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  • 學位論文

重度憂鬱症合併糖尿病發生住院或急診風險

The risk of getting hospitalization and emergency treatment among patients with major depressive disorders combined with diabetes

指導教授 : 邱政元

摘要


目的: 本研究評估重度憂鬱病人合併糖尿病因重度憂鬱症至急診或住院的風險,我們觀察糖尿病有無、年齡、性別、月收入、都市化程度、察爾森共病症指標(CCI)、照護連續性(COCI)以及是否參與糖尿病共同照護網等變項影響。 方法: 本研究利用2005年健保資料庫百萬歸人檔進行分析與研究,對象為1999到2001年18歲以上曾因重度憂鬱症就醫之病人並篩選出糖尿病族群為實驗組,為避免研究期間跨組產生,篩選資料年度從1999到2005,均未曾因糖尿病診斷就醫病人。本研究採用世代研究設計(cohort study),追蹤期間為2002年至2005年,進一步排除觀察起點前曾因精神疾病至急診或住院就醫病人。 結果:結果顯示,病人的年齡、月收入、都市化程度、察爾森共病症指標上,重度憂鬱症合併糖尿病病患與一般重度憂鬱症病患在統計上達顯著差異,並且根據存活分析顯示,在重度憂鬱症病患的變項上:是否罹患糖尿病、年齡、月收入以及察爾森共病症指標群組間皆達統計上的顯著差異。此外,未加入糖尿病共同照護網的病患之精神疾病的急診及住院風險為未罹患糖尿病病患的1.49倍,達統計上的顯著差異。 結論: 本研究發現憂鬱症狀與糖尿病具高度關聯性,憂鬱症合併糖尿病在近年才受到重視,國內外文獻中,都顯示憂鬱症患者可能有較高的新發糖尿病的風險。其實憂鬱症狀是相當可塑性的因子(modifiable factor),對於有情緒或心理問題無法有效解決的糖尿病病人,專業人員應該主動提供情緒評估,並決定是否需要轉介至專業諮商、心理或精神專科治療。提升專業領域人員相關心理評估能力有其必要性,可運用各種介入予以改善或預防。因此,定期篩檢憂鬱症狀或風險要及時的介入,可能是防範憂鬱症合併糖尿病有效策略的一環。

並列摘要


Objectives: This study evaluates the risk of patients with major depressive disorders combined with diabetes getting emergency treatment or hospitalization due to mental illness. It will observe the variables such as age, gender, monthly income, level of urbanisation, the Charlson comorbidity index (CCI), the continuity of care index (COCI) and DM Share Care. Methods: This study utilizes the National Health Insurance Research Database of Longitudinal Health Insurance Database 2005 for its analysis and investigations. The experiment's subjects are aged eighteen years old and over and have all had medical treatment for major depressive disorders in the period from 1999 to 2001. The diabetes patients have been picked out from those subjects to make up the experimental group. To avoid cross-grouping, patients selected from the 1999 to 2005 data are those that have never been diagnosed with diabetes. This study adopted a cohort study approach, tracing the period from 2002 to 2005, to exclude patients who had received emergency treatment or hospitalization due to mental illness before the starting point of observation. Results: The results reveal significant differences in age, monthly income, level of urbanisation and Charlson comorbidity index (CCI) between the group of patients with major depressive disorders and diabetes and the group of patients who only suffered from major depressive disorders. According to the survival analysis, there are also significant differences between the variables of major depressive disorders such as insurance amounts, Charlson comorbidy index (CCI) and whether or not the patients have diabetes. Moreover, major depressive disorder patients who also suffer from diabetes and who are not given care by Shared Care Disease Mangement Program for Diabetes (DM Share Care) are at 1.49 times more risk of getting emergency treatment or hospitalisation due to mental illness than major depressive disorder patients who do not have diabetes. Conclusion: This study has found that there is a high degree of correlation between depression and diabetes. The link between depression and diabetes has, until recently, not been highly focused. Both domestic and international literature reveals that patients with depression are at higher risks of suffering from new-onset diabetes. As depressive symptoms are quite malleable factors, diabetes patients who are unable to effectively solve emotional or psychological problems require professionals to take the initiative in providing emotional assessments and subsequently determining the need for referral to a professional consultative, psychological or psychiatric treatment. It is necessary that professionals enhance their psychological assessment abilities and utilise a variety of intervention methods to prevent or ameliorate depression. As a result, regular screenings of depressive symptoms and timely interventions may be an effective strategy in preventing major depressive disorders combined with diabetes.

參考文獻


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