Association of depressive symptomology and psychological trauma with diabetes control among older American Indian women: Does social support matter?
OBJECTIVE
Among older American Indian women with type 2 diabetes (T2DM), we examined the association between mental health and T2DM control and if social support modifies the association.


METHODS
Survey data were linked to T2DM medical record information. Mental health measures were the Center for Epidemiologic Studies - Depression Scale and the National Anxiety Disorders Screening Day instrument. T2DM control was all HbA1c values taken post mental health measures.


RESULTS
There was not a significant association between depressive symptomatology and higher HbA1c although increased depressive symptomatology was associated with higher HbA1c values among participants with low social support. There was a significant association between psychological trauma and higher HbA1c values 12months [mean 7.5, 95% CI 7.0-8.0 for no trauma vs. mean 7.0, 95% CI 6.3-7.6 for trauma with no symptoms vs. mean 8.4, 95% CI 7.7-9.1 for trauma with ≥1 symptom(s)] and 6months later [mean 7.2, 95% CI 6.7-7.7 for no trauma vs. mean HbA1c 6.8, 95% CI 6.2-7.4 for trauma with no symptoms vs. mean 8.4, 95% CI 7.6-9.2 for trauma with ≥1 symptom(s)]. High social support attenuated the association between psychological trauma and HbA1c values.


CONCLUSIONS
T2DM programs may consider activities that would strengthen participants' social support and thereby building on an intrinsic community strength.
Western Carolina University, College of Health and Human Sciences, 4121 Little Savannah Road, Cullowhee, NC 28723, USA. Electronic address: rtgoins@wcu.edu.
R Turner
RT
Goins
Washington State University, Initiative for Research and Education to Advance Community Health, 1100 Olive Way, Suite 1200, Seattle, WA 98101, USA. Electronic address: Carolyn.noonan@wsu.edu.
Carolyn
C
Noonan
Portland State University, School of Community Health, College of Urban and Public Affairs, 506 SW Mill Street, Suite 450, Portland, OR 97201, USA. Electronic address: Kelly.gonzales@pdx.edu.
Kelly
K
Gonzales
Eastern Band of Cherokee Indians, Cherokee Indian Hospital, 1 Hospital Road CB - 268, Cherokee, NC 28719, USA.
Blythe
B
Winchester
Eastern Band of Cherokee Indians, Public Health and Human Services, 43 John Crowe Hill Road, PO Box 666, Cherokee, NC 28719, USA. Electronic address: vickbrad@nc-cherokee.com.
Vickie L
VL
Bradley
D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000523:psychology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000208:ethnology / Q000209:etiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D004552:Elder Abuse / Q000208:ethnology / Q000523:psychology*; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006306:Health Surveys; D006767:Hospitals, District; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000208:ethnology / Q000517:prevention & control*; D007198:Indians, North American; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D000067073:Psychological Trauma / Q000150:complications* / Q000208:ethnology / Q000209:etiology / Q000523:psychology; D012944:Social Support; D015144:Southeastern United States; D014481:United States; D016549:United States Indian Health Service
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
American Indians; Depression; Mental health; Older adults; Psychological trauma; Social support