The mediating effect of diabetic distress on depressive symptoms and self-efficacy in elderly patients with T2DM
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摘要:
目的 探讨抑郁症状对社区老年2型糖尿病患者(type 2 diabetes mellitus, T2DM)自我效能的影响,以及糖尿病痛苦在其中的中介作用。 方法 采用便利抽样的方式对某社区服务管理中心的248名老年T2DM患者进行问卷调查。同时收集一般人口学特征、糖尿病相关信息、自我效能、抑郁症状和糖尿病痛苦情况。多元线性回归分析模型分析抑郁症状对自我效能的影响,Bootstrap法进行中介分析。 结果 抑郁症状(β=-0.272, P < 0.01)和糖尿病痛苦(β=-0.345, P < 0.01)是自我效能的影响因素,糖尿病痛苦在抑郁症状与自我效能之间具有中介作用(Boot CI: -2.460 2~-0.783 9, P < 0.05)。 结论 情绪障碍的改善有利于社区老年T2DM患者自我效能水平的提高。 Abstract:Objective To explore the influence of depression on self-efficacy in elderly patients with type 2 diabetes mellitus (T2DM) in the community and the mediating role of diabetic distress. Methods By convenience sampling, the 248 elderly T2DM patients managed by a community service center were investigated with questionnaire. The general demographic characteristics, diabetes-related information, self-efficacy, depression, and diabetic distress were collected. Multiple linear regression model was used to analyze the influence of depression on self-efficacy, and Bootstrap method was used for mediation analysis. Result Depression (β=-0.272, P < 0.01) and diabetes distress (β=-0.345, P < 0.01) were associated risk factors of self-efficacy, and diabetes distress played a mediating role between depression and self-efficacy (Boot CI: -2.460 2~-0.783 9, P < 0.05). Conclusion An important way to enhance the level of self-efficacy of elderly patients with T2DM in the community may be improving emotional disorder. -
Key words:
- Type 2 diabetes mellitus /
- Self-efficacy /
- Depression /
- Diabetes distress
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表 1 某社区老年糖尿病患者基本特征与自我效能的分布情况[n(%)]
Table 1. Distribution of basic characteristics and self-efficacy of elderly diabetes patients in a community [n(%)]
变量 N(%) 自我效能 χ2值 P值 变量 N(%) 自我效能 χ2值 P值 高水平 中等及以下水平 高水平 中等及以下水平 年龄(岁) 0.525 0.469 糖尿病病程(年) 0.397 0.529 60~<75 136(54.8) 45(18.1) 91(36.7) 1~≤10 135(54.4) 45(18.1) 90(36.3) 75~≤89 112(45.2) 42(16.9) 70(28.3) >10 113(45.6) 42(16.9) 71(28.6) 性别 0.503 0.478 个人糖尿病月花费(元) 0.243 0.886 男 115(46.4) 43(17.3) 72(29.1) <200 87(35.1) 32(12.9) 55(22.2) 女 133(53.6) 44(17.7) 89(35.9) 200~≤400 109(44.0) 38(15.3) 71(28.6) 婚姻状态 4.796 0.029 a >400 52(20.9) 17(6.9) 35(14.2) 在婚 188(75.8) 73(29.4) 115(46.4) BMI(kg/m2) 5.723 0.017 a 未在婚(含丧偶、未婚) 60(24.2) 14(5.6) 46(18.5) <24 137(55.2) 52(23.0) 80(32.3) 教育水平 17.239 0.001 b ≥24 111(44.8) 30(12.1) 81(32.7) 小学及以下 91(36.7) 19(7.7) 72(29.1) 抑郁症状 334.526 < 0.001 b 初中(含未毕业) 85(34.3) 36(14.5) 49(19.8) 无抑郁症状 131(52.8) 68(27.4) 63(25.4) 高中(含未毕业) 41(16.5) 14(5.6) 27(10.9) 有抑郁症状 117(47.2) 19(7.7) 98(39.5) 大学及以上 31(12.5) 18(7.3) 13(5.2) 糖尿病痛苦 9.209 0.010 a 家庭月收入(元) 2.144 0.342 中等以下痛苦 144(58.1) 57(23.0) 87(35.1) <2 000 38(15.3) 15(6.0) 23(9.3) 中等痛苦 59(23.8) 23(9.3) 36(14.5) 2 000~≤4 000 95(38.3) 28(11.3) 67(27.1) 中等以上痛苦 45(18.1) 7(2.8) 38(15.3) >4 000 115(46.4) 44(17.7) 71(28.6) 居住方式 15.628 0.001 b 独居 46(18.5) 17(6.9) 29(17.1) 与配偶居住 149(60.1) 62(25.0) 87(35.1) 与子女居住 35(14.1) 7(2.8) 28(11.3) 其他 18(7.3) 1(0.4) 17(6.9) 注:a表示P < 0.05;b表示P < 0.01。 表 2 糖尿病管理自我效能的多元线性回归分析
Table 2. Multiple linear regression analysis of diabetes management self-efficacy
变量 未标准化β值 sx值 标准化β值 t值 (95% CI)值 P值 常量 233.957 29.844 7.839 175.164~292.749 <0.001 年龄 -0.146 0.307 -0.025 -0.477 -0.751~0.459 0.634 性别 男(对照) 女 11.958 4.277 0.147 2.796 3.531~20.385 0.006 b 文化水平 小学及以下(对照) 初中(含未毕业) 15.222 5.148 0.178 2.957 5.080~25.364 0.003 b 高中(含未毕业) 11.585 6.542 0.106 1.771 -1.303~24.473 0.078 大学及以上 17.457 7.402 0.142 2.358 2.875~32.040 0.019 a 家庭月收入(元) >2 000(对照) 2 000~≤4 000 10.452 6.333 0.125 1.650 -2.024~22.928 0.100 >4 000 14.357 6.335 0.176 2.266 1.877~26.838 0.024 a BMI -2.154 0.719 -0.155 -2.994 -3.571~-0.737 0.003 b 抑郁症状 -2.868 0.607 -0.272 -4.726 -4.064~-1.673 <0.001 b 糖尿病痛苦 -1.350 0.221 -0.345 -6.108 -1.785~-0.914 <0.001 b 注:a表示P < 0.05;b表示P < 0.01。 表 3 自我效能、抑郁症状和糖尿病痛苦的相关性分析
Table 3. Correlation analysis of self-efficacy, depressive symptoms and diabetic distress
变量 自我效能 抑郁症状 糖尿病痛苦 自我效能 1.000 抑郁症状 -0.480 a 1.000 糖尿病痛苦 -0.478 a 0.427 a 1.000 注:表中数字为r,a表示P < 0.01。 表 4 糖尿病痛苦在抑郁症状与自我效能中的中介效应分析
Table 4. Analysis of the mediating effect of diabetic pain on depressive symptoms and self-efficacy
变量 间接效应Boot CI值 间接效应a×b 直接效应Boot CI值 直接效应c’ 中介效应比例a×b/c 糖尿病痛苦 模型1 -2.525 3~-0.695 5 -1.500 9 -4.786 7~-2.366 9 -3.576 8 29.56% 模型2 -2.460 2~-0.783 9 -1.472 0 -4.279 1~-1.863 6 -3.071 3 32.40% 注:模型2为控制了年龄、性别、文化水平以及家庭月收入的中介效应模型。 -
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