Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Smofsky Strategic Planning, Oakville, Ontario, Canada.
Can J Diabetes. 2018 Jun;42(3):289-295. doi: 10.1016/j.jcjd.2017.06.013. Epub 2017 Sep 25.
Type 2 diabetes mellitus (DM) is associated with substantial impairments in workplace function; however, the mediators of workplace performance in DM are not well characterized. Herein, we investigate depressive symptomatology and cognitive dysfunction as mediators of workplace productivity and hypothesize that workplace impairment is mediated principally by cognitive dysfunction in DM.
The Motivaction study screened individuals employed across Canada for diabetes. Subjects with impairments in glucose regulation indicative of risk for (i.e. glycated hemoglobin [A1C] levels 5.5% to 5.9%) or the presence of (i.e. A1C≥6.0%) DM were assessed on measures of depressive symptom severity [Patient Health Questionnaire, 9-item (PHQ-9)], self-rated cognitive impairment [Perceived Deficits Questionnaire, 5-item (PDQ-5)], and workplace impairment [Endicott Work Productivity Scale (EWPS)]. Multivariate regression and mediational analyses assessed for correlations between PHQ-9, PDQ-5 and EWPS total scores and the mediational role of self-reported cognitive dysfunction on the effect of depressive symptom severity on workplace impairment, respectively.
A total of 3627 individuals were screened, 1738 met eligibility criteria and 724 consented to the Motivaction study; 205 subjects with impaired glucose regulation were included in the analysis. Self-rated depressive and cognitive symptoms were positively correlated with workplace impairment among subjects with or at risk for DM. The deleterious effects of depressive symptomatology on workplace effectiveness was mediated principally by cognitive dysfunction in subjects with impaired glucose tolerance.
Among employed Canadians, impaired glucose tolerance is highly associated with impaired workplace performance. We report a novel finding insofar as the association between depressive symptoms and workplace impairment in individuals with impaired glucose regulation is mediated principally by self-rated cognitive dysfunction.
2 型糖尿病（DM）与工作场所功能的严重障碍有关；然而，DM 患者的工作场所表现的中介因素尚不清楚。在此，我们研究抑郁症状和认知功能障碍作为工作场所生产力的中介因素，并假设DM 患者的工作场所损害主要由认知功能障碍介导。
Motivaction 研究筛选了加拿大各地从事糖尿病工作的人员。有葡萄糖调节受损迹象的个体（即糖化血红蛋白 [A1C] 水平在 5.5%至 5.9%之间）或存在（即 A1C≥6.0%）DM 的个体，评估了抑郁症状严重程度[患者健康问卷，9 项（PHQ-9）]、自我报告的认知障碍[感知缺陷问卷，5 项（PDQ-5）]和工作场所损害[Endicott 工作生产力量表（EWPS）]。多变量回归和中介分析评估了 PHQ-9、PDQ-5 和 EWPS 总分之间的相关性，以及自我报告的认知功能障碍在抑郁症状严重程度对工作场所损害的影响中的中介作用。
共筛选了 3627 人，其中 1738 人符合入选标准，724 人同意参加 Motivaction 研究；纳入了 205 名葡萄糖调节受损的受试者。在 DM 患者或有患病风险的患者中，自我报告的抑郁和认知症状与工作场所损害呈正相关。在葡萄糖耐量受损的患者中，抑郁症状对工作效率的有害影响主要由认知功能障碍介导。
在加拿大就业人群中，葡萄糖耐量受损与工作场所表现受损高度相关。我们报告了一个新的发现，即葡萄糖耐量受损个体的抑郁症状与工作场所损害之间的关联主要由自我报告的认知功能障碍介导。
