Symptoms of depression prospectively predict poorer self‐care in patients with Type 2 diabetes
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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.
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Longitudinal data support the directionality of the relationship and show that baseline symptoms of depression and increases in depressive symptoms over time are each significantly associated with worse diabetes self-care 9 months later, even when baseline levels of self-care are controlled.
“we have recently published longitudinal data that support the directionality of this relationship and show that baseline symptoms of depression and increases in depressive symptoms over time are each significantly associated with worse diabetes self-care 9 months later, even when baseline levels of self-care are controlled [8].”
From Differentiating symptoms of depression from diabetes-specific distress: relationships with self-care in type 2 diabetes (2008) · cites this paper as [8]
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- Authors
- Gonzalez, J. S., Safren, S. A., Delahanty, L. M., Cagliero, E., Wexler, D. J., Meigs, J. B., & Grant, R. W.
- Affiliations
- Harvard University (US)
- Corresponding author
- Gonzalez, J. S.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2008-08-29
- Volume
- 25
- Issue
- 9
- Pages
- 1102-1107
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- PMC
- PMC2635490
- OpenAlex
- W2098960995
- Cited by
- 192
- References
- 27
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 6 · 2023: 6 · 2022: 12 · 2021: 9 · 2020: 10 · 2019: 11 · 2018: 14 · 2017: 17 · 2016: 12 · 2015: 11 · 2014: 18 · 2013: 19 · 2012: 10
- FWCI
- 6.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5k23dk080228-04, 1r01mh078571-01)
- National Institute of Mental Health (R21MH066660, 1R01MH078571-01, R01 MH-078571)
- National Institute on Drug Abuse (L30 DA022009)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK080140, K23-DK-080228, K23DK067452)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- depression, depressive symptoms, type 2 diabetes, diabetes self-care, medication adherence, dietary adherence, exercise adherence, foot care, primary care patients, prospective prediction
- MeSH terms
- Aged, Depressive Disorder, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Patient Compliance, Risk Factors, Self Care, Stress, Psychological
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