| 外文摘要： |
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<span style="font-size: 12px;">Objective:</span></p>
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Based on the theoretical framework of social determinants of health and psychological stress theory, this thesis analyzed the current status of depression in middle-aged and elderly diabetic patients in China, compared the influencing factors of depression of different severity in diabetic patients, explored the action path and intensity of the influencing factors, and analyzed blood sugar control. and self-related health as the mediating effects on depression, to provide a reference for formulating corresponding mental health intervention measures.</p>
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Methods:</p>
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The data of this study were obtained from the China Health and Retirement Longitudinal Survey (CHARLS) database, and a depression analysis database of Chinese middle-aged and elderly diabetic patients was established according to the inclusion and exclusion criteria. SPSS 22.0 software was used for general statistical description, enumeration data were expressed as relative numbers, and measurement data were expressed as (`x±s), χ<sup>2</sup> test, and unordered multi-category logistic regression were used to explore the influencing factors of depression severity in middle-aged and elderly diabetic patients. Pearson and Spearman correlation analysis was used to explore the correlation between research variables and depression scores, and Mplus8.0 software was used to conduct path analysis to further explore the action paths between influencing factors.</p>
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Result:</p>
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Based on the theoretical framework of social determinants of health, this study selected research variables according to the model and action theory framework, mainly from the aspects of the individual's basic situation, lifestyle, patient awareness rate of glycemic control, and individual disease status, and patient's self-perceived state. The main influencing factors of depression in middle-aged and elderly diabetic patients were analyzed, and the results were as follows:</p>
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1. A total of 1743 middle-aged and elderly diabetic patients were included in this study. The depression self-rating score was (9.47±7.09) points, a total of 740 (42.5%) were found to be depressed, including 335 (19.2%) patients with mild depression and 229(13.1%) patients with moderate depression and 176 (10.1%) patients with severe depression.</p>
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2. The results of the univariate analysis showed that grouped by depression severity, combined with the theoretical framework of social determinants of health, from the basic situation of individuals, gender, education level, marital status, annual income, lifestyle, whether drinking, exercise duration, Sleep duration, insulin use, frequency of blood glucose monitoring, glycemic control, drug purchase cost, number of other chronic diseases, awareness rate of glycemic control, self-related health status in terms of self-perceived status, and pain group The difference was statistically significant.</p>
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3. The results of multivariate analysis showed that compared with non-depressed patients, combined with the theoretical framework of social determinants of health, from the basic situation of the individual, the educational level was illiterate (OR=1.745, 95%CI: 1.012~3.007), primary school (OR=1.858, 95%CI: 1.182-2.921), junior high school (OR=1.660, 95%CI: 1.038-2.654), no income (OR=1.650, 95%CI: 1.160-2.349), lack of sleep in terms of lifestyle 6h (OR=1.442, 95%CI: 1.051-1.979), the individual's disease status did not know about glycemic control (OR=1.641, 95%CI: 1.175-2.291), and the self-related health was unknown in terms of self-perceived state ( OR=3.128, 95%CI: 1.571~6.227) and bad (OR=1.915, 95%CI: 1.162~3.157), a little pain trouble (OR=1.515, 95%CI: 1.100~2.086), a lot of pain Patients with distress (OR=2.076, 95%CI: 1.404-3.070) were more likely to have mild depression; when the number of other chronic diseases was 1 (OR=0.648, 95%CI: 0.422-1.127), the combined The lower the number of chronic diseases, the less likely it is to be depressed.</p>
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Compared with non-depressed patients, combined with the theoretical framework of social determinants of health, from the basic situation of the individual, women (OR=2.062, 95%CI: 1.397-3.043), no income (OR=1.551, 95%CI: 1.004~2.390), infrequent alcohol consumption (OR=2.779, 95%CI: 1.571-4.910), lack of sleep for 6 hours (OR=1.560, 95%CI: 1.062-2.290) in terms of personal lifestyle, and better glycemic control in terms of individual disease Poor (OR=1.949, 95%CI: 1.156-3.280), no blood glucose monitoring in the past 12 months (OR=1.846, 95%CI: 1.149-2.960), insulin use (OR=1.742, 95%CI: 1.151-2.630), self-rated health as unknown (OR=14.159, 95%CI: 5.626-35.640) and not good (OR=3.619, 95%CI: 1.613-8.110), a lot of pain troubles (OR=2.707, 95%CI: 1.692-4.330) patients were more likely to have moderate depression; while the sleep duration was 6-8 hours (OR=0.500, 95%CI: 0.279-0.890), and the number of other chronic diseases was 1 (OR=0.537, 95%CI: 0.322~0.890), 2 (OR=0.617, 95%CI: 0.400~0.953), 3 (OR=0.594, 95%CI: 0.369~0.950), longer sleep duration, When the number of combined chronic diseases is less, depression is less likely;</p>
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Compared with non-depressed patients, combined with the theoretical framework of social determinants of health, from the basic situation of the individual, women (OR=2.436, 95%CI: 1.505-3.943) and illiterate (OR=3.473, 95% CI: 1.039~5.883), no income (OR=1.796, 95%CI: 1.021~3.159) and income less than 10,000 rmb (OR=2.090, 95%CI: 1.249~3.500), no exercise in personal lifestyle ( OR=1.737, 95%CI: 1.065-2.832), lack of sleep for 6 hours (OR=2.217, 95%CI: 1.354-3.630), and do not know glycemic control in terms of personal illness (OR=1.958, 95%CI: 1.012 ~3.007), self-rated health is unknown (OR=22.290, 95%CI: 7.032-70.650) and not good (OR=3.670, 95%CI: 1.266-10.640), and there is a lot of pain (OR=3.885, 95%CI: 2.226-6.780) patients were more likely to have major depression; while the number of other chronic diseases was 1 (OR=0.408, 95%CI: 0.212-0.786), 2 (OR=0.521, 95%CI: 0.310-0.873), two kinds of awareness of glycemic control (OR=0.412, 95%CI: 0.187-0.906), the less the number of chronic diseases and the more awareness of glycemic control, the less likely to be depressed .</p>
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Regarding the path analysis results, based on psychological stress theory, diabetic patients were stimulated by stressors (which research variables selected based on the theoretical framework of social determinants of health), through mediating variables ( self-rated health status and glycemic control) The process of strengthening or weakening the psychological reaction of depression. The result was as follows:</p>
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4. Correlation analysis of various variables with depression scores in middle-aged and elderly diabetic patients. Pearson correlation results: age, sleep duration, number of chronic diseases, pain distress score, self-related health status score, and depression score were significantly correlated; Spearman correlation results: gender, education level, marital status, income classification, alcohol consumption, duration of exercise, frequency of blood glucose monitoring, exercise to guide blood sugar control, and glycemic control were associated with depression scores.</p>
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5. Based on the theory of psychological stress, the results of the path analysis of the influencing factors of depression in Chinese middle-aged and elderly diabetic patients showed that under the stimulation of stressors (the research variables selected based on the theoretical framework of social determinants of health), diabetic patients were stimulated by mediator variables (self-related health status and glycemic control) to strengthen or weaken the effect, resulting in the process of psychological reactions to depression.</p>
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The path analysis results showed that gender, age, educational level, and marital status were used as control variables, income, exercise time, sleep time, disease duration, number of chronic diseases, insulin use, blood sugar monitoring frequency, pain, glycemic control, and self-related of health. Status had a direct effect on the occurrence of depression, of which the maximum direct effect value of self-rated health on depression was -0.246; drug costs, pain, sleep duration, and glycemic control could affect depression by affecting self-related health status; disease duration, insulin use, diabetes education, pain, and sleep duration could indirectly affect depression by affecting glycemic control; Influence of glycemic control and self-related health status had an indirect effect on depression.</p>
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Conclusion:</p>
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1. The prevalence of depression in middle-aged and elderly diabetic patients was relatively high, and it was necessary to focus on the mental health of this population.</p>
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2. Under the theoretical framework of social determinants of health, the basic conditions of individuals, lifestyle, patient awareness rate of glycemic control, individual disease conditions, and patient self-perception all have an impact on the occurrence of depression of different severity in diabetic patients. Female, low education level, low-income level, living alone, sleeping less than 6 hours, exercising less than 2 hours, more complicated with other chronic diseases, longer duration of disease, insulin use, no blood sugar monitoring, no people with diabetes who know their glycemic control status and their poor glycemic control, poor self-related health, and pain distress were more likely to develop depression.</p>
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3. Combined with psychological stress theory, a path model was constructed, focusing on the strengthening and (or) weakening effects of intermediary variables on the stress response, self-rated health has the greatest direct effect on depression, self-rated health, and glycemic control were used as mediating variables. Other variables could directly affect depression or indirectly affect depression through mediating variables.</p>
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4. Medical workers and community health workers should strengthen the screening of depression in patients with diabetes, strengthen patient health education, improve their disease knowledge, maintain healthy communication with patients, provide protection for patients' treatment, and reduce patients' anxiety about the disease.</p>
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5. Relevant government departments should pay more attention to the co-morbidity of diabetes and depression, and establish corresponding psychological consultation channels so that patients can self-consult to relieve depression symptoms.</p>
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<strong>Key words:</strong> Diabetes; Depression; Influencing factor; Pathways analysis</p>
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谷歌
火狐
