Deschênes Sonya S, Burns Rachel J, Pouwer Frans, Schmitz Norbert
From the Department of Psychiatry (Deschênes, Burns, Schmitz), McGill University, Montreal, Canada; Douglas Mental Health University Institute (Deschênes, Burns, Schmitz), Montreal, Quebec, Canada; Department of Medical and Clinical Psychology (Pouwer), Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; and Department of Epidemiology and Biostatistics (Schmitz), McGill University, Montreal, Canada.
Psychosom Med. 2017 Jun;79(5):603-612. doi: 10.1097/PSY.0000000000000447.
Prospective studies testing the potential impact of diabetes complications on depression are limited. The present study examined the longitudinal associations between diabetes complications and the risk and recurrence/persistence of depressive symptoms.
Data were from a prospective community cohort telephone survey of adults with diabetes (N = 1314). Diabetes complications and depressive symptoms were assessed via self-report (Diabetes Complications Index and Patient Health Questionnaire-9, respectively) at baseline and annually for 5 years. Statistical models adjusted for sociodemographic, lifestyle, and diabetes characteristics.
The number of diabetes complications at baseline was positively associated with a greater risk of elevated depressive symptoms, with the highest risk found for those with four to six complications at baseline (risk ratio = 2.73, 95% confidence interval = 1.64-4.56). Cerebrovascular disease was the complication most strongly associated with incident depressive symptoms (risk ratio = 2.22, 95% confidence interval = 1.59-3.10). Coronary artery disease, peripheral vascular disease, and neuropathy were also associated with the risk of depression, whereas foot problems and eye problems were not. In addition, a greater number of diabetes complications were associated with recurrent/persistent depression, though with a small effect size (Δr = .02). A parallel process latent growth curve model indicated that increases in diabetes complications were associated with increases in depressive symptoms during the course of the follow-up period (β = .74, p < .001).
This study demonstrates the temporal relation between diabetes complications and depressive symptoms and underscores the psychological burden of diabetes complications by prospectively demonstrating the increased risk and recurrence of depressive symptoms associated with diabetes complications.
检验糖尿病并发症对抑郁症潜在影响的前瞻性研究有限。本研究考察了糖尿病并发症与抑郁症状风险及复发/持续存在之间的纵向关联。
数据来自一项针对成年糖尿病患者的前瞻性社区队列电话调查（N = 1314）。在基线时以及之后5年每年通过自我报告（分别使用糖尿病并发症指数和患者健康问卷-9）评估糖尿病并发症和抑郁症状。统计模型对社会人口学、生活方式和糖尿病特征进行了调整。
基线时糖尿病并发症的数量与抑郁症状加重的风险呈正相关，基线时有四至六种并发症的患者风险最高（风险比 = 2.73，95%置信区间 = 1.64 - 4.56）。脑血管疾病是与新发抑郁症状关联最密切的并发症（风险比 = 2.22，95%置信区间 = 1.59 - 3.10）。冠状动脉疾病、外周血管疾病和神经病变也与抑郁症风险相关，而足部问题和眼部问题则不然。此外，更多的糖尿病并发症与复发性/持续性抑郁症相关，尽管效应量较小（Δr = 0.02）。一个平行过程潜在增长曲线模型表明，在随访期间糖尿病并发症的增加与抑郁症状的增加相关（β = 0.74，p < 0.001）。
本研究证明了糖尿病并发症与抑郁症状之间的时间关系，并通过前瞻性地证明与糖尿病并发症相关的抑郁症状风险增加和复发，强调了糖尿病并发症的心理负担。
