Depression and diabetes:: A potentially lethal combination
Depression and diabetes:: A potentially lethal combination
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DOI：
10.1007/s11606-008-0731-9
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发表时间：
2008-10-01
影响因子：
5.7
通讯作者：
Schoenbaum, Michael
中科院分区：
文献类型：
--
作者：
Katon, Wayne;Fan, Ming-Yu;Schoenbaum, Michael
目的：为了评估是否医疗保险的收费服务受益人抑郁症和糖尿病有一个更高的死亡率超过2年的时间与受益人糖尿病solited.DESIGN：抑郁症的证据是基于医生诊断或自我报告的处方抗抑郁药在一年前筛选，或得分>= 3的患者健康问卷两项问卷。每两个月通过检查医疗保险索赔和资格文件或通过与参与者家属的电话联系来评估死亡率。考克斯比例风险回归模型用于计算糖尿病患者抑郁与非抑郁受益人死亡的调整风险比。参与者：共有10,704名糖尿病受益人参加了一项疾病管理计划，他们接受了健康评估问卷调查，并随访了两年。参与疾病管理计划的糖尿病医疗保险受益人的共病抑郁症与两年期间约36%至38%的全因死亡风险增加相关，这取决于当时对抑郁症的定义。在抑郁症与非抑郁症benefits.CONCLUSION：在一个大的医疗保险队列的收费服务受益人糖尿病，共病抑郁症与全因死亡率的增加，在两年内没有显着增加的原因，从大血管疾病的死亡率被发现。未来的研究将需要确定与抑郁症相关的死亡率增加是否是由于潜在的行为介质（即，吸烟，饮食依从性差）或生理异常（即，下丘脑-垂体轴失调）与抑郁症相关。
OBJECTIVE: To assess whether Medicare fee-for-service beneficiaries with depression and diabetes had a higher mortality rate over a 2-year period compared with beneficiaries with diabetes alone.DESIGN: Evidence of depression was based on a physician diagnosis or self-reported prescription of an antidepressant in the year prior to screening, or a score of >= 3 on the Patient Health Questionnaire two-item questionnaire. Mortality was assessed bi-monthly by checking Medicare claims and eligibility files or from information from telephone contact with the participant's family. Cox proportional hazard regression models were used to calculate adjusted hazard ratios of death in depressed versus nondepressed beneficiaries with diabetes.PARTICIPANTS: A total of 10,704 beneficiaries with diabetes enrolled in a disease management program were surveyed with a health assessment questionnaire and followed over a two-year period.MAIN RESULTS: Comorbid depression in Medicare beneficiaries with diabetes participating in a disease management program was associated with an increased risk for all-cause mortality over a two-year period of approximately 36% to 38%, depending on the definition of depression that was used. No significant increase in rates of cause-specific mortality from macrovascular disease were found in depressed versus nondepressed beneficiaries.CONCLUSION: Among a large Medicare cohort of fee-for-service beneficiaries with diabetes, comorbid depression was associated with an increase in all-cause mortality over a two-year period. Future research will be required to determine whether the increase in mortality associated with depression is due to potential behavioral mediators (i.e., smoking, poor adherence to diet) or physiologic abnormalities (i.e., hypothalamic-pituitary axis dysregulation) associated with depression.