Longitudinal Relationship between Depression and Diabetes Self-care in Minorities with Type 2 Diabetes
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This study evaluates the longitudinal relationship between depressive symptoms, diabetes-related self-efficacy, and diabetes self-management. The primary aims were: (1) to examine whether diabetes-related self-efficacy mediates the relationship between depression and diabetes self-care in African American and Latino adults with type 2 diabetes; (2) after controlling for intervention assignment, to examine the longitudinal association between depressive symptoms and diabetes self-management (i.e., diabetes self-care performance levels and glycemic control) and to determine if individuals with higher baseline levels of depression are less likely to increase diabetes management (i.e., self-care behaviors and glycemic control) during 6-, 12-, and 18-month follow-up; and (3) to examine biopsychosocial factors that predict change in depressive symptomatology across time, after controlling for intervention assignment. Baseline in-person survey data were collected from African American and Latinos aged greater than or equal to 18 years with type 2 diabetes participating in a diabetes self-management intervention at four primary care clinics (n = 276). The sample (n = 276) had a mean age of 53.2 years; 69% were female; 54% African American and 46% Hispanic; and 74% reported incomes below $20,000. Analyses of baseline data revealed that depression was negatively correlated with the self-care behaviors of general diet, specific diet, physical activity, foot care, and smoking, with higher depression scores associated with lower self-care performance. In the African American subgroup, diabetes-related self-efficacy was an important construct in the relational pathway between depression and diabetes self-care. Longitudinal analyses using generalized estimating equations revealed an inverse association between depressive symptoms and non-disease-specific health behaviors of diet and physical exercise. The longitudinal predictors of depression consisted of two intrapersonal constructs of diabetes-related self-efficacy and diabetes distress. These findings suggest that among Latino and African American adults with type 2 diabetes, depression may adversely affect adherence to non-disease-specific health behaviors across time, but the mutable risk factors of elevated diabetes distress levels and diminished self-efficacy may be targets for public health interventions related to mental well-being.
Generalized Estimating Equations