Chew Boon-How, Vos Rimke C, Stellato Rebecca K, Rutten Guy E H M
Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Front Psychol. 2017 Oct 17;8:1834. doi: 10.3389/fpsyg.2017.01834. eCollection 2017.
For people with type 2 diabetes mellitus (T2DM) the daily maintenance of physical and psychological health is challenging. However, the interrelatedness of these two health domains, and of diabetes-related distress (DRD) and depressive symptoms, in the Asian population is still poorly understood. DRD and depressive symptoms have important but distinct influences on diabetes self-care and disease control. Furthermore, the question of whether changes in DRD or depressive symptoms follow a more or less natural course or depend on disease and therapy-related factors is yet to be answered. The aim of this study was to identify the factors influencing changes in DRD or depressive symptoms, at a 3-year follow-up point, in Malaysian adults with T2DM who received regular primary diabetes care. Baseline data included age, sex, ethnicity, marital status, educational level, employment status, health-related quality of life (WHOQOL-BREF), insulin use, diabetes-related complications and HbA1c. DRD was assessed both at baseline and after 3 years using a 17-item Diabetes Distress Scale (DDS-17), while depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to examine the relationship between baseline variables and change scores in DDS-17 and PHQ-9. Almost half (336) of 700 participants completed both measurements. At follow-up, their mean (SD) age and diabetes duration were 60.6 (10.1) years and 9.8 (5.9) years, respectively, and 54.8% were women. More symptoms of depression at baseline was the only significant and independent predictor of improved DRD at 3 years (adjusted β = -0.06, = 0.002). Similarly, worse DRD at baseline was the only significant and independent predictor of fewer depressive symptoms 3 years later (adjusted β = -0.98, = 0.005). Thus, more "negative feelings" at baseline could be a manifestation of initial coping behaviors or a facilitator of a better psychological coaching by physicians or nurses that might be beneficial in the long term. We therefore conclude that initial negative feelings should not be seen as a necessarily adverse factor in diabetes care.
对于2型糖尿病（T2DM）患者而言，每日维持身心健康颇具挑战。然而，在亚洲人群中，这两个健康领域以及糖尿病相关困扰（DRD）与抑郁症状之间的相互关系仍未得到充分理解。DRD和抑郁症状对糖尿病自我护理及疾病控制有着重要但不同的影响。此外，DRD或抑郁症状的变化是或多或少遵循自然病程还是取决于疾病及治疗相关因素这一问题仍有待解答。本研究的目的是确定在接受常规初级糖尿病护理的马来西亚成年T2DM患者中，在3年随访时影响DRD或抑郁症状变化的因素。基线数据包括年龄、性别、种族、婚姻状况、教育水平、就业状况、健康相关生活质量（世界卫生组织生活质量简表，WHOQOL - BREF）、胰岛素使用情况、糖尿病相关并发症及糖化血红蛋白（HbA1c）。在基线和3年后均使用17项糖尿病困扰量表（DDS - 17）评估DRD，同时使用患者健康问卷（PHQ - 9）评估抑郁症状。采用线性混合模型来检验基线变量与DDS - 17和PHQ - 9变化分数之间的关系。700名参与者中近一半（336人）完成了两项测量。随访时，他们的平均（标准差）年龄和糖尿病病程分别为60.6（10.1）岁和9.8（5.9）年，女性占54.8%。基线时更多的抑郁症状是3年后DRD改善的唯一显著且独立的预测因素（调整后β = -0.06，P = 0.002）。同样，基线时更严重的DRD是3年后抑郁症状减少的唯一显著且独立的预测因素（调整后β = -0.98，P = 0.005）。因此，基线时更多的“负面情绪”可能是初始应对行为的一种表现，或者是医生或护士进行更好心理辅导的促进因素，从长远来看可能是有益的。我们因此得出结论，在糖尿病护理中，初始的负面情绪不应被视为必然的不利因素。
