title: What are the combined effects of negative emotions and illness cognitions on self-care in people with type 2 diabetes? A longitudinal structural equation model.
abstract: To explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care.
  
  
  
  Longitudinal observational study in adults with type 2 diabetes.
  
  
  
  Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling.
  
  
  
  Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern's effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion's effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time.
  
  
  
  Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.
authors.affiliation: a Health Psychology Section, Psychology Department , Institute of Psychiatry, Psychology, and Neuroscience, King's College London , London , UK.|b NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) - Greater Manchester and Manchester Academic Health Science Centre, University of Manchester , Manchester , UK.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Hudson
authors.affiliation: b NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) - Greater Manchester and Manchester Academic Health Science Centre, University of Manchester , Manchester , UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Bundy
authors.affiliation: b NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) - Greater Manchester and Manchester Academic Health Science Centre, University of Manchester , Manchester , UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Coventry
authors.affiliation: c Mental Health Research Group, Institute of Health Research , University of Exeter Medical School and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula (PenCLAHRC) , Exeter , UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Dickens
authors.affiliation: d Behavioral Science Centre, Stirling Management School , University of Stirling . Stirling , Scotland.|e Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester , Manchester , UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Wood
authors.affiliation: f Centre for Primary Care , NIHR School for Primary Care Research, University of Manchester , Manchester , UK.|g Centre for Biostatistics , University of Manchester , Manchester , UK.
authors.forename: David
authors.initials: D
authors.lastname: Reeves
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D001294:Attitude to Health; D003071:Cognition; D003863:Depression / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D004644:Emotions; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D012648:Self Care / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: anxiety; depression; diabetes self-care; illness cognitions; longitudinal; structural equation modelling