The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision.
The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision.
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DOI：
10.1111/dme.12428
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发表时间：
2014-07
期刊：
影响因子：
--
通讯作者：
Polonsky WH
中科院分区：
文献类型：
--
作者：
Fisher L;Gonzalez JS;Polonsky WH
研究发现，抑郁症与糖尿病之间存在重大联系，抑郁症与自我管理行为差、临床结果差和死亡率高有关。然而，研究结果并不一致，对这些关系产生了混乱和矛盾的结果。我们认为，一直未能以一致的方式定义和衡量“抑郁症”。由于抑郁症的诊断仅基于情绪，而不参考来源或内容，因此在解决糖尿病患者所经历的情绪困扰时，不考虑糖尿病的背景。为了减少这种混乱，我们建议将“情绪困扰”的潜在结构视为连接糖尿病相关困扰，亚临床抑郁症，抑郁症状升高和重度抑郁症的核心结构。我们认为情绪困扰是一个单一的，连续的维度，有两个主要特征：内容和严重程度;这些人的情绪困扰的主要内容包括糖尿病及其管理，其他生活压力和其他贡献者;并且在临床护理中直接解决困扰的内容和严重程度。我们进一步建议，所有的患者，即使是那些情绪困扰上升到严重抑郁症或焦虑症的水平，可以受益于考虑的内容的困扰，直接有效的护理，我们建议的策略，将糖尿病的情绪方面纳入定期糖尿病护理。这种方法可以减少抑郁症和痛苦之间的混淆，从而可以进行以患者为中心的适当和有针对性的干预。
Studies have identified significant linkages between depression and diabetes, with depression associated with poor self-management behaviour, poor clinical outcomes and high rates of mortality. However, findings are not consistent across studies, yielding confusing and contradictory results about these relationships. We suggest that there has been a failure to define and measure ‘depression’ in a consistent manner. Because the diagnosis of depression is symptom-based only, without reference to source or content, the context that diabetes is not considered when addressing the emotional distress experienced by individuals struggling with diabetes. To reduce this confusion, we suggest that an underlying construct of ‘emotional distress’ be considered as a core construct to link diabetes-related distress, subclinical depression, elevated depression symptoms and major depressive disorder. We view emotional distress as a single, continuous dimension that has two primary characteristics: content and severity; that the primary content of emotional distress among these individuals include diabetes and its management, other life stresses and other contributors; and that both the content and severity of distress be addressed directly in clinical care. We suggest further that all patients, even those whose emotional distress rises to the level of major depressive disorder or anxiety disorders, can benefit from consideration of the content of distress to direct care effectively, and we suggest strategies for integrating the emotional side of diabetes into regular diabetes care. This approach can reduce confusion between depression and distress so that appropriate and targeted patient-centred interventions can occur.
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3.3
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