Symptoms of depression prospectively predict poorer self-care in patients with Type 2 diabetes
Article first published online: 28 JUN 2008
© 2008 The Authors. Journal compilation © 2008 Diabetes UK
Volume 25, Issue 9, pages 1102–1107, September 2008
How to Cite
Gonzalez, J. S., Safren, S. A., Delahanty, L. M., Cagliero, E., Wexler, D. J., Meigs, J. B. and Grant, R. W. (2008), Symptoms of depression prospectively predict poorer self-care in patients with Type 2 diabetes. Diabetic Medicine, 25: 1102–1107. doi: 10.1111/j.1464-5491.2008.02535.x
- Issue published online: 29 AUG 2008
- Article first published online: 28 JUN 2008
- Accepted 12 June 2008
Aims To examine prospectively the association of depression symptoms with subsequent self-care and medication adherence in patients with Type 2 diabetes mellitus.
Methods Two hundred and eight primary care patients with Type 2 diabetes completed the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS) and the Summary of Diabetes Self-Care Activities (SDSCA) at baseline and at follow-up, an average of 9 months later. They also self-reported medication adherence at baseline and at a follow-up.
Results Baseline HANDS scores ranged from 0 to 27, with a mean score of 5.15 ± 4.99. In separate linear regression models that adjusted for baseline self-care, patients with higher levels of depressive symptoms at baseline reported significantly lower adherence to general diet recommendations and specific recommendations for consumption of fruits and vegetables and spacing of carbohydrates; less exercise; and poorer foot care at follow-up (β ranging from −0.12 to −0.23; P < 0.05). Similarly, each one-point increase in baseline HANDS score was associated with a 1.08-fold increase in the odds of non-adherence to prescribed medication at follow-up (95% confidence interval 1.001, 1.158, P = 0.047). Increases in depression scores over time also predicted poorer adherence to aspects of diet and exercise.
Conclusions Depressive symptoms predict subsequent non-adherence to important aspects of self-care in patients with Type 2 diabetes, even after controlling for baseline self-care. Although the relationship between symptoms of depression and poorer diabetes self-care is consistent, it is not large, and interventions may need to address depression and self-care skills simultaneously in order to maximize effects on diabetes outcomes.