رابطه افسردگی و اضطراب با نقش میانجی فعالیت های جسمانی بر پیامدهای درمان افراد مبتلا به دیابت نوع 2؛ مدل سازی معادلات ساختاری

ﺳﺎﺑﻘﻪ و ﻫﺪف: اﺧﺘﻼﻻت روان ﺷﻨﺎﺧﺘﯽ ﺷﺎﻣﻞ اﻓﺴﺮدﮔﯽ و اﺿﻄﺮاب ﻣﯽﺗﻮاﻧﻨﺪ ﺑﺮ ﭘﯿﺎﻣﺪﻫﺎی درﻣﺎن دﯾﺎﺑﺖ ﺗﺎﺛﯿﺮ ﺑﮕﺬارﻧﺪ، اﻣﺎ ﻣﺴﯿﺮ اﺛﺮ آنﻫﺎ ﻫﻨﻮز ﻣﺸﺨﺺ ﻧﯿﺴﺖ. ﻫﺪف ﭘﮋوﻫﺶ ﺣﺎﺿﺮ آﻧﺎﻟﯿﺰ ﻣﺪل ﺳﺎﺧﺘﺎری راﺑﻄﻪ اﻓﺴﺮدﮔﯽ و اﺿﻄﺮاب ﺑﺎ ﻧﻘﺶ ﻣﯿﺎﻧﺠﯽ ﻓﻌﺎﻟﯿﺖ ﺟﺴﻤﺎﻧﯽ ﺑﺮ ﭘﺎﯾﺒﻨﺪی ﺑﻪ درﻣﺎن و ﺳﻄﺢ ﮐﻨﺘﺮل دﯾﺎﺑﺖ ﺑﻮد. ﻣﻮاد و روشﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ اﺳﺘﻔﺎده از دادهﻫﺎی ﯾﮏ ﻣﻄﺎﻟﻌﻪ ﮐﻮﻫﻮرت در ﺷﻬﺮﮐﺮﻣﺎن اﻧﺠﺎم ﺷﺪ. ﮔﺮدآوری دادهﻫﺎ ﺷﺎﻣﻞ ﭘﺮﺳﺸﮕﺮی )اﻓﺴﺮدﮔﯽ ﺑﮏ، اﺿﻄﺮاب ﺑﮏ و ﻓﻌﺎﻟﯿﺖﻫﺎی ﺟﺴﻤﺎﻧﯽ gpaq( و آزﻣﺎﯾﺶ ﺧﻮن (hba1c و fbs) ﺑﻮد. اﺑﺘﻼ ﺑﻪ دﯾﺎﺑﺖ ﺑﺮاﺳﺎس ﺳﺎﺑﻘﻪ ﭘﺰﺷﮑﯽ ﻣﺸﺨﺺ ﺷﺪ. ﭘﯿﺎﻣﺪﻫﺎی درﻣﺎن ﺷﺎﻣﻞ ﭘﺎﯾﺒﻨﺪی ﺑﻪ درﻣﺎن وﮐﻨﺘﺮل دﯾﺎﺑﺖ (اﻧﺪازهﮔﯿﺮی ﺷﺪه ﺑﺎ hba1c) ﺑﻮد. از ﻣﺪل ﺗﺤﻠﯿﻞ ﺳﺎﺧﺘﺎری (structural equation modeling) ﺑﺮای آﻧﺎﻟﯿﺰ اﺳﺘﻔﺎده ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ: ﻓﺮاواﻧﯽ ﻋﺪم ﭘﺎﯾﺒﻨﺪی ﺑﻪ درﻣﺎن دﯾﺎﺑﺖ 5/7 درﺻﺪ و ﻓﺮاواﻧﯽ ﺷﮑﺴﺖ درﻣﺎن 67/9 درﺻﺪ ﺑﻮد. اﺿﻄﺮاب و اﻓﺴﺮدﮔﯽ درﮔﺬﺷﺘﻪ ﺑﺎ ﻣﻘﺪار hba1c ﻓﺮد ﻫﻤﺒﺴﺘﮕﯽ ﻣﺜﺒﺖ ﻣﻌﻨﯽدار داﺷﺖ (0/156=p= 0/032 ،β)، ﮐﻪ 61 درﺻﺪ از اﯾﻦ اﺛﺮ از ﻃﺮﯾﻖ اﺛﺮﻣﺴﺘﻘﯿﻢ (0/096=β) و 39 درﺻﺪ آن ﺑﻪﻃﻮر ﻏﯿﺮﻣﺴﺘﻘﯿﻢ و ازﻃﺮﯾﻖ ﻓﻌﺎﻟﯿﺖ ﺟﺴﻤﺎﻧﯽ (0/060=β) ﺑﻮد. اﺿﻄﺮاب و اﻓﺴﺮدﮔﯽ ﻓﻌﻠﯽ ﺑﺎ ﻋﺪم ﭘﺎﯾﺒﻨﺪی ﺑﻪ درﻣﺎن ﻓﺮد ﻫﻤﺒﺴﺘﮕﯽ ﻣﺜﺒﺖ ﻣﻌﻨﯽدار داﺷﺖ (0/093=p=0/001 ،β)،ﮐﻪ 96 درﺻﺪ از اﯾﻦ اﺛﺮ ازﻃﺮﯾﻖ اﺛﺮ ﻣﺴﺘﻘﯿﻢ (0/089=β) و 4 درﺻﺪ آن ﺑﻪﻃﻮر ﻏﯿﺮﻣﺴﺘﻘﯿﻢ و ازﻃﺮﯾﻖ ﻓﻌﺎﻟﯿﺖ ﺟﺴﻤﺎﻧﯽ (0/003=β) ﺑﻮد. اﺳﺘﻨﺘﺎج: ﺑﺎ وﺟﻮد ﺧﻮدﮔﺰارش دﻫﯽ ﻣﻄﻠﻮب ﭘﺎﯾﺒﻨﺪی ﺑﻪ درﻣﺎن، ﺣﺪود دو ﺳﻮم از اﻓﺮاد، دﯾﺎﺑﺖ ﮐﻨﺘﺮل ﻧﺸﺪه داﺷﺘﻨﺪ. اﻧﺠﺎم ﻣﺪاﺧﻼت ﺑﺮای اﻓﺰاﯾﺶ ﻓﻌﺎﻟﯿﺖ ﺟﺴﻤﺎﻧﯽ ﻣﯽﺗﻮاﻧﺪ اﺛﺮات ﻧﺎﻣﻄﻠﻮب اﺿﻄﺮاب و اﻓﺴﺮدﮔﯽ ﺑﺮﮐﻨﺘﺮل ﻧﺎﻣﻨﺎﺳﺐ ﻗﻨﺪﺧﻮن را ﮐﺎﻫﺶ دﻫﺪ.

Relationship between Treatment Outcomes and Depression and Anxiety in Patients with Type 2 Diabetes Considering the Mediating Role of Physical Activity: A Structural Equation Modeling

Background and purpose: Depression and anxiety affect the outcomes of diabetes treatment, but, it is not yet completely understood how this happens. We used a structural model to assess the relationship between depression and anxiety considering the mediating role of physical activity on treatment adherence and diabetes control.Materials and methods: The present study was conducted using the data of a cohort study in Kerman, Iran. Data was collected using Beck Depression Inventory, Beck Anxiety Inventory, and Global Physical Activity Questionnaire (GPAQ). Fasting blood sugar level and HbA1c levels were also measured. Diabetes was diagnosed based on medical history. Treatment outcomes included adherence to treatment and diabetes control (measured by HbA1c). Data analysis was carried out in Stata V15 applying structural analysis model.Results: Nonadherence to diabetes treatment was seen in 5.7% of the patients and treatment failure occurred in 67.9%. Anxiety and depression levels in the past had a significant positive correlation with HbA1c levels ( beta;= 0.156, P= 0.032); 61% through direct effect ( beta;= 0.096) and 39% through indirect effect via physical activity ( beta;= 0.060). Also, the findings showed a significant positive correlation between nonadherence to treatment and current anxiety and depression levels ( beta;= 0.093, P = 0.001); 96% through direct effect ( beta;= 0.089) and 4% through indirect effect via physical activity ( beta;= 0.003).Conclusion: Despite optimal selfreports of adherence to treatment, about two thirds of people studied had uncontrolled diabetes. Interventions aiming at increasing physical activity can reduce the adverse effects of anxiety and depression on poor glycemic control.