Prevalence and Correlates of Minor Depression in Type 2 Diabetes

2 型糖尿病患者轻度抑郁的患病率及其相关性

• 批准号: 8323965
• 负责人: SHERITA HILL GOLDEN
• 金额: $ 20.3万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8323965
• 关键词: Adjustment Disorders; Adrenal Gland Hyperfunction; Adult; Behavioral; Biological Factors; Blood Pressure; Body mass index; Clinic; Clinical; Complications of Diabetes Mellitus; Coupled; DSM-IV; Data; Depressed mood; Depressive Syndromes; Depressive disorder; Dexamethasone; Diabetes Mellitus; Diagnosis; Diagnostic; Diagnostic and Statistical Manual; Disease; Dyslipidemias; Energy Intake; Epidemiologic Studies; Frequencies; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Health; Health behavior; High Density Lipoprotein Cholesterol; High Prevalence; Hormonal; Hydrocortisone; Hypotension; Individual; Insulin Resistance; Interview; LDL Cholesterol Lipoproteins; Major Depressive Disorder; Mental Depression; Metabolic; Metabolic Control; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome Measure; Participant; Patient Self-Report; Patients; Positioning Attribute; Prevalence; Problem Solving; Questionnaires; Research; Risk; Sampling; Screening procedure; Secondary to; Smoking; Specific qualifier value; Structure; Text; Triglycerides; Visceral; base; depressive symptoms; dexamethasone suppression test; diabetic; disorder control; glycemic control; hypothalamic-pituitary-adrenal axis; macrovascular disease; medication compliance; meetings; mind control; minor depressive disorder; mortality; public health relevance; secondary outcome; waist circumference

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.

描述（由申请人提供）：重度抑郁症（MDD）与2型糖尿病（T2 DM）风险以及微血管和大血管并发症、代谢控制不良和全因死亡率风险增加在横断面和纵向上相关。关于轻度抑郁症（MinD）（本申请的重点）与T2 DM或其继发性并发症之间存在类似关联的证据较少。我们假设，根据诊断和统计手册-IV-文本修订版（DSM-IV-TR）标准，在T2 DM成人中，MinD是普遍存在的，并与代谢控制不良相关，如MDD中所见，这种相关性可能由与这些疾病相关的行为和生物学因素解释（即，不良的健康行为、问题解决能力受损和亚临床皮质醇增多症）。为了初步验证这一假设，我们的研究有以下具体目的：1）估计MinD在基于临床的T2 DM成人样本中的患病率，并将其与MDD的患病率进行比较。2)通过糖化血红蛋白（HbA 1c）评估，比较患有MinD的糖尿病患者与患有a）MDD或B）无抑郁症的糖尿病患者之间的血糖控制。代谢控制的次要结局指标包括LDL-胆固醇、HDL-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。我们的第二个目标是检查行为和激素因素，这些因素可能解释2型糖尿病患者MinD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例（250例/年）T2 DM成人的抑郁症状临床样本，以确定100例抑郁障碍筛查阳性的个体。我们将对这100名患者进行结构化的诊断精神病学访谈，这将使我们能够使用DSM-IV-TR标准区分MinD与MDD和其他轻度抑郁症。我们还将对随机抽取的50名PHQ-2筛查阴性的对照者进行结构化诊断访谈，以调整我们对PHQ-2筛查偏倚的患病率估计。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受试者的亚临床皮质醇增多症。这项初步研究将是第一个建立的粗患病率MinD作为一个独特的疾病在一个基于诊所的样本，并使用结构化的诊断面试。 公共卫生关系：我们将筛选多达750例（250/年）患有2型糖尿病的抑郁症状的临床样本，使用问卷调查确定100名抑郁症筛查阳性的个体。我们将对这100名患者进行结构化的诊断精神病学访谈，并随机抽取50名筛查阴性的患者，这将使我们能够估计轻度抑郁症（一种轻度抑郁症）的频率（患病率），并将其与重度抑郁症区分开来。我们将比较轻度抑郁症患者与1）重度抑郁症患者和2）无抑郁症患者之间的糖尿病代谢控制，并探讨行为和激素因素是否可以解释这种关联。

项目成果

The association of minor and major depression with health problem-solving and diabetes self-care activities in a clinic-based population of adults with type 2 diabetes mellitus.

• DOI: 10.1016/j.jdiacomp.2017.01.026
• 发表时间: 2017-05
• 期刊: Journal of diabetes and its complications
• 影响因子: 3
• 作者: Shin N;Hill-Briggs F;Langan S;Payne JL;Lyketsos C;Golden SH
• 通讯作者: Golden SH

The Prevalence and Specificity of Depression Diagnosis in a Clinic-Based Population of Adults With Type 2 Diabetes Mellitus.

• DOI: 10.1016/j.psym.2016.08.003
• 发表时间: 2017-01
• 期刊: Psychosomatics
• 影响因子: 3.4
• 作者: Golden SH;Shah N;Naqibuddin M;Payne JL;Hill-Briggs F;Wand GS;Wang NY;Langan S;Lyketsos C
• 通讯作者: Lyketsos C