Depression, self-management and ethnicity in diabetes

糖尿病影响着650万至1300万美国人，每年的直接医疗保健费用超过440亿美元。拉丁美洲人是美国增长最快的少数民族，其患病率约为欧洲裔美国人的两倍。抑郁症在23%的糖尿病患者中是一种共病，但拉丁美洲糖尿病患者的抑郁症发病率几乎为30%。抑郁症与自我管理行为减少、代谢控制不良和并发症风险增加有关。几乎完全基于横断面研究的解释模型表明，抑郁症通过自我管理对代谢控制有直接和间接的影响。疾病的严重程度、损伤、并发症、生活压力、个人资源、获得护理的机会和社会支持也会影响这些关系。考虑到抑郁情绪的普遍性，EA和拉丁美洲糖尿病患者自我管理的变异性，以及抑郁症对这些患者造成的行为和生物风险增加，需要进行具有干预意义的纵向研究来描述这些患者随着时间的推移抑郁症和自我管理的形式。本研究拟采用4波、24个月的纵向研究，旨在：（1）描述EA和拉丁裔2型糖尿病患者抑郁和自我管理随时间的变化和亚组模式;（2）确定抑郁、自我管理和代谢控制之间的联系，以及沿着调节这些联系的因素;以及（3）基于患者种族（EA、拉丁美洲人）确定这些关系的变化。拟议的纵向研究对干预具有重大意义：它将更完整地描述随着时间的推移，各种严重和轻微抑郁症和自我管理的自然过程;它将确定可能需要采取具体干预措施的亚组变化;它将确定抑郁症与疾病自我管理和代谢控制的连续联系在沿着什么时候变得明显;它将突出显示基于患者种族的这些关系的差异。

DESCRIPTION (provided by applicant): Diabetes affects between 6.5 and 13 million Americans and is associated with an expenditure of over $44 billion in direct health care costs per year. Prevalence rates for Latinos, America's fastest growing minority, are approximately twice that of European-Americans (EAs). Depression occurs as a comorbid condition in 23% of EAs with diabetes, but the rate of depression among Latinos with diabetes is almost 30%. Depression is associated with decreased self-management behavior, poor metabolic control, and increased risk for complications. Explanatory models, based almost exclusively on cross-sectional research, suggest that depression has both direct and indirect effects on metabolic control through self-management. Disease severity, impairment, complications, life stress, personal resources, access to care, and social support also affect these relationships. Given the pervasiveness of depressive affect, the variability in self-management among EA and Latino patients with diabetes, and the increased behavioral and biological risk that depression poses for these patients, longitudinal studies with implications for intervention are needed to describe the forms that depression and self-management can take in these patients over time. The proposed 4-wave, 24-month longitudinal project seek to: (1) describe the variation, and sub group patterning of depression and self-management over time in EA and Latino patients with type 2 diabetes; (2) identify the linkages among depression, self-management, and metabolic control, over time, along with factors that moderate these linkages; and (3) determine variations in these relationships based on patient ethnicity (EAs, Latinos). The proposed longitudinal research has major implications for intervention: it will provide a more complete description of the natural course of the full range of major and minor depression and self-management over time; it will identify sub group variations that may warrant specific interventions; it will identify at what point along the continuum of depression linkages with disease self-management and metabolic control become evident; and it will highlight differences in these relationships based on patient ethnicity.