Depression, self-management and ethnicity in diabetes

糖尿病患者的抑郁、自我管理和种族

• 批准号: 6606455
• 负责人: LAWRENCE FISHER
• 金额: $ 65.76万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-07-01 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6606455
• 关键词: Hispanic Americans; behavioral /social science research tag; caucasian American; clinical research; comorbidity; depression; diabetes mellitus; disease /disorder prevention /control; glucose metabolism; health behavior; human data; interview; longitudinal human study; racial /ethnic difference; self care; social support network; stress

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.

描述（由申请人提供）：糖尿病影响着 6.5 至 1300 万美国人，每年直接医疗费用支出超过 440 亿美元。拉丁裔是美国增长最快的少数族裔，其患病率大约是欧洲裔美国人 (EA) 的两倍。 23% 的 EA 糖尿病患者患有抑郁症，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、代谢控制不良以及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。疾病的严重程度、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。鉴于抑郁影响的普遍性、EA 和拉丁裔糖尿病患者自我管理的差异性以及抑郁对这些患者造成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来描述抑郁和糖尿病的形式。随着时间的推移，自我管理可以帮助这些患者。拟议的 3 波、18 个月纵向项目旨在：(1) 描述 2 型糖尿病 EA 和拉丁裔患者抑郁和自我管理随时间的变化和亚组模式； (2) 随着时间的推移，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、拉丁裔）确定这些关系的变化。拟议的纵向研究对干预措施具有重大影响：它将提供对随着时间的推移，重度和轻度抑郁症以及自我管理的全部自然过程的更完整的描述，它将识别可能需要特定干预措施的亚组差异，将确定抑郁影响与疾病自我管理和代谢控制之间的联系在什么时候变得明显，并将突出这些关系中基于患者种族的差异。