1 型糖尿病患儿和青少年的主要非正规照护者的负担：与抑郁、家庭功能障碍和血糖控制有关吗？
Burden in primary informal caregivers of children and adolescents with type 1 diabetes: Is it associated with depression, family dysfunction, and glycemic control?
机构信息
Endocrinology Department, Hospital de Especialidades, Unidad Médica de Alta Especialidad (UMAE) Centro Médico Nacional Siglo XXI, Mexico City, Mexico.
Pediatric Endocrinology Department, Hospital de Pediatría, Unidad Médica de Alta Especialidad Centro Médico Nacional Siglo XXI, Mexico City, Mexico.
出版信息
Front Endocrinol (Lausanne). 2023 Jan 19;13:1089160. doi: 10.3389/fendo.2022.1089160. eCollection 2022.
OBJECTIVE
The requirement of a chronic treatment and the increase in life expectancy in children with type 1 diabetes (T1D) leads to the possibility of caregiver burden. The aim of our study was to evaluate the burden in primary informal caregivers (PIC) of children and adolescents with type 1 diabetes and its association with depression, family dysfunction, and glycemic control.
MATERIALS AND METHODS
A retrospective study was performed in PIC of children and adolescents with T1D. Zarit Burden Interview Scale (ZBIS) was used to evaluate caregiver burden. Beck Depression Inventory (BDI-II) was used to evaluate depression in PIC, and the Family APGAR questionnaire was used to evaluate the family functionality.
RESULTS
A total of 100 PIC of children and adolescents with T1D were included. Caregiver burden was found in 33% of caregivers. The total score of the Zarit scale was 41 (34-49); 19% had mild caregiver burden, and 14% had severe caregiver burden. According to the BDI-II, 82% had minimal depression, 11% mild depression, 5% moderate depression, and 2% severe depression. Family function was good in 69%; 13% had moderate dysfunction, and 18% had severe dysfunction. A positive correlation between caregiver burden and BDI-II score (r = 0.84; p = 0.001) and the grade of depression (r = 0.87; p = 0.001) was found. A logistic regression model showed that BDI-II score was associated with caregiver burden (OR 1.14; 95% CI 1.061-1.23; p = 0.001). A BDI-II cut off of 9 or more had a sensibility and specificity of 58% and 28%, respectively, for caregiver burden [AUC 0.751 (0.64-0.85); p = 0.001]. A BDI-II score ≥9 was a predictor of caregiver burden (OR 3.4; 95% CI 1.4-8.1; p = 0.008).
CONCLUSION
Caregiver burden is present in more than one third of the PIC of patients with T1D and is associated with depression. A BDI-II score ≥9 is a predictor of caregiver burden which may be a point to take into account in the integral approach to the patient with T1D and his or her family nucleus.
目的
1 型糖尿病（T1D）患儿需要长期治疗和预期寿命的延长，这导致了照顾者负担的可能性。我们研究的目的是评估 T1D 患儿的主要非正式照顾者（PIC）的负担及其与抑郁、家庭功能障碍和血糖控制的关系。
材料和方法
对 T1D 患儿的 PIC 进行了回顾性研究。使用 Zarit 负担量表（ZBIS）评估照顾者负担。贝克抑郁量表第二版（BDI-II）用于评估 PIC 的抑郁情况，家庭 APGAR 问卷用于评估家庭功能。
结果
共纳入 100 名 T1D 患儿的 PIC。33%的照顾者存在照顾者负担。Zarit 量表总分 41（34-49）；19%有轻度照顾者负担，14%有重度照顾者负担。根据 BDI-II，82%有轻度抑郁，11%有轻度抑郁，5%有中度抑郁，2%有重度抑郁。69%的家庭功能良好；13%有中度功能障碍，18%有严重功能障碍。照顾者负担与 BDI-II 评分呈正相关（r=0.84；p=0.001）和抑郁程度呈正相关（r=0.87；p=0.001）。Logistic 回归模型显示，BDI-II 评分与照顾者负担相关（OR 1.14；95%CI 1.061-1.23；p=0.001）。BDI-II 评分≥9 时，对照顾者负担的敏感性和特异性分别为 58%和 28%[AUC 0.751（0.64-0.85）；p=0.001]。BDI-II 评分≥9 是照顾者负担的预测因素（OR 3.4；95%CI 1.4-8.1；p=0.008）。
结论
T1D 患儿的主要非正式照顾者中超过三分之一存在照顾者负担，且与抑郁有关。BDI-II 评分≥9 是照顾者负担的预测因素，这可能是 T1D 患儿及其家庭核心成员整体治疗的一个考虑因素。
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