中国六省市社区成人2型糖尿病患者伴抑郁症状现状调查

The cross-sectional investigation of depressive symptoms in adult type 2 diabetes mellitus patients in communities of six provinces in China

目的了解中国六省市社区成人2型糖尿病患者伴抑郁症状的流行现状,并分析其影响因素,为制定相应的心理干预策略和开展社区心理卫生服务提供依据。方法数据来源于中国疾病预防控制中心慢性非传染性疾病预防控制中心开展的中国糖尿病肾病现状及需求评估项目。于2021年12月至2022年3月,采用分层随机抽样的方法抽取天津市、黑龙江省、湖北省、广东省、重庆市和甘肃省基本公共卫生服务系统中登记的社区18岁及以上2型糖尿病患者为研究对象,对其进行问卷调查,采用抑郁自评量表(SDS)评估2型糖尿病患者的抑郁症状。采用SAS 9.4软件进行χ^(2)检验,采用二分类logistic回归模型分析2型糖尿病患者伴抑郁症状的影响因素,采用多分类logistic回归模型进一步分析2型糖尿病患者发生不同程度抑郁症状的影响因素。结果共发放问卷6713份,回收有效问卷6230份,问卷有效率为92.81%。2型糖尿病伴抑郁症状的患者1930例(30.98%),主要以轻度抑郁(867例,13.92%)和中度抑郁(972例,15.60%)为主。二分类logistic回归分析结果显示,女性(OR=1.14,95%CI:1.00~1.29)、小学及以下(OR=1.55,95%CI:1.17~2.05)和初中文化程度(OR=1.42,95%CI:1.08~1.86)、离异或丧偶(OR=1.24,95%CI:1.04~1.48)、糖尿病病程10年以上(OR=1.21,95%CI:1.05~1.39)、乡镇地区(OR=1.10,95%CI:1.06~1.14)、共病数≥2个(OR=1.52,95%CI:1.30~1.77)与2型糖尿病伴抑郁症状高风险相关;吸烟(OR=0.83,95%CI:0.69~1.00)和离退休人员(OR=0.60,95%CI:0.51~0.70)与2型糖尿病伴抑郁症状低风险相关,均有统计学意义(P<0.05)。多分类logistic回归分析结果显示,小学及以下(OR=2.32,95%CI:1.58~3.40)和初中文化程度(OR=1.82,95%CI:1.25~2.66)、共病数为1个(OR=1.31,95%CI:1.11~1.54)和≥2个(OR=1.61,95%CI:1.31~1.98)与轻度抑郁症状高风险相关;小学及以下文化程度(OR=1.52,95%CI:1.08~2.14)、离异或丧偶(OR=1.47,95%CI:1.19~1.83)、糖尿病病程10年以上(OR=1.24,95%CI:1.03~1.48)、共病个数≥2(OR=1.28,95%CI:1.05~1.57)与中度抑郁症状高风险相关;小学及以下文化程度(OR=3.69,95%CI:1.04~13.05)、离异或丧偶(OR=1.88,95%CI:1.09~3.25)、糖尿病病程10年以上(OR=1.71,95%CI:1.02~2.84)、共病数≥2个(OR=3.06,95%CI:1.87~4.99)与重度抑郁症状高风险相关。结论中国六省市社区成人2型糖尿病患者伴抑郁症状的发生率较高,应加强对2型糖尿病患者心理问题的关注,尤其是对相关影响因素进行筛查,以便提供心理干预,提高其生活质量。

Objective To understand the prevalence of depressive symptoms among adults with type 2 diabetes mellitus(T2DM)patients in communities of six provinces in China,analyze its influencing factors,provide the basis for formulating corresponding psychological intervention strategies and developing mental health services.Methods The data were from a study on the status and need assessment of diabetic nephropathy in China conducted by the National Center for Chronic and Non-communicable Disease Control and Prevention of the Chinese Center for Disease Control and Prevention.From December 2021 to March 2022,the stratified random sampling method was used to select the community T2DM patients(≥18 years old)registered in national basic public health service system of Tianjin,Heilongjiang,Hubei,Guangdong,Chongqing and Gansu as the subjects.The investigation was performed with questionnaire and the self-rating depression scale(SDS)which were used to evaluate the depression symptom in T2DM patients.The χ^(2)test was used to analyze the data.The binary logistic regression model was used to analyze the influencing factors for T2DM patients with depression symptom,the multiclass logistic regression model was used to analyze the influencing factors for different degree of depression symptom in T2DM patients.The used software was SAS 9.4.Results A total of 6713 questionnaires were distributed,6230 valid questionnaires were retrieved,and the effective rate of the questionnaire was 92.81%.There were 1930(30.98%)T2DM patients with depressive symptoms,mainly with mild depression(867cases,13.92%)and moderate depression(972 cases,15.60%).The binary logistic regression model showed that female(OR=1.14,95%CI:1.00-1.29),≤primary school level(OR=1.55,95%CI:1.17-2.05),junior middle school(OR=1.42,95%CI:1.08-1.86),dissociaton and bereave(OR=1.24,95%CI:1.04-1.48),diabetes duration>10 years(OR=1.21,95%CI:1.05-1.39),villages and towns(OR=1.10,95%CI:1.06-1.14),number of comorbidities≥2(OR=1.52,95%CI:1.30-1.77)were related to the high risk of T2DM with depressive symptoms;smoking(OR=0.83,95%CI:0.69-1.00)and retired(OR=0.60,95%CI:0.51-0.70)were related to the low risk of T2DM with depressive symptoms(P<0.05).The multiclass logistic regression model showed that≤primary school level(OR=2.32,95%CI:1.58-3.40),junior middle school(OR=1.82,95%CI:1.25-2.66),number of comorbidities=1(OR=1.31,95%CI:1.11-1.54)and number of comorbidities≥2(OR=1.61,95%CI:1.31-1.98)were related to the high risk of T2DM with mild depressive symptoms;≤primary school level(OR=1.52,95%CI:1.08-2.14),dissociaton and bereave(OR=1.47,95%CI:1.19-1.83),diabetes duration>10 years(OR=1.24,95%CI:1.03-1.48)and number of comorbidities≥2(OR=1.28,95%CI:1.05-1.57)were related to the high risk of moderate depression;≤primary school level(OR=3.69,95%CI:1.04-13.05),dissociaton and bereave(OR=1.88,95%CI:1.09-3.25),diabetes duration 10 years(OR=1.71,95%CI:1.02-2.84)and number of comorbidities≥2(OR=3.06,95%CI:1.87-4.99)were related to the high risk of severe depression.Conclusion The morbidity of T2DM patients with depressive symptoms is relatively high in adults of six provinces in China.More health services should be provided to target at the psychological problems of T2DM patients,especially it should screen the influencing factors,so that the psychological intervention is provided and the life quality could be increased.