Jacobson A M, de Groot M, Samson J A
Psychiatry Service, Joslin Diabetes Center, Boston, MA, USA.
Qual Life Res. 1997 Jan;6(1):11-20. doi: 10.1023/a:1026487509852.
The purpose of this study was to evaluate the influence of psychiatric symptoms and illness status on the health-related quality of life (HRQOL) of out-patients with Type I and Type II diabetes mellitus. Using a two-stage design, all patients were assessed by two measures of quality of life (Diabetes Quality of Life Measure; Medical Outcome Study Health Survey) and a psychiatric symptoms checklist (SCL-90R). Patients scoring 63 or greater on the global severity index of the SCL-90R and 30% below this cutoff were then evaluated using the Structured Clinical Interview for the DSM-III-R (SCID). Quality of life in both Type I and Type II diabetes was influenced by the level of current psychiatric symptoms and presence of co-morbid psychiatric disorder, after controlling for number of diabetic complications (e.g. effect of lifetime psychiatric illness on diabetes-related HRQOL; F = 46.8; df = 3, 135; p < 0.005). These effects were found consistently across specific domains. Both recent and past psychiatric disorders influenced HRQOL. Separate analyses comparing patients with and without depression showed similar effects. No interaction effects between diabetes type, number of complications, and psychiatric status were found in analyses. Finally, increased severity of psychiatric symptoms was correlated with decreased HRQOL in patients without current, recent, or past psychiatric diagnosis. This study shows the consistent, independent contribution of psychiatric symptoms and illness to the HRQOL of patients with a co-existing medical illness. Thus, psychiatric interventions addressing common conditions, such as depression, could improve the HRQOL of patients without changing medical status.
本研究的目的是评估精神症状和疾病状态对Ⅰ型和Ⅱ型糖尿病门诊患者健康相关生活质量（HRQOL）的影响。采用两阶段设计，通过两种生活质量测量方法（糖尿病生活质量测量；医学结局研究健康调查）和一份精神症状清单（SCL-90R）对所有患者进行评估。然后，对在SCL-90R的总体严重程度指数上得分63分或更高且低于该临界值30%的患者，使用《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）的结构化临床访谈（SCID）进行评估。在控制糖尿病并发症数量后，Ⅰ型和Ⅱ型糖尿病患者的生活质量均受到当前精神症状水平和共病精神障碍的影响（例如，终生精神疾病对糖尿病相关HRQOL的影响；F = 46.8；自由度 = 3, 135；p < 0.005）。在各个特定领域均一致发现了这些影响。近期和过去的精神障碍均影响HRQOL。对有抑郁和无抑郁患者进行的单独分析显示了类似的影响。分析中未发现糖尿病类型、并发症数量和精神状态之间的交互作用。最后，在没有当前、近期或过去精神疾病诊断的患者中，精神症状严重程度增加与HRQOL降低相关。本研究表明，精神症状和疾病对患有并存内科疾病患者的HRQOL具有一致、独立的影响。因此，针对常见病症（如抑郁症）的精神干预措施可在不改变医疗状况的情况下改善患者的HRQOL。
