Daily Depressive Affect & Disease Management in Diabetes

描述（由申请人提供）：糖尿病影响650万至1300万美国人，每年直接医疗费用支出超过440亿美元，抑郁症在23%的欧洲裔美国糖尿病患者中作为合并症发生，少数民族的抑郁症发病率要高得多。亚临床抑郁症的流行更增加了这种影响。抑郁症与自我管理能力下降、血糖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，抑郁情绪通过自我管理对血糖控制有直接和间接的影响，血糖控制可以直接影响抑郁情绪。这些关系因患者而异，并受到心理资源、家庭关系和慢性压力等潜在可延展性变量的影响。考虑到抑郁症对这些患者造成的行为和生物学风险的增加，需要进行具有干预意义的纵向研究，以描述这些结构随着时间的推移相互影响的方式。采用基于社区样本的“微纵向”方法，通过电话访谈收集日常数据，我们建议检查糖尿病患者21天内抑郁影响、疾病管理和血糖控制之间的日常变化。我们的目标是：(1)提供更清晰和特异性的顺序的因果关系随着时间的推移；(2)识别那些患者的因素，使这些关系符合条件，以努力解释在这些患者中发现的广泛记录的差异；(3)确定影响这些过程的配偶/伴侣相关因素，以解决这些患者管理糖尿病的社会背景。提出的纵向研究对干预有重要意义：它将提供一个更完整的描述，全面的抑郁影响，疾病管理和血糖控制随着时间的推移；它还将确定亚组患者之间的差异，这些差异可能需要特定的干预措施。

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, Depression occurs as a comorbid condition in 23% of European Americans with diabetes, and the rate of depression among ethnic minorities is considerably higher. The prevalence of sub clinical depression increases the impact even more. Depression is associated with decreased self-management, poor glycemic control, and increased risk for complications. Explanatory models, based almost exclusively on cross-sectional research, suggest that depressive affect has both direct and indirect effects on glycemic control through self-management, and that glycemic control can affect depressive affect directly. These relationships vary considerably from patient to patient and are affected by such potentially malleable variables as psychological resources, family relationships, and chronic stress. Given the increased behavioral and biological risks that depressive affect pose for these patients, longitudinal studies with implications for intervention are needed to describe the ways in which these constructs influence each other over time. Using a "micro longitudinal" approach with a community based sample that employs daily data collection via telephone interview, we propose to examine the day-to-day variation among depressive affect, disease-management and glycemic control over 21 days in patients with diabetes. Our aims are (1) to provide greater clarity and specificity to the sequence of causative effects over time; (2) to identify those patients factors that qualify these relationships in an effort to account for the widely documented variability found among these patients; and (3) to identify spouse/partner-related factors that influence these processes to address the social context in which these patients manage diabetes. The proposed longitudinal research has major implications for intervention: it will provide a more complete description of the causative effects of the full range of depressive affect, disease-management and glycemic control over time; and it will identify variations among sub groups of patients that may warrant specific interventions.