Kovacs M, Obrosky D S, Goldston D, Drash A
Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Diabetes Care. 1997 Jan;20(1):45-51. doi: 10.2337/diacare.20.1.45.
To determine whether IDDM affects the course of major depressive disorder (MDD) in youths.
The study samples include 24 youths with IDDM (of a group of 92) who developed MDD during a longitudinal follow-up of 10 years, on average, since onset of the medical condition, and 30 depressed psychiatric control subjects, matched on relevant variables. Both groups were repeatedly assessed by semistructured interviews and diagnosed by operational criteria.
In diabetic subjects, median time to recovery from the first episode of MDD was 6.4 months; by 12 months from onset, 69% of the youths will have recovered. Within 2 years of recovery, 32% were at risk for a new episode; by 6.5 years, altogether 47% are estimated to have a recurrence. Only 37.5% of diabetic subjects received treatment for the first episode of depression, and 50% received treatment for the second episode. Overall rates of recovery and recurrence were indistinguishable in the diabetic and psychiatric control groups. However, young women with diabetes were at nine times greater risk for recurrent depression than their male counterparts, and diabetic subjects eventually spent more time being depressed than the control subjects.
The course characteristics of MDD in young diabetic subjects and psychiatric control subjects appear to be similar in several regards. However, the eventual propensity of diabetic youths for more protracted depressions and the higher risk of recurrence among young diabetic women suggest that the mental health of patients with IDDM should be closely monitored. The findings confirm that depression is undertreated among patients in the primary health care sector.
确定胰岛素依赖型糖尿病（IDDM）是否会影响青少年重度抑郁症（MDD）的病程。
研究样本包括24名患有IDDM的青少年（在92名患者群体中），他们在自疾病发作起平均10年的纵向随访期间患上了MDD，以及30名抑郁的精神科对照受试者，两组在相关变量上进行了匹配。两组均通过半结构化访谈进行反复评估，并根据操作标准进行诊断。
在糖尿病患者中，从MDD首次发作恢复的中位时间为6.4个月；到发病后12个月，69%的青少年将会康复。在康复后的2年内，32%有再次发作的风险；到6.5年时，估计共有47%会复发。只有37.5%的糖尿病患者接受了首次抑郁发作的治疗，50%接受了第二次发作的治疗。糖尿病组和精神科对照组的总体康复率和复发率没有明显差异。然而，患有糖尿病的年轻女性复发抑郁症的风险是男性的九倍，并且糖尿病患者最终抑郁的时间比对照受试者更长。
年轻糖尿病患者和精神科对照受试者的MDD病程特征在几个方面似乎相似。然而，糖尿病青少年最终更易患长期抑郁症，且年轻糖尿病女性复发风险更高，这表明IDDM患者的心理健康应受到密切监测。研究结果证实，初级卫生保健部门的患者中抑郁症治疗不足。
