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  • 學位論文

糖尿病患者之憂鬱性別分析

Gender Difference in the Prevalence of Depression among Diabetes Mellitus Patients

指導教授 : 張菊惠

摘要


目的:憂鬱經常發生於糖尿病患者,女性又高於男性,世界心理衛生聯盟呼籲全球重視糖尿病與憂鬱之共病性問題。國際糖尿病聯盟近年亦展開女性糖尿病計畫,呼籲全球關注糖尿病的性別意涵。因此本研究將探討糖尿病患者憂鬱傾向是否高於一般民眾,是否存在性別差異。 方法:採橫斷式研究分析,以健保資料庫百萬抽樣歸人檔(LHID2005)為研究資料。研究對象為2005年罹患第二型糖尿病之成人(排除第一型與妊娠糖尿),共納入48,795位糖尿病患者。其糖尿病定義以國際疾病分類代碼前三碼為250且門診就醫紀錄2次以上,並服用降血糖藥物者判定,憂鬱傾向則以國際疾病分類代碼前四碼為296.2、296.3、298、311、300.4者或服用抗憂鬱症劑藥物者判定。先以卡方檢定分析性別與年齡、投保類別、投保金額及都市化程度之差異,再經由二元羅吉斯迴歸模型檢測性別與各變項之相關性,了解性別角色、社經地位、資源可近性對糖尿病患者憂鬱傾向之影響。 結果:糖尿病患者憂鬱診斷比率為無糖尿病者的1.23倍(95%CI 1.08-1.41;P<0.001),抗憂鬱症劑使用比率顯著高於無糖尿病者(OR=2.62 95%CI 2.54-2.70)。女性憂鬱診斷比率為男性的1.16倍(95%CI 1.07-1.25;P<0.001),女性糖尿病患(5.1%)憂鬱診斷率是男性(3.4%)的1.56倍(95%CI 1.43-1.71;P<0.0001)。 女性使用抗憂鬱症劑比率為男性的1.26倍(95%CI 1.23-1.28;P<0.0001),女性糖尿病患者(12.6%)服用抗憂鬱劑比率為男性(10.0%)的1.26倍(95%CI 1.26-1.34;P<0.0001)。若不區分性別,則年齡越大憂鬱率愈高,憂鬱用藥呈顯著性(P<0.0001);投保金額1-10000者憂鬱率最高,皆呈顯著性(P<0.0001)。憂鬱診斷以中都市化(OR=1.13;95%CI 1.05-1.21)呈顯著相關;憂鬱用藥則是中都市化(OR=1.45;95%CI 1.06-1.24)、一般鄉市鎮(OR=1.22;95%CI 1.12-1.33)、農業市鎮(OR=1.17;95%CI 1.02-1.35)皆呈顯著性。若區分性別,憂鬱診斷之男性(7.4%)以20-29歲最高;憂鬱用藥則以65歲以上(10.9%)最多(OR=1.50;95%CI 1.14-2.00;P<0.05)。憂鬱診斷之女性(15.1%)以50-65歲最高(OR=1.28;95%CI 0.87-1.90),無顯著性;憂鬱用藥則以65歲以上最高(OR=2.09;95%CI 1.52-2.85; P<0.0001)。投保金額皆以1-10000最高,呈顯著性(P<0.0001)。憂鬱用藥以農業市鎮的男性比率較高(OR=1.32;95%CI 1.07-1.63;P<0.05);女性則是一般鄉市鎮(OR=1.20;95%CI 1.06-1.35;P<0.05)。 結論與建議:經性別分析發現糖尿病患者憂鬱共病率高,無論是憂鬱症或憂鬱用藥,女性皆顯著高於男性,年齡別、身分別、收入別與都市化程度的性別影響呈現性別差異。建議糖尿病照護網之醫事人員教育訓練課程與教材,應融入性別敏感度與心理健康素養。

關鍵字

糖尿病 憂鬱 醫療利用 性別分析

並列摘要


Objective: This is now evidence that the prevalence of depression is increasing in people with diabetes mellitus. The International Diabetes Federation and the World Federation for Mental Health had raised awareness of woman’s diabetes and depression comorbidity with diabetes mellitus. The goal of this study was to estimate the prevalence of depression among diabetes mellitus patients and to examine the gender difference. Methods: This study was a cross-sectional study using Taiwan’s National Health Insurance Research Database of 2005. A total of 48,795 adult patients with type 2 diabetes mellitus were identified excluding type 1 and gestational diabetes. DM was defined by two or more outpatient visits with diagnostic codes (ICD-9-CM: 250) and took hypoglycemic agents. Depression was defined using ICD-9-CM diagnostic codes, or using antidepressant drugs (defined by Anatomic Therapeutic Chemical classification code N06A). Gender-specific prevalence of depression were calculated to describe the gender difference by using logistic regression after adjusting age, socioeconomic status and resources accessibility. Results: Prevalence of with diabetes patients have higher of depression(OR 1.23; 95%CI 1.08-1.41;P<0.001) and more used of antidepressants than people. (OR = 2.62 95% CI 2.54-2.70). The Female diabetes patients (12.6%) more than Male diabetes patients (10.0%) (OR 1.56; 95% CI 1.43-1.71; P <0.0001). Ratio of with diabetes patients have higher of used antidepressant (OR 1.26; 95% CI 1.26-1.34; P <0.0001). The Female diabetes patients (5.1%) more than Male diabetes patients (3.4%) (95% CI 1.26-1.34 ; P <0.0001). After analysis and separate gender, prevalence of depression and used antidepressant at age and insured amount in 1-10000 showed significant (P <0.0001). Prevalence of used antidepressant with diabetes patients at urbanization have higher and showed significant related (OR 1.13; 95% CI 1.05-1.21). Ratio of used antidepressant with diabetes patients at urbanization (OR 1.45; 95% CI 1.06-1.24), general rural town (OR 1.22; 95% CI 1.12-1.33), and agricultural town (OR 1.17; 95% CI 1.02-1.35) were highly significant. If the distinction between gender, The Prevalence of depression in patients with diabetes was higher in men, especially in the 20-29-year-old (7.4%) ,and the utilization rate of antidepressant was higher in men, especially over the age of 60 years (10.9%) (OR 1.50; 95% CI 1.14-2.00; P <0.05). The Prevalence of depression in patients with diabetes and the utilization rate of antidepressant was higher in women, especially in the 50-65-year-old (15.1%) were higher than those in men (OR 1.28; 95% CI 0.87-1.90) and no significant. Prevalence of depression at insured amount (1-10000) showed significant (P <0.0001). Ratio of used antidepressant with diabetes patients in man at agricultural town was higher and showed significant related (OR = 1.32; 95% CI 1.07-1.63; P <0.05) and women was generally rural town (OR = 1.20; 95% CI 1.06-1.35; P <0.05 ). Conclusion: Gender analysis revealed that patients with diabetes by depression comorbidity rate. Either depression or use of antidepressants, women were significantly higher than males, age, identity, income and degree of urbanization presents the gender impact of gender differences. Recommended diabetes care network of medical personnel training courses and materials should integrate gender sensitivity and mental health literacy.

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被引用紀錄


莊進德(2007)。羽球甲、乙組女子選手一般體能與專項體能之比較分析〔碩士論文,國立臺灣師範大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0021-2910200810561855

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