社区Ⅱ型糖尿病患者身心共病与生存质量、社会支持的关联性研究

Relationship between depressive disorder and quality of life and social support in type 2 diabetes patients in community

目的 调查及分析社区Ⅱ型糖尿病患者共病抑郁障碍的患病现状,识别Ⅱ型糖尿病患者出现身心共患疾病的人群特点及危险因素,探讨社区Ⅱ型糖尿病患者共病抑郁障碍与生存质量及社会支持的关联。方法 对深圳市坪山区2个街道4个社区健康服务中心已建档的Ⅱ型糖尿病患者,采用自编糖尿病患者一般情况调查表、Zung氏抑郁量表、糖尿病特异性生存质量量表(DSQL)、社会支持量表(SSRS)进行调查,用二元Logistic回归模型分析患者抑郁症状与生存质量及家庭支持的关联。结果 抑郁症状筛查率为42.6%。Logistic回归模型显示,HbA1c≥7 mmol/L、FPG≥8.6 mmol/L、职业为国家机关、党群组织、企事业单位负责人、专业技术人员及农林牧渔水利生产人员、城镇职工基本医保、家庭人均月收入≤2000元及≥4000元、吸烟、糖尿病病程10~20年的社区Ⅱ型糖尿病患者较易出现抑郁症状。生存质量好(DSQL评分,OR=0.832)及社会支持得分较高(SSRS评分,OR=0.848)的患者不易出现抑郁症状。结论 社区Ⅱ型糖尿病共病抑郁障碍患病率高且低收入及高收入两个不同社会阶层人群更易患有抑郁障碍;Ⅱ型糖尿病共病抑郁障碍等身心共病疾病的防治要遵循生物-心理-社会医学模式的整体防治观,识别对糖尿病患者生存质量产生负面影响的相关风险,将疾病的监测诊疗、心理指导、社会支持贯穿到主动健康管理的全过程中。

Objective To investigate current situation and characteristics of type 2 diabetes patients comorbid de-pressive disorder in community,and to explore the association of comorbid depression disorder with quality of life and social support in type 2 diabetes patients.Methods Self-compiled general situation questionnaire of diabetes patients,Chung de-pression scale,diabetes-specific quality of survival scale(DSQL)and social support scale(SSRS)were used,and mul-tiple Logistic regression model was conducted to analyze the relationship between depressive symptoms and family sup-port.Results The screening rate for depressive symptoms was 42.6%.Logistic regression model showed that type 2 diabetes patients who had HbAlc≥7 mmol/L,or FPG≥8.6 mmol/L,or who were leaders in state organs,party-mass organizations or enterprises and institutions,or who was professional and technical personnel,or production personnel working in agricul-ture,forestry,animal husbandry,fishery and water conservancy,or who had basic medical insurance for urban workers,or who had per capita monthly income of 2000 and 4000 yuan,or smoking or duration of diabetes for 10 to 20 years were more prone to have depression symptoms.Patients with good quality of life(DSQL,OR=0.832)and higher social support(SSRS,OR=0.848)were not prone to have depressive symptoms.Conclusion The community groups of dfferent social classes with high prevalence and low income and high income are more likely to have depressive disorder.The prevention and treatment should follow the bio-psychological-social medicine model,identify the negative risks affecting the living quality of diabetes patients,and integrate the monitoring,diagnosis and treatment,psychological guidance and social support throughout the whole process of active health management for type 2 diabetes patients.