Examining a bidirectional association between depressive symptoms and diabetes
Examining a bidirectional association between depressive symptoms and diabetes
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DOI：
10.1001/jama.299.23.2751
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发表时间：
2008-06-18
影响因子：
120.7
通讯作者：
Lyketsos, Constantine
中科院分区：
文献类型：
--
作者：
Golden, Sherita Hill;Lazo, Mariana;Lyketsos, Constantine
背景抑郁症状与2型糖尿病的发生有关，但目前尚不清楚2型糖尿病是否是抑郁症状升高的危险因素。目的探讨抑郁症状与2型糖尿病之间的双向关联。2000-2002年对年龄在45 - 84岁之间的美国男性和女性进行了一项多种族队列研究，并随访至2004- 2005年。主要结果测量流行病学研究中心抑郁量表（CES-D）定义的抑郁症状升高16分或更高，使用抗抑郁药物，或两者兼而有之。CES-D评分也连续建模。参与者被归类为正常空腹血糖（≥ 126 mg/dL或接受治疗）。分析1包括5201名基线时没有2型糖尿病的参与者，并估计了3.2年内有和没有抑郁症状的人发生2型糖尿病的相对危险性。分析2包括4847名参与者没有抑郁症状的基线和计算的相对优势，发展抑郁症状超过3.1年的2型diabetes.Results在分析1中，2型糖尿病的发病率为22.0和16.6每1000人年的抑郁症状，分别为那些没有升高。在调整人口统计学因素和体重指数后，CES-D评分每增加5个单位，2型糖尿病的发病风险增加1.10倍（95%置信区间[CI]，1.02-1.19）。在调整代谢、炎症、社会经济或生活方式因素后，这种相关性仍然存在，尽管在调整后者后不再具有统计学意义（相对危险度，1.08; 95%CI，0.99-1.19）。在分析2中，空腹血糖正常的参与者每1000人年抑郁症状升高的发生率为36.8;空腹血糖受损为27.9;未经治疗的2型糖尿病为31.2，治疗的2型糖尿病为61.9。与空腹血糖正常者相比，空腹血糖受损者发生抑郁症状升高的人口统计学校正比值比为0.79（95%CI，0.63-0.99），未经治疗的2型糖尿病患者为0.75（95%CI，0.44-1.27），经治疗的2型糖尿病患者为1.54（95%CI，1.13-2.09）。这些关联事件的抑郁症状没有实质性的改变调整身体质量指数，社会经济和生活方式因素，和合并症。在这两个分析结果是跨种族groups.Conclusions基线抑郁症状与事件2型糖尿病的存在，部分原因是生活方式因素的适度关联。空腹血糖受损和未治疗的2型糖尿病与抑郁症状呈负相关，而治疗的2型糖尿病与抑郁症状呈正相关。这些协会没有实质性的影响调整潜在的混杂或中介因素。
Context Depressive symptoms are associated with development of type 2 diabetes, but it is unclear whether type 2 diabetes is a risk factor for elevated depressive symptoms.Objective To examine the bidirectional association between depressive symptoms and type 2 diabetes.Design, Setting, and Participants Multi-Ethnic Study of Atherosclerosis, a longitudinal, ethnically diverse cohort study of US men and women aged 45 to 84 years enrolled in 2000-2002 and followed up until 2004-2005.Main Outcome Measures Elevated depressive symptoms defined by Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or higher, use of antidepressant medications, or both. The CES-D score was also modeled continuously. Participants were categorized as normal fasting glucose (= 126 mg/dL or receiving treatment). Analysis 1 included 5201 participants without type 2 diabetes at baseline and estimated the relative hazard of incident type 2 diabetes over 3.2 years for those with and without depressive symptoms. Analysis 2 included 4847 participants without depressive symptoms at baseline and calculated the relative odds of developing depressive symptoms over 3.1 years for those with and without type 2 diabetes.Results In analysis 1, the incidence rate of type 2 diabetes was 22.0 and 16.6 per 1000 person-years for those with and without elevated depressive symptoms, respectively. The risk of incident type 2 diabetes was 1.10 times higher for each 5-unit increment in CES-D score (95% confidence interval [CI], 1.02-1.19) after adjustment for demographic factors and body mass index. This association persisted following adjustment for metabolic, inflammatory, socioeconomic, or lifestyle factors, although it was no longer statistically significant following adjustment for the latter (relative hazard, 1.08; 95% CI, 0.99-1.19). In analysis 2, the incidence rates of elevated depressive symptoms per 1000-person years were 36.8 for participants with normal fasting glucose; 27.9 for impaired fasting glucose; 31.2 for untreated type 2 diabetes, and 61.9 for treated type 2 diabetes. Compared with normal fasting glucose, the demographic-adjusted odds ratios of developing elevated depressive symptoms were 0.79 (95% CI, 0.63-0.99) for impaired fasting glucose, 0.75 (95% CI, 0.44-1.27) for untreated type 2 diabetes, and 1.54 (95% CI, 1.13-2.09) for treated type 2 diabetes. None of these associations with incident depressive symptoms were materially altered with adjustment for body mass index, socioeconomic and lifestyle factors, and comorbidities. Findings in both analyses were comparable across ethnic groups.Conclusions A modest association of baseline depressive symptoms with incident type 2 diabetes existed that was partially explained by lifestyle factors. Impaired fasting glucose and untreated type 2 diabetes were inversely associated with incident depressive symptoms, whereas treated type 2 diabetes showed a positive association with depressive symptoms. These associations were not substantively affected by adjustment for potential confounding or mediating factors.