Relação entre automanejo e sintomas depressivos em pessoas com diabetes e hipertensão
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Introdução: As pessoas com diabetes e hipertensão experimentam com maior frequência a sintomatologia depressiva, o qual contribui a um inadequado automanejo da doença, que envolve tarefas como: a toma da medicação, assistir às consultas médicas, o conhecimento de signos e sintomas, além da toma de decisões.
Objetivo: Pelo anterior, o objetivo deste trabalho é identificar a relação entre automanejo em geral e suas dimensões com sintomas depressivos em pessoas com diabetes e hipertensão.
Método: Estudo transversal-correlacional com n=205 pacientes com diagnóstico de diabetes (100) e hipertensão (105). Amostragem não probabilística por conveniência. Utilizou-se a estatística descritiva e r de Pearson. Aplicaram-se os instrumentos Partners in Health (PIH) e The Patient Health Questionnaire (PHQ-8).
Resultados: Encontrou-se correlação estatisticamente significativa entre a sintomatologia depressiva e o automanejo (r=-0.308 ρ<0.001).
Discussão e Conclusões: Conclui-se que a sintomatologia depressiva relaciona-se com o automanejo da doença da seguinte maneira: a maior automanejo, menor sintomatologia de depressão, ou a maior sintomatologia depressiva, menor automanejo; esta relação confirma que ambas variáveis afetam-se mutuamente e/ou mantem uma relação estreita.
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Referências
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2. Aguilar-Salinas C, Hernández-Jiménez S, Hernández-Ávila M, Hernández Ávila JE. Acciones para enfrentar a la diabetes. Documento de Postura. México, D.F: Academia Nacional de Medicina; 2015.
3. Secretaria de Salud-Instituto Nacional De Salud Pública. Encuesta Nacional de Salud y Nutrición de Medio Camino 2016. México: Secretaria de Salud; 2016. https://bit.ly/2S5pT2w
4. Olaiz-Fernández G, Rivera J, Shamah-Levy T, Rojas R, Villalpando-Hernández S, Hernández-Ávila M, et al. (Ed). Encuesta Nacional de Salud y Nutrición 2006. Cuernavaca, México: Instituto Nacional de Salud Pública; 2006. https://bit.ly/2GP8dmk
5. Olaiz G, Rojas R, Barquera S, Shamah T, Aguilar C, Cravioto P, et al. (Ed). Encuesta Nacional de Salud 2000. Tomo 2. La salud de los adultos. Cuernavaca, Morelos, México: Instituto Nacional De Salud Pública-Secretaria de Salud; 2003. https://bit.ly/2SbcS7x
6. Gutiérrez J, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, et al. Encuesta Nacional de Salud y Nutrición 2012. Resultados Nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública; 2012. https://bit.ly/2uWxwQK
7. Montalvo-Prieto A, Cabrera-Nanclares B, Quiñones-Arrieta S. Enfermedad crónica y sufrimiento: Revisión de literatura. Aquichan. 2012; 12(2): 134-43. https://doi.org/10.5294/aqui.2012.12.2.4
8. Orozco GAM, Castiblanco OL. Factores psicosociales e intervención psicológica en enfermedades crónicas no Transmisibles. Rev Colomb Psicol. 2015; 24(1): 203-17. https://dx.doi.org/10.15446/rcp.v24n1.42949
9. Wilhem K, Reddy J, Crawford J, Robins L, Campell L, Proudfoot J. The Importance of screening for mild depression in adults with diabetes. Transl Biomed. 2017; 8(1). https://doi.org/10.2167/2172-0479.1000101
10. Bădescu SV, Tătaru C, Kobylinka L, Georgescu EL, Zahiun DM, Zăgrean AM, et al. The association between diabetes mellitus and depression. J Med Life. 2016; 9(2): 120-5. https://bit.ly/2ROfIQN
11. Siddiqui S. Depression in type 2 diabetes mellitus: A brief review. Diabetes Metab Syndr. 2014; 8(1): 62-5. https://doi.org/10.1016/j.dsx.2013.06.010
12. Domingo AK, Asmal L, Seedat S, Esterhuizen TM, Laurence C, Volmink J. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers. S Afr Med J. 2015; 105(12): 1057-60. https://doi.org/10.7196/SAMJ.2015.v105i12.9843
13. Zhang Y, Ting RZ, Yang W, Jia W, Li W, Ji L, et al. Depression in chinese patients with type 2 diabetes: associations with hyperglucemia, hypoglucemia, and poor treat adherence. J Diabetes. 2015; 7(6): 800-8. https://doi.org/1111/1753-0407.12238
14. Olvera R, Fisher-Hoch SP, Williamson DE, Vatcheva KP, McCormick JB. Depression in Mexican Americans with diagnosed and undiagnosed diabetes. Psychol Med. 2016; 46(3); 637-43. https://doi.org/10.1017/S0033291715002160
15. Lara MM, Jacobs EA, Escamilla M, Mendenhall E. Depression among diabetic women in urban centers in México and the United States of America: a comparative study. Rev Panam Salud Publica. 2014; 36(4):225-31.
16. Schmitt A, Reimer A, Kulzer B, Haak T, Gahr A, Hermanns N. Negative association between depression and diabetes control only when accompanied by diabetes-specific distress. J Behav Med. 2014; 38(3): 556-64. https://doi.org/10.1007/s10865-014-9604-3
17. Fisher L, Gonzalez JS, Polonsky WH. The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med. 2014; 31(7): 764-72. https://doi.org/10.1111/dme.12428
18. Yu M, Zhang X, Lu F, Fang L. Depression and risk for diabetes: A meta-analysis. Can J Diabetes. 2015; 39(4): 266-72. https://doi.org/10.1016/j.jcjd.2014.11.006
19. Chireh B, Li M, D'Arcy C. Diabetes increases the risk of depression: A systematic review, meta-analysis and estimates of population attributable fractions based on prospective studies. Prev Med Rep. 2019; 14: 100822. https://doi.org/10.1016/j.pmedr.2019.100822
20. Kretchy IA, Owusu-Daaku FT, Danquah SA. Mental Health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. Int J Ment Health Syst. 2014; 8(25). https://doi.org/10.1186/1752-4458-8-25
21. Cohen BE, Edmondson D, Kronish IM. State of the Art Review: Depression, Stress, Anxiety, and cardiovascular disease. Am J Hypertens. 2015; 28(11): 1295-302. https://doi.org/10.1093/ajh/hpv047
22. Rantanen AT, Korkeila JJA, Loyttyniemi E, Saxén U, Korhonen PE. Awareness of hypertension and depressive symptoms: a cross-sectional study in a primary care population. Scand J Prim Health Care. 2018; 36(3): 323-8. https://doi.org/10.1080/02813432.2018.1499588
23. Xue K, Chen S, Bogner HR, Tang W, Li L, Conwell Y. The prevalence of depressive symptoms among older patients with hypertension in rural China. Int J Geriatr Psychiatry. 2017; 32(12): 1411-7. https://doi.org/10.1002/gps.4628
24. Shoaib-Hamrah M, Hassan-Hamrah M, Ishii H, Suzuki S, Hussain-Hamrah M, Edris-Hamrah A, et al. Anxiety and depression among hypertensive outpatients in Afghanistan: A Cross-Sectional Study in Andkhoy City. Int J Hypertens. 2018; 8. https://doi.org/10.1155/2018/8560835
25. Alkhathami A, Alamin M, Alqahtani A, Alsaeed W, Alkhathami M, Al-Dhafeeri A. Depression and anxiety among hypertensive and diabetic primary health care patients. Could patients' perception of their diseases control be used as a screening tool? Saudi Med J. 2017; 38(6): 621-8. https://doi.org/10.15537/smj.2017.6.17941
26. Liu MY, Li N, Li W, Khan H. Association between psychosocial stress and hypertension: a systematic. Review and meta-analysis. Neurol Res. 2017; 39(6): 573-80. https://doi.org/10.1080/01616412.2017
27. Organización Panamericana de la Salud. Cuidados Innovadores para las condiciones crónicas: Organización y prestación de atención de alta calidad a las enfermedades crónicas no transmisibles en las Américas. Washington, D.C: OPS; 2013.
28. Lawn S, Battersby M, Harvey P, Ackland A. A behavioural therapy approach to self-management: The Flinders Program. Diabetes Voice. 2009; 54: 30-2. https://bit.ly/2uXenhC
29. Loring K, Ritter P, Jacquez A. Outcomes of border health Spanish/English chronic disease self-management programs. Diabetes educ. 2005; 31(3): 404-9. http://dx.doi.org/10.1177/0145721705276574
30. Van Grieken R, Van Tricht M, Koeter M, Van den Brink W, Schene AH. The use and helpfulness of self-management strategies for depression: The experiences of patients. Plos One. 2018; 13(12): 1-12. https://dx.doi.org/10.1371/journal.pone.0209109
31. Loring K, Mazonson P, Holman H. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum. 1993; 36(4): 439-46. https://dx.doi.org/10.1002/art.1780360403
32. Loring K, Ritter P, Villa FJ, Armas J. Community-based peer-led diabetes self-management: a randomized trial. Diabetes educ. 2009; 35(4): 641-51. http://dx.doi.org/10.1177/0145721709335006
33. Lee MC, WU SV, Hsieh NC, Tsai JM. Self-Management on eGFR, depression and Quality of life patients with Chronic Kidney Disease: A Meta-Analysis. Asian Nursing Research. 2016; 10(4): 255-62. http://dx.doi.org/10.1016/j.anr.2016.04.002
34. Loring K, Ritter Pl, Pifer C, Werner P. Effectiveness of the chronic disease self- management program for persons with a serious mental illness: a translation study. Community Ment Health J. 2014; 50(1): 96-103. http://dx.doi.org/10.1007/s10597-013-9615-5
35. Eyles C, Leydon GM, Hoffman C J, Copson ER, Prescott P, Chorozoglou M, et al. Mindfulness for the self-management of fatigue, anxiety, and depression in women with metastatic breast cancer: a mixed methods feasibility study. Integr Cancer Ther. 2015; 14(1): 42-56. http://dx.doi.org/10.1177/1534735414546567
36. Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Self-management of multiple chronic conditions by community-dwelling older adults: A concept analysis. SAGE Open Nursing. 2017; 1: 1-16 https://doi.org/10.1177/2377960817752471
37. Schulman-Green D, Jaser SS, Park C, Whittemore R. A Metasynthesis of factors affecting self-management of chronic illness. J Adv Nurs. 2016; 72(7): 1469-89. https://doi.org/10.1111/jan.12902
38. Sakraida TJ, Weber MT. The Relationship between depressive symptoms and self-management behaviors in patients with T2DM and Stage 3 CKD. Perspect Psychiatric Care. 2016; 52(4): 273-82. https://doi.org/10.1111/ppc.12128
39. Manaze D, Everrett B, Astorga C, Yogendra D, Salomason Y. The influence of health literacy and depression on diabetes self-management: A Cross-Sectional Study. J Diabetes Res. 2016; 2016: 3458969. http://dx.doi.org/10.1155/2016/3458969
40. Peñarrieta MI, Reyes G, Krenderdt S, Flores F, Resendiz E, Chávez-Flores E. Automanejo en enfermedades crónicas: diabetes mellitus tipo 2, hipertensión arterial y cáncer. Revista de Investigación de la Universidad Norbert Wiener. 2015; (4): 43-53. https://bit.ly/3b6xma7
41. Mar-García J, Peñarrieta-de Córdova I, León-Hernández R, Gutiérrez-Gómez T, Banda-González O, Rangel-Torres S, et al. Relación entre automanejo y percepción de funcionalidad familiar en personas con diabetes mellitus tipo 2. Enferm Univ. 2017; 14(3): 155-61. http://dx.doi.org/10.1016/j.reu.2017.05.005
42. León-Hernández RC, Peñarrieta-de Córdova MI, Gutiérrez-Gómez T, Banda-González O, Flores-Barrios F, Rivera MC. Predictores del comportamiento de automanejo en personas con enfermedades crónicas de Tamaulipas. Enferm. Univ. 2019; 16(2): 128-37. http://dx.doi.org/10.22201/eneo.23958421e.2019.2.637
43. León HRC, Peñarrieta DCM, Gutiérrez GT. Capítulo V: Validación de instrumentos de indicadores de salud y psicosociales. Red de automanejo de enfermedades crónicas. En: Gutiérrez GT. Estrategias de aprendizaje en cronicidad. México: Colofón; 2019. p.65-84.
44. Kroenke K, Spitzer RL, Williams JB. The PHQ-9 Validity of brief depression severity measure. J. Gen Intern Med. 2001; 16(9): 606-13. https://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x
45. Kroenke K, Spitzer RL. The PHQ-9: A New Depression Diagnostic and severy measure. Psychiatric Annals. 2002; 32(9): 1-7. http://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x
2. Aguilar-Salinas C, Hernández-Jiménez S, Hernández-Ávila M, Hernández Ávila JE. Acciones para enfrentar a la diabetes. Documento de Postura. México, D.F: Academia Nacional de Medicina; 2015.
3. Secretaria de Salud-Instituto Nacional De Salud Pública. Encuesta Nacional de Salud y Nutrición de Medio Camino 2016. México: Secretaria de Salud; 2016. https://bit.ly/2S5pT2w
4. Olaiz-Fernández G, Rivera J, Shamah-Levy T, Rojas R, Villalpando-Hernández S, Hernández-Ávila M, et al. (Ed). Encuesta Nacional de Salud y Nutrición 2006. Cuernavaca, México: Instituto Nacional de Salud Pública; 2006. https://bit.ly/2GP8dmk
5. Olaiz G, Rojas R, Barquera S, Shamah T, Aguilar C, Cravioto P, et al. (Ed). Encuesta Nacional de Salud 2000. Tomo 2. La salud de los adultos. Cuernavaca, Morelos, México: Instituto Nacional De Salud Pública-Secretaria de Salud; 2003. https://bit.ly/2SbcS7x
6. Gutiérrez J, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, et al. Encuesta Nacional de Salud y Nutrición 2012. Resultados Nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública; 2012. https://bit.ly/2uWxwQK
7. Montalvo-Prieto A, Cabrera-Nanclares B, Quiñones-Arrieta S. Enfermedad crónica y sufrimiento: Revisión de literatura. Aquichan. 2012; 12(2): 134-43. https://doi.org/10.5294/aqui.2012.12.2.4
8. Orozco GAM, Castiblanco OL. Factores psicosociales e intervención psicológica en enfermedades crónicas no Transmisibles. Rev Colomb Psicol. 2015; 24(1): 203-17. https://dx.doi.org/10.15446/rcp.v24n1.42949
9. Wilhem K, Reddy J, Crawford J, Robins L, Campell L, Proudfoot J. The Importance of screening for mild depression in adults with diabetes. Transl Biomed. 2017; 8(1). https://doi.org/10.2167/2172-0479.1000101
10. Bădescu SV, Tătaru C, Kobylinka L, Georgescu EL, Zahiun DM, Zăgrean AM, et al. The association between diabetes mellitus and depression. J Med Life. 2016; 9(2): 120-5. https://bit.ly/2ROfIQN
11. Siddiqui S. Depression in type 2 diabetes mellitus: A brief review. Diabetes Metab Syndr. 2014; 8(1): 62-5. https://doi.org/10.1016/j.dsx.2013.06.010
12. Domingo AK, Asmal L, Seedat S, Esterhuizen TM, Laurence C, Volmink J. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers. S Afr Med J. 2015; 105(12): 1057-60. https://doi.org/10.7196/SAMJ.2015.v105i12.9843
13. Zhang Y, Ting RZ, Yang W, Jia W, Li W, Ji L, et al. Depression in chinese patients with type 2 diabetes: associations with hyperglucemia, hypoglucemia, and poor treat adherence. J Diabetes. 2015; 7(6): 800-8. https://doi.org/1111/1753-0407.12238
14. Olvera R, Fisher-Hoch SP, Williamson DE, Vatcheva KP, McCormick JB. Depression in Mexican Americans with diagnosed and undiagnosed diabetes. Psychol Med. 2016; 46(3); 637-43. https://doi.org/10.1017/S0033291715002160
15. Lara MM, Jacobs EA, Escamilla M, Mendenhall E. Depression among diabetic women in urban centers in México and the United States of America: a comparative study. Rev Panam Salud Publica. 2014; 36(4):225-31.
16. Schmitt A, Reimer A, Kulzer B, Haak T, Gahr A, Hermanns N. Negative association between depression and diabetes control only when accompanied by diabetes-specific distress. J Behav Med. 2014; 38(3): 556-64. https://doi.org/10.1007/s10865-014-9604-3
17. Fisher L, Gonzalez JS, Polonsky WH. The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med. 2014; 31(7): 764-72. https://doi.org/10.1111/dme.12428
18. Yu M, Zhang X, Lu F, Fang L. Depression and risk for diabetes: A meta-analysis. Can J Diabetes. 2015; 39(4): 266-72. https://doi.org/10.1016/j.jcjd.2014.11.006
19. Chireh B, Li M, D'Arcy C. Diabetes increases the risk of depression: A systematic review, meta-analysis and estimates of population attributable fractions based on prospective studies. Prev Med Rep. 2019; 14: 100822. https://doi.org/10.1016/j.pmedr.2019.100822
20. Kretchy IA, Owusu-Daaku FT, Danquah SA. Mental Health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. Int J Ment Health Syst. 2014; 8(25). https://doi.org/10.1186/1752-4458-8-25
21. Cohen BE, Edmondson D, Kronish IM. State of the Art Review: Depression, Stress, Anxiety, and cardiovascular disease. Am J Hypertens. 2015; 28(11): 1295-302. https://doi.org/10.1093/ajh/hpv047
22. Rantanen AT, Korkeila JJA, Loyttyniemi E, Saxén U, Korhonen PE. Awareness of hypertension and depressive symptoms: a cross-sectional study in a primary care population. Scand J Prim Health Care. 2018; 36(3): 323-8. https://doi.org/10.1080/02813432.2018.1499588
23. Xue K, Chen S, Bogner HR, Tang W, Li L, Conwell Y. The prevalence of depressive symptoms among older patients with hypertension in rural China. Int J Geriatr Psychiatry. 2017; 32(12): 1411-7. https://doi.org/10.1002/gps.4628
24. Shoaib-Hamrah M, Hassan-Hamrah M, Ishii H, Suzuki S, Hussain-Hamrah M, Edris-Hamrah A, et al. Anxiety and depression among hypertensive outpatients in Afghanistan: A Cross-Sectional Study in Andkhoy City. Int J Hypertens. 2018; 8. https://doi.org/10.1155/2018/8560835
25. Alkhathami A, Alamin M, Alqahtani A, Alsaeed W, Alkhathami M, Al-Dhafeeri A. Depression and anxiety among hypertensive and diabetic primary health care patients. Could patients' perception of their diseases control be used as a screening tool? Saudi Med J. 2017; 38(6): 621-8. https://doi.org/10.15537/smj.2017.6.17941
26. Liu MY, Li N, Li W, Khan H. Association between psychosocial stress and hypertension: a systematic. Review and meta-analysis. Neurol Res. 2017; 39(6): 573-80. https://doi.org/10.1080/01616412.2017
27. Organización Panamericana de la Salud. Cuidados Innovadores para las condiciones crónicas: Organización y prestación de atención de alta calidad a las enfermedades crónicas no transmisibles en las Américas. Washington, D.C: OPS; 2013.
28. Lawn S, Battersby M, Harvey P, Ackland A. A behavioural therapy approach to self-management: The Flinders Program. Diabetes Voice. 2009; 54: 30-2. https://bit.ly/2uXenhC
29. Loring K, Ritter P, Jacquez A. Outcomes of border health Spanish/English chronic disease self-management programs. Diabetes educ. 2005; 31(3): 404-9. http://dx.doi.org/10.1177/0145721705276574
30. Van Grieken R, Van Tricht M, Koeter M, Van den Brink W, Schene AH. The use and helpfulness of self-management strategies for depression: The experiences of patients. Plos One. 2018; 13(12): 1-12. https://dx.doi.org/10.1371/journal.pone.0209109
31. Loring K, Mazonson P, Holman H. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum. 1993; 36(4): 439-46. https://dx.doi.org/10.1002/art.1780360403
32. Loring K, Ritter P, Villa FJ, Armas J. Community-based peer-led diabetes self-management: a randomized trial. Diabetes educ. 2009; 35(4): 641-51. http://dx.doi.org/10.1177/0145721709335006
33. Lee MC, WU SV, Hsieh NC, Tsai JM. Self-Management on eGFR, depression and Quality of life patients with Chronic Kidney Disease: A Meta-Analysis. Asian Nursing Research. 2016; 10(4): 255-62. http://dx.doi.org/10.1016/j.anr.2016.04.002
34. Loring K, Ritter Pl, Pifer C, Werner P. Effectiveness of the chronic disease self- management program for persons with a serious mental illness: a translation study. Community Ment Health J. 2014; 50(1): 96-103. http://dx.doi.org/10.1007/s10597-013-9615-5
35. Eyles C, Leydon GM, Hoffman C J, Copson ER, Prescott P, Chorozoglou M, et al. Mindfulness for the self-management of fatigue, anxiety, and depression in women with metastatic breast cancer: a mixed methods feasibility study. Integr Cancer Ther. 2015; 14(1): 42-56. http://dx.doi.org/10.1177/1534735414546567
36. Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Self-management of multiple chronic conditions by community-dwelling older adults: A concept analysis. SAGE Open Nursing. 2017; 1: 1-16 https://doi.org/10.1177/2377960817752471
37. Schulman-Green D, Jaser SS, Park C, Whittemore R. A Metasynthesis of factors affecting self-management of chronic illness. J Adv Nurs. 2016; 72(7): 1469-89. https://doi.org/10.1111/jan.12902
38. Sakraida TJ, Weber MT. The Relationship between depressive symptoms and self-management behaviors in patients with T2DM and Stage 3 CKD. Perspect Psychiatric Care. 2016; 52(4): 273-82. https://doi.org/10.1111/ppc.12128
39. Manaze D, Everrett B, Astorga C, Yogendra D, Salomason Y. The influence of health literacy and depression on diabetes self-management: A Cross-Sectional Study. J Diabetes Res. 2016; 2016: 3458969. http://dx.doi.org/10.1155/2016/3458969
40. Peñarrieta MI, Reyes G, Krenderdt S, Flores F, Resendiz E, Chávez-Flores E. Automanejo en enfermedades crónicas: diabetes mellitus tipo 2, hipertensión arterial y cáncer. Revista de Investigación de la Universidad Norbert Wiener. 2015; (4): 43-53. https://bit.ly/3b6xma7
41. Mar-García J, Peñarrieta-de Córdova I, León-Hernández R, Gutiérrez-Gómez T, Banda-González O, Rangel-Torres S, et al. Relación entre automanejo y percepción de funcionalidad familiar en personas con diabetes mellitus tipo 2. Enferm Univ. 2017; 14(3): 155-61. http://dx.doi.org/10.1016/j.reu.2017.05.005
42. León-Hernández RC, Peñarrieta-de Córdova MI, Gutiérrez-Gómez T, Banda-González O, Flores-Barrios F, Rivera MC. Predictores del comportamiento de automanejo en personas con enfermedades crónicas de Tamaulipas. Enferm. Univ. 2019; 16(2): 128-37. http://dx.doi.org/10.22201/eneo.23958421e.2019.2.637
43. León HRC, Peñarrieta DCM, Gutiérrez GT. Capítulo V: Validación de instrumentos de indicadores de salud y psicosociales. Red de automanejo de enfermedades crónicas. En: Gutiérrez GT. Estrategias de aprendizaje en cronicidad. México: Colofón; 2019. p.65-84.
44. Kroenke K, Spitzer RL, Williams JB. The PHQ-9 Validity of brief depression severity measure. J. Gen Intern Med. 2001; 16(9): 606-13. https://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x
45. Kroenke K, Spitzer RL. The PHQ-9: A New Depression Diagnostic and severy measure. Psychiatric Annals. 2002; 32(9): 1-7. http://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x
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