| Objective:(1) To estimate the prevalence rate of depression symptoms in patients with Type 2 Diabetes Mellitus (T2 DM) in communities of Beijing.(2) To explore the predictors of depression symptoms in patients with T2 DM.(3) To estimate quality of life (QOL) of the patients with Type 2 DM co-morbid depression symptoms and explore the factors that have influence on their QOL(4) To explore the effects of integrative traditional and western community health care on QOL, depression symptoms, fasting plasma glucose(FPG), glycosylated hemoglobin (GHbAlc), insulin sensitive index (ISI), and body mass index (BMI) of the patients with T2 DM co-morbid depression symptoms.Methods:(1) Cross-sectional study:From June,2009 to September,2009, four community health service stations in Chanyan District and Dongcheng District in Beijing were multi-stage cluster sampled randomly and all of the patients with T2 DM in these communities were selected.667 patients with T2 DM in communities were identified from electronic data records in these four community health service stations and investigated with questionnaires including demographic information sheet, self-rating depression scale (SDS), quality of life scale for patients with type 2 diabetes mellitus (DMQLS), and social support rating scale (SSRS).χ2 test, t test, and Wilcoxon rank sum test were used to compare the data of the patients with T2 DM co-morbid depression symptoms and T2 DM patients without co-morbid depression symptoms. With univariate analysis and multiple, unconditional logistic regression, the predictors of depression in patients with T2 DM and their Odds Ratio (OR) were analyzed. The factors that have influence on QOL of the patients with T2 DM co-morbid depression symptoms were analyzed with multivariate linear regression.(2) Community intervention of integrative traditional and western medicine:The study was a randomized, controlled, single-blind trial.130 patients with T2 DM co-morbid depression symptoms were selected and divided into three groups at random:integrative traditional and western medicine group (n=43), community health care group (n=44), and control group (n=43). Integrative traditional and western medicine group received traditional Chinese medicine (TCM) and community health nursing on the bases of medical aid from the doctor in consulting room of community hospital. TCM included excising Chinese Health Qigong-Baduanjin regularly and ear acupressure and health education on TCM dietetic therapy. Community health nursing included regular health education and mental care via telephone call. Community health care group (n=44) received community health nursing and medical aid from the doctor in consulting room of community hospital. Control group (n=43) received medical aid from the doctor in consulting room of community hospital only. DMQLS, SDS, FPG,ISI, and BMI of three groups were evaluated at baseline and 6th week and 12th week. GHbAlc of three groups were evaluated at baseline and 12th week. Differences among three groups at three timepoints were analyzed with ANOVA of repeated measurement and the tendency chart of the index were made.Results:(1) Among 667 patients with T2 DM in communities,295 suffered co-morbid depression symptoms. The prevalence rate of depression symptoms in patients with T2 DM was 44.20%.(2) Multiple, unconditional logistic regression analysis showed that DM related complication, SSRS, objective support domain of SSRS, subjective support domain of SSRS, and utilization domain of SSRS were factors independently predictive of depression in T2 DM, and their OR were 1.679,0.585,0.751,0.728,0.663 respectively. DM related complication was risk factor and social support was protective factor.(3) There was a significant negative correlation between score of SDS and score of DMQLS, r=-0.469, P=0.000.The total score and five domain score of DMQLS of the patients with T2 DM co-morbid depression symptoms were significantly lower than those of T2 DM patients without depression symptoms (P<0.001).(4) In the multivariable model, there were five statistics significant factors that had influence on QOL of the patients with T2 DM co-morbid depression symptoms, including DM related complication, monthly income, SDS, treatment, subjective support domain of SSRS.R2=23.6%. In addition, DM related complication, monthly income, and SDS had significant influence on five domains of DMQLS.(5) Community intervention of integrative traditional and western medicine relieved depression symptoms of the patients with T2 DM co-morbid depression symptoms. At 6th week, the total score of SDS of integrative traditional and western medicine group was lower than that of control group (54.27±9.42 v.s.59.90±8.63, P<0.05). At 12th week, the total score of SDS of integrative traditional and western medicine group was lower than community health care group (51.71±9.57 v.s.55.88±9.38, P<0.05) as well as control group (51.71±9.57 v.s.60.69±8.35, P<0.05).(6) Community intervention of integrative traditional and western medicine improved overall QOL of the patients with T2 DM co-morbid depression symptoms, especially in physical domain, psychological domain, and satisfaction domain. QOL of integrative traditional and western medicine group increased significantly from baseline. At 12th week, the total score of DMQLS of integrative traditional and western medicine group was higher than that of community health care group (370.67±40.41 v.s.355.09±26.18, P<0.05), and control group (370.67±40.41 v.s.330.72±39.54, P<0.05). After 12 weeks intervention, the score of physical domain of DMQLS of integrative traditional and western medicine group was higher than that of control group (69.58±11.46 v.s.64.60±8.59, P<0.05), while no significant difference between community health care group and control group. At 12th week, the score of psychological domain of DMQLS of integrative traditional and western medicine group was higher than that of community health care group (71.05±7.66 v.s.67.20±7.65, P<0.05) as well as control group (71.05±7.66 v.s.60.67±9.93, P<0.05). At 6th week, the score of satisfaction domain of DMQLS of integrative traditional and western medicine group was higher than that of community health care group (58.40±10.18 v.s.54.82±6.86, P<0.05) as well as control group (58.40±10.18 v.s.50.86±7.47, P<0.05). At 12th week, the score of satisfaction domain of DMQLS of integrative traditional and western medicine group was higher than that of control group (60.91±9.75 v.s. 53.30±7.86, P<0.05).(7) Community intervention of integrative traditional and western medicine decreased blood glucose of the patients with Type 2 DM co-morbid depression symptoms. At 6th week and 12th week, FPG of integrative traditional and western medicine group was lower than that of control group (6.06±2.28 v.s.7.23±2.82,6.45±1.80 v.s.7.67±2.54, P<0.05). At 12th week, GHbA1c of integrative traditional and western medicine group was lower than that of control group (6.86±1.13 v.s.7.79±2.63, P<0.05).(8) No statistical differences were observed among three groups in ISI and BMI.Conclusions:(1) The prevalence rate of depression symptoms in patients with T2 DM in communities of Beijing is high. DM related complication, SSRS, subjective support domain of SSRS, objective support domain of SSRS, and utilization domain of SSRS are predictors of depression in patients with T2 DM. DM related complication is risk factor and social support is protective factor. Community health nurses should screen depression symptoms for T2 DM patients in community, and focus on those suffered DM related complication because they have high-risk of suffering depression in order to find depression in T2 DM patients. Meanwhile, Community health nurses should strengthen social support for T2 DM patients to reduce the risk of depression.(2) There is significant negative correlation between depression and QOL. The patients with T2 DM co-morbid depression symptoms experience worse QOL than T2 DM patients without depression symptoms do. (3) The factors that have influence on QOL of the patients with T2 DM co-morbid depression symptoms include DM related complication, monthly income, depression symptoms, treatment, and subjective social support. DM related complication, monthly income, and depression have influence on five domains of QOL(4) In the patients with T2 DM co-morbid depression symptoms, integrative traditional and western community health care can relieve their depression status and promote their QOL, especially in physical domain, psychological domain, and satisfaction domain. Meanwhile, it can stabilize their blood glucose. Chinese Health Qigong·Baduanjin and ear acupressure and TCM dietetic therapy have many advantages such as convenient operation, less side-effects, lower medical cost and patients economic burden. So it is suggested that TCM combined community health nursing be used in treating the patients with T2 DM co-morbid depression symptom.
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