Daily Depressive Affect & Disease Management in Diabetes

糖尿病影响着650万至1300万美国人，每年直接医疗保健费用超过440亿美元，抑郁症在23%的欧洲裔美国人糖尿病患者中作为共病状态发生，少数民族的抑郁症发病率相当高。亚临床抑郁症的患病率甚至更大。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塑性变量的影响。鉴于抑郁情绪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，以描述这些结构随着时间的推移相互影响的方式。使用“微纵向”的方法，以社区为基础的样本，采用每天的数据收集，通过电话采访，我们建议检查一天到一天的变化之间的抑郁情绪，疾病管理和血糖控制超过21天的糖尿病患者。我们的目标是：（1）提供更清晰和特异性的因果关系随时间的顺序;（2）确定这些患者的因素，这些因素限定这些关系，努力解释这些患者中广泛记录的变异性;（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。拟议的纵向研究对干预有重大意义：它将提供一个更完整的描述，随着时间的推移，全方位的抑郁情绪，疾病管理和血糖控制的因果关系;它将确定可能需要特定干预的患者亚组之间的变化。

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.