Tangled Up in Blue: Unraveling the Links Between Emotional Distress and Treatment Adherence in Type 2 Diabetes
Tangled Up in Blue: Unraveling the Links Between Emotional Distress and Treatment Adherence in Type 2 Diabetes
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DOI：
10.2337/dc16-1657
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发表时间：
2016-12-01
期刊：
影响因子：
16.2
通讯作者：
Hoogendoorn, Claire J.
中科院分区：
文献类型：
--
作者：
Gonzalez, Jeffrey S.;Kane, Naomi S.;Hoogendoorn, Claire J.
目的：我们对情绪困扰进行了全面评估，以研究其与糖尿病药物依从性的关系。研究设计和方法不同种族和社会经济背景的2型糖尿病患者完成了糖尿病痛苦和抑郁的自我报告（SRs），接受了半结构化的抑郁访谈，并提供了A1C的血液样本。在随后的3个月里，104名参与者的药物依从性被电子监测（EM）；获得了药物依从性的有效SRs。层次线性回归评估糖尿病困扰和抑郁对依从性的独立影响。结果EM组3个月服药依从性平均+/- SD为76.1% +/- 25.7%，SR组为83.7% +/- 21.9%。较高的SR水平（P < 0.001）和基于访谈（P < 0.05）的抑郁症状严重程度（P < 0.05）和糖尿病相关窘迫（P < 0.01）与EM和SR不依从性呈显著的双变量关联。回归模型显示，基线糖尿病困扰是随访时EM （β = -0.29; P = 0.001）和SR依从性（β = -0.24; P < 0.02）的显著独立预测因子。SR抑郁是EM和SR依从性的独立预测因子，并将糖尿病困扰的影响降低到不显著。随后的模型表明，这种影响是由抑郁的躯体症状而不是认知情感症状驱动的。结果一致，但较弱的是基于访谈的抑郁症状。结论：研究结果支持糖尿病相关焦虑和抑郁症状严重程度是2型糖尿病药物不依从性的危险因素。通过抑郁测量捕获的躯体症状，而不是认知-情感症状，独立地预测不依从性，应该进一步研究作为情绪困扰和不依从性之间的潜在联系。
OBJECTIVEWe conducted comprehensive assessments of emotional distress to examine relations with diabetes medication adherence over time.RESEARCH DESIGN AND METHODSEthnically and socioeconomically diverse adults treated for type 2 diabetes completed validated self-reports (SRs) for diabetes distress and depression, were administered semistructured depression interviews, and provided blood samples for A1C. Medication adherence among 104 participants was electronically monitored (EM) over the subsequent 3 months; validated SRs of medication adherence were also obtained. Hierarchical linear regression evaluated independent effects of diabetes distress and depression on adherence.RESULTSMean +/- SD 3-month medication adherence was 76.1% +/- 25.7% for EM and 83.7% +/- 21.9% for SR. Higher levels of SR (P < 0.001) and interview-based (P < 0.05) depressive symptom severity (P < 0.05) and diabetes-related distress (P < 0.01) showed a significant bivariate association with EM and SR nonadherence. Regression models showed baseline diabetes distress was a significant independent predictor of EM (beta = -0.29; P = 0.001) and SR adherence (beta = -0.24; P < 0.02) at follow-up. SR depression was an independent predictor of EM and SR adherence and reduced the effects of diabetes distress to nonsignificance. Subsequent models indicated this effect was driven by somatic rather than cognitive-affective symptoms of depression. Results were consistent but weaker for interview-based depressive symptoms.CONCLUSIONSFindings support diabetes-related distress and depression symptom severity as risk factors for type 2 diabetes medication nonadherence. Somatic symptoms captured by depression measures, but not cognitive-affective symptoms, independently predict nonadherence and should be further investigated as a potential link between emotional distress and nonadherence.