title: Cyclical relationship between depressive symptoms and diabetes distress in people with Type 2 diabetes mellitus: results from the Montreal Evaluation of Diabetes Treatment Cohort Study.
abstract: OBJECTIVE
  To determine if longitudinal cyclical relationships exist between depressive symptoms and diabetes distress in people with Type 2 diabetes mellitus.
  
  
  METHODS
  Data were obtained from the Montreal Evaluation of Diabetes Treatment study, a cohort study of 1691 people with Type 2 diabetes mellitus. Depressive symptoms and diabetes distress, measured with the Patient Health Questionnaire and Diabetes Distress Scale, respectively, were assessed at baseline, 1 year and 2 years. A cross-lagged path model analysis with all autoregressive associations was used. Paths and indirect associations were examined.
  
  
  RESULTS
  All paths in the model were significant. Depressive symptoms were positively associated with diabetes distress across consecutive time points and diabetes distress was positively associated with depressive symptoms across consecutive time points. The association between depressive symptoms at baseline and depressive symptoms at 2 years was mediated by both depressive symptoms and diabetes distress at 1 year. The association between diabetes distress at baseline and diabetes distress at 2 years was also mediated by both depressive symptoms and diabetes distress.
  
  
  CONCLUSIONS
  Depressive symptoms and diabetes distress are cyclically related; results suggest that depressive symptoms influence diabetes distress, which, in turn, influences depressive symptoms. Although many studies focus on the differences between depressive symptoms and diabetes distress, the present study is the first to provide longitudinal evidence that these constructs are cyclically related.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.|Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.
authors.forename: R J
authors.initials: RJ
authors.lastname: Burns
authors.affiliation: Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.|Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.
authors.forename: S S
authors.initials: SS
authors.lastname: Deschênes
authors.affiliation: Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.|Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.|Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Schmitz
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010507:Periodicity; D011792:Quebec / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology*