Prevalence of Depression and the Influencing Factors in Patients with Type 2 Diabetes Mellitus: a National Multicenter Cross-sectional Study

doi:10.12114/j.issn.1007-9572.2025.0215

Chinese General Practice ›› 2026, Vol. 29 ›› Issue (12): 1558-1565.DOI: 10.12114/j.issn.1007-9572.2025.0215

Special Issue: 内分泌代谢性疾病最新文章合辑

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Prevalence of Depression and the Influencing Factors in Patients with Type 2 Diabetes Mellitus: a National Multicenter Cross-sectional Study

1. Department of Endocrinology and Metabolism, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
2. Department of Endocrinology and Metabolism, Beijing Shunyi District Hospital, Beijing 101300, China
3. Cardiovascular Disease Prevention and Control Office, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
4. Psychosomatic Medicine Department of Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
5. Department of Endocrinology and Metabolism, Beijing Shijingshan Hospital, Beijing 100040, China
6. Department of Endocrinology and Metabolism, Peking Union Medical College Hospital, Beijing 100005, China
7. Department of Endocrinology and Metabolism, Chinese People's Liberation Army General Hospital, Beijing 100141, China

Received:2025-05-10 Revised:2025-09-20 Published:2026-04-20 Online:2026-03-12
Contact: TAO Hong, YANG Xiaohui

2型糖尿病患者抑郁现状及危险因素：一项全国多中心横断面研究

1．100029　北京市，首都医科大学附属北京安贞医院内分泌科
2．101300　北京市顺义区医院内分泌科
3．100029　北京市，首都医科大学附属北京安贞医院北京市心血管疾病防治办公室
4．210009　江苏省南京市，东南大学附属中大医院心身医学科
5．100040　北京市石景山医院内分泌科
6．100005　北京市，北京协和医院内分泌科
7．100141　北京市，中国人民解放军总医院内分泌科

通讯作者: 陶红, 杨晓辉
作者简介:
作者贡献：
廖秋红进行文章构思与设计、数据收集、数据整理、统计学分析、结果分析与解释，撰写论文；陶红、袁勇贵、林珊珊、徐微、李玉秀、裴育负责研究实施与可行性分析、数据收集；杨晓辉负责研究的实施与可行性分析、数据收集、数据整理、数据分析；陶红进行文章构思与设计、结果分析与解释、论文修订，负责文章的质量控制及审校，对文章整体负责、监督管理。
基金资助:
首都卫生发展科研专项项目(首发2014-2-1054); 北京安贞医院科创基金(KCGY202204)

Abstract

Abstract:

Backgroud

Diabetes and depression have become two major public health challenges. Depression can reduce the treatment adherence of patients with diabetes, exacerbate diabetic complications and mortality, and severely affect the quality of life of patients. However, currently, clinicians tend to focus on biological factors while neglecting psychological factors. As a result, the diagnosis rate of depression in diabetic patients is low. Therefore, it is of great clinical significance to actively identify and screen type 2 diabetic patients at risk of depression and to conduct in-depth analysis of various influencing factors.

Objective

With the increasing incidence of diabetes, the related psychological problems are also becoming more and more concerned. In order to overcome the limitations of selection bias in single-center surveys, we conducted a nationwide multicenter survey to investigate the prevalence of depression and its influencing factors among patients with type 2 diabetes mellitus (T2DM) in China, and to provide a basis for developing mental health intervention strategies for diabetic patients.

Methods

A nationwide multicenter observational study was conducted using a probability proportional to size (PPS) sampling method. A total of 2 137 patients with T2DM were recruited from 52 hospitals across China. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms (PHQ-9≥10 indicated depression). Through a review of the literature, 29influential factors were identified: fasting blood glucose, 2-hour postprandial blood glucose, glycated hemoglobin, and lipid profiles, triglyceride-glucose index (TyG), diabetes duration, diabetes complications, anddiabetes comorbidities. Multivariate logistic regression analysis was performed to identify factors associated with depression in T2DM patients. Use the statistical software R package to analyze whether there is a nonlinear relationship between age, TyG, and depression and calculate the inflection point.

Results

Among 1 659 patients with type 2 diabetes, the prevalence of depression was 13.3% (220 cases). Multivariate logistic regression analysis identified the following independent risk factors for depression in type 2 diabetes patients: gender (female OR=1.815, 95%CI=1.220-2.701), age (OR=0.969, 95%CI=0.952-0.987), education level (below high school: OR=1.488, 95%CI=1.049-2.11), marital status (unmarried and others: OR=1.864, 95%CI=1.068-3.254), BMI (OR=0.936, 95%CI=0.896-0.977), ecomomic difficulties (OR=3.654, 95%CI=2.403-5.558), duration of disease (OR=1.031, 95%CI=1.006-1.057), diabetic peripheral neuropathy (OR=2.17, 95%CI=1.275-3.693), cardiovascular disease (OR=1.844, 95%CI=1.248-2.723), hypertension (OR=1.625, 95%CI=1.163-2.271), and TyG (OR=1.717, 95%CI=1.026-2.874)(P<0.05). After controlling for confounding factors, TyG showed a linear positive correlation with depression (P_nonlinear=0.191), while age exhibited a linear negative correlation with depression in the male population (P_nonlinear=0.946). The age of women was not linearly related to depression (P_nonlinear=0.013), and the time inflection point of the relationship was 49 years old (OR=0.921, 95%CI=0.857-0.99, P_nonlinear=0.025; OR=1.036, 95%CI=1.003-1.07, P_nonlinear=0.0323).

Conclusion

The prevalence of depression among Chinese patients with T2DM was 13.3%. Patients with low education levels, non-marital status, financial difficulties, high TyG index, and comorbid conditions such as diabetic peripheral neuropathy, cardiovascular disease, and hypertension were more likely to develop depression. Among male patients, the prevalence of depression decreased with increasing age. Among female patients, the relationship between age and the incidence of depression in the diabetic population followed a J-shaped curve, The risk of depression increases again after the age of 49. Early screening and intervention for depression are recommended for these high-risk groups to improve the overall health status and quality of life of T2DM patients.

Key words: Diabetes mellitus, type 2, Depression, Root cause analysis, Triglyceride-glucose index, Multicenter research

摘要：

背景

糖尿病和抑郁成为两大公共卫生挑战，抑郁会影响患者的预后和生活质量，增加自杀及死亡风险。目前糖尿病患者抑郁诊断率和治疗率均低，因此，主动识别筛查具有抑郁风险的2型糖尿病患者，并深入分析各种影响因素，具有重要的临床意义。

目的

探讨中国2型糖尿病患者抑郁患病率及其影响因素，为制订糖尿病患者精神心理健康干预策略提供依据。

方法

采用概率与规模成比例（PPS）抽样方法，于2022年5月—2023年12月在全国52家综合医院招募了18~75岁的门诊及住院的2型糖尿病患者为研究对象。使用抑郁症状自评量表（PHQ-9）评估抑郁（以PHQ-9≥10分为临床抑郁）。通过查阅文献确定空腹血糖、餐后2 h血糖、糖化血红蛋白、血脂四项、三酰甘油-葡萄糖指数（TyG）、糖尿病病程、糖尿病并发症及合并症等共29个影响因素。采用多因素Logistic回归分析2型糖尿病患者抑郁的影响因素。采用限制性立方样条回归分析年龄、TyG与抑郁剂量-反应关系并计算拐点。

结果

在1 659例2型糖尿病患者中，抑郁患病率为13.3%（220例）。多因素Logistic回归分析显示，2型糖尿病患者发生抑郁的独立危险因素为性别（女性：OR=1.815，95%CI=1.220~2.701）、年龄（OR=0.969，95%CI=0.952~0.987）、受教育水平（高中以下：OR=1.488，95%CI=1.049~2.110）、婚姻（未婚及其他：OR=1.864，95%CI=1.068~3.254）、BMI（OR=0.936，95%CI=0.896~0.977）、经济困难（OR=3.654，95%CI=2.403~5.558）、糖尿病病程（OR=1.031，95%CI=1.006~1.057）、糖尿病周围神经病变（OR=2.170，95%CI=1.275~3.693）、心血管疾病（OR=1.844，95%CI=1.248~2.723）、高血压（OR=1.625，95%CI=1.163~2.271）、TyG（OR=1.717，95%CI=1.026~2.874）（P<0.05）。在控制全部混杂因素后，TyG与抑郁呈线性正相关（P_非线性=0.191），男性人群的年龄与抑郁呈线性负相关（P_非线性=0.946）。女性人群的年龄与抑郁呈非线性关系（P_非线性=0.013），与抑郁关系的时间拐点为49岁（年龄<49岁时OR=0.921，95%CI=0.857~0.990，P_非线性=0.025；年龄≥49岁时OR=1.036，95%CI=1.003~1.070，P_非线性=0.032）。

结论

中国2型糖尿病患者抑郁患病率为13.3%，高TyG、低教育水平、未婚及离异、经济困难、合并糖尿病周围神经病变、心血管疾病和高血压的患者更易发生抑郁。男性患者随着年龄增加，抑郁患病率降低。女性患者年龄与糖尿病抑郁发病率呈非线性关系，49岁后抑郁风险升高。建议针对这些高危人群进行早期抑郁筛查和干预，以改善2型糖尿病患者的整体健康状况和生活质量。

关键词: 糖尿病，2型, 抑郁, 影响因素分析, 三酰甘油-葡萄糖指数, 多中心研究

LIAO Qiuhon,TAO Hong,YANG Xiaohui, et al. Prevalence of Depression and the Influencing Factors in Patients with Type 2 Diabetes Mellitus: a National Multicenter Cross-sectional Study[J]. Chinese General Practice, 2026, 29(12): 1558-1565. DOI: 10.12114/j.issn.1007-9572.2025.0215.
廖秋红,陶红,杨晓辉等. 2型糖尿病患者抑郁现状及危险因素：一项全国多中心横断面研究[J]. 中国全科医学, 2026, 29(12): 1558-1565. DOI: 10.12114/j.issn.1007-9572.2025.0215.

Figures/Tables 6

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项目	抑郁组（n=220）	非抑郁组（n=1 439）	检验统计量值	P值
性别[例（%）]			13.210^a	<0.001
男性	98（44.5）	829（57.6）
女性	122（55.5）	610（42.4）
年龄（±s，岁）	54.5±13.8	55.8±11.5	2.481^b	0.115
受教育水平[例（%）]			8.892^a	0.003
高中以下	107（48.6）	854（59.3）
高中及以上	113（51.4）	585（40.7）
工作[例（%）]			9.987^a	0.007
有	107（48.6）	726（50.5）
无	53（24.1）	229（15.9）
退休	60（27.3）	484（33.6）
婚姻[例（%）]			15.913^a	<0.01
已婚	190（86.4）	1350（93.8）
未婚及其他	30（13.6）	89（6.2）
BMI（±s，kg/m²）	25.0±4.1	25.4±3.7	2.285^b	0.131
吸烟[例（%）]			1.462^a	0.481
否	160（72.7）	989（68.7）
既往吸烟	35（15.9）	257（17.9）
当前吸烟	25（11.4）	193（13.4）
饮酒[例（%）]			2.490^a	0.115
否	192（87.3）	1 195（83）
是	28（12.7）	244（17）
居住地[例（%）]			7.936^a	0.001
城市	166（75.5）	1 198（83.3）
农村	54（24.5）	241（16.7）
一周工作时间[M（P₂₅，P₇₅），h]	9.5（0，43.2）	28.0（0，40.0）	0.001^c	0.98
经济困难[例（%）]			61.597^a	<0.001
否	167（75.9）	1 333（92.6）
是	53（24.1）	106（7.4）
独居[例（%）]			6.009^a	0.014
否	198（90）	1 357（94.3）
是	22（10）	82（5.7）
糖尿病病程[M（P₂₅，P₇₅），年]	10.0（4.0，15.0）	8.0（3.0，13.0）	2.822^c	0.093
糖尿病并发症[例（%）]			1.795^a	0.180
否	104（47.3）	750（52.1）
是	116（52.7）	689（47.9）
糖尿病视网膜病变[例（%）]			3.900^a	0.048
否	157（71.4）	1 114（77.4）
是	63（28.6）	325（22.6）
糖尿病肾病[例（%）]			0.455^a	0.500
否	191（86.8）	1 272（88.4）
是	29（13.2）	167（11.6）
糖尿病周围神经病变[例（%）]			6.332^a	0.012
否	130（59.1）	974（67.7）
是	90（40.9）	465（32.3）
糖尿病足[例（%）]			0.952^a	0.329
否	212（96.4）	1 403（97.5）
是	8（3.6）	36（2.5）
心血管病变[例（%）]			9.220^a	0.002
否	163（74.1）	1 189（82.6）
是	57（25.9）	250（17.4）
脑血管病变[例（%）]			3.441^a	0.064
否	194（88.2）	1 323（91.9）
是	26（11.8）	116（8.1）
高血压[例（%）]			7.699^a	0.006
否	77（35）	647（45）
是	143（65）	792（55）
空腹血糖（±s，mmol/L）	9.0±3.2	8.5±3.1	5.177^b	0.023
餐后2 h血糖（±s，mmol/L）	12.8±4.9	12.2±4.4	4.022^b	0.045
糖化血红蛋白（±s，%）	8.9±2.2	8.8±2.2	0.061^b	0.805
三酰甘油[M（P₂₅，P₇₅），mmol/L]	1.8（1.3, 2.6）	1.6（1.1，2.5）	3.346^c	0.067
总胆固醇（±s，mmol/L）	4.9±1.8	4.7±1.5	4.474^b	0.035
低密度脂蛋白胆固醇（±s，mmol/L）	3.0±1.6	2.8±1.1	10.569^b	0.001
高密度脂蛋白胆固醇[M（P₂₅，P₇₅），mmol/L]	1.1（0.9，1.4）	1.1（0.9，1.3）	0.072^c	0.789
TyG（±s）	9.5±0.7	9.3±0.8	6.495^b	0.011

项目	抑郁组（n=220）	非抑郁组（n=1 439）	检验统计量值	P值
性别[例（%）]			13.210^a	<0.001
男性	98（44.5）	829（57.6）
女性	122（55.5）	610（42.4）
年龄（±s，岁）	54.5±13.8	55.8±11.5	2.481^b	0.115
受教育水平[例（%）]			8.892^a	0.003
高中以下	107（48.6）	854（59.3）
高中及以上	113（51.4）	585（40.7）
工作[例（%）]			9.987^a	0.007
有	107（48.6）	726（50.5）
无	53（24.1）	229（15.9）
退休	60（27.3）	484（33.6）
婚姻[例（%）]			15.913^a	<0.01
已婚	190（86.4）	1350（93.8）
未婚及其他	30（13.6）	89（6.2）
BMI（±s，kg/m²）	25.0±4.1	25.4±3.7	2.285^b	0.131
吸烟[例（%）]			1.462^a	0.481
否	160（72.7）	989（68.7）
既往吸烟	35（15.9）	257（17.9）
当前吸烟	25（11.4）	193（13.4）
饮酒[例（%）]			2.490^a	0.115
否	192（87.3）	1 195（83）
是	28（12.7）	244（17）
居住地[例（%）]			7.936^a	0.001
城市	166（75.5）	1 198（83.3）
农村	54（24.5）	241（16.7）
一周工作时间[M（P₂₅，P₇₅），h]	9.5（0，43.2）	28.0（0，40.0）	0.001^c	0.98
经济困难[例（%）]			61.597^a	<0.001
否	167（75.9）	1 333（92.6）
是	53（24.1）	106（7.4）
独居[例（%）]			6.009^a	0.014
否	198（90）	1 357（94.3）
是	22（10）	82（5.7）
糖尿病病程[M（P₂₅，P₇₅），年]	10.0（4.0，15.0）	8.0（3.0，13.0）	2.822^c	0.093
糖尿病并发症[例（%）]			1.795^a	0.180
否	104（47.3）	750（52.1）
是	116（52.7）	689（47.9）
糖尿病视网膜病变[例（%）]			3.900^a	0.048
否	157（71.4）	1 114（77.4）
是	63（28.6）	325（22.6）
糖尿病肾病[例（%）]			0.455^a	0.500
否	191（86.8）	1 272（88.4）
是	29（13.2）	167（11.6）
糖尿病周围神经病变[例（%）]			6.332^a	0.012
否	130（59.1）	974（67.7）
是	90（40.9）	465（32.3）
糖尿病足[例（%）]			0.952^a	0.329
否	212（96.4）	1 403（97.5）
是	8（3.6）	36（2.5）
心血管病变[例（%）]			9.220^a	0.002
否	163（74.1）	1 189（82.6）
是	57（25.9）	250（17.4）
脑血管病变[例（%）]			3.441^a	0.064
否	194（88.2）	1 323（91.9）
是	26（11.8）	116（8.1）
高血压[例（%）]			7.699^a	0.006
否	77（35）	647（45）
是	143（65）	792（55）
空腹血糖（±s，mmol/L）	9.0±3.2	8.5±3.1	5.177^b	0.023
餐后2 h血糖（±s，mmol/L）	12.8±4.9	12.2±4.4	4.022^b	0.045
糖化血红蛋白（±s，%）	8.9±2.2	8.8±2.2	0.061^b	0.805
三酰甘油[M（P₂₅，P₇₅），mmol/L]	1.8（1.3, 2.6）	1.6（1.1，2.5）	3.346^c	0.067
总胆固醇（±s，mmol/L）	4.9±1.8	4.7±1.5	4.474^b	0.035
低密度脂蛋白胆固醇（±s，mmol/L）	3.0±1.6	2.8±1.1	10.569^b	0.001
高密度脂蛋白胆固醇[M（P₂₅，P₇₅），mmol/L]	1.1（0.9，1.4）	1.1（0.9，1.3）	0.072^c	0.789
TyG（±s）	9.5±0.7	9.3±0.8	6.495^b	0.011

变量	β	标准误差	Wald χ²值	P值	OR值	95%CI
性别	0.596	0.203	8.639	0.003	1.815	1.22~2.701
年龄	-0.031	0.009	11.497	0.001	0.969	0.952~0.987
受教育水平	0.397	0.178	4.965	0.026	1.488	1.049~2.11
婚姻	0.623	0.284	4.804	0.028	1.864	1.068~3.254
BMI	-0.067	0.022	9.22	0.002	0.936	0.896~0.977
经济困难	1.296	0.214	36.691	0	3.654	2.403~5.558
糖尿病病程	0.031	0.013	5.969	0.015	1.031	1.006~1.057
糖尿病周围神经病变	0.775	0.271	8.157	0.004	2.17	1.275~3.693
心血管疾病	0.612	0.199	9.453	0.002	1.844	1.248~2.723
高血压	0.486	0.171	8.093	0.004	1.625	1.163~2.271
TyG	0.541	0.263	4.241	0.039	1.717	1.026~2.874
常量	-4.365	2.197	3.946	0.047	0.013

变量	β	标准误差	Wald χ²值	P值	OR值	95%CI
性别	0.596	0.203	8.639	0.003	1.815	1.22~2.701
年龄	-0.031	0.009	11.497	0.001	0.969	0.952~0.987
受教育水平	0.397	0.178	4.965	0.026	1.488	1.049~2.11
婚姻	0.623	0.284	4.804	0.028	1.864	1.068~3.254
BMI	-0.067	0.022	9.22	0.002	0.936	0.896~0.977
经济困难	1.296	0.214	36.691	0	3.654	2.403~5.558
糖尿病病程	0.031	0.013	5.969	0.015	1.031	1.006~1.057
糖尿病周围神经病变	0.775	0.271	8.157	0.004	2.17	1.275~3.693
心血管疾病	0.612	0.199	9.453	0.002	1.844	1.248~2.723
高血压	0.486	0.171	8.093	0.004	1.625	1.163~2.271
TyG	0.541	0.263	4.241	0.039	1.717	1.026~2.874
常量	-4.365	2.197	3.946	0.047	0.013

Prevalence of Depression and the Influencing Factors in Patients with Type 2 Diabetes Mellitus: a National Multicenter Cross-sectional Study

2型糖尿病患者抑郁现状及危险因素：一项全国多中心横断面研究

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年龄阈值	OR值	95%CI	P值
<49岁	0.921	0.857~0.990	0.025
≥49岁	1.036	1.003~1.070	0.032
似然比检验			0.004
线性检验			0.002

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