Racial Differences in Diabetes-Depression Comorbidity

描述（由申请人提供）：糖尿病（DM）患者发生重度抑郁症（MDD）的风险增加，这与DM结局不良可靠相关。与高加索人相比，非裔美国人更容易患糖尿病，糖尿病的预后也较差。他们也更有可能患有未经治疗的MDD，并持有关于MDD的性质和护理的信念，这些信念没有被当前的精神卫生保健提供系统很好地适应。尽管存在这些明显的差异，但指导制定适合DM中MDD合并症的文化干预措施的数据严重短缺，因为非裔美国人在这一主题的研究中代表性非常不足。我们的初步数据强调了这一经验差距的重要性，这表明抑郁症状对非裔美国人的DM控制可能比白人更具破坏性，即使在调整了潜在的混杂因素后。具体目标1是测试我们的概念模型，其中MDD和DM结局（血糖控制和DM生活质量）之间的关联既受种族调节，又受DM自我护理行为介导。我们计划在10周的评估方案中研究262例底特律地区的2型糖尿病患者（50%非裔美国人，50%白人）。在第1周和第10周;将评估MDD的存在和严重程度、DM自我护理、血糖控制和DM生活质量;在研究中期对自我护理和MDD进行额外评估。自我护理和MDD的数据将在不同时间进行汇总，研究假设将使用OLS多元回归路径分析进行检验。具体目标2是了解抑郁相关的行为和信念，这将为患有MDD的DM患者制定文化敏感的干预措施提供信息。为了满足目标2，我们将开发一个由30例共病MDD受试者组成的人种分层子样本。使用基于疾病表征常识模型的半结构化访谈工具，我们将收集有关MDD性质和护理的信念的定性数据。我们将进行定性分析，以确定和比较种族的主题。最后，我们将使用三角测量和其他混合方法整合我们的定量（目标1）和定性结果，以描述DM患者中MDD表现、寻求治疗和心理健康障碍的文化差异。该项目的成果将推动疾病自我管理的科学。研究结果还将使试验设计能够开发和测试改善数千名非洲裔美国人身心健康的创新。

DESCRIPTION (provided by applicant): Patients with diabetes mellitus (DM) are at increased risk for major depressive disorder (MDD), which is reliably associated with poor DM outcomes. Compared to Caucasians, African Americans are more likely to develop DM and to have poor DM outcomes. They are also more likely to have untreated MDD, and to hold beliefs about the nature and care of MDD that are not well-accommodated by current mental health care delivery systems. Despite these clear disparities, there is a dire shortage of data to guide the development of culturally-appropriate interventions for MDD comorbidity in DM, because African Americans have been tremendously under-represented in research on this topic. The significance of this empirical gap is highlighted by our preliminary data, which suggest that depressive symptoms may be more disruptive to DM control for African Americans than for Caucasians, even after adjusting for potential confounders. Specific Aim 1 is to test our conceptual model, in which the association between MDD and DM outcomes (glycemic control and DM quality of life) is both moderated by race and mediated by DM self-care behavior. We plan to study 262 Detroit-region Type 2 DM patients (50% African American, 50% Caucasian) in a 10-week assessment protocol. At Weeks 1 and 10; assessments will be made of MDD presence and severity, DM self-care, glycemic control, and DM quality of life; with an additional assessment of self-care and MDD made at mid-study. Data on self-care and MDD will be aggregated across time, and the study hypotheses will be tested using OLS multiple regression path analysis. Specific Aim 2 is to gain an understanding of depression-related behavior and beliefs that will inform the development of culturally-sensitive interventions for DM patients who have comorbid MDD. To meet Aim 2, we will develop a race-stratified subsample of 30 subjects with comorbid MDD. Using a semi-structured interview tool based on the Commonsense Model of Illness Representations, we will collect qualitative data on beliefs about the nature and care of MDD. We will perform qualitative analysis to identify and compare themes by race. Finally, we will integrate our quantitative (Aim 1) and qualitative results using triangulation and other mixed-methods approaches, to characterize cultural differences in MDD representations, treatment-seeking, and mental health barriers among DM patients. The project outcomes will advance the science of illness self-management. Findings will also enable the design of trials to develop and test innovations that improve mental and physical health for many thousands of African Americans.