Racial Differences in Diabetes-Depression Comorbidity

糖尿病-抑郁症合并症的种族差异

• 批准号: 6709792
• 负责人: James E Aikens
• 金额: $ 39万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-03-01 至 2007-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6709792
• 关键词: African American; belief; caucasian American; clinical depression; clinical research; comorbidity; culture; glucose metabolism; health behavior; health care service utilization; health disparity; health services research tag; human subject; interview; mental health services; noninsulin dependent diabetes mellitus; quality of life; questionnaires; racial /ethnic difference; self care; socioeconomics

DESCRIPTION (provided by applicant): Patients with diabetes mellitus (DM) are at increased risk for major depressive disorder (MDD), which is reliably associated with poor DM outcomes. Compared to Caucasians, African Americans are more likely to develop DM and to have poor DM outcomes. They are also more likely to have untreated MDD, and to hold beliefs about the nature and care of MDD that are not well-accommodated by current mental health care delivery systems. Despite these clear disparities, there is a dire shortage of data to guide the development of culturally-appropriate interventions for MDD comorbidity in DM, because African Americans have been tremendously under-represented in research on this topic. The significance of this empirical gap is highlighted by our preliminary data, which suggest that depressive symptoms may be more disruptive to DM control for African Americans than for Caucasians, even after adjusting for potential confounders. Specific Aim 1 is to test our conceptual model, in which the association between MDD and DM outcomes (glycemic control and DM quality of life) is both moderated by race and mediated by DM self-care behavior. We plan to study 262 Detroit-region Type 2 DM patients (50% African American, 50% Caucasian) in a 10-week assessment protocol. At Weeks 1 and 10; assessments will be made of MDD presence and severity, DM self-care, glycemic control, and DM quality of life; with an additional assessment of self-care and MDD made at mid-study. Data on self-care and MDD will be aggregated across time, and the study hypotheses will be tested using OLS multiple regression path analysis. Specific Aim 2 is to gain an understanding of depression-related behavior and beliefs that will inform the development of culturally-sensitive interventions for DM patients who have comorbid MDD. To meet Aim 2, we will develop a race-stratified subsample of 30 subjects with comorbid MDD. Using a semi-structured interview tool based on the Commonsense Model of Illness Representations, we will collect qualitative data on beliefs about the nature and care of MDD. We will perform qualitative analysis to identify and compare themes by race. Finally, we will integrate our quantitative (Aim 1) and qualitative results using triangulation and other mixed-methods approaches, to characterize cultural differences in MDD representations, treatment-seeking, and mental health barriers among DM patients. The project outcomes will advance the science of illness self-management. Findings will also enable the design of trials to develop and test innovations that improve mental and physical health for many thousands of African Americans.

描述（由申请人提供）：糖尿病患者（DM）患有重度抑郁症（MDD）的风险增加，这与DM差的结果可靠地相关。与高加索人相比，非洲裔美国人更有可能发展DM并具有较差的DM结果。他们也更有可能拥有未经治疗的MDD，并且对当前精神卫生保健提供系统无法满足的MDD的性质和护理保持信念。尽管存在这些明显的差异，但仍有很少的数据来指导DM中MDD合并症的文化合并干预措施的发展，因为非洲裔美国人在研究这一主题的研究中的代表性不足。我们的初步数据强调了这一经验差距的重要性，这表明，即使在调整了潜在的混杂因素之后，抑郁症状也可能对非裔美国人的DM控制更具破坏性。具体目的1是测试我们的概念模型，在这种模型中，MDD和DM结果之间的关联（血糖控制和DM生活质量）既由种族进行调节，又由DM自我保健行为介导。我们计划在10周的评估方案中研究262个底特律2型DM患者（50％非裔美国人，50％高加索人）。在第1周和第10周；评估将对MDD的存在和严重性，DM自我保健，血糖控制和DM生活质量进行评估；随着对自我保健和MDD在中期进行的额外评估。关于自我护理和MDD的数据将在整个时间内汇总，研究假设将使用OLS多重回归路径分析进行检验。具体目的2是了解与抑郁症相关的行为和信念，这将为患有MDD合并症的DM患者的文化敏感干预措施发展。为了满足AIM 2，我们将开发一个与合并MDD的30个受试者的种族分层子样本。使用基于疾病表示常识模型的半结构访谈工具，我们将收集有关MDD性质和护理信念的定性数据。我们将进行定性分析，以识别和比较种族主题。最后，我们将使用三角剖分和其他混合方法方法整合定量（目标1）和定性结果，以表征DM患者中MDD表示，寻求治疗和心理健康障碍的文化差异。该项目的结果将推动疾病自我管理的科学。调查结果还将使试验的设计能够开发和测试创新，从而改善成千上万非洲裔美国人的身心健康。