2型糖尿病合并抑郁的影响因素研究
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摘要
背景
近年来，我国糖尿病患病率急速上升。据估计，中国现有成人糖尿病患者9240万，已成为世界糖尿病人数最多的国家。糖尿病患者中90%以上是2型糖尿病，不仅给患者带来沉重的躯体危害和经济负担，而且导致很多严重的心理障碍，其中抑郁是最常见的心理障碍之一。抑郁与糖尿病相互影响并形成恶性循环，给患者带来沉重的精神压力，降低治疗效果，加速心、肾等并发症的发生，加重了患者的痛苦，影响病情的预后。因此，针对2型糖尿病合并抑郁的影响因素开展研究，具有重要的意义。
目的
了解抑郁在2型糖尿病患者中的患病率和分布情况；分析2型糖尿病合并抑郁的影响因素；为2型糖尿病合并抑郁的防治和相应的健康政策制订提供科学依据。
方法
编制结构性问卷，内容包括：人口学特征和临床相关特征调查，社会支持量表（SSRS），生活事件量表（LES），归因方式量表（ASQ），应对方式量表（SCSQ）和抑郁量表（BDI）。2012年3月1日至4月31日在北京市解放军总医院第一附属内分泌科就诊的约2500名2型糖尿病人中，运用系统抽样的方法，随机抽取450例患者作为本研究的对象人群。对样本人群进行问卷调查，在解抑郁的患病率和分布情况的基础上，以患有2型糖尿病合并抑郁的病人作为病例组，以患有2型糖尿病但未患抑郁的患者作为对照组，比较两组的差异。应用逐步Logistic多因素回归、主成分和因子分析控制变量间的共线性，筛选影响2型糖尿病合并抑郁的主要因素，然后在此基础上针对32例患者使用药物治疗结合认知行为疗法、家庭疗法进行综合治疗，并以BDI评分衡量抑郁的转归结果，对其进行追踪分析，然后根据数据分析结果对综合治疗的效果进行评价。
结果
在450例糖尿病患者中，完成调查的对象共有412人，应答率为91.6%，其中有抑郁者235例，占总体的57.0%，包括重度抑郁44例，占总体的10.7%；中度抑郁98例，占总体的23.7%；轻度抑郁93例，占总体的22.6%。经分析发现，高龄、单身、低教育水平和非公职业者更易患抑郁，而性别、收入、报销比例、BMI等指标与抑郁无关。经过Logistic逐步回归和主成分因子分析，与2型糖尿病合并抑郁的相关程度最高的因素主要有以下9个：生活事件， D型人格，病程，糖化血红蛋白和吸烟5个因素为正相关，饮食控制，锻炼，社会支持，家族史4个因素为负相关。结构方程模型分析发现，生活事件和社会支持情况通过间接效应作用于抑郁；D型人格对抑郁同时有直接和间接效应，而临床因素对抑郁的影响则主要是直接效应。经过药物和心理综合治疗，32例2型糖尿病患者抑郁治疗效果明显的患者有18人，占56%。仅有2人抑郁病情略有加重，由轻度抑郁转为中度抑郁。
结论
2型糖尿病患者的抑郁患病率远高于普通人群；生活事件，D型人格，病程，糖化血红蛋白和吸烟是2型糖尿合并抑郁的主要危险因素，饮食控制，锻炼，社会支持是2型糖尿合并抑郁的主要保护因素；糖尿病家族史与抑郁呈负相关；药物与心理治疗结合的综合干预模式效果显著，有利于缓解抑郁的病情，提高2型糖尿病患者的生存质量；2型糖尿病合并抑郁患者健康知识的提高和健康行为的改变有很大的提升空间。
Background
In recent years, diabetes prevalence is rising rapidly, and it affects an estimated92.4million adults in China, which may be the country with the largest numbers of peoplewith diabetes in the world. Of all diabetic patients, approximately90to95percenthave type2diabetes mellitus (T2DM), a condition where the body does not produceenough insulin and/or the cells in the body do not respond normally to insulin. Poorlymanaged diabetes not only increases morbidity and mortality and decreases thequality of life, but also leads to a wide range of complications such as Hypertension,nephropathy, psychological disorders. And depression is one of the most commonpsychological disoders, which accelerates the development and deterioration ofdiabetes and other disease. Therefore, it’s necessary to launch the study on depressionin patients with type2diabetes mellitus.
Objective
To investigate the prevalence of depression in type2diabetes patients, analyze thefactors which are related to depression in patients with diabetes mellitus (DM), andprovide scientific basis for the corresponding clinical practice for DM and healthpolicy formulation for diabetic patients.
Methods
Four hundred and fifty individuals with type2Diabetes mellitus, which were selected randomly from two thousand five hundred patients at the outpatient department ofendocrinology at the First Affiliated Hospital of the General Hospital of the People'sLiberation Army (PLAGH), from March1th to May31st,2012, were recruited in thisstudy. All the selected subjects were interviewed by using the structuredquestionnaires including the demographic characteristics, clinical features, socialsupports rating scale (SSRS), life event scale (LES), attribution style scale (ASQ),coping styles scale (SCSQ) and beck depression scale (BDI). Then the diabeticpatients with co-existing depression and the subjects with diabetes mellitus only weredivided into two groups, respectively, and the difference between these two groupswere compared and analyzed, based on the investigation of the prevalence and thedistribution of depression in patients with diabetes mellitus. The major impact factorsof co-existing depression in patients with diabetes mellitus were screened on thecontrol of the co linearity in weighted independent variable by using the multi-factorlogistic regression analysis, principal component analysis and factor analysis. Andthen, comprehensive treatment combining medicine and psychological intervention(the latter includes cognitive behavior therapy and family therapy) was taken for thirtytwo patients with co-existing depression and diabetes mellitus from the samples ofthis study. The BDI scores and glaciated hemoglobin (HbA1c), which were regardedas the indicators for evaluating the effect of comprehensive treatment, wereinvestigated and analyzed at the end of intervention.
Results
A total of450participants were included in this study, and412subjects completed thequestionnaires entirely, the response rate was91.6%. Among these subjects, therewere235cases diagnosed with depression, accounting for57.0%, including44severecases,98moderate cases, and93mild cases. The statistical analysis showed that highaged, single, low education level and non-public employee were more susceptible todepression, and gender, income, reimbursement of medical costs and body mass index(BMI) were not significantly relative to depression. In addition, the results of logisticregression and principal component factor analysis indicated that life events, type Dpersonality, duration, HbA1c, and smoke were positively related to depression, whereas diet control, exercise, social support and family history were negative relatedto depression. Structural equation modeling (SEM) showed that life events and socialsupport condition have indirect effect on depression; Type D personality has bothdirect and indirect effect, and clinical factors (such as duration, HbA1c) have mainlydirect effect on depression. Of all32patients, the depression symptoms of18patientswere alleviated significantly after phycological intervention combined with clinicaltreatment, accounting for56%. And there were only two patients whose depressionstatus deteriorated from mild to moderate.Conclusion
The prevalence of co-morbid depression in patients with type2diabetes wassignificantly higher than that of general population reported in previous studies. Lifeevents, type D personality, duration, HbA1c, and smoke are the main risk factors ofco-morbid depression, whereas the diet control, exercise, social support are the mainprotective factors. Family history of type2diabetes is negatively related to depression.Comprehensive treatment, which combined medical and psychological therapy,significantly alleviated the symptoms of co-morbid depression and improved thequality of life of patients with type2diabetes. A lot of space in improving theknowledge and the health behavior of patients with Type2diabetes remains.
近年来，我国糖尿病患病率急速上升。据估计，中国现有成人糖尿病患者9240万，已成为世界糖尿病人数最多的国家。糖尿病患者中90%以上是2型糖尿病，不仅给患者带来沉重的躯体危害和经济负担，而且导致很多严重的心理障碍，其中抑郁是最常见的心理障碍之一。抑郁与糖尿病相互影响并形成恶性循环，给患者带来沉重的精神压力，降低治疗效果，加速心、肾等并发症的发生，加重了患者的痛苦，影响病情的预后。因此，针对2型糖尿病合并抑郁的影响因素开展研究，具有重要的意义。
目的
了解抑郁在2型糖尿病患者中的患病率和分布情况；分析2型糖尿病合并抑郁的影响因素；为2型糖尿病合并抑郁的防治和相应的健康政策制订提供科学依据。
方法
编制结构性问卷，内容包括：人口学特征和临床相关特征调查，社会支持量表（SSRS），生活事件量表（LES），归因方式量表（ASQ），应对方式量表（SCSQ）和抑郁量表（BDI）。2012年3月1日至4月31日在北京市解放军总医院第一附属内分泌科就诊的约2500名2型糖尿病人中，运用系统抽样的方法，随机抽取450例患者作为本研究的对象人群。对样本人群进行问卷调查，在解抑郁的患病率和分布情况的基础上，以患有2型糖尿病合并抑郁的病人作为病例组，以患有2型糖尿病但未患抑郁的患者作为对照组，比较两组的差异。应用逐步Logistic多因素回归、主成分和因子分析控制变量间的共线性，筛选影响2型糖尿病合并抑郁的主要因素，然后在此基础上针对32例患者使用药物治疗结合认知行为疗法、家庭疗法进行综合治疗，并以BDI评分衡量抑郁的转归结果，对其进行追踪分析，然后根据数据分析结果对综合治疗的效果进行评价。
结果
在450例糖尿病患者中，完成调查的对象共有412人，应答率为91.6%，其中有抑郁者235例，占总体的57.0%，包括重度抑郁44例，占总体的10.7%；中度抑郁98例，占总体的23.7%；轻度抑郁93例，占总体的22.6%。经分析发现，高龄、单身、低教育水平和非公职业者更易患抑郁，而性别、收入、报销比例、BMI等指标与抑郁无关。经过Logistic逐步回归和主成分因子分析，与2型糖尿病合并抑郁的相关程度最高的因素主要有以下9个：生活事件， D型人格，病程，糖化血红蛋白和吸烟5个因素为正相关，饮食控制，锻炼，社会支持，家族史4个因素为负相关。结构方程模型分析发现，生活事件和社会支持情况通过间接效应作用于抑郁；D型人格对抑郁同时有直接和间接效应，而临床因素对抑郁的影响则主要是直接效应。经过药物和心理综合治疗，32例2型糖尿病患者抑郁治疗效果明显的患者有18人，占56%。仅有2人抑郁病情略有加重，由轻度抑郁转为中度抑郁。
结论
2型糖尿病患者的抑郁患病率远高于普通人群；生活事件，D型人格，病程，糖化血红蛋白和吸烟是2型糖尿合并抑郁的主要危险因素，饮食控制，锻炼，社会支持是2型糖尿合并抑郁的主要保护因素；糖尿病家族史与抑郁呈负相关；药物与心理治疗结合的综合干预模式效果显著，有利于缓解抑郁的病情，提高2型糖尿病患者的生存质量；2型糖尿病合并抑郁患者健康知识的提高和健康行为的改变有很大的提升空间。
Background
In recent years, diabetes prevalence is rising rapidly, and it affects an estimated92.4million adults in China, which may be the country with the largest numbers of peoplewith diabetes in the world. Of all diabetic patients, approximately90to95percenthave type2diabetes mellitus (T2DM), a condition where the body does not produceenough insulin and/or the cells in the body do not respond normally to insulin. Poorlymanaged diabetes not only increases morbidity and mortality and decreases thequality of life, but also leads to a wide range of complications such as Hypertension,nephropathy, psychological disorders. And depression is one of the most commonpsychological disoders, which accelerates the development and deterioration ofdiabetes and other disease. Therefore, it’s necessary to launch the study on depressionin patients with type2diabetes mellitus.
Objective
To investigate the prevalence of depression in type2diabetes patients, analyze thefactors which are related to depression in patients with diabetes mellitus (DM), andprovide scientific basis for the corresponding clinical practice for DM and healthpolicy formulation for diabetic patients.
Methods
Four hundred and fifty individuals with type2Diabetes mellitus, which were selected randomly from two thousand five hundred patients at the outpatient department ofendocrinology at the First Affiliated Hospital of the General Hospital of the People'sLiberation Army (PLAGH), from March1th to May31st,2012, were recruited in thisstudy. All the selected subjects were interviewed by using the structuredquestionnaires including the demographic characteristics, clinical features, socialsupports rating scale (SSRS), life event scale (LES), attribution style scale (ASQ),coping styles scale (SCSQ) and beck depression scale (BDI). Then the diabeticpatients with co-existing depression and the subjects with diabetes mellitus only weredivided into two groups, respectively, and the difference between these two groupswere compared and analyzed, based on the investigation of the prevalence and thedistribution of depression in patients with diabetes mellitus. The major impact factorsof co-existing depression in patients with diabetes mellitus were screened on thecontrol of the co linearity in weighted independent variable by using the multi-factorlogistic regression analysis, principal component analysis and factor analysis. Andthen, comprehensive treatment combining medicine and psychological intervention(the latter includes cognitive behavior therapy and family therapy) was taken for thirtytwo patients with co-existing depression and diabetes mellitus from the samples ofthis study. The BDI scores and glaciated hemoglobin (HbA1c), which were regardedas the indicators for evaluating the effect of comprehensive treatment, wereinvestigated and analyzed at the end of intervention.
Results
A total of450participants were included in this study, and412subjects completed thequestionnaires entirely, the response rate was91.6%. Among these subjects, therewere235cases diagnosed with depression, accounting for57.0%, including44severecases,98moderate cases, and93mild cases. The statistical analysis showed that highaged, single, low education level and non-public employee were more susceptible todepression, and gender, income, reimbursement of medical costs and body mass index(BMI) were not significantly relative to depression. In addition, the results of logisticregression and principal component factor analysis indicated that life events, type Dpersonality, duration, HbA1c, and smoke were positively related to depression, whereas diet control, exercise, social support and family history were negative relatedto depression. Structural equation modeling (SEM) showed that life events and socialsupport condition have indirect effect on depression; Type D personality has bothdirect and indirect effect, and clinical factors (such as duration, HbA1c) have mainlydirect effect on depression. Of all32patients, the depression symptoms of18patientswere alleviated significantly after phycological intervention combined with clinicaltreatment, accounting for56%. And there were only two patients whose depressionstatus deteriorated from mild to moderate.Conclusion
The prevalence of co-morbid depression in patients with type2diabetes wassignificantly higher than that of general population reported in previous studies. Lifeevents, type D personality, duration, HbA1c, and smoke are the main risk factors ofco-morbid depression, whereas the diet control, exercise, social support are the mainprotective factors. Family history of type2diabetes is negatively related to depression.Comprehensive treatment, which combined medical and psychological therapy,significantly alleviated the symptoms of co-morbid depression and improved thequality of life of patients with type2diabetes. A lot of space in improving theknowledge and the health behavior of patients with Type2diabetes remains.
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