Contributors to depression in Latino and European-American patients with type 2 diabetes
Contributors to depression in Latino and European-American patients with type 2 diabetes
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DOI：
10.2337/diacare.24.10.1751
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发表时间：
2001-10-01
期刊：
影响因子：
16.2
通讯作者：
Kanter, RA
中科院分区：
文献类型：
--
作者：
Fisher, L;Chesla, CA;Kanter, RA
目的 - 确定糖尿病和其他生活压力对拉丁裔和欧洲裔美国人 (EA) 糖尿病患者抑郁和焦虑的独立和累积贡献。 研究设计和方法 - 从管理式医疗机构招募的总共 75 名拉丁裔和 113 名 EA 2 型糖尿病患者，对三组潜在压力进行了评估：人口统计学（年龄、性别和教育程度）、疾病状态（功能影响、诊断后时间、合并症、HbA(1c) 和 BMI）、家庭压力（经济压力、配偶冲突解决和家庭亲密程度）。因变量是抑郁症（流行病学研究中心抑郁量表 [CES-D]）和焦虑症（症状检查表 [SCL-90]）。多元回归方程评估了每个预测因子对抑郁和焦虑的独立贡献。 结果 - 对于两个种族群体，教育、功能影响和财务压力显着且独立地预测抑郁；配偶冲突解决不佳是 EA 患者的第四个重要预测因素。这些方程解释了很高的方差百分比 (43-55%)。排除教育因素，相同的变量预测两个族群的焦虑。疾病状况和家庭压力变量组可独立显着预测结果。这些变量之间的关系适用于所有患者，而不仅仅是那些可能患有抑郁症的患者。 结论 - 研究结果表明，考虑多种生活压力（而不仅仅是糖尿病）是有用的，这些压力结合起来会影响抑郁和焦虑。我们认为，这些影响是所有糖尿病患者（而不仅仅是那些可能患有抑郁症的患者）普遍心理困扰的累积经历。总而言之，这些发现强调以生命为中心、以患者为中心的抑郁症治疗方法，而不是排他性的疾病相关观点。
OBJECTIVE - To deter-mine the independent and cumulative contributions of diabetes and other life stresses on depression and anxiety in Latino and European-American (EA) patients with diabetes.RESEARCH DESIGN AND METHODS - A total of 75 Latino and 113 EA patients with type 2 diabetes, recruited from managed care settings, were assessed regarding three groups of potential Stresses: demographics (age, sex, and education), disease status (functional impact, time since diagnosis, comorbidities, HbA(1c) and BMI), an family stress (financial stress, spouse conflict resolution, and family closeness). Dependent variables were depression (Center for Epidemiological Studies-Depression scale [CES-D]) and anxiety (Symptom Checklist [SCL-90]). Multiple regression equations assessed the independent contribution of each predictor on depression and anxiety.RESULTS - For both ethnic groups, education, functional impact, and financial stress significantly and independently predicted depression; poor spouse conflict resolution was a fourth significant predictor for EA patients only. The equations accounted for a high percentage of variance (43-55%). Excluding education, the same variables predicted anxiety for both ethnic groups. The disease status and family Stress variable groups significantly predicted outcomes independently. The relationships among these variables an occurred for all patients, not only for those classified as likely depressed.CONCLUSIONS - The findings suggest the utility of considering many life stresses, not just diabetes alone, that combine to affect depression and anxiety. We suggest that these effects are experienced cumulatively as general psychological distress for all patients with diabetes, not just those classified as likely depressed. Taken together, the findings emphasize a life-centered, patient-focused approach to the treatment of depression, rather than an exclusive disease-related perspective.