Depressive symptoms and diabetes management from late adolescence to emerging adulthood.
Depressive symptoms and diabetes management from late adolescence to emerging adulthood.
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DOI：
10.1037/hea0000645
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Wiebe DJ
中科院分区：
文献类型：
--
作者：
Baucom KJW;Turner SL;Tracy EL;Berg CA;Wiebe DJ
本研究旨在考察从青少年晚期向成年初期过渡期间，抑郁症状的变化情况，以及抑郁症状与1型糖尿病（T1D）管理之间的个体间和个体内关联。
从高三开始，197名患有T1D的青少年晚期个体（平均年龄 = 17.77岁）每年在三个时间点报告自己的学生身份和居住情况，并完成关于抑郁症状以及对糖尿病治疗方案依从性的自我报告测量。同时在这些时间点通过糖化血红蛋白（HbA1c）检测试剂盒收集血糖控制情况。
多层模型结果显示，基线时抑郁症状水平较高，当参与者不住在父母家中时，抑郁症状随时间显著增加，而与父母同住时则无变化。与同龄人相比，抑郁症状平均水平较高的参与者（个体间关联），其平均依从性和血糖控制较差（即HbA1c水平较高）。个体内抑郁症状的波动与依从性显著相关：抑郁症状增加幅度越大（相对于青少年自身平均水平），依从性恶化程度越大。个体内抑郁症状对血糖控制没有显著影响。
从青少年晚期向成年初期的过渡对T1D患者来说尤其具有挑战性。研究结果表明，与抑郁症状较轻者相比，抑郁症状较重的个体依从性和血糖控制较差，且抑郁症状的增加与依从性下降相关，这凸显了在这一人生过渡阶段筛查和监测抑郁症状的重要性。
To examine changes in depressive symptoms as well as between- and within-person associations between depressive symptoms and type 1 diabetes (T1D) management across the transition from late adolescence to emerging adulthood. Beginning in the senior year of high school, 197 late adolescents with T1D (M age = 17.77) reported on their student status and living situation, and completed self-report measures of depressive symptoms and adherence to the diabetes regimen, annually at three time points. Glycemic control was gathered from HbA1c assay kits at the same time points. Results of multilevel models demonstrated high depressive symptoms at baseline, with significant increases in depressive symptoms across time when participants were not living in their parental home, but no change when living with parents. Participants with higher mean levels of depressive symptoms relative to peers (between-person association) had poorer adherence and glycemic control (i.e., higher HbA1c) on average. Within-person fluctuations in depressive symptoms were significantly associated with adherence: greater increases in depressive symptoms (relative to adolescents’ own average) were associated with greater deteriorations in adherence. There was not a significant within-person effect of depressive symptoms on glycemic control. The transition from late adolescence to emerging adulthood is particularly challenging for those with T1D. The findings that individuals with greater depressive symptoms have poorer adherence and glycemic control relative to those with lower depressive symptoms, and that increases in depressive symptoms are associated with declines in adherence, highlight the importance of screening and monitoring depressive symptoms during this life transition.
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