Symptoms of depression prospectively predict poorer self-care in patients with Type 2 diabetes.
OBJECTIVE
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 (beta 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.
Gonzalez
J S
JS
Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. jsgonzalez@partners.org
Safren
S A
SA
Delahanty
L M
LM
Cagliero
E
E
Wexler
D J
DJ
Meigs
J B
JB
Grant
R W
RW
D000368:Aged; D003866:Depressive Disorder / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D012307:Risk Factors; D012648:Self Care / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology