Depression, self-care, and medication adherence in type 2 diabetes
Depression, self-care, and medication adherence in type 2 diabetes
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DOI：
10.2337/dc07-0158
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发表时间：
2007-09-01
期刊：
影响因子：
16.2
通讯作者：
Grant, Richard W.
中科院分区：
文献类型：
--
作者：
Gonzalez, Jeffrey S.;Safren, Steven A.;Grant, Richard W.
研究设计与方法--我们使用哈佛精神病学/全国抑郁症筛查日量表(HANDS)、糖尿病自我护理活动概要(HANDS)和自我报告的药物依从性，对来自两个初级保健诊所的879名2型糖尿病患者进行了调查。结果：在这些患者中，19%的患者符合可能的严重抑郁的标准(HANDS评分=9)，另外66.5%的患者报告至少有一些抑郁症状。在控制了协变量后，与所有其他受访者相比，可能患有重度抑郁症的患者报告坚持饮食、锻炼和血糖自我监测方案的天数显著减少(P<；0.01)，前一周错过药物剂量的几率增加2.3倍(95%可信区间1.5-3.6，P<；0.001)。持续的抑郁症状严重程度评分比明确定义的可能的重度抑郁症更能预测不坚持饮食、锻炼和药物治疗。重度抑郁对血糖监测有更好的预测作用。在三分之二不符合严重抑郁症标准(Hands Score<；9，n=709)的患者中，Hands评分的增加与较差的自我护理行为逐渐相关(P<；0.01)。结论--这些发现挑战了抑郁的概念化，认为抑郁是不遵守的绝对风险因素，并表明即使抑郁症状水平较低，也与不遵守糖尿病自我护理的重要方面有关。在糖尿病自我护理方面的显著改善。
OBJECTIVE - We examined the association between depression, measured as either a continuous symptom severity score or a clinical disorder variable, with self-care behaviors in type 2 diabetes.RESEARCH DESIGN AND METHODS - We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence.RESULTS - Of the patients, 19% met the criteria for probable major depression (HANDS score >= 9), and an additional 66.5% reported at least some depressive symptoms. After controlling for covariates, patients with probable major depression reported significantly fewer days' adherent to diet, exercise, and glucose self-monitoring regimens (P < 0.01) and 2.3-fold increased odds of missing medication doses in the previous week (95% CI 1.5-3.6, P < 0.001) compared with all other respondents. Continuous depressive symptom severity scores were I better predictors of nonadherence to diet, exercise, and medications than categorically defined probable major depression. Major depression was a better predictor of glucose monitoring. Among the two-thirds of patients not meeting the criteria for major depression (HANDS score < 9, n = 709), increasing HANDS scores were incrementally associated with poorer self-care behaviors (P < 0.01).CONCLUSIONS - These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care. in significant improvements in diabetes self-care.