抑郁在2型糖尿病患者孤独感与生活质量关系间的中介效应研究

Study on the mediating effect of depression between loneliness and quality of life in Type 2 diabetes mellitus patients

目的探讨抑郁对2型糖尿病(T2DM)患者孤独与生活质量的影响,以期为T2DM患者健康干预提供依据。方法采用整群抽样法抽取皖南医学院第一附属医院T2DM患者350例作为研究对象,通过孤独量表(UCLA)、流调用抑郁自评量表(CES-D)、健康调查简表(SF-36)对T2DM患者进行调查,使用SPSS 25.0和AMOS 21.0软件分析数据并构建结构方程模型。结果有效回收问卷338份,相关性分析结果显示,T2DM患者孤独、抑郁和生活质量得分之间均为线性相关(P<0.01);其中孤独和抑郁得分呈显著正相关(r=0.484,P<0.01);生活质量得分和孤独、抑郁得分呈显著负相关(r=-0.298,P<0.01;r=-0.530,P<0.01)。多元回归分析显示,T2DM患者年龄、受教育程度和抑郁对生活质量有预测作用,可以解释生活质量34.3%的变异量(P<0.05)。结构方程模型显示:孤独对抑郁的直接效应为0.58(P<0.001);抑郁对生活质量的直接效应为-0.72(P<0.001)。孤独感通过抑郁对T2DM患者生活质量的间接效应为-0.42(P<0.05),孤独、抑郁共解释T2DM患者生活质量51.70%的变异量。结论孤独感能加重T2DM患者的抑郁水平,且抑郁在孤独感和生活质量间起完全中介作用。因此,医护人员应早期识别T2DM患者的抑郁症状,采取有效措施调节抑郁对生活质量的作用,从而有效改善T2DM患者的生活质量。

Objective To explore the effect of depression on loneliness and quality of life in patients with type 2 diabetes mellitus(T2 DM),so as to provide evidence for health intervention for T2 DM patients.Methods 350 cases of T2 DM patients were selected as study objects from the first affiliated hospital of Wannan Medical College according to cluster sampling method.Loneliness scale of University of California at Los Angeles(UCLA),center for epidemiological studies depression scale(CES-D)and the 36-item Medical outcome Short-Form Health Study Survey(SF-36)were used to carried the survey among patients with T2 DM.SPSS25.0 and AMOS21.0 software were used to analyze the data and construct the structural equation model.Results Finally 338 valid questionnaires were collected.The correlation analysis showed that there was a linear correlation between UCLA Score,CES-D score,and the SF-36 score in T2 DM patients(P<0.01).There was a positive correlation between UCLA score and CES-D score(r=0.484,P<0.01).The SF-36 score were negatively correlated with UCLA score and CES-D score(r=-0.298,P<0.01;r=-0.530,P<0.01).Multiple regression analysis showed that age,education level and depression in T2 DM patients could predict the quality of life,which could explain 34.3%of the variation of quality of life(P<0.05).The structural equation model showed that the direct effect of loneliness on depression was 0.58(P<0.001).The direct effect of depression on quality of life was-0.72(P<0.001).The indirect effect of loneliness on the quality of life of T2 DM patients through depression was-0.42(P<0.05).Loneliness and depression explained 51.70%of the variation of the quality of life of T2 DM patients.Conclusions Loneliness could aggravate the level of depression in T2 DM patients,and depression plays a complete intermediary role between loneliness and quality of life.Therefore,medical staff should recognize the depressive symptoms of T2 DM patients early and take effective measures to regulate the effect of depression on quality of life,so as to effectively improve the quality of life of T2 DM patients.