Distress and Type 2 Diabetes Self-Care: Putting the Pieces Together

Claire J. Hoogendoorn, Clyde B. Schechter, Maria M. Llabre, Elizabeth A. Walker, Jeffrey S. Gonzalez

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Conflicting research emphasizes depression, diabetes distress, or well-being in relation to diabetes self-care and risk for poor health outcomes. Purpose: The purpose of this study was to test whether a latent variable for general psychological distress derived from shared variance of depression symptoms, diabetes distress, and well-being predicts a latent variable of diabetes self-care and to examine evidence for unique effects once shared effects are adjusted for. Methods: Adults with suboptimally controlled diabetes were recruited from the South Bronx, NY, for a telephonic diabetes self-management support trial. Baseline diabetes self-care, medication adherence, depression symptoms, diabetes distress, and well-being were measured by validated self-report. Structural equation modeling specified a latent variable for general psychological distress derived from shared variance of depression symptoms, diabetes distress, and well-being. Diabetes self-care was a latent variable indicated by diet, glucose self-monitoring, and medication adherence. Results: Participants (N = 627, 65% female) were predominantly ethnic minority (70% Hispanic; 45% Black) and 77% reported household income <$20K/year. Mean (standard deviation) age = 56 (12) years; A1c = 9.1% (1.9%); body mass index = 32 (8) kg/m2. The latent variable for psychological distress was a robust predictor of poorer diabetes self-care (coefficient = -0.59 [confidence interval = -0.71, -0.46], p <. 001) with good model fit. Unique paths from depression symptoms, diabetes distress, and well-being (all ps >. 99) to self-care were not observed. Conclusions: In this population of disadvantaged adults with suboptimally controlled diabetes, general psychological distress was strongly associated with poorer diabetes self-care and fully accounted for the effects of depression, diabetes distress, and positive well-being. This suggests that general distress may underlie previously reported associations between these constructs and diabetes self-care.

Original languageEnglish (US)
Pages (from-to)938-948
Number of pages11
JournalAnnals of Behavioral Medicine
Volume55
Issue number10
DOIs
StatePublished - Oct 1 2021

Keywords

  • Depression
  • Diabetes distress
  • Psychological distress
  • Self-care behavior
  • Type 2 diabetes
  • Well-being

ASJC Scopus subject areas

  • Psychology(all)
  • Psychiatry and Mental health

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