Daily Depressive Affect & Disease Management in Diabetes

日常抑郁影响

• 批准号: 6727696
• 负责人: LAWRENCE FISHER
• 金额: $ 55.02万
• 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 2006-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6727696
• 关键词: behavior test; behavioral /social science research tag; clinical research; comorbidity; depression; dyadic interaction; emotions; gender difference; glucose metabolism; health behavior; human subject; longitudinal human study; mood disorders; noninsulin dependent diabetes mellitus; patient oriented research; personal log /diary; psychological tests; psychometrics; questionnaires; social psychology; socioeconomics; spouses; statistics /biometry; stressor

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, Depression occurs as a comorbid condition in 23% of European Americans with diabetes, and the rate of depression among ethnic minorities is considerably higher. The prevalence of sub clinical depression increases the impact even more. Depression is associated with decreased self-management, poor glycemic control, and increased risk for complications. Explanatory models, based almost exclusively on cross-sectional research, suggest that depressive affect has both direct and indirect effects on glycemic control through self-management, and that glycemic control can affect depressive affect directly. These relationships vary considerably from patient to patient and are affected by such potentially malleable variables as psychological resources, family relationships, and chronic stress. Given the increased behavioral and biological risks that depressive affect pose for these patients, longitudinal studies with implications for intervention are needed to describe the ways in which these constructs influence each other over time. Using a "micro longitudinal" approach with a community based sample that employs daily data collection via telephone interview, we propose to examine the day-to-day variation among depressive affect, disease-management and glycemic control over 21 days in patients with diabetes. Our aims are (1) to provide greater clarity and specificity to the sequence of causative effects over time; (2) to identify those patients factors that qualify these relationships in an effort to account for the widely documented variability found among these patients; and (3) to identify spouse/partner-related factors that influence these processes to address the social context in which these patients manage diabetes. The proposed longitudinal research has major implications for intervention: it will provide a more complete description of the causative effects of the full range of depressive affect, disease-management and glycemic control over time; and it will identify variations among sub groups of patients that may warrant specific interventions.

描述（由申请人提供）：糖尿病影响 6.5 至 1300 万美国人，每年直接医疗费用支出超过 440 亿美元，抑郁症是 23% 的欧洲裔美国人糖尿病患者的共病，并且少数族裔的抑郁症发病率相当高。亚临床抑郁症的流行进一步增加了影响。抑郁症与自我管理能力下降、血糖控制不佳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，抑郁情绪通过自我管理对血糖控制有直接和间接的影响，并且血糖控制可以直接影响抑郁情绪。这些关系因患者而异，并受到心理资源、家庭关系和慢性压力等潜在可塑性变量的影响。鉴于抑郁影响对这些患者造成的行为和生物学风险增加，需要对干预措施进行纵向研究，以描述这些结构随着时间的推移相互影响的方式。我们建议使用“微观纵向”方法和基于社区的样本，通过电话访谈进行日常数据收集，研究糖尿病患者 21 天内抑郁情绪、疾病管理和血糖控制之间的日常变化。我们的目标是（1）随着时间的推移，使因果效应的顺序更加清晰和具体； (2) 确定那些符合这些关系的患者因素，以解释在这些患者中发现的广泛记录的变异性； (3) 确定影响这些过程的配偶/伴侣相关因素，以解决这些患者管理糖尿病的社会背景。拟议的纵向研究对干预具有重大意义：它将更完整地描述随着时间的推移，全方位的抑郁影响、疾病管理和血糖控制的因果影响；它将识别出可能需要特定干预措施的患者亚组之间的差异。