Division of General Internal Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA, USA.
Ann Behav Med. 2019 Oct 7;53(11):975-987. doi: 10.1093/abm/kaz009.
U.S. Hispanics/Latinos experience high lifetime risk for Type 2 diabetes and concurrent psychological depression. This comorbidity is associated with poorer self-management, worse disease outcomes, and higher mortality. Syndemic theory is a novel social epidemiological framework that emphasizes the role of economic and social adversity in promoting disease comorbidity and health disparities.
Informed by the syndemic framework, this study explored associations of socioeconomic and psychosocial adversity (low income/education, trauma history, adverse childhood experiences, ethnic discrimination, neighborhood problems [e.g., violence]) with comorbidity of diabetes and depression symptoms in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and Sociocultural Ancillary Study.
Participants were 5,247 Latino adults, aged 18-74, enrolled in four U.S. cities from 2008 to 2011. Participants completed a baseline physical exam and measures of depression symptoms and psychosocial adversity. Multinomial logistic regression analyses were conducted to examine associations of adversity variables with comorbid diabetes and high depression symptoms.
Household income below $30,000/year was associated with higher odds of diabetes/depression comorbidity (odds ratio [OR] = 4.61; 95% confidence interval [CI]: 2.89, 7.33) compared to having neither condition, as was each standard deviation increase in adverse childhood experiences (OR = 1.41; 95% CI: 1.16, 1.71), ethnic discrimination (OR = 1.23; 95% CI: 1.01, 1.50), and neighborhood problems (OR = 1.53; 95% CI: 1.30, 1.80).
Low household income, adverse childhood experiences, ethnic discrimination, and neighborhood problems are related to comorbid diabetes and depression in U.S. Latinos. Future studies should explore these relationships longitudinally.
美国西班牙裔/拉丁裔人群终生患 2 型糖尿病和并发心理抑郁的风险较高。这种合并症与较差的自我管理、更差的疾病结果和更高的死亡率有关。综合征理论是一种新的社会流行病学框架，强调经济和社会逆境在促进疾病合并症和健康差距方面的作用。
本研究以综合征理论为指导，探讨了社会经济和心理社会逆境（低收入/教育程度低、创伤史、不良童年经历、族裔歧视、邻里问题[如暴力]）与西班牙裔社区健康研究/拉丁裔研究（HCHS/SOL）和社会文化辅助研究中糖尿病和抑郁症状合并症的关系。
参与者为 5247 名年龄在 18-74 岁的拉丁裔成年人，于 2008 年至 2011 年期间在美国四个城市参加。参与者完成了基线体检和抑郁症状及社会心理逆境的测量。采用多分类逻辑回归分析，检验逆境变量与合并糖尿病和高抑郁症状的关系。
与既无糖尿病又无抑郁症状者相比，家庭收入低于 30000 美元/年（比值比[OR] = 4.61；95%置信区间[CI]：2.89，7.33），以及每个标准偏差增加的不良童年经历（OR = 1.41；95% CI：1.16，1.71）、族裔歧视（OR = 1.23；95% CI：1.01，1.50）和邻里问题（OR = 1.53；95% CI：1.30，1.80），发生糖尿病/抑郁合并症的可能性更高。
美籍拉丁裔人群中，家庭收入低、不良童年经历、族裔歧视和邻里问题与合并糖尿病和抑郁有关。未来的研究应该从纵向角度探讨这些关系。
