糖尿病患者心理状况的相关因素：第二项糖尿病态度、愿望与需求（DAWN2(™)）研究结果

Correlates of psychological outcomes in people with diabetes: results from the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study.

作者信息

Nicolucci A, Kovacs Burns K, Holt R I G, Lucisano G, Skovlund S E, Kokoszka A, Massi Benedetti M, Peyrot M

机构信息

Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.

Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada.

出版信息

Diabet Med. 2016 Sep;33(9):1194-203. doi: 10.1111/dme.13178. Epub 2016 Jul 15.

DOI:10.1111/dme.13178

PMID:27353119

Abstract

AIMS

To assess country- and individual-level correlates of psychological outcomes, and differences among countries in the associations of individual characteristics with psychological outcomes among adults with diabetes.

METHODS

The second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study assessed self-reported characteristics of people with diabetes in 17 countries, including 1368 adults with Type 1 diabetes and 7228 with Type 2 diabetes. In each country, a sample of 500 adults, stratified by diabetes type and treatment, completed a questionnaire incorporating the validated WHO-5 wellbeing index, the WHOQOL-BREF, and the five-item Problem Areas in Diabetes Scale, as well as the newly developed Diabetes Impact on Life Dimensions that assessed impact ranging from very positive to very negative, with no impact as the midpoint. Multilevel regression analyses identified significant (P < 0.05) independent correlates of psychological outcomes.

RESULTS

There were significant variations in all outcomes across countries before adjustment for individual-level factors; adjustment reduced between-country disparities. Worse psychological outcomes were associated with more complications, incidence of hypoglycaemia, hypoglycaemic medication, perceived burden of diabetes, family conflict and experience of discrimination. Better psychological outcomes were associated with higher self-rated health, greater access to diabetes education and healthcare, and more psychosocial support from others. The associations of many factors with the outcomes were mediated by modifiable factors. The association of all factors with the outcomes varied across (interacted with) countries, highlighting the need for country-specific analyses.

CONCLUSIONS

Improvements in modifiable risk factors (reductions in burden and increases in support) may lead to better psychological outcomes in adults with diabetes.

摘要

目的

评估心理结果在国家和个体层面的相关因素，以及不同国家中个体特征与糖尿病成年人心理结果之间关联的差异。

方法

第二项糖尿病态度、愿望与需求（DAWN2(™)）研究评估了17个国家糖尿病患者的自我报告特征，其中包括1368名1型糖尿病成年人和7228名2型糖尿病成年人。在每个国家，抽取500名成年人作为样本，按照糖尿病类型和治疗方式进行分层，他们完成了一份问卷，其中包括经过验证的WHO-5幸福指数、WHOQOL-BREF、糖尿病问题领域五项量表，以及新开发的糖尿病对生活维度的影响量表，该量表评估了从非常积极到非常消极的影响，以无影响作为中点。多水平回归分析确定了心理结果的显著（P<0.05）独立相关因素。

结果

在对个体层面因素进行调整之前，各国在所有结果方面均存在显著差异；调整后减少了国家间的差异。较差的心理结果与更多并发症、低血糖发生率、低血糖药物治疗、糖尿病感知负担、家庭冲突和歧视经历相关。较好的心理结果与较高的自我健康评分、更多获得糖尿病教育和医疗保健的机会以及更多来自他人的社会心理支持相关。许多因素与结果之间的关联由可改变因素介导。所有因素与结果之间的关联在不同国家有所不同（相互作用），突出了进行特定国家分析的必要性。