Depressive symptoms, daily stress, and adherence in late adolescents with type 1 diabetes

Abstract

Objective: To examine whether depressive symptoms are associated with greater perceived daily stress and moderate the link between stress severity and poorer daily adherence in late adolescents with Type 1 diabetes (T1D).

Method: 175 late adolescents with T1D completed measures of depressive symptoms and glycemic control during a baseline laboratory assessment. This assessment was followed by a 14-day daily diary during which adolescents rated the severity of general (GS) and diabetes-specific (DSS) stressful events, as well as adherence to their diabetes regimen.

Results: Multilevel modeling revealed that adolescents with more depressive symptoms reported more severe daily stress and poorer daily adherence on average, and had poorer glycemic control. On days with more severe DSS, but not GS, adolescents reported poorer adherence. This association was moderated by an interaction between depressive symptoms and the mean level of DSS severity experienced across the 2-week diary. In adolescents with low levels of depressive symptoms, poorer adherence was reported on days with more severe DSS across all levels of mean DSS severity. In adolescents with average or high levels of depressive symptoms, poorer adherence was reported on days with more severe DSS only when mean DSS severity was average or high.

Conclusions: Depressive symptoms are associated with poorer daily adherence and greater stress severity, and interact with mean DSS severity to moderate the link between daily stress and adherence. The results point to the importance of depressive symptoms for understanding associations between stress and adherence during late adolescence.

Figure 1. Simple Slopes at Low, Average, and High Levels of Mean DSS Severity as a Function of Level of Depressive Symptoms

Note. DSS = diabetes-specific stress. Low, average, and high values of mean DSS severity are defined as plus and minus one SD about the mean (centered values −0.68, 0, 0.68). Low, average, and high values of depressive symptoms are defined as plus and minus one SD about the mean (CES-D raw score values of 4.16, 16.56, and 29.01, respectively). The simple slopes of associations between daily DSS severity and adherence are not significantly different from zero for those with low mean DSS severity and average or high depressive symptoms; all other simple slopes are significantly different from zero (see text for simple slope estimates and results of significance tests).

Figure 2. Simple Slopes as a Function of Mean DSS Severity and Level of Depressive Symptoms

Note. Simple slopes of the association between daily DSS severity and adherence. DSS = diabetes-specific stress. Low, average, and high values of depressive symptoms are defined as plus and minus one SD about the mean (CES-D raw score values of 4.16, 16.56, and 29.01, respectively). The y-axis represents the association between daily DSS severity and daily adherence and the x-axis the centered value of mean DSS severity (i.e., a slope of 0 suggests no association between daily DSS severity and daily adherence). See text for values of significance region boundaries and associated simple slope estimates.