Depression, self-management and ethnicity in diabetes

描述（由申请人提供）：糖尿病影响650万至1300万美国人，每年直接医疗保健费用支出超过440亿美元。拉美裔是美国增长最快的少数族裔，其患病率大约是欧裔美国人的两倍。抑郁症在23%的东亚裔糖尿病患者中作为合并症发生，但拉丁裔糖尿病患者的抑郁症发生率几乎为30%。抑郁症与自我管理行为下降、代谢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，抑郁症通过自我管理对代谢控制有直接和间接的影响。疾病严重程度、损伤、并发症、生活压力、个人资源和社会支持也会影响这些关系。考虑到抑郁症的普遍性、EA和拉丁裔糖尿病患者自我管理的可变性，以及抑郁症给这些患者带来的行为和生物学风险的增加，需要进行具有干预意义的纵向研究，以描述抑郁症和自我管理在这些患者中随着时间的推移可能采取的形式。拟议的3波，18个月的纵向项目旨在：(1)描述EA和拉丁裔2型糖尿病患者抑郁和自我管理的变化和亚组模式；(2)确定抑郁、自我管理和代谢控制之间的联系，以及调节这些联系的因素；(3)根据患者种族（ea，拉丁美洲人）确定这些关系的变化。提出的纵向研究对干预有重要意义：它将提供一个更完整的描述，随着时间的推移，所有主要和次要抑郁症和自我管理的自然过程，它将确定可能需要特定干预的亚组变化，它将确定在抑郁影响与疾病自我管理和代谢控制的联系的连续点上变得明显，它将强调基于患者种族的这些关系的差异。

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. Prevalence rates for Latinos, America's fastest growing minority, are approximately twice that of European-Americans (EAs). Depression occurs as a comorbid condition in 23% of EAs with diabetes, but the rate of depression among Latinos with diabetes is almost 30%. Depression is associated with decreased self-management behavior, poor metabolic control, and increased risk for complications. Explanatory models, based almost exclusively on cross-sectional research, suggest that depression has both direct and indirect effects on metabolic control through self-management. Disease severity, impairment, complications, life stress, personal resources, and social support also affect these relationships. Given the pervasiveness of depressive affect, the variability in self-management among EA and Latino patients with diabetes, and the increased behavioral and biological risk that depression poses for these patients, longitudinal studies with implications for intervention are needed to describe the forms that depression and self-management can take in these patients over time. The proposed 3-wave, 18-month longitudinal project seek to: (1) describe the variation, and sub group patterning of depression and self-management over time in EA and Latino patients with type 2 diabetes; (2) identify the linkages among depression, self-management, and metabolic control, over time, along with factors that moderate these linkages; and (3) determine variations in these relationships based on patient ethnicity (EAs, Latinos). The proposed longitudinal research has major implications for intervention: it will provide a more complete description of the natural course of the full range of major and minor depression and self-management over time, it will identify sub group variations that may warrant specific interventions, it will identify at what point along the continuum of depressive affect linkages with disease self-management and metabolic control become evident, and it will highlight differences in these relationships based on patient ethnicity.