2型糖尿病患者的抑郁与健康相关生活质量：尼泊尔的一项横断面研究。
Depression and Health-Related Quality of Life among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Nepal.
作者信息
Mishra Shiva Raj, Sharma Abhishek, Bhandari Parash Mani, Bhochhibhoya Shristi, Thapa Kiran
机构信息
Nepal Development Society, Bharatpur 10, Chitwan, Nepal.
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
出版信息
PLoS One. 2015 Nov 23;10(11):e0141385. doi: 10.1371/journal.pone.0141385. eCollection 2015.
BACKGROUND
Diabetes is accompanied by a marked reduction in patient's quality of life (QOL) and leads to higher disability-adjusted life years than most diseases. Depression further deteriorates QOL and is associated with poor treatment outcomes and lowered glycemic control in diabetes. We analysed the QOL and depression among the people living with diabetes in Nepal.
METHODS
We conducted a cross-sectional survey among a random sample of 157 diabetic patients visiting diabetes clinic at a major teaching hospital in Kathmandu, Nepal. We administered the Nepali version of WHO-BREF for face to face interviews to obtain data on QOL scores. The Nepali version of Patient Health Questionnaire-9was also used to record responses on depression items.
RESULTS
More than half of the respondents (54.1%) experienced depression with mean PHQ-9 score of 6.15 ± 5.01 on a scale of 0-27. On a scale of 0 to 100, highest QOL mean score was reported in social relationship domain (57.32 ± 11.83), followed by environment domain (54.71 ± 7.74), psychological health (53.25 ± 10.32) and physical health (50.74 ± 11.83). After adjusting for other covariates, urban residence decreased the physical health score by 4.74 (β = -4.74, 95% CI: -8.664,-0.821), social relationship domain score by 3.420 (β = -3.420, 95% CI: -6.433,-0.406) and the overall QOL by 2.773 (β = -2.773, 95% CI: -5.295,-0.252). Having diagnosed with diabetes since more than 10 years increased physical health by 5.184 score points (β = 5.184; 95% CI: 0.753, 9.615).Similarly, having severe depression decreased social relation domain score by 6.053 (β = -6.053, 95% CI:-11.169,-.936).
CONCLUSION
Having urban residence significantly decreased the physical health and social relation domain scores as well as the overall QOL scores. Similarly, having diagnosed since more than 10 years increased physical health domain score. Severe depression decreased social relationship domain score. Since depression affects QOL, we suggest early diagnosis and prompt treatment of depression in T2DM people as part of their routine primary care in Nepal.
背景
糖尿病患者的生活质量（QOL）显著降低，与大多数疾病相比，其伤残调整生命年更高。抑郁症会进一步恶化生活质量，并与糖尿病治疗效果不佳及血糖控制降低有关。我们分析了尼泊尔糖尿病患者的生活质量和抑郁症情况。
方法
我们对尼泊尔加德满都一家主要教学医院糖尿病门诊的157名糖尿病患者进行了随机抽样横断面调查。我们采用尼泊尔语版的世界卫生组织简明生活质量量表进行面对面访谈，以获取生活质量得分数据。还使用尼泊尔语版的患者健康问卷-9记录抑郁症项目的回答。
结果
超过一半的受访者（54.1%）患有抑郁症，PHQ-9平均得分为6.15±5.01（范围为0-27）。在0至100的量表上，社会关系领域的生活质量平均得分最高（57.32±11.83），其次是环境领域（54.71±7.74）、心理健康（53.25±10.32）和身体健康（50.74±11.83）。在对其他协变量进行调整后，城市居住使身体健康得分降低4.74（β=-4.74，95%CI：-8.664，-0.821），社会关系领域得分降低3.420（β=-3.420，95%CI：-6.433，-0.406），总体生活质量降低2.773（β=-2.773，95%CI：-5.295，-0.252）。糖尿病诊断超过10年使身体健康得分提高5.184分（β=5.184；95%CI：0.753，9.615）。同样，患有重度抑郁症使社会关系领域得分降低6.053（β=-6.053，95%CI：-11.169，-0.936）。
结论
城市居住显著降低了身体健康和社会关系领域得分以及总体生活质量得分。同样，糖尿病诊断超过10年提高了身体健康领域得分。重度抑郁症降低了社会关系领域得分。由于抑郁症会影响生活质量，我们建议在尼泊尔将2型糖尿病患者抑郁症的早期诊断和及时治疗作为其常规初级保健的一部分。
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