Depression, anxiety and quality of life among diabetic patients: a comparative study

OBJECTIVE: The aim of this study was to compare psychiatric morbidity among diabetic patients, asthmatics and healthy individuals and also to assess the association of psychiatric morbidity and other variables with quality of life among diabetes patients. METHOD: For each respondent, the questionnaire on sociodemographic and clinical variables was completed. They also completed the Zung Self-Rating Depression Scale and the State Trait Anxiety Inventory (STAI 1). Diabetic patients also completed the Diabetic Well-Being Questionnaire. RESULTS: A total of 180 subjects were used for this study-80 diabetics (males=37, females=43) were compared with 50 asthmatics (males=22, females=28) and 50 healthy individuals (males=23, females=27). Depression was more prevalent among diabetic patients (20%) compared with asthmatics (12%) and healthy individuals (4%), while anxiety was more prevalent among asthmatics (34%) compared with diabetics (20%) and healthy individuals (8%). Predictors of depression include age of the patient, poor glycemic control and duration of diabetes mellitus. Factors that correlated significantly with diabetic general well-being include depression, anxiety and fasting blood glucose level. Depression and the presence of comorbid medical conditions significantly predicted a low quality of life. CONCLUSION: Psychiatric morbidity has significant effects on diabetic patients' quality of life.     

糖尿病患者伴发抑郁症的临床对照研究

目的:评价帕罗西汀治疗糖尿病患者伴发抑郁症的疗效和对患者血糖的影响.方法:对48名伴发抑郁症的糖尿病患者,进行8周的随机对照研究,实验组、对照组各24例.帕罗西汀20-40mg/日,以Beck抑郁问卷(BDI)和汉密尔顿抑郁量表(HAMD)评定疗效.糖化血红蛋白(GHb)用于血糖控制的监测.结果:帕罗西汀组抑郁症状的减轻明显优于对照组(P<0.05～0.01),根据BDI评分,帕罗西汀组的显效率明显高于对照组(62.5%,33.3%,P<0.05).根据HAMD评分,帕罗西汀组的治愈率高于对照组(45.8%,25.0%,P<0.05),帕罗西汀组GHb降低的趋势比对照组更明显(-0.5%,-0.1% ).结论:帕罗西汀能有效减轻糖尿病患者的抑郁症状,这种治疗更有利于血糖的控制.     

Subthreshold depression is linked to the functional polymorphism of the 5HT transporter gene

BACKGROUND: The functional polymorphism of the serotonin transporter gene (5HTTLPR) has been earlier associated with affective disorders. No research has however been carried out to identify the relationship between this polymorphism and depressive traits and subclinical depressive symptoms within a psychiatrically healthy population. METHODS: One hundred and twenty-eight female subjects with no lifetime or current history of DSM-IV Axis I disorders participated in the study. All subjects completed the Zung Self-Rating Depression Scale and were genotyped for the 5HTTLPR polymorphism. RESULTS: Significant differences were found on the Zung SDS and also on the physical-vegetative subscale of the Zung SDS according to both phenotype and genotype. Subjects carrying the s allele scored significantly higher on the Zung SDS and had also significantly higher scores on the physical-vegetative symptom subscale. Furthermore, subjects carrying the ss genotype scored highest and subjects carrying the ll genotype scored the lowest on both scales. CONCLUSION: Subclinical depressive symptoms (i.e. DSM-IV subthreshold depression) are associated with the functional polymorphism of the serotonin transporter gene. The main association between this polymorphism and subclinical depression is primarily carried by the physical symptoms of depression. The s allele of the 5HTTLPR gene is associated with a "low mood endophenotype".     

Similarity of depression in diabetic and psychiatric patients.

Diabetic and psychiatric out-patients were studied to determine whether the symptom profile of depression was similar in medically ill and medically well subjects. The diagnosis of major depression was determined using psychiatric interviews and DSM-IIIR criteria. The 21-item Beck Depression Inventory (BDI) was used to characterize the prevalence and severity of depression symptoms, and the measure was divided into cognitive (13 symptoms) and somatic (eight symptoms) subsets. Seventeen (81%) of 21 symptoms (including 12/13 cognitive and 5/8 somatic symptoms) were not statistically different in prevalence or severity between the depressed diabetic patients (N = 41) and the depressed psychiatric patients (N = 68). Both of these depressed groups were significantly different from a nondepressed diabetic comparison group (N = 58) in the prevalence and severity of every BDI symptom except weight loss. These data show that the symptom profile of depression in diabetic patients (in particular the cognitive symptoms) is similar to that in depressed psychiatric patients and is readily differentiated from the symptom profile in nondepressed diabetic patients. Our observations support the diagnostic validity of the DSM-IIIR criteria for major depression in this medically-ill outpatient sample.     

抑郁情绪及负性态度对糖尿病患者血糖控制的影响

糖尿病是内科多发病与常见病,近年来发病率呈不断上升的趋势。有部分糖尿病患者存在情绪问题和负性态度。国外已有学者对糖尿病人的抑郁状况及其影响作了研究,国内也开始关注这方面的问题。如Ｌｅｅｄｏｍ等在1991年就报告一组伴有并发症的Ⅱ型糖尿病患者,用Ｂｅｃｋ抑郁?..     

A comparison of four scales for anxiety,depression, and neuroticism

Examined the Beck Depression Inventory (BDI), the Zung Self-Rating Depression Scale (SDS), and the Taylor Manifest Anxiety Scale (TMAS) for specificity and validity as measures of anxiety and depression. It was hypothesized that if the BDI and SDS were specific to symptoms of depression, they would show high correlations with each other, low correlations with the TMAS, and intermediate correlations with the Neuroticism scale of the Eysenck Personality Inventory (EPI-N). The four instruments were administered to 170 undergraduate students, and correlations and qualitative content analyses showed that the BDI, SDS and TMAS were intercorrelated significantly with the EPI-N scale and that item content overlapped heavily among the tests. The results suggest all four tests tap an emotionality factor of stability-instability.     

糖尿病并发抑郁症的研究进展

抑郁症在糖尿病人群中的发病率显著高于非糖尿病人群,是糖尿病的重要并发症之一。抑郁与下丘脑-垂体-肾上腺素轴的活动相关,可导致升糖激素增多,胰岛素分泌水平降低。近年来,糖尿病并发抑郁症的潜在机制研究愈来愈受到医学界的重视。高血糖氧化应激状态下产生的过多自由基,以及与之伴随的高分子氧化损伤可能在糖尿病诱导抑郁的发生过程中起到重要作用。同时,炎症与线粒体的功能损伤可能也参与了抑郁在糖尿病患者的发生发展过程。糖尿病引发的神经系统的改变,包括神经递质的改变,重要区域的结构变化,神经细胞凋亡的发生等,都可能是其抑郁症高发的原因。本文主要阐述糖尿病并发抑郁症的研究进展。     

Depression in sickle cell disease

PURPOSE: To assess the prevalence of depressive symptoms and examine the contribution of demographics, disease severity, and health care use variables to depressive symptoms in sickle cell patients who had been in stable health for at least one month. PATIENTS AND METHODS: Subjects were a convenience sample of 27 men and 23 women selected during a routine visit to the sickle cell clinic at Howard University Hospital. Depression was assessed using a cut-off score from the Beck Depression Inventory (BDI) and related to a variety of health outcomes. RESULTS: The results of the analyses indicate that 44% (n=22) of the sample scored within the mild to severe (>20) range of depression on the BDI. Depressed sickle cell patients were more frequently treated in emergency rooms and more likely to be hospitalized with vaso-occlusive crises. Patients more likely to be depressed were: those with low family income (<$10,000); less than high school education; female; those who had multiple blood transfusions; poor pain control; inadequate social support; hydroxyurea use; and had histories of frequent vaso-occlusive crises. CONCLUSION: The prevalence of depressive symptoms in sickle cell patients is high compared to the general African American population. Our findings confirmed previous studies examining the occurrence of depression in adults with sickle cell disease. Treatment of depression should be strongly considered to improve the quality of life and probably disease course in sickle cell patients.     

睡眠呼吸暂停低通气综合征患者的抑郁焦虑症状研究

目的:探讨睡眠呼吸暂停低通气综合征(SAHS)患者并发抑郁焦虑情况.方法:对50例SAHS患者和30例正常对照者进行整夜多导睡眠图(PSG)检查,分别对其进行抑郁、焦虑症状评定.结果:SAHS组SAS量表、SDS量表标准分均高于正常对照组(P<0.05).SAHS组抑郁和焦虑发生率分别为42.0%和32.0%.SAHS组抑郁焦虑情绪与夜间总睡眠时间、NREM和REM睡眠时间呈显著负相关(r>0.6),与觉醒次数及睡眠潜伏期呈正相关(r>0.3).结论:SAHS患者存在显著的抑郁焦虑症状.     

Beck depression inventory: exploring its dimensionality in a nonclinical population

The Beck Depression Inventory (BDI) was factor analyzed to examine its potential multidimensionality. Results indicate that the items on the BDI assess two primary dimensions of depression: cognitive-affective and physiological symptoms. Reliabilities for the items comprising each of the factors were acceptable. Between-groups analyses showed that women scored significantly higher than men on both of the factors and on total depression. Within-group analyses showed that levels of cognitive-affective and physiological depression did not differ significantly within the total sample, or for men or women. In future revisions of the BDI, it may be useful to develop scoring systems based on these two dimensions, both to differentiate between types and levels of depression, and to consider implications for prognosis and treatment response.     

Identification of Beck Depression Inventory Items Related to Multiple Sclerosis

The percentage contribution of each item on the Beck Depression Inventory (BDI) to the total BDI score was compared across patients with multiple sclerosis (MS), patients diagnosed with major depressive disorder, and normal college students. We considered an item to be confounded by MS-related symptoms if its percentage contribution to the total BDI score was significantly greater in the MS group than the major depression and control groups. Items measuring work difficulty, fatigue, and concerns about health met this criterion. These items accounted for 34, 17, and 19% of the total BDI score in the MS, major depression, and control groups, respectively. Using the 18-item BDI (BDI-18) which resulted from excluding the 3 confounded items, MS patients found to be were more depressed than controls but less depressed than the major depression group. The identification of signs of depression not confounded with MS which could be substituted for confounded signs was also discussed.     

Depression among hospitalised medically ill patients: a two-stage screening study

BACKGROUND: There is wide variability in prevalence of depression in the physically ill. Moreover, data from the developing world is scarce. METHODS: Consecutive patients between the age 20-60 years and excluding those with malignancies and neurological illnesses, admitted to medical units (N=176), were screened with Beck's Depression Inventory (BDI). Those scoring more than 10 on BDI (N=55) were assessed with the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Age/sex matched healthy relatives served as controls. RESULTS: Thirty two percent (32%) of patients scored more than 10 on the BDI. None among controls scored more than the cut-off on BDI. Second-stage screening with SCAN on 33 subjects yielded a figure of 17% for depressive syndrome among the physically ill. Depression was mostly of the mild to moderate variety. CONCLUSIONS: High rates of depression were detected among physically ill hospitalised patients. Perhaps, differences in instruments used and population screened accounted for this. CLINICAL IMPLICATIONS: Need for increasing awareness as well as improving methods of detecting depression in physically ill is underscored. LIMITATIONS: a significant number of patients who screened positive on the BDI could not be interviewed with the SCAN for various reasons. Thus figures obtained after second stage screening are likely to be an underestimate.     

Prevalence of depression among Israeli alcoholics

The Zung Depression Scale was given to 45 Israeli male alcoholics as diagnosed by DSM-III criteria. Eighteen subjects came from an outpatient alcohol clinic, and 27 came from an inpatient detoxification center. In this cohort, 60% of subjects were classified as having clinical depression, and major depressive disorder was found in 26% of inpatients and 17% of outpatients. Pattern analysis of the Zung showed a disproportionately high percentage of all subjects responding to clinical symptoms featured in bipolar disorder, while the inpatient group reported significantly more difficulty than the outpatient group on parameters of pervasive affective disorder, early and frequent waking, constipation, irritability, and emptiness.     

Diabetes and heterozygotic sickle-cell anemia: study of erythrocyte deformability

The erythrocyte filterability of 25 diabetics, 6 patients with sickle cell trait ( HbAS ) and diabetes mellitus, and 25 controls was studied. Erythrocyte filterability was estimated by a filtration technique with washed erythrocytes. Red cell filterability was significantly decreased in diabetic patients compared to control subjects and this abnormality was correlated with the extent and severity of vascular complications. The values of erythrocyte filterability in diabetics + HbAs and diabetic patients were in the same range. These results suggest that HbAS does not influence the abnormalities of erythrocyte filterability observed in diabetes mellitus.     

Depressed mood is a factor in glycemic control in type 1 diabetes

OBJECTIVE: The diabetes literature contains conflicting evidence on the relationship between depression and glycemic control. This may be due, in part, to the fact that past studies failed to distinguish between patients with type 1 and type 2 diabetes. Because these are actually completely different diseases that are often treated differently and consequently make different demands on patients, the relationship between glycemic control and depressed mood in type 1 and type 2 diabetes was examined separately. METHODS: The relationship between Beck Depression Inventory (BDI) scores and HbA1c, as an index of long-term glycemic control, was measured in samples of 30 patients with type 1 and 34 patients with type 2 diabetes. RESULTS: Groups of patients with type 1 and type 2 diabetes did not differ in mean BDI score or HbA1c level. Correlation analysis revealed a significant positive relationship between BDI scores and HbA1c in the type 1 group (r = .44, p < .02) but not in the type 2 group (r = -0.06, p > .05). This relationship was evident throughout the entire range of BDI scores and was not restricted to scores indicative of clinical depression. Patients with type 1 diabetes who had higher HbA1c and BDI scores reported a lower frequency of home blood glucose monitoring. CONCLUSIONS: Variations in depressive mood, below the level of clinical depression, are associated with meaningful differences in glycemic control in type 1 but not type 2 diabetes. Preliminary data analysis suggests that this effect may be mediated, at least in part, by decreased self-care behaviors in patients with more depressed mood.     

Symptoms of depression and anxiety among a sample of South African patients living with a chronic illness

The present study reports on a survey conducted among 119 patients receiving treatment for diabetes or hypertension at semi-rural community health care clinics in South Africa. Participants completed the Hopkins Symptom Checklist (HSCL) and the Beck Depression Inventory (BDI). On the HSCL, 38.5 per cent of the sample scored in the elevated range. On the BDI, 19.8 per cent of the sample fell in or above the moderate range for depression. The results suggest that a considerable proportion of the sample may be experiencing significant psychiatric difficulty, for which they may not be receiving treatment.     

2型糖尿病患者抑郁患病情况与危险因素调查

目的:调查2型糖尿病患者抑郁的患病情况及评价2型糖尿病合并抑郁与无抑郁两组患者相关因素的差异。方法:T2DM患者151例采用汉密顿抑郁量表(17项)测评。根据评分临床诊断:合并有抑郁的患者59例为抑郁组,无抑郁的糖尿病患者92例为对照组。调查两组患者年龄、性别、身高、体重、收入情况、糖尿病病程、并发症、饮食习惯、生活习惯、糖尿病治疗情况、血糖、糖化血红蛋白(HBA1C)、血脂等。结果:调查的151例2型糖尿病患者中抑郁患病率为39.1%。抑郁组(病例组)女性(44.3%VS27.8%,P=0.035,病例组和对照组比较),独居或丧偶(35.6%VS 8.7%,P<0.001),低收入(81.4%VS 40.2%,P<0.001),有并发症的患者(98.3%VS 88.0%,P=0.023)的比率都显著高于非抑郁组。抑郁组HBA1C(98.3%VS 22.8%,P<0.001)显著高于对照组。注射胰岛素者(45.8%VS 28.3%,P=0.028)均显著多于非抑郁组;而缺少锻炼的人的比率显著超过无抑郁组(55.9%VS20.7%,P<0.001)。结论:2型糖尿病患者中抑郁的患病率较高,女性、丧偶或独居、低收入、血糖控制不良、并发症、和注射胰岛素、及缺少锻炼和抑郁关系密切。     

Association of depression and diabetes complications: a meta-analysis

OBJECTIVE: The objective of this study was to examine the strength and consistency of the relationship between depression and diabetes complications in studies of type 1 and type 2 adult patients with diabetes. METHOD: MEDLINE and PsycINFO databases were searched for articles examining depression and diabetes complications in type 1 and type 2 diabetes samples published between 1975 and 1999. Meta-analytic procedures were used. Studies were reviewed for diabetes type, sample size, statistical tests, and measures of diabetes complications and depression. Significance values, weighted effect sizes r, 95% confidence intervals (CI), and tests of homogeneity of variance were calculated for the overall sample (k = 27) and for subsets of interest. RESULTS: A total of 27 studies (total combined N = 5374) met the inclusion criteria. A significant association was found between depression and complications of diabetes (p < .00001, z = 5.94). A moderate and significant weighted effect size (r = 0.25; 95% CI: 0.22-0.28) was calculated for all studies reporting sufficient data (k = 22). Depression was significantly associated with a variety of diabetes complications (diabetic retinopathy, nephropathy, neuropathy, macrovascular complications, and sexual dysfunction). Effect sizes were in the small to moderate range (r = 0.17 to 0.32). CONCLUSIONS: These findings demonstrate a significant and consistent association of diabetes complications and depressive symptoms. Prospective, longitudinal studies are needed to identify the pathways that mediate this association.     

Prevention and treatment of post-partum depression: a controlled randomized study on women at risk

BACKGROUND: Research is needed to evaluate the efficacy of prevention and treatment for post-partum depression. METHOD: Subjects were screened with the Edinburgh Post-natal Depression Scale (EPDS) at the obstetric clinic. Mothers at risk (N = 258) (EPDS scores > or = 9) were randomly assigned to a prevention/treatment group or a control group. The prevention group received one cognitive-behavioural prevention session during hospitalization. At 4 to 6 weeks post-partum, subjects were screened again with the EPDS, after drop-out rates (refusals plus no return of the second EPDS) of 25.4% (33/130) in the intervention group and 10.9% (14/128) in the control group. Mothers with probable depression (EPDS scores > or = 11) were assessed using the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI). Mothers with major depression continued in the treatment group (N = 18) or in the control group (N = 30). Treated subjects received a cognitive-behavioural programme of between five and eight weekly home-visits. RESULTS: Compared with the control group, women in the prevention group had significant reductions in the frequency of probable depression (30.2 % v. 48.2%). Recovery rates based on HDRS scores of < 7 and BDI scores of < 4 were also significantly greater in the treated group than in the control group. CONCLUSIONS: The study suggests that this programme for prevention and treatment of post-partum depression is reasonably well-accepted and efficacious.     

Gender differences in depressive symptoms. An artefact caused by measurement instruments?

BACKGROUND: According to studies depression and depressive symptoms are more prevalent in females than in males. It is possible, however, that instruments meant to measure depressiveness are gender-biased. METHOD: This was studied by comparing two screening instruments (the Beck Depression Inventory (BDI) and the Depression Scale (DEPS) within the same population. The study sample consisted of 330 subjects taken from general population in south-western part of Finland. RESULTS: The mean BDI scores were borderline higher in females than in males, with no gender difference in DEPS scores. The difference between BDI and DEPS scores was significant between genders but not for other variables. Crying and lost interest in sex were the items on which females scored higher. CONCLUSIONS: It has been argued that these items, crying and lost interest in sex, are biologically, psychologically and culturally related to female gender and, therefore, give gender-biased results in measuring depressiveness. CLINICAL IMPLICATIONS: It is important to realise that some instruments meant for screening depression may include gender-biased items and therefore give too high scores of depressiveness in females. LIMITATIONS: The study is based on self-filled scales and its results cannot, therefore, be directly generalised to clinical depression.