Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Seville, Spain.
Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain.
Acta Diabetol. 2018 Sep;55(9):943-953. doi: 10.1007/s00592-018-1172-5. Epub 2018 Jun 13.
To determine gender and age differences in the prevalence of depression and anxiety and their predictive factors in adult patients with type 1 diabetes (DM1).
Random sample of DM1 adult patients from a tertiary care hospital cohort. To evaluate the presence of depression and anxiety, psychological evaluation was performed using structured clinical interview (MINI). For the specific evaluation of fear of hypoglycemia (FH), FH-15 questionnaire was used.
339 patients [51.6% male; 38.5 ± 12.9 years; HbA 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.1 ± 12.0 years of DM1] met the inclusion criteria. Prevalence of depression, anxiety, and FH in men vs. women was as follows (%): depression: 15.4 vs. 33.5 (p < 0.05); anxiety: 13.7 vs. 26.2 (p < 0.05); and FH: 42.8 vs. 46.0 (p = NS). Among midlife female patients, prevalence of depression and anxiety was higher compared to male. Moreover, comorbid depressive and anxious symptoms were also higher in midlife female patients compared to age-matched male patients (3.5 vs. 14%, p < 0.05). Apart from age-related vulnerability, female gender, poor glycemic control, and microvascular and macrovascular complications were predictive factors for depressive and anxious symptomatology. Unawareness hypoglycemia and anxiety-prone personality were predictor factors for FH.
In adults with DM1, prevalence of depression and anxiety is higher in women. Midlife patients, in particular women, show a significantly higher prevalence of anxiety symptoms and comorbid depression and anxiety. The presence of secondary complications and sustained poor glycemic control should alert to the possibility of these mental disorders, especially in the most vulnerable age population; clinical, gender and age-related patterns could help to design more effective psychological assessment and support in adult patients with DM1.
确定 1 型糖尿病（DM1）成年患者中抑郁和焦虑的性别和年龄差异及其预测因素。
从三级护理医院队列中随机抽取 DM1 成年患者。为了评估抑郁和焦虑的存在，使用结构化临床访谈（MINI）进行心理评估。为了专门评估对低血糖的恐惧（FH），使用 FH-15 问卷。
339 名患者[51.6%为男性；38.5±12.9 岁；HbA17.5±1.1%（58.5±14.2mmol/mol）；DM120.1±12.0 年]符合纳入标准。男性与女性的抑郁、焦虑和 FH 患病率如下（%）：抑郁：15.4 vs. 33.5（p<0.05）；焦虑：13.7 vs. 26.2（p<0.05）；和 FH：42.8 vs. 46.0（p=NS）。在中年女性患者中，抑郁和焦虑的患病率高于男性。此外，与年龄匹配的男性患者相比，中年女性患者的抑郁和焦虑共病症状也更高（3.5 vs. 14%，p<0.05）。除了与年龄相关的脆弱性外，女性性别、血糖控制不佳以及微血管和大血管并发症是抑郁和焦虑症状的预测因素。低血糖无知和焦虑倾向的个性是 FH 的预测因素。
在 DM1 成年患者中，女性的抑郁和焦虑患病率更高。尤其是中年患者，女性出现焦虑症状和共病抑郁和焦虑的比例明显更高。存在二级并发症和持续的血糖控制不佳应警惕这些精神障碍的可能性，尤其是在最脆弱的年龄人群中；临床、性别和年龄相关模式有助于为 DM1 成年患者设计更有效的心理评估和支持。
