Racial Differences in Diabetes-Depression Comorbidity

描述(由申请人提供)：糖尿病(DM)患者患严重抑郁障碍(MDD)的风险增加，这与DM预后不良密切相关。与高加索人相比，非裔美国人更有可能患糖尿病，糖尿病预后较差。他们也更有可能患有未经治疗的MDD，并对MDD的性质和护理持有信念，而目前的精神卫生保健提供系统并不能很好地适应这些信念。尽管存在这些明显的差异，但严重缺乏数据来指导针对糖尿病中MDD共病的文化适当干预措施的发展，因为在这一主题的研究中，非裔美国人的代表性严重不足。我们的初步数据突显了这种经验差距的重要性，这些数据表明，即使在对潜在的混杂因素进行调整后，抑郁症状对非裔美国人的糖尿病控制可能比对高加索人更具破坏性。具体目标1是测试我们的概念模型，在该模型中，MDD和DM结果(血糖控制和DM生活质量)之间的关联既受种族的调节，又受DM自我护理行为的调节。我们计划对底特律地区262名2型糖尿病患者(50%非裔美国人，50%高加索人)进行为期10周的评估。在第1周和第10周，将对MDD的存在和严重程度、DM自我护理、血糖控制和DM生活质量进行评估；并在研究中期对自我护理和MDD进行额外评估。关于自我护理和MDD的数据将随着时间的推移进行汇总，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是了解与抑郁相关的行为和信念，这将为发展对患有MDD的糖尿病患者进行文化敏感的干预措施提供信息。为了达到目标2，我们将开发一个种族分层的亚样本，包括30名患有MDD的受试者。使用基于疾病表现常识模型的半结构化访谈工具，我们将收集有关MDD的性质和护理的信念的定性数据。我们将进行定性分析，根据种族确定和比较主题。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，以表征糖尿病患者在MDD表现、寻求治疗和心理健康障碍方面的文化差异。该项目的成果将推进疾病自我管理的科学。这些发现还将使试验的设计成为可能，以开发和测试改善成千上万非裔美国人心理和身体健康的创新。

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.