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首页> 外文期刊>Diabetes care >Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity.
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Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity.

机译：2型糖尿病的抑郁症，自我护理和药物依从性：整个症状严重程度之间的关系。

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OBJECTIVE: We examined the association between depression, measured as either a continuous symptom severity score or a clinical disorder variable, with self-care behaviors in type 2 diabetes. RESEARCH DESIGN AND METHODS: We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence. RESULTS: Of the patients, 19% met the criteria for probable major depression (HANDS score >or=9), and an additional 66.5% reported at least some depressive symptoms. After controlling for covariates, patients with probable major depression reported significantly fewer days' adherent to diet, exercise, and glucose self-monitoring regimens (P < 0.01) and 2.3-fold increased odds of missing medication doses in the previous week (95% CI 1.5-3.6, P < 0.001) compared with all other respondents. Continuous depressive symptom severity scores were better predictors of nonadherence to diet, exercise, and medications than categorically defined probable major depression. Major depression was a better predictor of glucose monitoring. Among the two-thirds of patients not meeting the criteria for major depression (HANDS score <9, n = 709), increasing HANDS scores were incrementally associated with poorer self-care behaviors (P < 0.01). CONCLUSIONS: These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care. Interventions aimed at alleviating depressive symptoms, which are quite common, could result in significant improvements in diabetes self-care.
机译：目的：我们研究了抑郁（以连续症状严重程度评分或临床疾病变量来衡量）与2型糖尿病自我护理行为之间的关系。研究设计和方法：我们使用哈佛大学精神病学/国家抑郁筛查日量表（HANDS），糖尿病自我护理活动摘要和自我报告的药物依从性对来自两家初级保健诊所的879位2型糖尿病患者进行了调查。结果：在这些患者中，有19％符合可能的严重抑郁症标准（HANDS评分>或= 9），另有66.5％的患者报告了至少一些抑郁症状。在控制了协变量之后，可能的重度抑郁症患者报告的坚持饮食，运动和血糖自我监测方案的天数明显减少（P <0.01），并且前一周错过药物剂量的几率增加了2.3倍（95％CI 1.5-3.6，P <0.001）与所有其他受访者相比。与明确定义的可能的严重抑郁症相比，持续性抑郁症症状严重程度评分是不坚持饮食，运动和药物的更好预测指标。重度抑郁是血糖监测的较好预测指标。在三分之二的不符合重度抑郁症标准的患者中（HANDS得分<9，n = 709），HANDS得分的增加与较差的自我护理行为相关（P <0.01）。结论：这些发现挑战了将抑郁症作为不依从性的绝对危险因素的概念，并暗示即使是低水平的抑郁症状也与不依从糖尿病自我护理的重要方面有关。旨在缓解抑郁症状的干预措施非常普遍，可以显着改善糖尿病的自我保健。

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