Clinical depression versus distress among patients with type 2 diabetes - Not just a question of semantics
Clinical depression versus distress among patients with type 2 diabetes - Not just a question of semantics
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DOI：
10.2337/dc06-1614
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发表时间：
2007-03-01
期刊：
影响因子：
16.2
通讯作者：
Laurencin, Grace
中科院分区：
文献类型：
--
作者：
Fisher, Lawrence;Skaff, Marilyn M.;Laurencin, Grace
目的-我们试图确定结构化访谈，症状问卷调查，和痛苦的措施之间的差异，以评估抑郁症的糖尿病patients.Research设计和方法-我们评估了506糖尿病患者的抑郁症（MDD）的结构化访谈（复合国际诊断访谈[CIDI]），抑郁症状问卷（流行病学研究中心抑郁量表[CESD]）和糖尿病苦恼量表。评估了人口统计学特征，两个生物变量（A1 C和非HDL胆固醇）和四个行为管理措施（千卡，饱和脂肪的卡路里，水果和蔬菜的数量以及体力活动的分钟数）。对CIDI和CESD.RESULTS结果进行了比较，结果显示22%的患者达到CESD 16，9.9%的患者符合CIDI诊断的MDD。在那些高于CESD临界点的人中，70%没有临床抑郁，34%的临床抑郁没有达到CESD评分！16.与CESD评分< 16的人相比，那些得分为-16的人具有更高的A1 C，千卡和饱和脂肪的卡路里以及更低的体力活动。使用CIDI未发现差异。糖尿病痛苦与MDD的关系最小，但与CESD评分和outcomes.CONCLUSIONS -大多数糖尿病患者和高水平的抑郁症状并不临床抑郁。CESD可能比临床抑郁症更能反映一般情绪和糖尿病特异性困扰。然而，大多数痛苦的治疗是基于抑郁症的文献，这表明需要考虑不同的干预措施，但不是临床抑郁的糖尿病患者。
OBJECTIVE - We sought to determine differences between structured interviews, symptom questionnaires, and distress measures for assessment of depression in patients with diabetes.RESEARCH DESIGN AND METHODS - We assessed 506 diabetic patients for major depressive disorder (MDD) by a structured interview (Composite International Diagnostic Interview [CIDI]), a questionnaire for depressive symptoms (Center for Epidemiological Studies Depression Scale [CESD]), and on the Diabetes Distress Scale. Demographic characteristics, two biological variables (A1C and non-HDL cholesterol), and four behavioral management measures (kilocalories, calories of saturated fat, number of fruit and vegetable servings, and minutes of physical activity) were assessed. Comparisons were made between those with and without depression on the CIDI and the CESD.RESULTS - Findings showed that 22% of patients reached CESD 16, and 9.9% met a CIDI diagnosis of MDD. Of those above CESD cut points, 70% were not clinically depressed, and 34% o t ose who were clinically depressed did not reach CESD scores ! 16. Those scoring - 16, compared with those < 16 on the CESD, had higher A1C, kilocalories, and calories of saturated fat and lower physical activity. No differences were found using the CIDI. Diabetes distress as minimally related to MDD but substantively linked to CESD scores and to outcomes.CONCLUSIONS - Most patients with diabetes and high levels of depressive symptoms are not clinically depressed. The CESD may be more reflective of general emotional and diabetes-specific distress than clinical depression. Most treatment of distress, however, is based on the depression literature, which suggests the need to consider different interventions for distressed but not clinically depressed diabetic patients.