Journal
DIABETES CARE
Volume 30, Issue 9, Pages 2222-2227Publisher
AMER DIABETES ASSOC
DOI: 10.2337/dc07-0158
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Funding
- AHRQ HHS [1 K02 HS014010, K02 HS014010] Funding Source: Medline
- NIDDK NIH HHS [K23 DK067452, K23 DK067452-04, K23 DK080228] Funding Source: Medline
- NIMH NIH HHS [R01 MH078571, 1R01MH078571-01] Funding Source: Medline
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OBJECTIVE - We examined the association between depression, measured as either a continuous symptom severity score or a clinical disorder variable, with self-care behaviors in type 2 diabetes. RESEARCH DESIGN AND METHODS - We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence. RESULTS - Of the patients, 19% met the criteria for probable major depression (HANDS score >= 9), and an additional 66.5% reported at least some depressive symptoms. After controlling for covariates, patients with probable major depression reported significantly fewer days' adherent to diet, exercise, and glucose self-monitoring regimens (P < 0.01) and 2.3-fold increased odds of missing medication doses in the previous week (95% CI 1.5-3.6, P < 0.001) compared with all other respondents. Continuous depressive symptom severity scores were I better predictors of nonadherence to diet, exercise, and medications than categorically defined probable major depression. Major depression was a better predictor of glucose monitoring. Among the two-thirds of patients not meeting the criteria for major depression (HANDS score < 9, n = 709), increasing HANDS scores were incrementally associated with poorer self-care behaviors (P < 0.01). CONCLUSIONS - These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care. in significant improvements in diabetes self-care.
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