Shin Na, Hill-Briggs Felicia, Langan Susan, Payne Jennifer L, Lyketsos Constantine, Golden Sherita Hill
Department of Medicine, Johns Hopkins University, Baltimore, MD.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD.
J Diabetes Complications. 2017 May;31(5):880-885. doi: 10.1016/j.jdiacomp.2017.01.026. Epub 2017 Feb 12.
We examined whether problem-solving and diabetes self-management behaviors differ by depression diagnosis - major depressive disorder (MDD) and minor depressive disorder (MinDD) - in adults with Type 2 diabetes (T2DM).
We screened a clinical sample of 702 adults with T2DM for depression, identified 52 positive and a sample of 51 negative individuals, and performed a structured diagnostic psychiatric interview. MDD (n=24), MinDD (n=17), and no depression (n=62) were diagnosed using Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) Text Revised criteria. Health Problem-Solving Scale (HPSS) and Summary of Diabetes Self-Care Activities (SDSCA) questionnaires determined problem-solving and T2DM self-management skills, respectively. We compared HPSS and SDSCA scores by depression diagnosis, adjusting for age, sex, race, and diabetes duration, using linear regression.
Total HPSS scores for MDD (β=-4.38; p<0.001) and MinDD (β=-2.77; p<0.01) were lower than no depression. Total SDSCA score for MDD (β=-10.1; p<0.01) was lower than for no depression, and was partially explained by total HPSS.
MinDD and MDD individuals with T2DM have impaired problem-solving ability. MDD individuals had impaired diabetes self-management, partially explained by impaired problem-solving. Future studies should assess problem-solving therapy to treat T2DM and MinDD and integrated problem-solving with diabetes self-management for those with T2DM and MDD.
我们研究了2型糖尿病（T2DM）成人患者中，根据抑郁症诊断——重度抑郁症（MDD）和轻度抑郁症（MinDD）——划分的问题解决能力和糖尿病自我管理行为是否存在差异。
我们对702例T2DM成人临床样本进行抑郁症筛查，确定了52例阳性个体和51例阴性个体样本，并进行了结构化诊断性精神科访谈。根据《精神疾病诊断与统计手册》第四版（DSM-IV）修订版标准诊断出MDD（n = 24）、MinDD（n = 17）和无抑郁症（n = 62）。健康问题解决量表（HPSS）和糖尿病自我护理活动总结（SDSCA）问卷分别用于确定问题解决能力和T2DM自我管理技能。我们通过抑郁症诊断比较HPSS和SDSCA得分，并使用线性回归对年龄、性别、种族和糖尿病病程进行校正。
MDD（β = -4.38；p < 0.001）和MinDD（β = -2.77；p < 0.01）的HPSS总分低于无抑郁症组。MDD的SDSCA总分（β = -10.1；p < 0.01）低于无抑郁症组，且部分可由HPSS总分解释。
患有T2DM的MinDD和MDD个体的问题解决能力受损。MDD个体的糖尿病自我管理能力受损，部分原因是问题解决能力受损。未来的研究应评估问题解决疗法对T2DM和MinDD的治疗效果，以及对患有T2DM和MDD的患者将问题解决与糖尿病自我管理相结合的效果。
