Health Psychol：临床确诊糖尿病者抑郁风险增加

　　最近发表于《健康心理学》杂志上的一项研究表明，对于糖尿病与抑郁症的关系，以及是否给患者服用抗抑郁药最重要的决定因素在于糖尿病是否已经临床诊断。

　　研究旨在评估临床诊断及未诊断的糖尿病前期与合并抑郁的2型糖尿病和抗抑郁药使用的联系。研究数据来自全国健康营养调查（2005年和2007年），这是一项基于人群的横断面调查。所有受试者均为30岁及以上的成年人（3183例，平均年龄52.1岁）。抑郁症状通过患者健康问卷-9评估。受试者根据空腹血糖水平分为血糖正常（血糖水平100mg／dL）、未经诊断的糖尿病前期（血糖水平100-125.9 mg／dL），临床诊断的糖尿病前期（血糖水平100-125.9 mg／dL并经医师诊断），未经诊断的2型糖尿病（血糖水平>126 mg／dL）以及临床诊断的2型糖尿病（血糖>126 mg／dL并经医师诊断或接受降糖治疗）。健康行为指标包括吸烟、饮食状况较差、过量饮酒及肥胖。增进健康的行为包括改善饮食、减重和增强体力活动。    

　　结果表明，临床诊断的糖尿病患者并发抑郁的风险会增加4.3倍，但未经诊断糖尿病与抑郁则无明显相关性。临床诊断的糖尿病患者需要服用抗抑郁药的可能性增加1.8倍，但未经诊断糖尿病与抗抑郁药使用无明显相关性。健康行为并不总与抑郁症状相关。

　　研究者认为，研究结果符合“糖尿病与抑郁的关系和疾病诊疗阶段有关”这一假说。

与糖尿病相关的拓展阅读：

• ABEM：抑郁治疗可改善糖尿病人体力活动
• PDS：抗抑郁药降低糖尿病人服药依从性
• J Affect Disord：2型糖尿病常加重抑郁患者负担
• PLOS ONE：合并抑郁增加糖尿病患者死亡风险
• Diabetes Care：糖尿病患者高血压越早治疗越好
更多信息请点击：有关糖尿病更多资讯

Is ignorance bliss? Depression, antidepressants, and the diagnosis of prediabetes and type 2 diabetes.

Objective

To examine the association between clinically identified and undiagnosed prediabetes and Type 2 diabetes with depression and antidepressant medication use. 

Methods

Data come from the National Health and Nutrition Examination Study (2005 and 2007), a population-based cross-sectional survey. Analysis is limited to adults aged 30 and older (n = 3,183, Mean age = 52.1 year). Depression syndrome was measured by the Patient Health Questionnaire-9. Participants were categorized using fasting glucose levels as normoglycemic (glucose <100 mg/dL), undiagnosed prediabetes (glucose 100-125.9), clinically identified prediabetes (glucose 100-125.9 plus clinician diagnosis), undiagnosed Type 2 diabetes (glucose >126), and clinically identified Type 2 diabetes (glucose >126 plus clinician diagnosis or use of antidiabetic medications). Health behaviors included smoking, poor diet, excessive alcohol use, and obesity. Health promotion behaviors included efforts to change diet, lose weight, and increase physical activity. 

Results

Clinically identified diabetes was associated with 4.3-fold greater odds of depression, but undiagnosed diabetes was not significantly associated with depression. This relationship was more pronounced for prediabetes. Clinically identified diabetes was associated with 1.8-fold greater odds of antidepressant use, but undiagnosed diabetes was not significantly associated with antidepressant use. Health behaviors were not consistently related to depression syndrome. 

Conclusion

The relationship between diabetes status and depression and antidepressant use depends on whether the diabetes has been clinically identified. Findings are consistent with the hypothesis that the relationship between diabetes and depression may be attributable to factors related to disease management. Previous reports linking antidepressants and diabetes may be attributable to clinical ascertainment bias. (PsycINFO Database Record (c) 2013 APA, all rights reserved).