Role of motivation in the relationship between depression, self-care, and glycemic control in adults with type 2 diabetes

Abstract

Purpose: The mechanism by which depression influences health outcomes in persons with diabetes is uncertain. The purpose of this study was to test whether depression is related to self-care behavior via social motivation and indirectly related to glycemic control via self-care behavior.

Methods: Patients with diabetes were recruited from an outpatient clinic. Information gathered pertained to demographics, depression, and diabetes knowledge (information); diabetes fatalism (personal motivation); social support (social motivation); and diabetes self-care (behavior). Hemoglobin A1C values were extracted from the patient medical record. Structural equation models tested the predicted pathways.

Results: Higher levels of depressive symptoms were significantly related to having less social support and decreased performance of diabetes self-care behavior. In addition, when depressive symptoms were included in the model, fatalistic attitudes were no longer associated with behavioral performance.

Conclusions: Among adults with diabetes, depression impedes the adoption of effective self-management behaviors (including physical activity, appropriate dietary behavior, foot care, and appropriate self-monitoring of blood glucose behavior) through a decrease in social motivation.

Figure 1

Depressive Symptoms and the Information-Motivation-Behavioral Skills Model of Diabetes Self-Care (full). Note: Coefficients are standardized path coefficients. Overall model fit, χ²(23, N=126)=19.70, p=0.66, CFI=1.00, RMSEA=0.00 (90% CI: 0.00–0.06). For tests of significance of individual paths, ^tp = 0.08, *p < 0.05, **p < 0.01 and ***p < 0.001.

Figure 2

Depressive Symptoms and the Information-Motivation-Behavioral Skills Model of Diabetes Self-Care (trimmed). Note: Coefficients are standardized path coefficients. Overall model fit, χ²(18, N=126)=18.16, p=0.44, CFI=1.00, RMSEA=0.01 (90% CI: 0.00–0.08). For tests of significance of individual paths, ^tp = 0.06, *p < 0.05, **p < 0.01 and ***p < 0.001.