title: The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: a structural equation modeling approach.
abstract: OBJECTIVE
  We investigated the longitudinal association between depressive symptoms and glycemic control (HbA1c) in adults with type 2 diabetes, and the extent to which that association was explained by health behaviors.
  
  
  METHODS
  This study assessed data on 998 adults (aged 51 and above) with type 2 diabetes in the US nationally representative Health and Retirement Study and its diabetes-specific mail survey. Participants' depressive symptoms and baseline health behaviors (exercise, body weight control, and smoking status) were collected in 1998. Follow-up health behaviors and the glycemic control outcome were measured at a 2- and 5-year intervals, respectively.
  
  
  RESULTS
  Nearly one in four of participants (23%) reported moderate or high levels of depressive symptoms at baseline (CES-D score >or=3). Adults with higher levels of depressive symptoms at baseline showed lower scores on baseline and follow-up health behaviors as well as higher HbA1c levels at a 5-year follow-up. Structural equation models (SEM) reveal that health behaviors accounted for 13% of the link between depressive symptoms and glycemic control.
  
  
  CONCLUSIONS
  The long-term relationship between depressive symptoms and glycemic control was supported in the present study. Health behaviors, including exercise, body weight control, and smoking status, explained a sizable amount of the association between depressive symptoms and glycemic control. More comprehensive diabetes self-care behaviors should be examined with available data. Other competing explicators for the link, such as endocrinological process and antidepressant effects, also warrant further examination.
authors.affiliation: Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, 16802, USA. cuc197@psu.edu
authors.forename: Ching-Ju
authors.initials: CJ
authors.lastname: Chiu
authors.forename: Linda A
authors.initials: LA
authors.lastname: Wray
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Beverly
authors.forename: Oralia G
authors.initials: OG
authors.lastname: Dominic