Depressive symptom dimensions and medication non-adherence in suboptimally controlled type 2 diabetes

Claire J. Hoogendoorn, Amit Shapira, Juan F. Roy, Elizabeth A. Walker, Hillel W. Cohen, Jeffrey S. Gonzalez

Research output: Contribution to journalArticle

Abstract

Aims: Research suggests differential effects for somatic and cognitive-affective depressive symptoms in predicting health outcomes. This study evaluated differential relations with medication non-adherence among disadvantaged, and predominantly immigrant adults with sub-optimally controlled type 2 diabetes (T2D). Methods: Health plan members taking oral diabetes medication and who had A1c ≥ 7.5% were recruited for a trial of telephonic self-management support. A subset (n = 376; age, M = 55.6 ± 7.2 years; A1c M = 9.1% ± 1.6) completed the Patient Health Questionnaire-8 (PHQ-8). Diabetes medication adherence was measured by self-report and claims-based records. Multivariable logistic regression modeled depressive symptoms and odds of non-adherence using pre-intervention data. Results: A positive PHQ-8 screen (OR = 2.72 [95%CI: 1.56–4.73]) and each standard deviation increase in PHQ-8 score (OR = 1.40 [95%CI: 1.11–1.75]) were associated with non-adherence, with no independent effects for somatic versus cognitive-affective symptoms. Exploration of individual symptoms identified three significantly associated with non-adherence in covariate-adjusted models; after adjustment for likely presence of clinical depression, only fatigue was independently associated with non-adherence (OR = 1.71 [95%CI: 1.06–2.77]). Conclusions: Findings support depression symptom severity as a significant correlate of medication non-adherence among disadvantaged adults with T2D. Support was limited for differential associations for symptom dimensions, but findings suggest that fatigue may be associated with non-adherence independent of the likely presence of depression.

Original languageEnglish (US)
JournalJournal of Diabetes and its Complications
DOIs
StateAccepted/In press - Jan 1 2018

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Medication Adherence
Type 2 Diabetes Mellitus
Depression
Health
Affective Symptoms
Vulnerable Populations
Fatigue
Neurobehavioral Manifestations
Self Care
Self Report
Logistic Models
Research
Surveys and Questionnaires

Keywords

  • Cognitive-affective symptoms
  • Depression
  • Medication adherence
  • Somatic symptoms
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Depressive symptom dimensions and medication non-adherence in suboptimally controlled type 2 diabetes. / Hoogendoorn, Claire J.; Shapira, Amit; Roy, Juan F.; Walker, Elizabeth A.; Cohen, Hillel W.; Gonzalez, Jeffrey S.

In: Journal of Diabetes and its Complications, 01.01.2018.

Research output: Contribution to journalArticle

Hoogendoorn, Claire J. ; Shapira, Amit ; Roy, Juan F. ; Walker, Elizabeth A. ; Cohen, Hillel W. ; Gonzalez, Jeffrey S. / Depressive symptom dimensions and medication non-adherence in suboptimally controlled type 2 diabetes. In: Journal of Diabetes and its Complications. 2018.
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abstract = "Aims: Research suggests differential effects for somatic and cognitive-affective depressive symptoms in predicting health outcomes. This study evaluated differential relations with medication non-adherence among disadvantaged, and predominantly immigrant adults with sub-optimally controlled type 2 diabetes (T2D). Methods: Health plan members taking oral diabetes medication and who had A1c ≥ 7.5{\%} were recruited for a trial of telephonic self-management support. A subset (n = 376; age, M = 55.6 ± 7.2 years; A1c M = 9.1{\%} ± 1.6) completed the Patient Health Questionnaire-8 (PHQ-8). Diabetes medication adherence was measured by self-report and claims-based records. Multivariable logistic regression modeled depressive symptoms and odds of non-adherence using pre-intervention data. Results: A positive PHQ-8 screen (OR = 2.72 [95{\%}CI: 1.56–4.73]) and each standard deviation increase in PHQ-8 score (OR = 1.40 [95{\%}CI: 1.11–1.75]) were associated with non-adherence, with no independent effects for somatic versus cognitive-affective symptoms. Exploration of individual symptoms identified three significantly associated with non-adherence in covariate-adjusted models; after adjustment for likely presence of clinical depression, only fatigue was independently associated with non-adherence (OR = 1.71 [95{\%}CI: 1.06–2.77]). Conclusions: Findings support depression symptom severity as a significant correlate of medication non-adherence among disadvantaged adults with T2D. Support was limited for differential associations for symptom dimensions, but findings suggest that fatigue may be associated with non-adherence independent of the likely presence of depression.",
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