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: 7953420
• 负责人: SHERITA HILL GOLDEN
• 金额: $ 20.5万
• 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 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7953420
• 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; Minor; 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; 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)：严重抑郁障碍(MDD)与2型糖尿病(T2 DM)的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的风险增加有横向和纵向关联。本研究的重点--轻度抑郁(精神)与T2 DM或其继发性并发症之间的相似关联的证据较少。我们假设，根据诊断和统计手册-IV-文本修订版(DSM-IV-TR)标准，成年T2 DM患者中的精神普遍存在，并与MDD中看到的代谢控制不良有关，这种联系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皮质醇增多症)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人T2 DM患者的心理疾病患病率，并将其与MDD的患病率进行比较。2)通过糖化血红蛋白(HbA1c)评估糖尿病患者和有精神障碍或无抑郁的糖尿病患者之间的血糖控制情况。代谢控制的次要结果指标将包括低密度脂蛋白-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。我们的第二个目标将是检查行为和荷尔蒙因素，这些因素可能解释T2 DM患者的精神和血糖控制之间的联系。为了实现这些目标，我们建议使用患者健康问卷-2(PHQ-2)对多达750名成年T2 DM患者(每年250人)进行抑郁症状筛查，以确定100名筛查阳性的抑郁障碍患者。我们将对这100名患者进行有组织的精神病学诊断访谈，这将使我们能够使用DSM-IV-TR标准将精神与MDD和其他较轻微的抑郁障碍区分开来。我们还将对PHQ-2筛查阴性的50名对照随机抽样进行结构化诊断性访谈，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(与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测试，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组的亚临床皮质醇增多症。这项初步研究将是第一次在以临床为基础的样本中，使用结构化的诊断性访谈，将精神疾病的粗略流行率确定为一种明显的障碍。 公共卫生相关性：我们将对多达750名患有2型糖尿病的成年人(每年250人)的临床样本进行抑郁症状筛查，使用问卷确定100名抑郁障碍筛查呈阳性的个人。我们将对这100个人和50个筛查阴性的人进行有组织的精神病学诊断访谈，这将使我们能够估计轻度抑郁症的频率(流行)，并将其与重度抑郁症区分开来。我们将比较患有轻度抑郁症的人和患有1)重度抑郁症和2)无抑郁症的人对糖尿病的代谢控制，并探索行为和激素因素是否可以解释这种联系。