The utility of the Diabetes Anxiety Depression Scale in Type 2 diabetes mellitus: The Fremantle Diabetes Study Phase II

BackgroundPrevious research using latent class analysis (LCA) identified classes of people with type 2 diabetes and specific profiles of depression and anxiety. Since LCA-derived anxious depression strongly predicts cardiovascular outcomes and mortality but cannot be applied to individuals, we developed a validated combined depression-anxiety metric, the Diabetes Anxiety Depression Scale (DADS), for potential clinical application in people with type 2 diabetes.Methods1,337 participants with type 2 diabetes from the observational community-based Fremantle Diabetes Study Phase II completed the Patient Health Questionnaire 9-item version (PHQ-9) to assess symptoms of depression, and the Generalised Anxiety Disorder Scale (GADS) to assess symptoms of anxiety. A single score was calculated by adding all the PHQ-9 items and the four GADS items used for the LCA. Cut-off scores were calculated with Receiver Operating Characteristic (ROC) area under the curve (AUC).ResultsThe optimum cut-off scores in terms of sensitivity, specificity, positive and negative predictive value were 18 points for major anxious depression and 8 points for minor anxious depression. A score of 8–17 was associated with a significantly increased incidence of coronary heart disease, whereas a score 18–39 was associated with an increase in both coronary heart disease and cardiovascular mortality.ConclusionsThe DADS has strong psychometric validity in the identification of mixed depression-anxiety in type 2 diabetes, and may contribute to cardiovascular risk prediction.背景 既往研究采用潜在类别分析（latent class analysis, LCA），对2型糖尿病人群进行亚组划分，并明确了该人群中抑郁与焦虑的特定表型。由于LCA得出的焦虑型抑郁虽可显著预测心血管结局与死亡率，但无法应用于个体层面，因此我们开发了一款经过验证的抑郁-焦虑联合评分工具——糖尿病焦虑抑郁量表（Diabetes Anxiety Depression Scale, DADS），以期用于2型糖尿病患者的潜在临床应用。方法 本研究纳入基于社区的观察性研究——弗里曼特尔糖尿病研究二期（Fremantle Diabetes Study Phase II）中的1337名2型糖尿病参与者，所有参与者均完成了患者健康问卷9条目版（Patient Health Questionnaire 9-item version, PHQ-9）的填写以评估抑郁症状，同时完成了广泛性焦虑障碍量表（Generalised Anxiety Disorder Scale, GADS）的填写以评估焦虑症状。将PHQ-9所有条目得分与LCA分析所用的4项GADS条目得分相加，计算得到单一总分，并采用受试者工作特征曲线下面积（Receiver Operating Characteristic area under the curve, ROC-AUC）确定截断值。结果 综合灵敏度、特异度、阳性预测值与阴性预测值来看，重度焦虑型抑郁的最佳截断值为18分，轻度焦虑型抑郁的最佳截断值为8分。得分8~17分的参与者冠心病发病率显著升高，而得分18~39分的参与者冠心病发病率与心血管死亡率均有所上升。结论 糖尿病焦虑抑郁量表（DADS）在识别2型糖尿病患者的抑郁焦虑共病状态时具有良好的心理测量学效度，或可用于心血管疾病风险的预测。