Perez Nicole Beaulieu, D'Eramo Melkus Gail, Fletcher Jason, Allen-Watts Kristen, Jones Deborah L, Collins Lauren F, Ramirez Catalina, Long Amanda, Cohen Mardge H, Merenstein Daniel, Wilson Tracey E, Sharma Anjali, Aouizerat Brad
Rory Meyers College of Nursing, New York University, New York, NY, 10010, United States.
School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States.
Ann Behav Med. 2025 Jan 4;59(1). doi: 10.1093/abm/kaae080.
Depression affects 33% of women with type 2 diabetes (T2D) and leads to increased risks of premature mortality. Fluctuation and variation of depressive presentations can hinder clinical identification.
We aimed to identify and examine subgroups characterized by distinct depressive symptom trajectories among women with T2D.
This retrospective analysis leveraged the Women's Interagency HIV Study data to identify depressive symptom trajectories based on the Center for Epidemiological Studies Depression scores (2014-2019) among women with and without HIV. Descriptive statistics characterized sample demographics (eg, age, race, income), clinical indices (eg, hemoglobin A1C [HbA1c], BMI, HIV status), and psychosocial experiences (eg, discrimination, social support, anxiety, pain). We used growth mixture modeling to identify groups defined by distinct depressive symptom trajectories and parametric and non-parametric tests to examine demographic, clinical, and psychosocial differences across subgroups.
Among the 630 women included, the mean age was 50.4 (SD = 8.3) years, 72.4% identified as Black and non-Hispanic, and 68.2% were living with HIV. Five subgroups were identified and distinguished by severity and symptom type. Participants with lower incomes (P = .01), lower employment (P < .0001), lower social support (P = .0001), and experiences of discrimination (P < .0001) showed greater membership in threshold, moderate, and severe depressive subgroups. Subgroup membership was not associated with metabolic indices (BMI, HbA1c) or HIV status. Anxiety, pain, and loneliness (all P = .0001) were worse in subgroups with higher depressive symptoms.
Among women with T2D, depressive symptom trajectories differ across clinical and social contexts. This study advances precision by delineating subgroups within a broad clinical category.
抑郁症影响33%的2型糖尿病（T2D）女性患者，并导致过早死亡风险增加。抑郁表现的波动和变化会阻碍临床识别。
我们旨在识别和研究2型糖尿病女性中具有不同抑郁症状轨迹特征的亚组。
这项回顾性分析利用妇女机构间HIV研究数据，根据流行病学研究中心抑郁量表评分（2014 - 2019年）确定有或无HIV感染的女性的抑郁症状轨迹。描述性统计描述了样本人口统计学特征（如年龄、种族、收入）、临床指标（如糖化血红蛋白[HbA1c]、体重指数、HIV感染状况）以及心理社会经历（如歧视、社会支持、焦虑、疼痛）。我们使用生长混合模型识别由不同抑郁症状轨迹定义的组，并使用参数和非参数检验来检查各亚组之间在人口统计学、临床和心理社会方面的差异。
在纳入的630名女性中，平均年龄为50.4（标准差 = 8.3）岁，72.4%为非西班牙裔黑人，68.2%感染HIV。识别出五个亚组，它们在严重程度和症状类型上有所不同。收入较低（P = 0.01）、就业水平较低（P < 0.0001）、社会支持较低（P = 0.0001）以及有歧视经历（P < 0.0001）的参与者在阈下、中度和重度抑郁亚组中的比例更高。亚组成员身份与代谢指标（体重指数、糖化血红蛋白）或HIV感染状况无关。在抑郁症状较重的亚组中，焦虑、疼痛和孤独感（均P = 0.0001）更严重。
在2型糖尿病女性中，抑郁症状轨迹在临床和社会背景方面存在差异。本研究通过在广泛的临床类别中划分亚组推进了精准医学。
