title: The association of minor and major depression with health problem-solving and diabetes self-care activities in a clinic-based population of adults with type 2 diabetes mellitus.
abstract: OBJECTIVE
  We examined whether problem-solving and diabetes self-management behaviors differ by depression diagnosis - major depressive disorder (MDD) and minor depressive disorder (MinDD) - in adults with Type 2 diabetes (T2DM).
  
  
  METHODS
  We screened a clinical sample of 702 adults with T2DM for depression, identified 52 positive and a sample of 51 negative individuals, and performed a structured diagnostic psychiatric interview. MDD (n=24), MinDD (n=17), and no depression (n=62) were diagnosed using Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) Text Revised criteria. Health Problem-Solving Scale (HPSS) and Summary of Diabetes Self-Care Activities (SDSCA) questionnaires determined problem-solving and T2DM self-management skills, respectively. We compared HPSS and SDSCA scores by depression diagnosis, adjusting for age, sex, race, and diabetes duration, using linear regression.
  
  
  RESULTS
  Total HPSS scores for MDD (β=-4.38; p<0.001) and MinDD (β=-2.77; p<0.01) were lower than no depression. Total SDSCA score for MDD (β=-10.1; p<0.01) was lower than for no depression, and was partially explained by total HPSS.
  
  
  CONCLUSIONS
  MinDD and MDD individuals with T2DM have impaired problem-solving ability. MDD individuals had impaired diabetes self-management, partially explained by impaired problem-solving. Future studies should assess problem-solving therapy to treat T2DM and MinDD and integrated problem-solving with diabetes self-management for those with T2DM and MDD.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Na
authors.initials: N
authors.lastname: Shin
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Felicia
authors.initials: F
authors.lastname: Hill-Briggs
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Susan
authors.initials: S
authors.lastname: Langan
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Payne
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD.
authors.forename: Constantine
authors.initials: C
authors.lastname: Lyketsos
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins University, Baltimore, MD. Electronic address: sahill@jhmi.edu.
authors.forename: Sherita Hill
authors.initials: SH
authors.lastname: Golden
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D015142:Baltimore / Q000453:epidemiology; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000523:psychology; D017281:Cost of Illness; D003863:Depression / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D003865:Major Depressive Disorder / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D015995:Prevalence; D011340:Problem Solving; D057566:Self Report; D000073278:Self-Management / Q000523:psychology; D000067559:Specific Learning Disorder / Q000150:complications* / Q000209:etiology / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology
keywords: Depression; Diabetes self-care activities; Major depressive disorder; Minor depressive disorder; Problem-solving; Type 2 diabetes mellitus