Supplementary Material for: Sex difference in the association between depression and adherence to recommended dilated eye examinations among patients with diabetes: Findings from National Health and Nutrition Examination Survey

Introduction: The relationship between depression and adherence to regular dilated fundus examination (DFE) in patients with diabetes remains unclear. This study aimed to assess the association between depression and adherence to annual or biennial DFE among individuals with diabetes. Methods: In this cross-sectional study, we used the National Health and Nutrition Examination Survey database from 2005 to 2016 which contains information on demographics, clinical characteristics, health-related factors, and the time since last DFE. Participants were classified as having depression based on a score of > 9 on the Patient Health Questionnaire-9. The main outcomes were the association between depression and the adherence of patients with diabetes to annual or biennial DFE. The second objective was to explore the potential influence of gender in this association. The independent association of depression with DFE compliance was explored by a series of multivariate logistic regression analyses (overall sample and then stratified by sex). Results: In total, 3656 eligible participants were identified. The adherence rates to annual or biennial DFE were all higher for participants without depression than those with depression (64.8% vs. 56.1% and 80.3% vs. 69.7%, respectively). In the multivariate analyses, depression was neither independently associated with the adherence to annual DFE nor biennial DFE in the overall sample. An interaction was observed between depression and gender for the adherence to annual or biennial DFE (p = 0.017 and p = 0.026, respectively). When analyses were stratified by sex, female patients with diabetes and depression had a significantly increased odds ratio (OR) of being nonadherent to annual and biennial DFE (OR = 1.52, 95% confidence interval [CI], 1.02–2.25, p = 0.039; OR = 1.55, 95% CI, 1.02–2.35, p = 0.039, respectively). However, this relationship was not evident in men with diabetes. Conclusions: The independent association between depression and DFE compliance varied by sex, that is, only female patients with diabetes and depression were at a higher risk of nonadherence to annual or biennial DFE compared to those without depression.

研究背景：糖尿病患者抑郁状态与遵规接受散瞳眼底检查（dilated fundus examination, DFE）之间的关联尚未明确。本研究旨在探讨糖尿病患者抑郁状态与每年或每两年一次散瞳眼底检查依从性的关联。
研究方法：本研究为横断面研究，采用2005至2016年美国国家健康与营养检查调查（National Health and Nutrition Examination Survey, NHANES）数据库，该数据库包含人口统计学特征、临床资料、健康相关影响因素以及上次散瞳眼底检查间隔时间等信息。研究对象的抑郁状态依据患者健康问卷-9（Patient Health Questionnaire-9, PHQ-9）得分＞9分进行判定。本研究的主要结局为抑郁状态与糖尿病患者每年或每两年一次散瞳眼底检查依从性的关联；次要目标为探究性别在该关联中的潜在调节作用。通过一系列多因素logistic回归分析（先对总样本进行分析，再按性别分层），探讨抑郁状态与散瞳眼底检查依从性的独立关联。
研究结果：最终共纳入3656名符合入组标准的研究对象。无抑郁状态的研究对象每年及每两年一次散瞳眼底检查的依从率均高于抑郁组（分别为64.8% vs. 56.1%、80.3% vs. 69.7%）。多因素分析显示，在总样本中，抑郁状态与每年或每两年一次散瞳眼底检查的依从性均无独立关联。但在每年及每两年一次散瞳眼底检查依从性方面，抑郁状态与性别存在交互作用（分别为p=0.017、p=0.026）。按性别分层分析后可见，合并抑郁的女性糖尿病患者未依从每年及每两年一次散瞳眼底检查的比值比（odds ratio, OR）显著升高（OR=1.52，95%置信区间[CI]：1.02~2.25，p=0.039；OR=1.55，95%CI：1.02~2.35，p=0.039）；而该关联在男性糖尿病患者中未显现。
研究结论：抑郁状态与散瞳眼底检查依从性的独立关联存在性别差异，即仅合并抑郁的女性糖尿病患者相较于无抑郁的女性糖尿病患者，存在更高的未依从每年或每两年一次散瞳眼底检查的风险。