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Soc Psychiatry Psychiatr Epidemiol. 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.

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  • 1Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, 16802, USA. cuc197@psu.edu

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.

PMID:
19343264
[PubMed - indexed for MEDLINE]
PMCID:
PMC2804782
Free PMC Article
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