潜在概念视为一个核心概念，以连接糖尿病相关困扰、亚临床抑郁症、抑郁症状加重及重度抑郁症（MDD）。我们将情绪困扰视为一个单一的连续维度，它有两个主要特征：内容和严重程度；这些个体情绪困扰的主要内容包括糖尿病及其管理、其他生活压力和其他影响因素；并且在临床护理中应直接处理困扰的内容和严重程度。我们进一步建议，所有患者，即使是那些情绪困扰达到重度抑郁症或焦虑症水平的患者，都能从考虑困扰内容以有效指导护理中受益，我们还提出了将糖尿病的情感方面纳入常规糖尿病护理的策略。这种方法可以减少抑郁症和困扰之间的混淆，从而能够进行适当且有针对性的以患者为中心的干预。
