2型糖尿病伴抑郁症状患者中西医结合社区干预效果研究
|
摘要
目的：
(1)了解北京市社区2型糖尿病(T2 DM)患者中抑郁症状的发生率；
(2)探讨T2 DM患者发生抑郁症状的影响因素；
(3)探讨T2 DM伴抑郁症状患者的生活质量及其影响因素；
(4)评价中医疗法(健身气功·八段锦、耳穴贴压法及中医食疗法)结合社区护理干预对于减轻T2 DM伴抑郁症状患者的抑郁症状,改善其生活质量、空腹血糖(FPG)、糖化血红蛋白(GHbAlc)、胰岛素敏感指数(ISI)、体质指数(BMI)的效果。
方法：
(1)横断面调查：2009年6月～9月,采用多阶段整群随机抽样的方法,抽取北京市朝阳区、东城区内4个社区卫生服务站,对所抽样社区卫生服务站所辖社区内T2 DM患者进行调查。对符合纳入标准的667例T2 DM患者采用一般情况调查表(自行设计)、抑郁自评量表(SDS)、糖尿病患者生命质量特异性量表(DMQLS)、社会支持量表(SSRS)进行调查,同时使用体重秤、身高测量仪测量身高、体重以计算BMI值,并使用强生血糖仪(稳步型)测量空腹(全血)血糖(FBG)。运用χ2检验、t检验、秩和检验进行T2 DM伴抑郁症状患者与T2 DM无抑郁症状患者间一般情况及生活质量比较；运用多因素非条件Logistic回归分析T2 DM患者发生抑郁的影响因素及其OR值；运用多元线性回归分析T2 DM伴抑郁症状患者生活质量的影响因素。
(2)中西医结合社区干预：采取随机、对照、单盲法的研究设计,干预时间共12周。随机抽取130例T2 DM伴抑郁症状患者,取得患者知情同意后,将其随机分为三组,其中中西医结合组43例、社区护理组44例、基础治疗组43例。中西医结合组在社区医院门诊就医的基础上接受中医疗法及社区护理,中医疗法包括规律练习健身气功·八段锦,耳穴贴压法,以及中医食疗法指导,社区护理措施包括定期健康教育及心理指导(电话访视)；社区护理组在社区医院门诊就医的基础上接受社区护理,社区护理措施包括定期健康教育及心理指导(电话访视),基础治疗组在社区医院门诊就医。在入组时、第6周、第12周采用SDS及DMQLS对三组患者的抑郁症状、生活质量进行评价,测量BMI,并抽取患者静脉血检测FPG、ISI,在入组时及第12周检测三组患者的GHbA1c。采用重复测量设计的方差分析法以分析三组在3个不同时间点各指标的差别,并绘制三组各评价指标变化趋势图。结果：
(1)667例社区T2 DM患者中,筛查出抑郁症状者295例,本组T2 DM患者抑郁症状发生率为44.20%。
(2)多因素非条件Logistic回归分析显示,并发症、SSRS、SSRS客观支持维度、SSRS主观支持维度、SSRS支持利用度维度是T2 DM患者抑郁症状发生的影响因素,其OR值分别为1.679,0.585,0.751,0.728,0.663。其中并发症为危险因素,社会支持为保护因素。
(3)SDS总分与DMQLS总分呈负相关,r=-0.469,P=0.000。T2 DM伴抑郁症状患者与T2 DM无抑郁症状患者生活质量比较,结果显示T2 DM伴抑郁症状患者DMQLS,总分及五个维度得分明显低于T2 DM无抑郁症状患者(P<0.001)。
(4)对295例T2 DM伴抑郁症状患者的生活质量影响因素进行多元逐步回归分析,5个变量进入总体生活质量多元逐步回归模型,即有无并发症、月收入、SDS总分、治疗方法、SSRS主观支持维度；R2=23.6%。有无并发症、SDS总分、月收入均进入DMQLS五个维度的多元逐步回归模型。
(5)中西医结合社区干预可减轻T2 DM伴抑郁症状患者的抑郁症状：第6周,中西医结合组SDS总分低于基础治疗组同期均值(54.27±9.42 v.s.59.90±8.63,P<0.05),第12周,中西医结合组SDS总分低于社区护理组及基础治疗组同期均值(51.71±9.57 v.s.55.88±9.38,51.71±9.57 v.s.60.69±8.35,P<0.05)。
(6)中西医结合社区干预可全面提高T2 DM伴抑郁症状患者的生活质量,尤其是在生理维度、心理维度及满意度维度方面：干预期间,中西医结合组DMQLS总分及其五个维度得分逐渐上升；第12周,中西医结合组DMQLS总分高于社区护理组(370.67±40.41 v.s.355.09±26.18,P<0.05)及基础治疗组(370.67±40.41 v.s.330.72±39.54,P<0.05)；第12周,中西医结合组的DMQLS生理维度得分高于基础治疗组(69.58±11.46 v.s.64.60±8.59,P<0.05),社区护理组与基础治疗组比较,差异无统计学意义；第12周,中西医结合组DMQLS心理维度得分高于社区护理组及基础治疗组(71.05±7.66 v.s.67.20±7.65,71.05±7.66 v.S.60.67±9.93,P值均<0.05)；第6周,中西医结合组DMQLS满意度维度得分高于社区护理组及基础治疗组(58.40±10.18 v.S.54.82±6.86,58.40±10.18v.s.50.86±7.47,P值均<0.05),第12周,中西医结合组满意度维度得分高于基础治疗组(60.91±9.75 v.S.53.30±7.86,P<0.05)。
(7)中西医结合社区干预可改善T2 DM伴抑郁症状患者血糖控制水平：第6周及第12周,中西医结合组FPG均低于基础治疗组(6.06±2.28 v.S.7.23±2.82,6.45±1.80 v.s.7.67±2.54,P值均<0.05)；第12周,中西医结合组GHbA1c均值低于基础治疗组(6.86±1.13 v.S.7.79±2.63,P<0.05)。
(8)在3个时间点上三组组间ISI、BMI两两比较,差异均未见统计学意义(P>0.05)。
结论：
(1)本组北京市社区T2 DM患者抑郁症状发生率较高；并发症、社会支持及其主观支持维度、客观支持维度、支持利用度维度是T2 DM患者抑郁症状发生的影响因素,其中并发症为危险因素,社会支持为保护因素。社区护士应定期对社区中T2 DM患者进行抑郁筛查,特别关注T2 DM患者中存在并发症者这类发生抑郁的高危人群,以及时发现伴有抑郁的患者,同时在应加强T2 DM患者的社会支持,从而降低患者发生抑郁的风险。
(2)抑郁症状与生活质量存在相关性,T2 DM伴抑郁症状患者生活质量差于T2 DM无抑郁症状患者。
(3)有无并发症、月收入、抑郁症状、治疗方法、主观支持是T2 DM伴抑郁症状患者总体生活质量的影响因素,而且有无并发症、SDS总分、月收入对生活质量五个维度均有影响。
(4)中西医结合社区干预可减轻T2 DM伴抑郁症状患者的抑郁症状,提高患者的总体生活质量,尤其是在患者生理维度、心理维度及满意度维度方面,并可使T2 DM伴抑郁症状患者更好地控制血糖水平。本研究所采用的健身气功·八段锦、耳穴贴压法、中医食疗法等中医非药物疗法操作方便,副作用少,医疗成本低,患者经济负担轻,可行性好,建议对于T2 DM伴抑郁症状患者采取此类中医疗法与社区护理相结合的干预措施。
Objective:
(1) To estimate the prevalence rate of depression symptoms in patients with Type 2 Diabetes Mellitus (T2 DM) in communities of Beijing.
(2) To explore the predictors of depression symptoms in patients with T2 DM.
(3) To estimate quality of life (QOL) of the patients with Type 2 DM co-morbid depression symptoms and explore the factors that have influence on their QOL
(4) To explore the effects of integrative traditional and western community health care on QOL, depression symptoms, fasting plasma glucose(FPG), glycosylated hemoglobin (GHbAlc), insulin sensitive index (ISI), and body mass index (BMI) of the patients with T2 DM co-morbid depression symptoms.
Methods:
(1) Cross-sectional study:From June,2009 to September,2009, four community health service stations in Chanyan District and Dongcheng District in Beijing were multi-stage cluster sampled randomly and all of the patients with T2 DM in these communities were selected.667 patients with T2 DM in communities were identified from electronic data records in these four community health service stations and investigated with questionnaires including demographic information sheet, self-rating depression scale (SDS), quality of life scale for patients with type 2 diabetes mellitus (DMQLS), and social support rating scale (SSRS).χ2 test, t test, and Wilcoxon rank sum test were used to compare the data of the patients with T2 DM co-morbid depression symptoms and T2 DM patients without co-morbid depression symptoms. With univariate analysis and multiple, unconditional logistic regression, the predictors of depression in patients with T2 DM and their Odds Ratio (OR) were analyzed. The factors that have influence on QOL of the patients with T2 DM co-morbid depression symptoms were analyzed with multivariate linear regression.
(2) Community intervention of integrative traditional and western medicine:The study was a randomized, controlled, single-blind trial.130 patients with T2 DM co-morbid depression symptoms were selected and divided into three groups at random:integrative traditional and western medicine group (n=43), community health care group (n=44), and control group (n=43). Integrative traditional and western medicine group received traditional Chinese medicine (TCM) and community health nursing on the bases of medical aid from the doctor in consulting room of community hospital. TCM included excising Chinese Health Qigong-Baduanjin regularly and ear acupressure and health education on TCM dietetic therapy. Community health nursing included regular health education and mental care via telephone call. Community health care group (n=44) received community health nursing and medical aid from the doctor in consulting room of community hospital. Control group (n=43) received medical aid from the doctor in consulting room of community hospital only. DMQLS, SDS, FPG、ISI, and BMI of three groups were evaluated at baseline and 6th week and 12th week. GHbAlc of three groups were evaluated at baseline and 12th week. Differences among three groups at three timepoints were analyzed with ANOVA of repeated measurement and the tendency chart of the index were made.
Results:
(1) Among 667 patients with T2 DM in communities,295 suffered co-morbid depression symptoms. The prevalence rate of depression symptoms in patients with T2 DM was 44.20%.
(2) Multiple, unconditional logistic regression analysis showed that DM related complication, SSRS, objective support domain of SSRS, subjective support domain of SSRS, and utilization domain of SSRS were factors independently predictive of depression in T2 DM, and their OR were 1.679,0.585,0.751,0.728,0.663 respectively. DM related complication was risk factor and social support was protective factor.
(3) There was a significant negative correlation between score of SDS and score of DMQLS, r=-0.469, P=0.000.The total score and five domain score of DMQLS of the patients with T2 DM co-morbid depression symptoms were significantly lower than those of T2 DM patients without depression symptoms (P<0.001).
(4) In the multivariable model, there were five statistics significant factors that had influence on QOL of the patients with T2 DM co-morbid depression symptoms, including DM related complication, monthly income, SDS, treatment, subjective support domain of SSRS.R2=23.6%. In addition, DM related complication, monthly income, and SDS had significant influence on five domains of DMQLS.
(5) Community intervention of integrative traditional and western medicine relieved depression symptoms of the patients with T2 DM co-morbid depression symptoms. At 6th week, the total score of SDS of integrative traditional and western medicine group was lower than that of control group (54.27±9.42 v.s.59.90±8.63, P<0.05). At 12th week, the total score of SDS of integrative traditional and western medicine group was lower than community health care group (51.71±9.57 v.s.55.88±9.38, P<0.05) as well as control group (51.71±9.57 v.s.60.69±8.35, P<0.05).
(6) Community intervention of integrative traditional and western medicine improved overall QOL of the patients with T2 DM co-morbid depression symptoms, especially in physical domain, psychological domain, and satisfaction domain. QOL of integrative traditional and western medicine group increased significantly from baseline. At 12th week, the total score of DMQLS of integrative traditional and western medicine group was higher than that of community health care group (370.67±40.41 v.s.355.09±26.18, P<0.05), and control group (370.67±40.41 v.s.330.72±39.54, P<0.05). After 12 weeks intervention, the score of physical domain of DMQLS of integrative traditional and western medicine group was higher than that of control group (69.58±11.46 v.s.64.60±8.59, P<0.05), while no significant difference between community health care group and control group. At 12th week, the score of psychological domain of DMQLS of integrative traditional and western medicine group was higher than that of community health care group (71.05±7.66 v.s.67.20±7.65, P<0.05) as well as control group (71.05±7.66 v.s.60.67±9.93, P<0.05). At 6th week, the score of satisfaction domain of DMQLS of integrative traditional and western medicine group was higher than that of community health care group (58.40±10.18 v.s.54.82±6.86, P<0.05) as well as control group (58.40±10.18 v.s.50.86±7.47, P<0.05). At 12th week, the score of satisfaction domain of DMQLS of integrative traditional and western medicine group was higher than that of control group (60.91±9.75 v.s. 53.30±7.86, P<0.05).
(7) Community intervention of integrative traditional and western medicine decreased blood glucose of the patients with Type 2 DM co-morbid depression symptoms. At 6th week and 12th week, FPG of integrative traditional and western medicine group was lower than that of control group (6.06±2.28 v.s.7.23±2.82,6.45±1.80 v.s.7.67±2.54, P<0.05). At 12th week, GHbA1c of integrative traditional and western medicine group was lower than that of control group (6.86±1.13 v.s.7.79±2.63, P<0.05).
(8) No statistical differences were observed among three groups in ISI and BMI.
Conclusions:
(1) The prevalence rate of depression symptoms in patients with T2 DM in communities of Beijing is high. DM related complication, SSRS, subjective support domain of SSRS, objective support domain of SSRS, and utilization domain of SSRS are predictors of depression in patients with T2 DM. DM related complication is risk factor and social support is protective factor. Community health nurses should screen depression symptoms for T2 DM patients in community, and focus on those suffered DM related complication because they have high-risk of suffering depression in order to find depression in T2 DM patients. Meanwhile, Community health nurses should strengthen social support for T2 DM patients to reduce the risk of depression.
(2) There is significant negative correlation between depression and QOL. The patients with T2 DM co-morbid depression symptoms experience worse QOL than T2 DM patients without depression symptoms do.
(3) The factors that have influence on QOL of the patients with T2 DM co-morbid depression symptoms include DM related complication, monthly income, depression symptoms, treatment, and subjective social support. DM related complication, monthly income, and depression have influence on five domains of QOL
(4) In the patients with T2 DM co-morbid depression symptoms, integrative traditional and western community health care can relieve their depression status and promote their QOL, especially in physical domain, psychological domain, and satisfaction domain. Meanwhile, it can stabilize their blood glucose. Chinese Health Qigong·Baduanjin and ear acupressure and TCM dietetic therapy have many advantages such as convenient operation, less side-effects, lower medical cost and patients economic burden. So it is suggested that TCM combined community health nursing be used in treating the patients with T2 DM co-morbid depression symptom.
(1)了解北京市社区2型糖尿病(T2 DM)患者中抑郁症状的发生率；
(2)探讨T2 DM患者发生抑郁症状的影响因素；
(3)探讨T2 DM伴抑郁症状患者的生活质量及其影响因素；
(4)评价中医疗法(健身气功·八段锦、耳穴贴压法及中医食疗法)结合社区护理干预对于减轻T2 DM伴抑郁症状患者的抑郁症状,改善其生活质量、空腹血糖(FPG)、糖化血红蛋白(GHbAlc)、胰岛素敏感指数(ISI)、体质指数(BMI)的效果。
方法：
(1)横断面调查：2009年6月～9月,采用多阶段整群随机抽样的方法,抽取北京市朝阳区、东城区内4个社区卫生服务站,对所抽样社区卫生服务站所辖社区内T2 DM患者进行调查。对符合纳入标准的667例T2 DM患者采用一般情况调查表(自行设计)、抑郁自评量表(SDS)、糖尿病患者生命质量特异性量表(DMQLS)、社会支持量表(SSRS)进行调查,同时使用体重秤、身高测量仪测量身高、体重以计算BMI值,并使用强生血糖仪(稳步型)测量空腹(全血)血糖(FBG)。运用χ2检验、t检验、秩和检验进行T2 DM伴抑郁症状患者与T2 DM无抑郁症状患者间一般情况及生活质量比较；运用多因素非条件Logistic回归分析T2 DM患者发生抑郁的影响因素及其OR值；运用多元线性回归分析T2 DM伴抑郁症状患者生活质量的影响因素。
(2)中西医结合社区干预：采取随机、对照、单盲法的研究设计,干预时间共12周。随机抽取130例T2 DM伴抑郁症状患者,取得患者知情同意后,将其随机分为三组,其中中西医结合组43例、社区护理组44例、基础治疗组43例。中西医结合组在社区医院门诊就医的基础上接受中医疗法及社区护理,中医疗法包括规律练习健身气功·八段锦,耳穴贴压法,以及中医食疗法指导,社区护理措施包括定期健康教育及心理指导(电话访视)；社区护理组在社区医院门诊就医的基础上接受社区护理,社区护理措施包括定期健康教育及心理指导(电话访视),基础治疗组在社区医院门诊就医。在入组时、第6周、第12周采用SDS及DMQLS对三组患者的抑郁症状、生活质量进行评价,测量BMI,并抽取患者静脉血检测FPG、ISI,在入组时及第12周检测三组患者的GHbA1c。采用重复测量设计的方差分析法以分析三组在3个不同时间点各指标的差别,并绘制三组各评价指标变化趋势图。结果：
(1)667例社区T2 DM患者中,筛查出抑郁症状者295例,本组T2 DM患者抑郁症状发生率为44.20%。
(2)多因素非条件Logistic回归分析显示,并发症、SSRS、SSRS客观支持维度、SSRS主观支持维度、SSRS支持利用度维度是T2 DM患者抑郁症状发生的影响因素,其OR值分别为1.679,0.585,0.751,0.728,0.663。其中并发症为危险因素,社会支持为保护因素。
(3)SDS总分与DMQLS总分呈负相关,r=-0.469,P=0.000。T2 DM伴抑郁症状患者与T2 DM无抑郁症状患者生活质量比较,结果显示T2 DM伴抑郁症状患者DMQLS,总分及五个维度得分明显低于T2 DM无抑郁症状患者(P<0.001)。
(4)对295例T2 DM伴抑郁症状患者的生活质量影响因素进行多元逐步回归分析,5个变量进入总体生活质量多元逐步回归模型,即有无并发症、月收入、SDS总分、治疗方法、SSRS主观支持维度；R2=23.6%。有无并发症、SDS总分、月收入均进入DMQLS五个维度的多元逐步回归模型。
(5)中西医结合社区干预可减轻T2 DM伴抑郁症状患者的抑郁症状：第6周,中西医结合组SDS总分低于基础治疗组同期均值(54.27±9.42 v.s.59.90±8.63,P<0.05),第12周,中西医结合组SDS总分低于社区护理组及基础治疗组同期均值(51.71±9.57 v.s.55.88±9.38,51.71±9.57 v.s.60.69±8.35,P<0.05)。
(6)中西医结合社区干预可全面提高T2 DM伴抑郁症状患者的生活质量,尤其是在生理维度、心理维度及满意度维度方面：干预期间,中西医结合组DMQLS总分及其五个维度得分逐渐上升；第12周,中西医结合组DMQLS总分高于社区护理组(370.67±40.41 v.s.355.09±26.18,P<0.05)及基础治疗组(370.67±40.41 v.s.330.72±39.54,P<0.05)；第12周,中西医结合组的DMQLS生理维度得分高于基础治疗组(69.58±11.46 v.s.64.60±8.59,P<0.05),社区护理组与基础治疗组比较,差异无统计学意义；第12周,中西医结合组DMQLS心理维度得分高于社区护理组及基础治疗组(71.05±7.66 v.s.67.20±7.65,71.05±7.66 v.S.60.67±9.93,P值均<0.05)；第6周,中西医结合组DMQLS满意度维度得分高于社区护理组及基础治疗组(58.40±10.18 v.S.54.82±6.86,58.40±10.18v.s.50.86±7.47,P值均<0.05),第12周,中西医结合组满意度维度得分高于基础治疗组(60.91±9.75 v.S.53.30±7.86,P<0.05)。
(7)中西医结合社区干预可改善T2 DM伴抑郁症状患者血糖控制水平：第6周及第12周,中西医结合组FPG均低于基础治疗组(6.06±2.28 v.S.7.23±2.82,6.45±1.80 v.s.7.67±2.54,P值均<0.05)；第12周,中西医结合组GHbA1c均值低于基础治疗组(6.86±1.13 v.S.7.79±2.63,P<0.05)。
(8)在3个时间点上三组组间ISI、BMI两两比较,差异均未见统计学意义(P>0.05)。
结论：
(1)本组北京市社区T2 DM患者抑郁症状发生率较高；并发症、社会支持及其主观支持维度、客观支持维度、支持利用度维度是T2 DM患者抑郁症状发生的影响因素,其中并发症为危险因素,社会支持为保护因素。社区护士应定期对社区中T2 DM患者进行抑郁筛查,特别关注T2 DM患者中存在并发症者这类发生抑郁的高危人群,以及时发现伴有抑郁的患者,同时在应加强T2 DM患者的社会支持,从而降低患者发生抑郁的风险。
(2)抑郁症状与生活质量存在相关性,T2 DM伴抑郁症状患者生活质量差于T2 DM无抑郁症状患者。
(3)有无并发症、月收入、抑郁症状、治疗方法、主观支持是T2 DM伴抑郁症状患者总体生活质量的影响因素,而且有无并发症、SDS总分、月收入对生活质量五个维度均有影响。
(4)中西医结合社区干预可减轻T2 DM伴抑郁症状患者的抑郁症状,提高患者的总体生活质量,尤其是在患者生理维度、心理维度及满意度维度方面,并可使T2 DM伴抑郁症状患者更好地控制血糖水平。本研究所采用的健身气功·八段锦、耳穴贴压法、中医食疗法等中医非药物疗法操作方便,副作用少,医疗成本低,患者经济负担轻,可行性好,建议对于T2 DM伴抑郁症状患者采取此类中医疗法与社区护理相结合的干预措施。
Objective:
(1) To estimate the prevalence rate of depression symptoms in patients with Type 2 Diabetes Mellitus (T2 DM) in communities of Beijing.
(2) To explore the predictors of depression symptoms in patients with T2 DM.
(3) To estimate quality of life (QOL) of the patients with Type 2 DM co-morbid depression symptoms and explore the factors that have influence on their QOL
(4) To explore the effects of integrative traditional and western community health care on QOL, depression symptoms, fasting plasma glucose(FPG), glycosylated hemoglobin (GHbAlc), insulin sensitive index (ISI), and body mass index (BMI) of the patients with T2 DM co-morbid depression symptoms.
Methods:
(1) Cross-sectional study:From June,2009 to September,2009, four community health service stations in Chanyan District and Dongcheng District in Beijing were multi-stage cluster sampled randomly and all of the patients with T2 DM in these communities were selected.667 patients with T2 DM in communities were identified from electronic data records in these four community health service stations and investigated with questionnaires including demographic information sheet, self-rating depression scale (SDS), quality of life scale for patients with type 2 diabetes mellitus (DMQLS), and social support rating scale (SSRS).χ2 test, t test, and Wilcoxon rank sum test were used to compare the data of the patients with T2 DM co-morbid depression symptoms and T2 DM patients without co-morbid depression symptoms. With univariate analysis and multiple, unconditional logistic regression, the predictors of depression in patients with T2 DM and their Odds Ratio (OR) were analyzed. The factors that have influence on QOL of the patients with T2 DM co-morbid depression symptoms were analyzed with multivariate linear regression.
(2) Community intervention of integrative traditional and western medicine:The study was a randomized, controlled, single-blind trial.130 patients with T2 DM co-morbid depression symptoms were selected and divided into three groups at random:integrative traditional and western medicine group (n=43), community health care group (n=44), and control group (n=43). Integrative traditional and western medicine group received traditional Chinese medicine (TCM) and community health nursing on the bases of medical aid from the doctor in consulting room of community hospital. TCM included excising Chinese Health Qigong-Baduanjin regularly and ear acupressure and health education on TCM dietetic therapy. Community health nursing included regular health education and mental care via telephone call. Community health care group (n=44) received community health nursing and medical aid from the doctor in consulting room of community hospital. Control group (n=43) received medical aid from the doctor in consulting room of community hospital only. DMQLS, SDS, FPG、ISI, and BMI of three groups were evaluated at baseline and 6th week and 12th week. GHbAlc of three groups were evaluated at baseline and 12th week. Differences among three groups at three timepoints were analyzed with ANOVA of repeated measurement and the tendency chart of the index were made.
Results:
(1) Among 667 patients with T2 DM in communities,295 suffered co-morbid depression symptoms. The prevalence rate of depression symptoms in patients with T2 DM was 44.20%.
(2) Multiple, unconditional logistic regression analysis showed that DM related complication, SSRS, objective support domain of SSRS, subjective support domain of SSRS, and utilization domain of SSRS were factors independently predictive of depression in T2 DM, and their OR were 1.679,0.585,0.751,0.728,0.663 respectively. DM related complication was risk factor and social support was protective factor.
(3) There was a significant negative correlation between score of SDS and score of DMQLS, r=-0.469, P=0.000.The total score and five domain score of DMQLS of the patients with T2 DM co-morbid depression symptoms were significantly lower than those of T2 DM patients without depression symptoms (P<0.001).
(4) In the multivariable model, there were five statistics significant factors that had influence on QOL of the patients with T2 DM co-morbid depression symptoms, including DM related complication, monthly income, SDS, treatment, subjective support domain of SSRS.R2=23.6%. In addition, DM related complication, monthly income, and SDS had significant influence on five domains of DMQLS.
(5) Community intervention of integrative traditional and western medicine relieved depression symptoms of the patients with T2 DM co-morbid depression symptoms. At 6th week, the total score of SDS of integrative traditional and western medicine group was lower than that of control group (54.27±9.42 v.s.59.90±8.63, P<0.05). At 12th week, the total score of SDS of integrative traditional and western medicine group was lower than community health care group (51.71±9.57 v.s.55.88±9.38, P<0.05) as well as control group (51.71±9.57 v.s.60.69±8.35, P<0.05).
(6) Community intervention of integrative traditional and western medicine improved overall QOL of the patients with T2 DM co-morbid depression symptoms, especially in physical domain, psychological domain, and satisfaction domain. QOL of integrative traditional and western medicine group increased significantly from baseline. At 12th week, the total score of DMQLS of integrative traditional and western medicine group was higher than that of community health care group (370.67±40.41 v.s.355.09±26.18, P<0.05), and control group (370.67±40.41 v.s.330.72±39.54, P<0.05). After 12 weeks intervention, the score of physical domain of DMQLS of integrative traditional and western medicine group was higher than that of control group (69.58±11.46 v.s.64.60±8.59, P<0.05), while no significant difference between community health care group and control group. At 12th week, the score of psychological domain of DMQLS of integrative traditional and western medicine group was higher than that of community health care group (71.05±7.66 v.s.67.20±7.65, P<0.05) as well as control group (71.05±7.66 v.s.60.67±9.93, P<0.05). At 6th week, the score of satisfaction domain of DMQLS of integrative traditional and western medicine group was higher than that of community health care group (58.40±10.18 v.s.54.82±6.86, P<0.05) as well as control group (58.40±10.18 v.s.50.86±7.47, P<0.05). At 12th week, the score of satisfaction domain of DMQLS of integrative traditional and western medicine group was higher than that of control group (60.91±9.75 v.s. 53.30±7.86, P<0.05).
(7) Community intervention of integrative traditional and western medicine decreased blood glucose of the patients with Type 2 DM co-morbid depression symptoms. At 6th week and 12th week, FPG of integrative traditional and western medicine group was lower than that of control group (6.06±2.28 v.s.7.23±2.82,6.45±1.80 v.s.7.67±2.54, P<0.05). At 12th week, GHbA1c of integrative traditional and western medicine group was lower than that of control group (6.86±1.13 v.s.7.79±2.63, P<0.05).
(8) No statistical differences were observed among three groups in ISI and BMI.
Conclusions:
(1) The prevalence rate of depression symptoms in patients with T2 DM in communities of Beijing is high. DM related complication, SSRS, subjective support domain of SSRS, objective support domain of SSRS, and utilization domain of SSRS are predictors of depression in patients with T2 DM. DM related complication is risk factor and social support is protective factor. Community health nurses should screen depression symptoms for T2 DM patients in community, and focus on those suffered DM related complication because they have high-risk of suffering depression in order to find depression in T2 DM patients. Meanwhile, Community health nurses should strengthen social support for T2 DM patients to reduce the risk of depression.
(2) There is significant negative correlation between depression and QOL. The patients with T2 DM co-morbid depression symptoms experience worse QOL than T2 DM patients without depression symptoms do.
(3) The factors that have influence on QOL of the patients with T2 DM co-morbid depression symptoms include DM related complication, monthly income, depression symptoms, treatment, and subjective social support. DM related complication, monthly income, and depression have influence on five domains of QOL
(4) In the patients with T2 DM co-morbid depression symptoms, integrative traditional and western community health care can relieve their depression status and promote their QOL, especially in physical domain, psychological domain, and satisfaction domain. Meanwhile, it can stabilize their blood glucose. Chinese Health Qigong·Baduanjin and ear acupressure and TCM dietetic therapy have many advantages such as convenient operation, less side-effects, lower medical cost and patients economic burden. So it is suggested that TCM combined community health nursing be used in treating the patients with T2 DM co-morbid depression symptom.
引文
[1]陆再英,钟南山.内科学(7版).北京：人民卫生出版社,2009.770～775,778～779
[2]中华医学会糖尿病学分会.中国糖尿病防治指南.中华内分泌代谢病杂志,2008,24(2)：2～4
[3]World Health Organization(2001). Depression. What is depression? http://www. who.int/mental_health/management/depression/definition/en/
[4]Ryan J Anderson, Kenneth E Freedland, Ray E Clouse, et al. The prevalence of comorbid depression in adults with diabetes:A meta-analysis. Diabetes Care,2001, 24(6):1069-1078
[5]Martin P. Cosgrove, Lincoln A. Sargeant, Simon J. Griffin. Does depression increase the risk of developing type 2 diabetes? Occupational Medicine,2008, 58(1):7-14
[6]唐平.医学心理学.北京：人民卫生出版社,2009.155
[7]范晓清.远离抑郁.北京：化学工业出版社,2008.8-10,69
[8]Robins LN, Cottler LB, Bucholz K, et al. Diagnostic Interview Schedule for DMS-IV. St. Louis, MO:Washington University,1995.78
[9]Janet Thomas, Glenn Jones, Isabel Scarinci, et al. A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. Diabetes Care,2003,26(8):2311-2317
[10]Anne Engum, Arnstein Mykletun, Kristian Midthjell, et al. Depression and Diabetes:A large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes. Diabetes Care,2005, 28(8):1904-1909
[11]Maren J. Cofman. Effects of tangible social support and depression on diabetes self-efficacy. Journal of Gerontological Nursing,2008,34(4):32-39
[12]Egede LE. Diabetes, Major Depression, and Functional Disability among U.S. Adults. Diabetes Care,2004,27(2):421-428
[13]Robert D Goldney, Pat J Phillips, Laura J Fisher, et al. Diabetes, Depression, and Quality of Life:A population study. Diabetes Care,2004,27(5):1066-1070
[14]Zhang X, Norris SL, Gregg EW, et al. Depression symptoms and mortality among persons with and without diabetes. America Journal of Epidemiology,2005, 161(7):652-660
[15]Cristina Fortes, Sara Farchi, Francesco Forastiere, et al. Depressive symptoms lead, to impaired cellular immune response. Psychotherapy and Psychosomatics, 2003,72(5):253-260
[16]Wayne Katon, Paul Ciechanowski. Impact of major depression on chronic medical illness.the Journal of Psychosomatic Research,2002,53:859-863
[17]Donna E. Stewart. Battling depression. Canadian Medical Association Journal, 2008,178(8):1023-1024
[18]Khalida Ismail, Kirsty Winkley, Daniel Stahl, et al. A cohort study of people with diabetes and their first foot ulcer:the role of depression on mortality. Diabetes Care,2007,30(6):1473-1479
[19]孟凡菊,索新华,张清贵.2型糖尿病患者抑郁情绪表现及其对疗效的影响.中国临床康复,2004,8(6)：1008-1009
[20]张文汉,胡素君,刘一心,等.深圳市社区老年2型糖尿病患者生存质量和心理及社会支持调查研究.中国全科医学,2009,12(1B)：166-168
[21]Mohammad E. Khamseh, Hamid R.Baradaran, Hassan Rajaball. Depression and diabetes in Iranian patients:A compative study, International Journal of Psychiatry in Medicine,2007,37(1):81-86
[22]Gregory A. Nichols, Jonathan B. Brown. Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes. Diabetes Care,2003,26(3):744-749
[23]Blazer DG, Moody-Ayers S, Craft-Morgan J, et al. Depression in diabetes and obesity:racial/ethnic/gender issues in older adults. Journal of Psychsom Research, 2002, Oct,53(4):913-916
[24]Ronnemaa T, Ronnemaa EM, Puukka P, et al. Smoking is independently associated with high plasma insulin levels in nondiabetic men. Diabetes Care, 1996,19(11):1229-1232
[25]Black S, Markids K, Ray L. Depression predicts increased incidence of adverse health outcomes in older Mexican American with type 2 diabetes. Diabetes Care, 2003,26(10):2822-2828
[26]Lauren C.Brown, Sumit R.Majumdar, Stephen C.Newman, et al. Type 2 diabetes does not increase risk of depression. Canadian Medical Association Journal, 2006,175(1):42-46
[27]Kolawole Mosaku, Babatope Kolawole, MBCHb, FWACP;Celestine Mume, et al. Depression, anxiety and quality of life among diabetic patients:a comparative study. Journal of the National Medical Association,2008,100(1):73-78
[28]WHO. Report of the WHO Meeting on the Assessment of Quality of Life in the Health Care.Geneva:WHO,1991.1
[29]江玲.与健康有关的生存质量评定探讨.中国康复理论与实践,2002,8(12)：768,746
[30]Ciechanowski PS, Katon WJ, Russo JE, et al. Depression and Diabetes:Impact of Depressive Symptoms on Adherence, Function and Costs. Arch Intern Med,2000, 160(21):3278-3285.
[31]Wandell PE, Tovi J. The quality of life of elderly diabetic patients. J Diabetes Complications,2000,14(1):25-30
[32]Hiltunen L, Keinanen-Kiukaanniemi S. Does glucose tolerance affect quality of life in an elderly population. Diabetes Res Clin Pract,1999,46(2):161-167
[33]Monique M. Williams, Ray E. Clouse, Patrick J. Lustman. Treating depression to prevent diabetes and its complications:understanding depression as a medical risk factor. Clinical Diabetes, April,2006,24(2):79-86
[34]A. Nicolucci, D. Cucinotta. S. Squatrito, et al. Clinical and socio-economic correlates of quality of life and treatment satisfaction in patients with type 2 diabetes. Nutrition, Metabolism & Cardiovascular Diseases,2009,19(1):45-53
[35]Ranjita Misra, Julie Lager. Predictors of quality of life among adults with type 2 diabetes mellitus. Journal of Diabetes and Its Complications,2008,22(3):217-223
[36]Gary C. Brown, Melissa M. Brown, Sanjay Sharma, et al. Quality of life associated with diabetes mellitus in an adult population. Journal of Diabetes and Its Complications,2000,14(1):18-24
[37]http://www.chab.org.cn/NewsDetail.asp?id=4894
[38]孙振球.医学科学研究与设计.北京：人民卫生出版社,2008.125,132
[39]李立明.流行病学(6版). 北京：人民卫生出版社,2008.47
[40]季建林.医学心理学(4版). 上海：复旦大学出版社,2008.230-231
[41]蔡华俭.外显自尊、内隐自尊与抑郁的关系.中国心理卫生杂志,2003,17(5)：331～336
[42]王乐三,孙振球,胡明,等.2型糖尿病生活质量量表的编制策略及条目筛选.中国卫生统计,2006,23(2)：146-148
[43]王乐三,孙振球,蔡太生,等.T2 DM患者生活质量量表的研制与考评.中南大学学报(医学版),2005,30(1)：21-27
[44]汪向东.心理卫生评定手册(增订版).北京：中国心理卫生杂志社,1999,127～131
[45]刘继文,李富业,连玉龙.社会支持评定量表的信度效度研究.新疆医科大学学报,2008,31(1)：1-3
[46]D.G.Bruce, W.A.Davis, S.E.Starkstein, et al. A prospective study of depression and mortality in patients with type 2 diabetes:the Fremantle Diabetes Study. Diabetologia,2005,48(12):2532-2539
[47]Joseph Keawe aimoku Kaholokula, Stephen N.Haynes, Andrew Grandinetti, et al. Biological, psychosocial, and sociodemographic variables associated with depression symptoms in persons with Type 2 Diabetes. Journal of Behacioral Medicine,2003,26(5):435-458
[48]徐天和,柳青.中国医学统计百科全书多元统计分册.北京：人民卫生出版社,2004.206
[49]Leonard E Egede, Deyi Zheng. Independent factors associated with major depressive disorder in a national sample of individuals with diabetes. Diabetes Care, Jan 2003,26(1):104-111
[50]Jouko A Hanninen, Jorma K Takala, Sirkka M Keinanen-Kiukanniemi. Depression in subjects with type 2 diabetes. Diabetes Care,1999,22(6):997-998
[51]Elaine A. Anderson, Julie K. Kohler, Bethany L. Letiecq. Predictors of depression among low-income, nonresidential fathers. Journal of Family Issues, 2005,26(5):547-567
[52]Vanderhorst R. K., McLaren S. Social relationships as predictors of depression and suicidal ideation in older adults. Aging and Mental Health,2005,9(6): 517-525
[53]William P. Sacco, Tovah Yanove. Diabetes and Depression:The Role of Social Support and Medical Symptoms. Journal of Behavioral Medicine,2006,29(6):523-531
[54]Friedman L.C., Brown A.E., Romero C. Depressed mood and social support as predictors of quality of life in women receiving home health care. Quality of life research,2005, Oct,14(8):1925-1929
[55]Briana Mezuk, Sandra Albrecht, Willian W. Eaton, et al. Depression and type 2 diabetes over the lifespan. Diabetes Care,2008,31(12):2383-2390
[56]P. de Jonge, J. F. Roy, P. Saz, et al. Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus:results from the ZARADEMP project. Diabetologia,2006,49(11):2627-2633
[57]Wexler DJ, Grant RW, Wittenberg E, et al. Correlates of health-related quality of life in type 2 diabetes. Diabetologia,2006,49(7):1489-1497
[58]Fisher L, Chesla CA, Mullan JT, et al. Contributors to depression in Latino and European-American patients with type 2 diabetes. Diabetes Care,2001,24(10): 1751-1757
[59]Matthias R, Thea S, Herbert F, et al. The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control. Diabetes Care,2002,25(1):35-41
[60]UK Prospective Diabetes Study Group. Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). U.K. Prospective Diabetes Study Group. Diabetes Care,1999,22(7):1125-1136
[61]J. S. Gonzalez, L. M. Delahanty, S. A. Safren, et al. Differentiating symptoms of depression from diabetes-specific distress:relationships with self-care in type 2 diabetes. Diabetologia,2008,51(10):1822-1825
[62]Redekop WK, Koopmanschap MA, Stolk RP, et al. Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes. Diabetes Care, 2002,25(3):458-463
[63]Timothy M.E. Davis, Rhonda M. Clifford, Wendy A. Davis. Effect of insulin therapy on quality of life in Type 2diabetes mellitus:The Fremantle Diabetes Study. Diabetes Research and Clinical Practice,2001,52(1):63-71
[64]Grandinetti, A., Kaholokula, J.K., Crabbe K.M.. et al. Relationship between depressive symptoms and diabetes among Native Hawaiians. Psychoneuroendocrinology,2000,25(3):239-246
[65]Nico Hutter, Christa Scheidt-Nave, Harald Baumeister. Health care utilization and quality of life in individuals with diabetes and comorbid mental disorders. General Hospital Psychiatry,2009,31(1):33-35
[66]Sheldon Cohen. Social relationships and health. American Psychologist,2004, 59(8):676-684
[67]Henk A. van Dam, Frans G. van der Horst, Lut Knoops,et al. Social support in diabetes:a systematic review of controlled intervention studies. Patient Education and Counseling,2005,59(1):1-12
[68]Frank Petrak, Stephan Herpertz. Treatment of depression in diabetes:an update. Current Opinion in Psychiatry,2009,22(2):211-217
[69]D'sa C, Duman RS. Antidepressants and neuroplasticity. Bipolar Disord, 2002,4(3):183-194
[70]Duman RS, Malbery J, Nakagawa S. Regulation of adault neurogenesis by psychotropic drugs and stress. J Pharmacol Exp Ther,2001,299(2):401-407
[71]Duman RS, Nakagawa S, Malbery J. Regulation of adault neurogensis by antidepressant treatment. Neuropsychopharmacology,2001,25 (6):836-844
[72]Paul J Goodnick, Mark Hernandez. Treatment of depression in co-morbid medical illness. Expert Opin Pharmacother,2000,1(7):1367-1384
[73]王步军,蓝长安.2型糖尿病与抑郁症的相关性.中国临床康复,2006,10(46)：149～151
[74]Patrick J. Lustman, Linda S Griffith, Kenneth E Freedland, et al. Cognitive behavior therapy for depression in Type 2 diabetes mellitus. Annals of Internal Medicine,1998,129(8):613-621
[75]C. Paschalides, A.J. Wearden, R. Dunkerley, et al. The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus. Journal of Psychosomatic Research,2004,57(6):557-564
[76]Simon Gilbody,, Paula Whitty, Jeremy Grimshaw, et al. Educational and organizational interventions to improve the management of depression in primary care: a systemic review.the Journal of the American Medical Association,2003, 289:3145-3151
[77]曲淼,唐启盛.抑郁症与中医“郁证”的关系探讨.北京中医药大学学报,2004,27(1)：11～13
[78]孙雪.运用疏肝健脾、养心安神法治疗抑郁症56例临床观察. 新疆中医药,2007,25(3)：34～35
[79]宣磊,曹晋红.中医对糖尿病合并抑郁症研究的概况.北京中医,2007,26(2)：125～126
[80]宋·史崧校.灵枢经.北京：人民卫生出版社,1963.88
[81]张子和(金代).儒门事亲.太原：山西科学技术出版社,2009.97
[82]赵进喜.糖尿病及其并发症的中医药治疗.中国执业药师,2005,12：22-24
[83]American Diabetes Association. Diabetes mellitus and exercise. Diabetes Care, 2002,25(Suppl 1):64-68
[84]Rena R Wing, Suzanne Phelan, Deborah Tate. The role of adherence in mediating the relationship between depression and health outcomes. Journal of Psychosomatic Research,2002,53(4):877-881
[85]吴志超.导引健身解说.北京：北京体育大学出版社,2002.12
[86]王耀光,刘连军,寇正杰,等.健身气功八段锦锻炼辅助治疗2型糖尿病疗效观察.中国运动医学杂志,2007,26(2)：208-210
[87]潘华山,冯毅翀.八段锦运动处方对2型糖尿病患者康复治疗的临床研究.广州中医药大学学报,2008,25(3)：196～199
[88]温木生.耳穴贴压疗法治百病.北京：人民军医出版社,2005.3-5
[89]黄丽春.耳穴诊断治疗学.北京：科学技术文献出版社,2000.26
[90]谢建谋,路月香,章浩军.针灸配合耳穴贴压治疗失眠症疗效观察.针灸临床杂志,2005,21(7)：11
[91]卜彤文,田新乐,王少锦, 等.不同疗法治疗单纯性肥胖的疗效比较与分析.中国针灸,2007,27(5)：337-340
[92]何乐中.电针配合耳压治疗糖尿病周围神经病变疗效观察.上海针灸杂志,2009,28(2)：100～101
[93]党毅.中医营养食疗学.北京：科学技术出版社,1995.1
[94]匡调元.体质食养学纲要.浙江中医药大学学报,2006,30(3)：217-219
[95]陈静,侯在庸.64例糖尿病中医食疗与常规治疗临床效果对比观察.四川医学,2000,21(8)：719-720
[96]唐启盛.抑郁症中西医基础与临床.北京：中国中医药出版社,2006.228-230
[97]邹恂.现代护理新概念与相关理论(3版).北京：北京大学医学出版社,2004.58～,186
[98]邹恂.现代护理新概念.北京：北京医科大学中国协和医科大学联合出版社,1992.168～178
[99]Patrick J Lustman, Ray E Clouse. Treatment of depression in diabetes:impact on mood and medical outcome. Journal of Psychosomatic Research, 2002,53(4):917-924
[100]程爵棠.耳针疗法治百病.北京：人民军医出版社,2005.71
[101]马学毅.现代糖尿病诊断治疗学.北京：人民军医出版社,2007.90,123
[102]李光伟,潘孝仁,Stephen Lillioja,等.检测人群胰岛素敏感性的一项新指数.中华内科杂志,1993,32(10)：656-660
[103]American Diabetes Association. Diabetes mellitus and exercise. Diabetes Care,2002,25(Suppl 1):64-68
[104]Kristin S Vickers, Mary A Nies, Christi A Patten, et al. Patients with diabetes and depression may need additional support for exercise. American Journal of Health Behavior,2006,30(4):353-360
[105]Goodwin R D. Association between physical activity and mental disorders among adults in the United States. Preventive Medicine,2003,36(6):698-703
[106]Dunn AL, Trivedi MH, O'Neal HA. Physical activity dose-response effects on outcomes of depression and anxiety. Medical Science Sports Exercise,2001,33(Suppl 6):587-597
[107]Debbie A Lawlor, Stephen W Hopker. The effectiveness of exercise as an intervention in the management of depression:systematic review and meta-regression analysis of randomized controlled trials. BMJ,2001,322:1-8
[108]马启伟.体育心理学.北京：高等教育出版社,1996.58
[109]林颖娜,王芳,张容瑞.中医养生功法对2型糖尿病患者症状自评量表评分的影响.中医杂志,2009,50(5)：419-421
[110]唐·王焘撰.外台秘要.北京：人民卫生出版社影印,1982.303,318
[111]高鹤亭.中国医用气功学.北京：人民卫生出版社,1989.134～140,236
[112]景莉玲,陈更业,陈东毅.失眠患者耳穴贴压治疗后的慢波睡眠结构分析与疗效观察.宁夏医学杂志,2007,29(1)：53-54
[113]Hoseinabadi Reza, Nourozi Kian, Zahra Pouresmail, et al. The effect of acupressure on quality of sleep in Iranian elderly nursing home residents. Complementary Therapies in Clinical Practice,2010,16(2):81-85
[114]Basa RP, Melod B. Evaluation of a diabetes specialty centre:structure,process and outcome. Patient Educ Couns,1995,25(1):23-29
[115]方积乾.生存质量测定方法及应用.北京：北京医科大学出版社,2000.41-42,166-167
[116]隋·巢元方等著.诸病源候论.北京：人民卫生出版社影印,1982.30
[117]Rhonda Orr, Tracey Tsang, Paul Lam, et al. Mobility Impairment in Type 2 Diabetes:Association with muscle power and effect of Tai Chi intervenetion. Diabetes Car,2006,29(9):2120-2122
[118]国家体育总局健身气功管理中心.健身气功·八段锦.北京：人民体育出版社,2003.3～7
[119]伍艳明,林凯玲,陈瑞芳.八段锦锻炼结合健康教育对糖尿病亚健康状态生活质量的影响.广东医学,2008,29(8)：1307-1308
[120]清·程国彭原著.田代华,朱世杰,王长民点校.医学心悟.天津：天津科学技术出版社,2005.170
[121]张学勋.耳穴疗法治百病(2版).北京：人民卫生出版社,2004.239
[122]樊玲,文秀英.糖尿病中西医饮食疗法比较.安徽中医学院学报,2004,23(2)：5～6
[123]国家中医药管理局.中医病证诊断疗效标准.南京：南京大学出版社,1995.35
[124]孙清廉.初练气功者应掌握的常识.中老年保健,2005,7：24-25
[125]廖桃玲,张金华.不同体育锻炼项目对老年人心肺功能的影响.绵阳师范学院学报,2007,26(11)：122-124
[126]周成林,于晶,谢虹.不同身体锻炼方式对老年人心理效益的实验研究.天津体育学院学报,2003,18(1)：51～53
[127]孙黎明,庄向华.运动与生活习惯病的预防.辽宁医学杂志,2002,16(5)：230
[128]王湘,朱熊兆,王丽.抑郁情绪及负性态度对糖尿病患者血糖控制的影响.中国临床心理学杂志,2000,8(1)：32-33
[129]王淑娟,周惠平,夏铁安.现代实验诊断学手册.北京：北京医科大学中国协和医科大学联合出版社,1995.307
[130]张阳.糖化血红蛋白检测方法及临床应用.现代医药卫生,2007,23(15)：2286～2287
[131]丁振若,于文彬,苏明权,等. 实用检验医学手册(2版). 北京：人民军医出版社,2008.393-394
[132]王战建,苏杰英.动态血糖监测系统在糖尿病诊治中的应用进展.中国内科杂志,2007,27(4)：307～309
[133]Brun J F, Varlet-Marie E,Cassan D,et al. Blood fluidity is related to the ability to oxidize lipids at exercise. Clin Hemorheol Microcirc,2004,30(3-4):339-343
[134]陈选京,刘兆杰,刘文,等.达源降糖(太极)操对老年糖尿病胰岛素敏感指数影响的观察.光明中医,2004,19(1)：61-62
[135]Ramasubbu R. Insulin resistance:a metabolic link between depressive disorder and atherosclerotic vascular diseases. Medical Hypotheses,2002, 59(5):537-551
[1]Egede L, Nietert P, Zheng D. Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care,2005, 28(6):1339-1345
[2]Katon W, Rutter C. Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care,2005,28(11):2668-2672
[3]Zhang X, SL Norris, EW Gregg, et al. Depression symptoms and mortality among persons with and without diabetes. Am J Epidemiol,2005,161(7):652-660
[4]Ryan J Anderson, Kenneth E Freedland, Ray E Clouse, et al. The prevalence of comorbid depression in adults with diabetes:A meta-analysis. Diabetes Care,2001, 24(6):1069-1078
[5]World Health Organization(2001). Depression. What is depression? http://www.who.int/mental_health/management/depression/definition/en/
[6]李广智.抑郁症. 中国医药科技出版社,2009.3,60-61
[7]Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care, 2002,25(3):464-470
[8]Wexler DJ, Grant RW, Wittenberg E, et al. Correlates of health-related quality of life in type 2 diabetes. Diabetologia,2006,49(7):1489-1497
[9]P. de Jonge, J. F. Roy, P. Saz, et al. Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus:results from the ZARADEMP project. Diabetologia,2006,49(11):2627-2633
[10]Kumari M, Head J, Marmot M. Prospective study of social and other risk factors for incidence of type 2 diabetes in the White hall Ⅱ study. Archives of Internal Medicine,2004,164(17):1873-1880
[11]F. Pouwer, A. T. F. Beekman, G. Nijpels, et al. Rates and risks for co-morbid depression in patients with Type 2 diabetes mellitus:results from a community-based study. Diabetologia,2003,46(7):892-898
[12]Brown LC, Majumdar SR, Newman SC, et al. History of depression increases risk of type 2 diabetes in younger adults. Diabetes Care,2005,28(5):1063-1067
[13]Cassandra Arroyo, Frank B Hu, Louise M Ryan, et al. Depressive symptoms and risk of type 2 diabetes in women. Diabetes Care,2004,27(1):129-133
[14]Lauren C Brown, Sumit R Majumdar, Stephen C Newman, et al. Type 2 diabetes does not increase risk of depression. Canadian Medical Association Journal, 2006,175(1):42-46
[15]France Talbot, Arie Nouwen. A review of the relationship between depression and diabetes in adults:Is there a link? Diabetes Care,2000,23(10):1556-1562
[16]唐平.医学心理学.北京：人民卫生出版社,2009.155-156
[17]唐启盛.抑郁症中西医基础与临床.北京：中国中医药出版社,2006.168-169,180
[18]Robins LN, Cottler LB, Bucholz K, et al. Diagnostic Interview Schedule for DMS-1V. St. Louis, MO:Washington University,1995.78
[19]Janet Thomas, Glenn Jones, Isabel Scarinci, et al. A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. Diabetes Care, 2003,26(8):2311-2317
[20]Robert D Goldney, Pat J Phillips, Laura J Fisher, et al. Diabetes, depression, and quality of life:a population study. Diabetes Care,2004,27 (5):1066-1070
[21]Khalida Ismail, Kirsty Winkley, Daniel Stahl, et al. A cohort study of people with diabetes and their first foot ulcer:the role of depression on mortality. Diabetes Care,2007,30(6):1473- 1479
[22]孟凡菊,索新华,张清贵.2型糖尿病患者抑郁情绪表现及其对疗效的影响.中国临床康复,2004,8(6)：1008～1009
[23]张文汉,胡素君,刘一心,等.深圳市社区老年2型糖尿病患者生存质量和心理及社会支持调查研究. 中国全科医学,2009,12(1B)：166-168
[24]Joseph Keawe aimoku Kaholokula, Stephen N.Haynes, Andrew Grandinetti, et al. Biological, psychosocial, and sociodemographic variables associated with depression symptoms in persons with Type 2 Diabetes. Journal of Behacioral Medicine,2003,26(5):435-458
[25]Mohammad E. Khamseh, Hamid R.Baradaran, Hassan Rajaball. Depression and diabetes in Iranian patients:A compative study, International Journal of Psychiatry in Medicine,2007,37(1):81-86
[26]Maren J. Cofman. Effects of tangible social support and depression on diabetes self-efficacy. Journal of Gerontological Nursing,2008,34(4):32-39
[27]Gregory A. Nichols, Jonathan B. Brown. Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes. Diabetes Care,2003,26(3):744-749
[28]I. Rakovac, R. J. Gfrerer, W. Habacher,et al. Screening of depression in patients with diabetes mellitus. Diabetologia,2004,47(8):1469-1470
[29]Blazer DG, Moody-Ayers S, Craft-Morgan J, et al. Depression in diabetes and obesity:racial/ethnic/gender issues in older adults. Journal of Psychsom Research, 2002, Oct,53(4):913-916
[30]Leonard E Egede, Deyi Zheng. Independent factors associated with major depressive disorder in a national sample of individuals with diabetes. Diabetes Care, 2003,26(1):104-111
[31]Anne Engum, Arnstein Mykletun, Kristian Midthjell, et al. Depression and Diabetes:A large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes. Diabetes Care,2005, 28(8):1904-1909
[32]Ronnemaa T, Ronnemaa EM, Puukka P, et al. Smoking is independently associated with high plasma insulin levels in nondiabetic men. Diabetes Care, 1996,19(11):1229-1232
[33]Black S, Markids K, Ray L. Depression predicts increased incidence of adverse health outcomes in older Mexican American with type 2 diabetes. Diabetes Care, 2003,26(10):2822-2828
[34]Wayne Katon, Michael Von Korff, Paul Ciechanowski, et al. Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care,2004,27(4):914-920
[35]Kolawole Mosaku, Babatope Kolawole, MBCHb, FWACP; Celestine Mume, et al. Depression, anxiety and quality of life among diabetic patients:a comparative study. Journal of the National Medical Association,2008,100(1):73-78
[36]P J Lustman, R J Anderson, K E Freedland, et al. Depression and poor glycaemic control:a meta-analytic review of the literature. Diabetes Care,2000, 23(7):934-942
[37]William P. Sacco, Tovah Yanove. Diabetes and Depression:The Role of Social Support and Medical Symptoms. Journal of Behavioral Medicine,2006,29(6):523-531
[38]D'sa C, Duman RS. Antidepressants and neuroplasticity. Bipolar Disord,2002, 4(3):183-194
[39]姚军,吴文源,李春波,等.2型糖尿病伴发抑郁症患者生命质量研究.中国行为医学科学,2006,10(4)：323～325
[40]Paul J Goodnick, Mark Hernandez. Treatment of depression in co-morbid medical illness. Expert Opin Pharmacother,2000,1(7):1367-1384
[41]Patrick J. Lustman, Linda S Griffith, Kenneth E Freedland, et al. Cognitive behavior therapy for depression in Type 2 diabetes mellitus. Annals of Internal Medicine,1998,129(8):613-621
[42]Simon Gilbody,, Paula Whitty, Jeremy Grimshaw, et al. Educational and organizational interventions to improve the management of depression in primary care: a systemic review, the Journal of the American Medical Association,2003, 289:3145-3151
[43]Donna E. Stewart. Battling depression. Canadian Medical Association Journal, 2008,178(8):1023-1024
[1]吴志超.导引健身解说.北京：北京体育大学出版社,2002.12
[2]包来发.八段锦简史.中医文献杂志,2001,(2)：37
[3]国家体育总局健身气功管理中心.健身气功·八段锦.北京：人民体育出版社,2003.3-7
[4]王记生.从中医角度谈传统健身方法一八段锦.河南中医,2006,26(1)：81
[5]王耐.浅谈中医养生与全民健.河南中医,2003,23(12)：84
[6]陈嵘,毕云,秦竹,等.中医心理疗法与行为疗法的相关性研究.云南中医学院学报,2006,29(4)：10-12
[7]杨冬.基于中医理论的心理治疗.辽宁中医药大学学报,2008,10(11)：22-23
[8]翟向阳.健身气功锻炼与提高心理健康作用的研究分析.河南中医学院学报,2006,21(3)：47～48
[9]黄涛,常建东.健身气功·八段锦对不同性别中老年人一氧化氮、丙二醛和超氧化物歧化酶代谢的影响.中国临床康复,2005,16(9)：162-164
[10]王耀光,刘连军,寇正杰,等.健身气功八段锦锻炼辅助治疗2型糖尿病疗效观察.中国运动医学杂志,2007,26(2)：208-210
[11]伍艳明,林凯玲,陈瑞芳.八段锦锻炼结合健康教育对糖尿病亚健康状态生活质量的影响.广东医学,2008,29(8)：1307～1308
[12]潘华山,冯毅翀.八段锦运动处力对2型糖尿病患者康复治疗的临床研究.广州中医药大学学报,2008,25(3)：196-199
[13]刘俊荣,姜希娟,夏西薇,等.健身气功“八段锦”调节中老年脂质代谢的实验研究.中国老年学杂志,2006,26(3)：317-319
[14]杨玉英,黄辉.颈操八段锦锻炼对颈椎病社区康复效果的评价.中国农村卫生事业管理,2008,28(9)：716-718
[15]潘杰.八段锦结合针灸对神经衰弱的治疗.硅谷,2009,3：11
[16]孔莉,戴立强.中医八段锦治疗骨关节炎在社区康复中的效果评价.实用心脑肺血管病杂志,2008,16(11)：17-18
[17]苏恺,金宏柱.健身气功·八段锦改善女大学生体质健康状态效果分析.中外健康文摘,2007,10：114-115
[18]曾云贵,周小青,王安利,等. 健身气功·八段锦锻炼对中老年人身体形态和生理机能影响的研究.北京体育大学学报,2005,28(9)：12
[19]王松涛.新编健身八段锦功法对老年人智能生理年龄的影响.中国组织工程研究与临床康复,2007,11(39)：7910～7913
[20]张仲斌.气功健身21辨证.中国气功,2000,5：38～39
[21]王耀.从气功源流考看社会性集体练功之弊端.中医文献杂志,2002,4：38-39
[22]李岩.八段锦治好肺结核.中国气功科学,2000,(10)：49
[23]高厚增.锻炼八段锦须意气形并重.气功杂志,2000,21(5)：207
[2]中华医学会糖尿病学分会.中国糖尿病防治指南.中华内分泌代谢病杂志,2008,24(2)：2～4
[3]World Health Organization(2001). Depression. What is depression? http://www. who.int/mental_health/management/depression/definition/en/
[4]Ryan J Anderson, Kenneth E Freedland, Ray E Clouse, et al. The prevalence of comorbid depression in adults with diabetes:A meta-analysis. Diabetes Care,2001, 24(6):1069-1078
[5]Martin P. Cosgrove, Lincoln A. Sargeant, Simon J. Griffin. Does depression increase the risk of developing type 2 diabetes? Occupational Medicine,2008, 58(1):7-14
[6]唐平.医学心理学.北京：人民卫生出版社,2009.155
[7]范晓清.远离抑郁.北京：化学工业出版社,2008.8-10,69
[8]Robins LN, Cottler LB, Bucholz K, et al. Diagnostic Interview Schedule for DMS-IV. St. Louis, MO:Washington University,1995.78
[9]Janet Thomas, Glenn Jones, Isabel Scarinci, et al. A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. Diabetes Care,2003,26(8):2311-2317
[10]Anne Engum, Arnstein Mykletun, Kristian Midthjell, et al. Depression and Diabetes:A large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes. Diabetes Care,2005, 28(8):1904-1909
[11]Maren J. Cofman. Effects of tangible social support and depression on diabetes self-efficacy. Journal of Gerontological Nursing,2008,34(4):32-39
[12]Egede LE. Diabetes, Major Depression, and Functional Disability among U.S. Adults. Diabetes Care,2004,27(2):421-428
[13]Robert D Goldney, Pat J Phillips, Laura J Fisher, et al. Diabetes, Depression, and Quality of Life:A population study. Diabetes Care,2004,27(5):1066-1070
[14]Zhang X, Norris SL, Gregg EW, et al. Depression symptoms and mortality among persons with and without diabetes. America Journal of Epidemiology,2005, 161(7):652-660
[15]Cristina Fortes, Sara Farchi, Francesco Forastiere, et al. Depressive symptoms lead, to impaired cellular immune response. Psychotherapy and Psychosomatics, 2003,72(5):253-260
[16]Wayne Katon, Paul Ciechanowski. Impact of major depression on chronic medical illness.the Journal of Psychosomatic Research,2002,53:859-863
[17]Donna E. Stewart. Battling depression. Canadian Medical Association Journal, 2008,178(8):1023-1024
[18]Khalida Ismail, Kirsty Winkley, Daniel Stahl, et al. A cohort study of people with diabetes and their first foot ulcer:the role of depression on mortality. Diabetes Care,2007,30(6):1473-1479
[19]孟凡菊,索新华,张清贵.2型糖尿病患者抑郁情绪表现及其对疗效的影响.中国临床康复,2004,8(6)：1008-1009
[20]张文汉,胡素君,刘一心,等.深圳市社区老年2型糖尿病患者生存质量和心理及社会支持调查研究.中国全科医学,2009,12(1B)：166-168
[21]Mohammad E. Khamseh, Hamid R.Baradaran, Hassan Rajaball. Depression and diabetes in Iranian patients:A compative study, International Journal of Psychiatry in Medicine,2007,37(1):81-86
[22]Gregory A. Nichols, Jonathan B. Brown. Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes. Diabetes Care,2003,26(3):744-749
[23]Blazer DG, Moody-Ayers S, Craft-Morgan J, et al. Depression in diabetes and obesity:racial/ethnic/gender issues in older adults. Journal of Psychsom Research, 2002, Oct,53(4):913-916
[24]Ronnemaa T, Ronnemaa EM, Puukka P, et al. Smoking is independently associated with high plasma insulin levels in nondiabetic men. Diabetes Care, 1996,19(11):1229-1232
[25]Black S, Markids K, Ray L. Depression predicts increased incidence of adverse health outcomes in older Mexican American with type 2 diabetes. Diabetes Care, 2003,26(10):2822-2828
[26]Lauren C.Brown, Sumit R.Majumdar, Stephen C.Newman, et al. Type 2 diabetes does not increase risk of depression. Canadian Medical Association Journal, 2006,175(1):42-46
[27]Kolawole Mosaku, Babatope Kolawole, MBCHb, FWACP;Celestine Mume, et al. Depression, anxiety and quality of life among diabetic patients:a comparative study. Journal of the National Medical Association,2008,100(1):73-78
[28]WHO. Report of the WHO Meeting on the Assessment of Quality of Life in the Health Care.Geneva:WHO,1991.1
[29]江玲.与健康有关的生存质量评定探讨.中国康复理论与实践,2002,8(12)：768,746
[30]Ciechanowski PS, Katon WJ, Russo JE, et al. Depression and Diabetes:Impact of Depressive Symptoms on Adherence, Function and Costs. Arch Intern Med,2000, 160(21):3278-3285.
[31]Wandell PE, Tovi J. The quality of life of elderly diabetic patients. J Diabetes Complications,2000,14(1):25-30
[32]Hiltunen L, Keinanen-Kiukaanniemi S. Does glucose tolerance affect quality of life in an elderly population. Diabetes Res Clin Pract,1999,46(2):161-167
[33]Monique M. Williams, Ray E. Clouse, Patrick J. Lustman. Treating depression to prevent diabetes and its complications:understanding depression as a medical risk factor. Clinical Diabetes, April,2006,24(2):79-86
[34]A. Nicolucci, D. Cucinotta. S. Squatrito, et al. Clinical and socio-economic correlates of quality of life and treatment satisfaction in patients with type 2 diabetes. Nutrition, Metabolism & Cardiovascular Diseases,2009,19(1):45-53
[35]Ranjita Misra, Julie Lager. Predictors of quality of life among adults with type 2 diabetes mellitus. Journal of Diabetes and Its Complications,2008,22(3):217-223
[36]Gary C. Brown, Melissa M. Brown, Sanjay Sharma, et al. Quality of life associated with diabetes mellitus in an adult population. Journal of Diabetes and Its Complications,2000,14(1):18-24
[37]http://www.chab.org.cn/NewsDetail.asp?id=4894
[38]孙振球.医学科学研究与设计.北京：人民卫生出版社,2008.125,132
[39]李立明.流行病学(6版). 北京：人民卫生出版社,2008.47
[40]季建林.医学心理学(4版). 上海：复旦大学出版社,2008.230-231
[41]蔡华俭.外显自尊、内隐自尊与抑郁的关系.中国心理卫生杂志,2003,17(5)：331～336
[42]王乐三,孙振球,胡明,等.2型糖尿病生活质量量表的编制策略及条目筛选.中国卫生统计,2006,23(2)：146-148
[43]王乐三,孙振球,蔡太生,等.T2 DM患者生活质量量表的研制与考评.中南大学学报(医学版),2005,30(1)：21-27
[44]汪向东.心理卫生评定手册(增订版).北京：中国心理卫生杂志社,1999,127～131
[45]刘继文,李富业,连玉龙.社会支持评定量表的信度效度研究.新疆医科大学学报,2008,31(1)：1-3
[46]D.G.Bruce, W.A.Davis, S.E.Starkstein, et al. A prospective study of depression and mortality in patients with type 2 diabetes:the Fremantle Diabetes Study. Diabetologia,2005,48(12):2532-2539
[47]Joseph Keawe aimoku Kaholokula, Stephen N.Haynes, Andrew Grandinetti, et al. Biological, psychosocial, and sociodemographic variables associated with depression symptoms in persons with Type 2 Diabetes. Journal of Behacioral Medicine,2003,26(5):435-458
[48]徐天和,柳青.中国医学统计百科全书多元统计分册.北京：人民卫生出版社,2004.206
[49]Leonard E Egede, Deyi Zheng. Independent factors associated with major depressive disorder in a national sample of individuals with diabetes. Diabetes Care, Jan 2003,26(1):104-111
[50]Jouko A Hanninen, Jorma K Takala, Sirkka M Keinanen-Kiukanniemi. Depression in subjects with type 2 diabetes. Diabetes Care,1999,22(6):997-998
[51]Elaine A. Anderson, Julie K. Kohler, Bethany L. Letiecq. Predictors of depression among low-income, nonresidential fathers. Journal of Family Issues, 2005,26(5):547-567
[52]Vanderhorst R. K., McLaren S. Social relationships as predictors of depression and suicidal ideation in older adults. Aging and Mental Health,2005,9(6): 517-525
[53]William P. Sacco, Tovah Yanove. Diabetes and Depression:The Role of Social Support and Medical Symptoms. Journal of Behavioral Medicine,2006,29(6):523-531
[54]Friedman L.C., Brown A.E., Romero C. Depressed mood and social support as predictors of quality of life in women receiving home health care. Quality of life research,2005, Oct,14(8):1925-1929
[55]Briana Mezuk, Sandra Albrecht, Willian W. Eaton, et al. Depression and type 2 diabetes over the lifespan. Diabetes Care,2008,31(12):2383-2390
[56]P. de Jonge, J. F. Roy, P. Saz, et al. Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus:results from the ZARADEMP project. Diabetologia,2006,49(11):2627-2633
[57]Wexler DJ, Grant RW, Wittenberg E, et al. Correlates of health-related quality of life in type 2 diabetes. Diabetologia,2006,49(7):1489-1497
[58]Fisher L, Chesla CA, Mullan JT, et al. Contributors to depression in Latino and European-American patients with type 2 diabetes. Diabetes Care,2001,24(10): 1751-1757
[59]Matthias R, Thea S, Herbert F, et al. The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control. Diabetes Care,2002,25(1):35-41
[60]UK Prospective Diabetes Study Group. Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). U.K. Prospective Diabetes Study Group. Diabetes Care,1999,22(7):1125-1136
[61]J. S. Gonzalez, L. M. Delahanty, S. A. Safren, et al. Differentiating symptoms of depression from diabetes-specific distress:relationships with self-care in type 2 diabetes. Diabetologia,2008,51(10):1822-1825
[62]Redekop WK, Koopmanschap MA, Stolk RP, et al. Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes. Diabetes Care, 2002,25(3):458-463
[63]Timothy M.E. Davis, Rhonda M. Clifford, Wendy A. Davis. Effect of insulin therapy on quality of life in Type 2diabetes mellitus:The Fremantle Diabetes Study. Diabetes Research and Clinical Practice,2001,52(1):63-71
[64]Grandinetti, A., Kaholokula, J.K., Crabbe K.M.. et al. Relationship between depressive symptoms and diabetes among Native Hawaiians. Psychoneuroendocrinology,2000,25(3):239-246
[65]Nico Hutter, Christa Scheidt-Nave, Harald Baumeister. Health care utilization and quality of life in individuals with diabetes and comorbid mental disorders. General Hospital Psychiatry,2009,31(1):33-35
[66]Sheldon Cohen. Social relationships and health. American Psychologist,2004, 59(8):676-684
[67]Henk A. van Dam, Frans G. van der Horst, Lut Knoops,et al. Social support in diabetes:a systematic review of controlled intervention studies. Patient Education and Counseling,2005,59(1):1-12
[68]Frank Petrak, Stephan Herpertz. Treatment of depression in diabetes:an update. Current Opinion in Psychiatry,2009,22(2):211-217
[69]D'sa C, Duman RS. Antidepressants and neuroplasticity. Bipolar Disord, 2002,4(3):183-194
[70]Duman RS, Malbery J, Nakagawa S. Regulation of adault neurogenesis by psychotropic drugs and stress. J Pharmacol Exp Ther,2001,299(2):401-407
[71]Duman RS, Nakagawa S, Malbery J. Regulation of adault neurogensis by antidepressant treatment. Neuropsychopharmacology,2001,25 (6):836-844
[72]Paul J Goodnick, Mark Hernandez. Treatment of depression in co-morbid medical illness. Expert Opin Pharmacother,2000,1(7):1367-1384
[73]王步军,蓝长安.2型糖尿病与抑郁症的相关性.中国临床康复,2006,10(46)：149～151
[74]Patrick J. Lustman, Linda S Griffith, Kenneth E Freedland, et al. Cognitive behavior therapy for depression in Type 2 diabetes mellitus. Annals of Internal Medicine,1998,129(8):613-621
[75]C. Paschalides, A.J. Wearden, R. Dunkerley, et al. The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus. Journal of Psychosomatic Research,2004,57(6):557-564
[76]Simon Gilbody,, Paula Whitty, Jeremy Grimshaw, et al. Educational and organizational interventions to improve the management of depression in primary care: a systemic review.the Journal of the American Medical Association,2003, 289:3145-3151
[77]曲淼,唐启盛.抑郁症与中医“郁证”的关系探讨.北京中医药大学学报,2004,27(1)：11～13
[78]孙雪.运用疏肝健脾、养心安神法治疗抑郁症56例临床观察. 新疆中医药,2007,25(3)：34～35
[79]宣磊,曹晋红.中医对糖尿病合并抑郁症研究的概况.北京中医,2007,26(2)：125～126
[80]宋·史崧校.灵枢经.北京：人民卫生出版社,1963.88
[81]张子和(金代).儒门事亲.太原：山西科学技术出版社,2009.97
[82]赵进喜.糖尿病及其并发症的中医药治疗.中国执业药师,2005,12：22-24
[83]American Diabetes Association. Diabetes mellitus and exercise. Diabetes Care, 2002,25(Suppl 1):64-68
[84]Rena R Wing, Suzanne Phelan, Deborah Tate. The role of adherence in mediating the relationship between depression and health outcomes. Journal of Psychosomatic Research,2002,53(4):877-881
[85]吴志超.导引健身解说.北京：北京体育大学出版社,2002.12
[86]王耀光,刘连军,寇正杰,等.健身气功八段锦锻炼辅助治疗2型糖尿病疗效观察.中国运动医学杂志,2007,26(2)：208-210
[87]潘华山,冯毅翀.八段锦运动处方对2型糖尿病患者康复治疗的临床研究.广州中医药大学学报,2008,25(3)：196～199
[88]温木生.耳穴贴压疗法治百病.北京：人民军医出版社,2005.3-5
[89]黄丽春.耳穴诊断治疗学.北京：科学技术文献出版社,2000.26
[90]谢建谋,路月香,章浩军.针灸配合耳穴贴压治疗失眠症疗效观察.针灸临床杂志,2005,21(7)：11
[91]卜彤文,田新乐,王少锦, 等.不同疗法治疗单纯性肥胖的疗效比较与分析.中国针灸,2007,27(5)：337-340
[92]何乐中.电针配合耳压治疗糖尿病周围神经病变疗效观察.上海针灸杂志,2009,28(2)：100～101
[93]党毅.中医营养食疗学.北京：科学技术出版社,1995.1
[94]匡调元.体质食养学纲要.浙江中医药大学学报,2006,30(3)：217-219
[95]陈静,侯在庸.64例糖尿病中医食疗与常规治疗临床效果对比观察.四川医学,2000,21(8)：719-720
[96]唐启盛.抑郁症中西医基础与临床.北京：中国中医药出版社,2006.228-230
[97]邹恂.现代护理新概念与相关理论(3版).北京：北京大学医学出版社,2004.58～,186
[98]邹恂.现代护理新概念.北京：北京医科大学中国协和医科大学联合出版社,1992.168～178
[99]Patrick J Lustman, Ray E Clouse. Treatment of depression in diabetes:impact on mood and medical outcome. Journal of Psychosomatic Research, 2002,53(4):917-924
[100]程爵棠.耳针疗法治百病.北京：人民军医出版社,2005.71
[101]马学毅.现代糖尿病诊断治疗学.北京：人民军医出版社,2007.90,123
[102]李光伟,潘孝仁,Stephen Lillioja,等.检测人群胰岛素敏感性的一项新指数.中华内科杂志,1993,32(10)：656-660
[103]American Diabetes Association. Diabetes mellitus and exercise. Diabetes Care,2002,25(Suppl 1):64-68
[104]Kristin S Vickers, Mary A Nies, Christi A Patten, et al. Patients with diabetes and depression may need additional support for exercise. American Journal of Health Behavior,2006,30(4):353-360
[105]Goodwin R D. Association between physical activity and mental disorders among adults in the United States. Preventive Medicine,2003,36(6):698-703
[106]Dunn AL, Trivedi MH, O'Neal HA. Physical activity dose-response effects on outcomes of depression and anxiety. Medical Science Sports Exercise,2001,33(Suppl 6):587-597
[107]Debbie A Lawlor, Stephen W Hopker. The effectiveness of exercise as an intervention in the management of depression:systematic review and meta-regression analysis of randomized controlled trials. BMJ,2001,322:1-8
[108]马启伟.体育心理学.北京：高等教育出版社,1996.58
[109]林颖娜,王芳,张容瑞.中医养生功法对2型糖尿病患者症状自评量表评分的影响.中医杂志,2009,50(5)：419-421
[110]唐·王焘撰.外台秘要.北京：人民卫生出版社影印,1982.303,318
[111]高鹤亭.中国医用气功学.北京：人民卫生出版社,1989.134～140,236
[112]景莉玲,陈更业,陈东毅.失眠患者耳穴贴压治疗后的慢波睡眠结构分析与疗效观察.宁夏医学杂志,2007,29(1)：53-54
[113]Hoseinabadi Reza, Nourozi Kian, Zahra Pouresmail, et al. The effect of acupressure on quality of sleep in Iranian elderly nursing home residents. Complementary Therapies in Clinical Practice,2010,16(2):81-85
[114]Basa RP, Melod B. Evaluation of a diabetes specialty centre:structure,process and outcome. Patient Educ Couns,1995,25(1):23-29
[115]方积乾.生存质量测定方法及应用.北京：北京医科大学出版社,2000.41-42,166-167
[116]隋·巢元方等著.诸病源候论.北京：人民卫生出版社影印,1982.30
[117]Rhonda Orr, Tracey Tsang, Paul Lam, et al. Mobility Impairment in Type 2 Diabetes:Association with muscle power and effect of Tai Chi intervenetion. Diabetes Car,2006,29(9):2120-2122
[118]国家体育总局健身气功管理中心.健身气功·八段锦.北京：人民体育出版社,2003.3～7
[119]伍艳明,林凯玲,陈瑞芳.八段锦锻炼结合健康教育对糖尿病亚健康状态生活质量的影响.广东医学,2008,29(8)：1307-1308
[120]清·程国彭原著.田代华,朱世杰,王长民点校.医学心悟.天津：天津科学技术出版社,2005.170
[121]张学勋.耳穴疗法治百病(2版).北京：人民卫生出版社,2004.239
[122]樊玲,文秀英.糖尿病中西医饮食疗法比较.安徽中医学院学报,2004,23(2)：5～6
[123]国家中医药管理局.中医病证诊断疗效标准.南京：南京大学出版社,1995.35
[124]孙清廉.初练气功者应掌握的常识.中老年保健,2005,7：24-25
[125]廖桃玲,张金华.不同体育锻炼项目对老年人心肺功能的影响.绵阳师范学院学报,2007,26(11)：122-124
[126]周成林,于晶,谢虹.不同身体锻炼方式对老年人心理效益的实验研究.天津体育学院学报,2003,18(1)：51～53
[127]孙黎明,庄向华.运动与生活习惯病的预防.辽宁医学杂志,2002,16(5)：230
[128]王湘,朱熊兆,王丽.抑郁情绪及负性态度对糖尿病患者血糖控制的影响.中国临床心理学杂志,2000,8(1)：32-33
[129]王淑娟,周惠平,夏铁安.现代实验诊断学手册.北京：北京医科大学中国协和医科大学联合出版社,1995.307
[130]张阳.糖化血红蛋白检测方法及临床应用.现代医药卫生,2007,23(15)：2286～2287
[131]丁振若,于文彬,苏明权,等. 实用检验医学手册(2版). 北京：人民军医出版社,2008.393-394
[132]王战建,苏杰英.动态血糖监测系统在糖尿病诊治中的应用进展.中国内科杂志,2007,27(4)：307～309
[133]Brun J F, Varlet-Marie E,Cassan D,et al. Blood fluidity is related to the ability to oxidize lipids at exercise. Clin Hemorheol Microcirc,2004,30(3-4):339-343
[134]陈选京,刘兆杰,刘文,等.达源降糖(太极)操对老年糖尿病胰岛素敏感指数影响的观察.光明中医,2004,19(1)：61-62
[135]Ramasubbu R. Insulin resistance:a metabolic link between depressive disorder and atherosclerotic vascular diseases. Medical Hypotheses,2002, 59(5):537-551
[1]Egede L, Nietert P, Zheng D. Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care,2005, 28(6):1339-1345
[2]Katon W, Rutter C. Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care,2005,28(11):2668-2672
[3]Zhang X, SL Norris, EW Gregg, et al. Depression symptoms and mortality among persons with and without diabetes. Am J Epidemiol,2005,161(7):652-660
[4]Ryan J Anderson, Kenneth E Freedland, Ray E Clouse, et al. The prevalence of comorbid depression in adults with diabetes:A meta-analysis. Diabetes Care,2001, 24(6):1069-1078
[5]World Health Organization(2001). Depression. What is depression? http://www.who.int/mental_health/management/depression/definition/en/
[6]李广智.抑郁症. 中国医药科技出版社,2009.3,60-61
[7]Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care, 2002,25(3):464-470
[8]Wexler DJ, Grant RW, Wittenberg E, et al. Correlates of health-related quality of life in type 2 diabetes. Diabetologia,2006,49(7):1489-1497
[9]P. de Jonge, J. F. Roy, P. Saz, et al. Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus:results from the ZARADEMP project. Diabetologia,2006,49(11):2627-2633
[10]Kumari M, Head J, Marmot M. Prospective study of social and other risk factors for incidence of type 2 diabetes in the White hall Ⅱ study. Archives of Internal Medicine,2004,164(17):1873-1880
[11]F. Pouwer, A. T. F. Beekman, G. Nijpels, et al. Rates and risks for co-morbid depression in patients with Type 2 diabetes mellitus:results from a community-based study. Diabetologia,2003,46(7):892-898
[12]Brown LC, Majumdar SR, Newman SC, et al. History of depression increases risk of type 2 diabetes in younger adults. Diabetes Care,2005,28(5):1063-1067
[13]Cassandra Arroyo, Frank B Hu, Louise M Ryan, et al. Depressive symptoms and risk of type 2 diabetes in women. Diabetes Care,2004,27(1):129-133
[14]Lauren C Brown, Sumit R Majumdar, Stephen C Newman, et al. Type 2 diabetes does not increase risk of depression. Canadian Medical Association Journal, 2006,175(1):42-46
[15]France Talbot, Arie Nouwen. A review of the relationship between depression and diabetes in adults:Is there a link? Diabetes Care,2000,23(10):1556-1562
[16]唐平.医学心理学.北京：人民卫生出版社,2009.155-156
[17]唐启盛.抑郁症中西医基础与临床.北京：中国中医药出版社,2006.168-169,180
[18]Robins LN, Cottler LB, Bucholz K, et al. Diagnostic Interview Schedule for DMS-1V. St. Louis, MO:Washington University,1995.78
[19]Janet Thomas, Glenn Jones, Isabel Scarinci, et al. A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. Diabetes Care, 2003,26(8):2311-2317
[20]Robert D Goldney, Pat J Phillips, Laura J Fisher, et al. Diabetes, depression, and quality of life:a population study. Diabetes Care,2004,27 (5):1066-1070
[21]Khalida Ismail, Kirsty Winkley, Daniel Stahl, et al. A cohort study of people with diabetes and their first foot ulcer:the role of depression on mortality. Diabetes Care,2007,30(6):1473- 1479
[22]孟凡菊,索新华,张清贵.2型糖尿病患者抑郁情绪表现及其对疗效的影响.中国临床康复,2004,8(6)：1008～1009
[23]张文汉,胡素君,刘一心,等.深圳市社区老年2型糖尿病患者生存质量和心理及社会支持调查研究. 中国全科医学,2009,12(1B)：166-168
[24]Joseph Keawe aimoku Kaholokula, Stephen N.Haynes, Andrew Grandinetti, et al. Biological, psychosocial, and sociodemographic variables associated with depression symptoms in persons with Type 2 Diabetes. Journal of Behacioral Medicine,2003,26(5):435-458
[25]Mohammad E. Khamseh, Hamid R.Baradaran, Hassan Rajaball. Depression and diabetes in Iranian patients:A compative study, International Journal of Psychiatry in Medicine,2007,37(1):81-86
[26]Maren J. Cofman. Effects of tangible social support and depression on diabetes self-efficacy. Journal of Gerontological Nursing,2008,34(4):32-39
[27]Gregory A. Nichols, Jonathan B. Brown. Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes. Diabetes Care,2003,26(3):744-749
[28]I. Rakovac, R. J. Gfrerer, W. Habacher,et al. Screening of depression in patients with diabetes mellitus. Diabetologia,2004,47(8):1469-1470
[29]Blazer DG, Moody-Ayers S, Craft-Morgan J, et al. Depression in diabetes and obesity:racial/ethnic/gender issues in older adults. Journal of Psychsom Research, 2002, Oct,53(4):913-916
[30]Leonard E Egede, Deyi Zheng. Independent factors associated with major depressive disorder in a national sample of individuals with diabetes. Diabetes Care, 2003,26(1):104-111
[31]Anne Engum, Arnstein Mykletun, Kristian Midthjell, et al. Depression and Diabetes:A large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes. Diabetes Care,2005, 28(8):1904-1909
[32]Ronnemaa T, Ronnemaa EM, Puukka P, et al. Smoking is independently associated with high plasma insulin levels in nondiabetic men. Diabetes Care, 1996,19(11):1229-1232
[33]Black S, Markids K, Ray L. Depression predicts increased incidence of adverse health outcomes in older Mexican American with type 2 diabetes. Diabetes Care, 2003,26(10):2822-2828
[34]Wayne Katon, Michael Von Korff, Paul Ciechanowski, et al. Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care,2004,27(4):914-920
[35]Kolawole Mosaku, Babatope Kolawole, MBCHb, FWACP; Celestine Mume, et al. Depression, anxiety and quality of life among diabetic patients:a comparative study. Journal of the National Medical Association,2008,100(1):73-78
[36]P J Lustman, R J Anderson, K E Freedland, et al. Depression and poor glycaemic control:a meta-analytic review of the literature. Diabetes Care,2000, 23(7):934-942
[37]William P. Sacco, Tovah Yanove. Diabetes and Depression:The Role of Social Support and Medical Symptoms. Journal of Behavioral Medicine,2006,29(6):523-531
[38]D'sa C, Duman RS. Antidepressants and neuroplasticity. Bipolar Disord,2002, 4(3):183-194
[39]姚军,吴文源,李春波,等.2型糖尿病伴发抑郁症患者生命质量研究.中国行为医学科学,2006,10(4)：323～325
[40]Paul J Goodnick, Mark Hernandez. Treatment of depression in co-morbid medical illness. Expert Opin Pharmacother,2000,1(7):1367-1384
[41]Patrick J. Lustman, Linda S Griffith, Kenneth E Freedland, et al. Cognitive behavior therapy for depression in Type 2 diabetes mellitus. Annals of Internal Medicine,1998,129(8):613-621
[42]Simon Gilbody,, Paula Whitty, Jeremy Grimshaw, et al. Educational and organizational interventions to improve the management of depression in primary care: a systemic review, the Journal of the American Medical Association,2003, 289:3145-3151
[43]Donna E. Stewart. Battling depression. Canadian Medical Association Journal, 2008,178(8):1023-1024
[1]吴志超.导引健身解说.北京：北京体育大学出版社,2002.12
[2]包来发.八段锦简史.中医文献杂志,2001,(2)：37
[3]国家体育总局健身气功管理中心.健身气功·八段锦.北京：人民体育出版社,2003.3-7
[4]王记生.从中医角度谈传统健身方法一八段锦.河南中医,2006,26(1)：81
[5]王耐.浅谈中医养生与全民健.河南中医,2003,23(12)：84
[6]陈嵘,毕云,秦竹,等.中医心理疗法与行为疗法的相关性研究.云南中医学院学报,2006,29(4)：10-12
[7]杨冬.基于中医理论的心理治疗.辽宁中医药大学学报,2008,10(11)：22-23
[8]翟向阳.健身气功锻炼与提高心理健康作用的研究分析.河南中医学院学报,2006,21(3)：47～48
[9]黄涛,常建东.健身气功·八段锦对不同性别中老年人一氧化氮、丙二醛和超氧化物歧化酶代谢的影响.中国临床康复,2005,16(9)：162-164
[10]王耀光,刘连军,寇正杰,等.健身气功八段锦锻炼辅助治疗2型糖尿病疗效观察.中国运动医学杂志,2007,26(2)：208-210
[11]伍艳明,林凯玲,陈瑞芳.八段锦锻炼结合健康教育对糖尿病亚健康状态生活质量的影响.广东医学,2008,29(8)：1307～1308
[12]潘华山,冯毅翀.八段锦运动处力对2型糖尿病患者康复治疗的临床研究.广州中医药大学学报,2008,25(3)：196-199
[13]刘俊荣,姜希娟,夏西薇,等.健身气功“八段锦”调节中老年脂质代谢的实验研究.中国老年学杂志,2006,26(3)：317-319
[14]杨玉英,黄辉.颈操八段锦锻炼对颈椎病社区康复效果的评价.中国农村卫生事业管理,2008,28(9)：716-718
[15]潘杰.八段锦结合针灸对神经衰弱的治疗.硅谷,2009,3：11
[16]孔莉,戴立强.中医八段锦治疗骨关节炎在社区康复中的效果评价.实用心脑肺血管病杂志,2008,16(11)：17-18
[17]苏恺,金宏柱.健身气功·八段锦改善女大学生体质健康状态效果分析.中外健康文摘,2007,10：114-115
[18]曾云贵,周小青,王安利,等. 健身气功·八段锦锻炼对中老年人身体形态和生理机能影响的研究.北京体育大学学报,2005,28(9)：12
[19]王松涛.新编健身八段锦功法对老年人智能生理年龄的影响.中国组织工程研究与临床康复,2007,11(39)：7910～7913
[20]张仲斌.气功健身21辨证.中国气功,2000,5：38～39
[21]王耀.从气功源流考看社会性集体练功之弊端.中医文献杂志,2002,4：38-39
[22]李岩.八段锦治好肺结核.中国气功科学,2000,(10)：49
[23]高厚增.锻炼八段锦须意气形并重.气功杂志,2000,21(5)：207