Reduction of diabetes-related distress predicts improved depressive symptoms: A secondary analysis of the DIAMOS study

ObjectiveDepressive symptoms in people with diabetes are associated with increased risk of adverse outcomes. Although successful psychosocial treatment options are available, little is known about factors that facilitate treatment response for depression in diabetes. This prospective study aims to examine the impact of known risk factors on improvement of depressive symptoms with a special interest in the role of diabetes-related distress.Methods181 people with diabetes participated in a randomized controlled trial. Diabetes-related distress was assessed using the Problem Areas In Diabetes (PAID) scale; depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Multiple logistic and linear regression analyses were used to assess associations between risk factors for depression (independent variables) and improvement of depressive symptoms (dependent variable). Reliable change indices were established as criteria of meaningful reductions in diabetes distress and depressive symptoms.ResultsA reliable reduction of diabetes-related distress (15.43 points in the PAID) was significantly associated with fourfold increased odds for reliable improvement of depressive symptoms (OR = 4.25, 95% CI: 2.05–8.79; PPPPConclusionsThe reduction of diabetes distress is a statistical predictor of improvement of depressive symptoms. Diabetes patients with comorbid depressive symptomatology might benefit from treatments to reduce diabetes-related distress.

**研究目的** 糖尿病（diabetes）患者伴发抑郁症状（depressive symptoms）与不良结局风险升高密切相关。尽管目前已有成熟的社会心理治疗方案，但针对糖尿病合并抑郁患者的治疗应答促进因素仍知之甚少。本前瞻性研究旨在探究已知抑郁危险因素对抑郁症状改善的影响，并重点关注糖尿病相关困扰（diabetes-related distress）的作用。
**研究方法** 本研究共纳入181名糖尿病（diabetes）患者，所有受试者均参与一项随机对照试验（randomized controlled trial）。采用糖尿病问题领域量表（Problem Areas In Diabetes, PAID）评估糖尿病相关困扰（diabetes-related distress），采用流调中心抑郁量表（Center for Epidemiologic Studies Depression Scale, CES-D）评估抑郁症状（depressive symptoms）。通过多元logistic回归与线性回归分析，探究抑郁危险因素（自变量，independent variables）与抑郁症状改善情况（因变量，dependent variable）之间的关联。本研究以可靠变化指数（reliable change indices）作为糖尿病相关困扰与抑郁症状具有临床意义的减轻的判定标准。
**研究结果** 糖尿病相关困扰的可靠减轻（PAID量表得分降低15.43分）与抑郁症状可靠改善的四倍比值比（odds ratio, OR）升高显著相关（OR=4.25，95%置信区间（95% CI）：2.05~8.79；P=PPPP）。
**研究结论** 糖尿病相关困扰的减轻是抑郁症状改善的统计学预测因子。合并抑郁症状的糖尿病患者，可通过针对糖尿病相关困扰的干预治疗获得临床获益。