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Comparative Study
. 2010 Jan;45(1):67-76.
doi: 10.1007/s00127-009-0043-3. Epub 2009 Apr 3.

The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: a structural equation modeling approach

Ching-Ju Chiu  1 , Linda A Wray, Elizabeth A Beverly, Oralia G Dominic
Affiliations
Comparative Study

The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: a structural equation modeling approach

Ching-Ju Chiu et al. Soc Psychiatry Psychiatr Epidemiol. 2010 Jan.

Abstract

Objectives: We investigated the longitudinal association between depressive symptoms and glycemic control (HbA1c) in adults with type 2 diabetes, and the extent to which that association was explained by health behaviors.

Methods: This study assessed data on 998 adults (aged 51 and above) with type 2 diabetes in the US nationally representative Health and Retirement Study and its diabetes-specific mail survey. Participants' depressive symptoms and baseline health behaviors (exercise, body weight control, and smoking status) were collected in 1998. Follow-up health behaviors and the glycemic control outcome were measured at a 2- and 5-year intervals, respectively.

Results: Nearly one in four of participants (23%) reported moderate or high levels of depressive symptoms at baseline (CES-D score >or=3). Adults with higher levels of depressive symptoms at baseline showed lower scores on baseline and follow-up health behaviors as well as higher HbA1c levels at a 5-year follow-up. Structural equation models (SEM) reveal that health behaviors accounted for 13% of the link between depressive symptoms and glycemic control.

Conclusions: The long-term relationship between depressive symptoms and glycemic control was supported in the present study. Health behaviors, including exercise, body weight control, and smoking status, explained a sizable amount of the association between depressive symptoms and glycemic control. More comprehensive diabetes self-care behaviors should be examined with available data. Other competing explicators for the link, such as endocrinological process and antidepressant effects, also warrant further examination.

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Figures

Fig. 1
Fig. 1
Hypothesized relationships between depressive symptoms, concurrent baseline health behaviors, 2-year follow-up health behaviors, and 5-year follow-up glycemic control. CESDpar1 CESD scale items: feel depressed and restless sleep, CESDpar2 CESD scale items: feel sad and not getting going, CESDpar3 CESD scale items: did not feel happy and did not enjoy life, CESDpar4 CESD scale items: feel lonely and everything is an effort. Source: 1998–2000 Health and Retirement Study (HRS) and 2003 diabetes-specific mail survey
Fig. 2
Fig. 2
Final model of the relationships between depressive symptoms, baseline health behaviors, follow-up lifestyle behaviors, and HbA1c levels (N = 998). Source: 1998–2000 Health and Retirement Study (HRS) and 2003 diabetes-specific mail survey
See this image and copyright information in PMC

References

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