The Study On The Related Factors Of Coexisting Depression In Patients With Diabetes Mellitus

BackgroundIn recent years, diabetes prevalence is rising rapidly, and it affects an estimated92.4million adults in China, which may be the country with the largest numbers of peoplewith diabetes in the world. Of all diabetic patients, approximately90to95percenthave type2diabetes mellitus (T2DM), a condition where the body does not produceenough insulin and/or the cells in the body do not respond normally to insulin. Poorlymanaged diabetes not only increases morbidity and mortality and decreases thequality of life, but also leads to a wide range of complications such as Hypertension,nephropathy, psychological disorders. And depression is one of the most commonpsychological disoders, which accelerates the development and deterioration ofdiabetes and other disease. Therefore, it’s necessary to launch the study on depressionin patients with type2diabetes mellitus.ObjectiveTo investigate the prevalence of depression in type2diabetes patients, analyze thefactors which are related to depression in patients with diabetes mellitus (DM), andprovide scientific basis for the corresponding clinical practice for DM and healthpolicy formulation for diabetic patients.MethodsFour hundred and fifty individuals with type2Diabetes mellitus, which were selected randomly from two thousand five hundred patients at the outpatient department ofendocrinology at the First Affiliated Hospital of the General Hospital of the People’sLiberation Army (PLAGH), from March1th to May31st,2012, were recruited in thisstudy. All the selected subjects were interviewed by using the structuredquestionnaires including the demographic characteristics, clinical features, socialsupports rating scale (SSRS), life event scale (LES), attribution style scale (ASQ),coping styles scale (SCSQ) and beck depression scale (BDI). Then the diabeticpatients with co-existing depression and the subjects with diabetes mellitus only weredivided into two groups, respectively, and the difference between these two groupswere compared and analyzed, based on the investigation of the prevalence and thedistribution of depression in patients with diabetes mellitus. The major impact factorsof co-existing depression in patients with diabetes mellitus were screened on thecontrol of the co linearity in weighted independent variable by using the multi-factorlogistic regression analysis, principal component analysis and factor analysis. Andthen, comprehensive treatment combining medicine and psychological intervention(the latter includes cognitive behavior therapy and family therapy) was taken for thirtytwo patients with co-existing depression and diabetes mellitus from the samples ofthis study. The BDI scores and glaciated hemoglobin (HbA1c), which were regardedas the indicators for evaluating the effect of comprehensive treatment, wereinvestigated and analyzed at the end of intervention.ResultsA total of450participants were included in this study, and412subjects completed thequestionnaires entirely, the response rate was91.6%. Among these subjects, therewere235cases diagnosed with depression, accounting for57.0%, including44severecases,98moderate cases, and93mild cases. The statistical analysis showed that highaged, single, low education level and non-public employee were more susceptible todepression, and gender, income, reimbursement of medical costs and body mass index(BMI) were not significantly relative to depression. In addition, the results of logisticregression and principal component factor analysis indicated that life events, type Dpersonality, duration, HbA1c, and smoke were positively related to depression, whereas diet control, exercise, social support and family history were negative relatedto depression. Structural equation modeling (SEM) showed that life events and socialsupport condition have indirect effect on depression; Type D personality has bothdirect and indirect effect, and clinical factors (such as duration, HbA1c) have mainlydirect effect on depression. Of all32patients, the depression symptoms of18patientswere alleviated significantly after phycological intervention combined with clinicaltreatment, accounting for56%. And there were only two patients whose depressionstatus deteriorated from mild to moderate.ConclusionThe prevalence of co-morbid depression in patients with type2diabetes wassignificantly higher than that of general population reported in previous studies. Lifeevents, type D personality, duration, HbA1c, and smoke are the main risk factors ofco-morbid depression, whereas the diet control, exercise, social support are the mainprotective factors. Family history of type2diabetes is negatively related to depression.Comprehensive treatment, which combined medical and psychological therapy,significantly alleviated the symptoms of co-morbid depression and improved thequality of life of patients with type2diabetes. A lot of space in improving theknowledge and the health behavior of patients with Type2diabetes remains.