title: The relationship of diabetes-related distress and depressive symptoms with physical activity and dietary behaviors in adults with type 2 diabetes: A cross-sectional study.
abstract: Diabetes-related distress (DD) and depressive symptoms (DS) may influence self-management behaviors in people living with type 2 diabetes (T2D). We examined the association of DD and DS with physical activity (PA) and adherence to recommended dietary behaviors in adults with T2D.
  
  
  
  Using baseline data from 2040 adults with T2D in the Alberta's Caring for Diabetes (ABCD) cohort study, DD, DS, PA and adherence to dietary behaviors were assessed. A composite variable for presence of DD and DS was computed for analyses. ANOVA and logistic regression tested independent associations of DS and DD with PA and adherence to diet.
  
  
  
  Participants were 64±10.6years, 45% female, 76% with annual household income≤$80,000, and 86% with high school education or more. Those with DD alone were 1.8 times (95% CI 1.1, 2.9) and those with DD and DS combined were 2.0 times (95% CI 1.1, 3.7) more likely not to meet PA guidelines compared to those without DD or DS. The presence of DS alone was not significantly associated with meeting PA guidelines (OR 1.4; 95% CI 0.7, 3.0). Compared to those without DD or DS, patients with DD alone (OR 1.5; 95% CI 1.4, 3.4), DS alone (OR 5.2; 95% CI 2.7, 9.7), or DD and DS combined (OR 2.5; 95% CI 1.6, 3.8) were more likely to have poor adherence to recommended dietary behaviors.
  
  
  
  Greater distress or depressive symptoms were associated with worse self-management behaviors in adults with T2D. Attention to mental health status may improve participation in PA and adherence to diet recommendations in these patients.
authors.affiliation: Centre for Nursing and Health Studies, Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S-3A3, Canada; Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada T6G 2E1. Electronic address: sjohnson@athabascau.ca.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Johnson
authors.affiliation: Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada T6G 2E1.
authors.forename: Fatima
authors.initials: F
authors.lastname: Al Sayah
authors.affiliation: Centre for Nursing and Health Studies, Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S-3A3, Canada; Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada T6G 2E1.
authors.forename: Nonsikelelo
authors.initials: N
authors.lastname: Mathe
authors.affiliation: Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada T6G 2E1.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000416:Alberta; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000523:psychology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D003927:Diet, Diabetic / Q000009:adverse effects* / Q000523:psychology; D015444:Exercise / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D011446:Prospective Studies; D057566:Self Report; D000073278:Self-Management / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology
keywords: Depressive symptoms; Diabetes distress; Diet recommendations; Physical activity