Depression, Self-Care, and Medication Adherence in Type 2 Diabetes
- 1 September 2007
- journal article
- clinical trial
- Published by American Diabetes Association in Diabetes Care
- Vol. 30 (9), 2222-2227
- https://doi.org/10.2337/dc07-0158
Abstract
OBJECTIVE—We examined the association between depression, measured as either a continuous symptom severity score or a clinical disorder variable, with self-care behaviors in type 2 diabetes. RESEARCH DESIGN AND METHODS—We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence. RESULTS—Of the patients, 19% met the criteria for probable major depression (HANDS score ≥9), and an additional 66.5% reported at least some depressive symptoms. After controlling for covariates, patients with probable major depression reported significantly fewer days' adherent to diet, exercise, and glucose self-monitoring regimens (P < 0.01) and 2.3-fold increased odds of missing medication doses in the previous week (95% CI 1.5–3.6, P < 0.001) compared with all other respondents. Continuous depressive symptom severity scores were better predictors of nonadherence to diet, exercise, and medications than categorically defined probable major depression. Major depression was a better predictor of glucose monitoring. Among the two-thirds of patients not meeting the criteria for major depression (HANDS score n = 709), increasing HANDS scores were incrementally associated with poorer self-care behaviors (P < 0.01). CONCLUSIONS—These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care. Interventions aimed at alleviating depressive symptoms, which are quite common, could result in significant improvements in diabetes self-care.Keywords
This publication has 28 references indexed in Scilit:
- Factors Influencing Glycemic Control in Type 2 Diabetes During Acute- and Maintenance-Phase Treatment of Major Depressive Disorder With BupropionDiabetes Care, 2007
- Association of diabetes‐related emotional distress with diabetes treatment in primary care patients with Type 2 diabetesDiabetic Medicine, 2007
- Internet use among primary care patients with type 2 diabetesJournal of General Internal Medicine, 2005
- Individuals with type 2 diabetes and depressive symptoms exhibited lower adherence with self-careJournal of Clinical Epidemiology, 2004
- Depression Increases Diabetes Symptoms by Complicating Patients’ Self-Care AdherenceThe Diabetes Educator, 2004
- Screening for depression in medical careJournal of Psychosomatic Research, 2003
- Longitudinal investigation of depression outcomes in primary care in six countries: the LIDO Study. Functional status, health service use and treatment of people with depressive symptomsPsychological Medicine, 2002
- The summary of diabetes self-care activities measure: results from 7 studies and a revised scale.Diabetes Care, 2000
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- The Hopkins Symptom Checklist (HSCL): A self-report symptom inventoryBehavioral Science, 1974