Prevalence and Correlates of Minor Depression in Type 2 Diabetes

描述（由申请人提供）：重度抑郁症（MDD）在横断面和纵向上与2型糖尿病（T2DM）的风险相关，也与微血管和大血管并发症风险增加、代谢控制恶化和全因死亡率相关。关于轻度抑郁（MinD）与T2DM或其继发并发症之间的类似关联的证据较少。根据《诊断与统计手册- iv -文本修订版》（DSM-IV-TR）标准，我们假设MinD在成年T2DM患者中普遍存在，并与代谢控制不良相关，正如在重度抑郁症中所见，这种关联可能由与这些疾病相关的行为和生物学因素（即不良健康行为、问题解决能力受损和亚临床高皮质醇症）来解释。为了初步检验这一假设，我们的研究有以下具体目的：1)估计以临床为基础的成年T2DM患者的MinD患病率，并将其与MDD患病率进行比较。2)比较伴有MinD的糖尿病患者与伴有重度抑郁症或无抑郁的糖尿病患者的血糖控制情况（以糖化血红蛋白（HbA1c）评估）。代谢控制的次要指标包括低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、体重指数、腰围、血压和糖尿病并发症的存在。我们的第二个目的是研究行为和激素因素，这些因素可能解释2型糖尿病患者的思维和血糖控制之间的关系。为了实现这些目标，我们建议使用患者健康问卷-2 （PHQ-2）筛选多达750名成年（250人/年）T2DM患者的抑郁症状的临床样本，以确定100名抑郁症筛查阳性的个体。我们将对这100个人进行结构化的诊断性精神病学访谈，这将使我们能够根据DSM-IV-TR标准将MinD与重度抑郁症和其他轻度抑郁症区分开来。我们还将对50名PHQ-2筛查为阴性的随机对照样本进行结构化诊断访谈，以调整我们对PHQ-2筛查偏差的患病率估计。我们将评估所有参与者的行为因素（糖尿病相关的健康行为和解决问题的能力），并将使用地塞米松抑制试验评估所有100名PHQ-2筛查阳性的受试者和50名PHQ-2筛查阴性的随机对照者的亚临床高皮质醇症。这项初步研究将是第一个在基于临床的样本和使用结构化诊断访谈中将MinD作为一种独特疾病的粗略患病率建立起来的研究之一。

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is cross-sectionally and longitudinally associated with risk of type 2 diabetes (T2DM), as well as with an increased risk of micro- and macrovascular complications, worse metabolic control, and all-cause mortality. There is less evidence about similar associations between minor depression (MinD), the focus of this application, and T2DM or its secondary complications. We hypothesize that MinD, based on Diagnostic and Statistical Manual-IV-Text Revised (DSM-IV-TR) criteria, among adults with T2DM is prevalent and is associated with poor metabolic control, as is seen in MDD, and that this association might be explained by behavioral and biological factors associated with these disorders (i.e., poor health behaviors, impaired problem solving ability, and subclinical hypercortisolism). To preliminarily examine this hypothesis, our study has the following specific aims: 1) To estimate the prevalence of MinD in a clinic-based sample of adults with T2DM and compare it to the prevalence of MDD. 2) To compare glycemic control, assessed by glycated hemoglobin (HbA1c), between diabetic individuals with MinD and diabetic individuals with a) MDD or b) no depression. Secondary outcome measures of metabolic control will include LDL-cholesterol, HDL-cholesterol, triglycerides, body-mass index, waist circumference, blood pressure, and presence of diabetic complications. Our secondary aim will be to examine behavioral and hormonal factors that might explain the association between MinD and glycemic control among individuals with T2DM. To accomplish these aims, we propose to screen a clinical sample of up to 750 adults (250/year) with T2DM for depressive symptoms using the Patient Health Questionnaire-2 (PHQ-2) to identify 100 individuals who screen positive for a depressive disorder. We will perform a structured diagnostic psychiatric interview on these 100 individuals, which will enable us to differentiate MinD from MDD and other milder depressive disorders using DSM-IV-TR criteria. We will also perform a structured diagnostic interview on a random sample of 50 controls who screen negative on the PHQ-2 to adjust our prevalence estimates for screening biases on the PHQ-2. We will assess behavioral factors (diabetes-related health behaviors and problem-solving ability) in all participants and will assess subclinical hypercortisolism, using a dexamethasone suppression test, in all 100 subjects who screen positive on the PHQ-2 and in 50 random controls who screen negative on the PHQ-2. This preliminary study will be one of the first to establish the crude prevalence of MinD as a distinct disorder in a clinic-based sample and using a structured diagnostic interview. PUBLIC HEALTH RELEVANCE: We will screen a clinical sample of up to 750 adults (250/year) with type 2 diabetes for depressive symptoms using a questionnaire to identify 100 individuals who screen positive for a depressive disorder. We will perform a structured diagnostic psychiatric interview on these 100 individuals plus a random sample of 50 individuals who screen negative, which will enable us to estimate the frequency (prevalence) of minor depression, a milder depressive disorder, and distinguish it from major depression. We will compare metabolic control of diabetes between those with minor depression and those with 1) major depression and 2) no depression and explore whether behavioral and hormonal factors might explain the association.