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Interaction between depressive symptoms and illness representations in predicting self-care behaviours in type 2 diabetic patients

Background and aims: Predictive value of illness representations including seriousness, treatment effectiveness and control, on multiple diabetes outcomes has been well established. This study aimed to determine how depressive symptoms interacted with personal model’s domains in predicting eating behaviour, physical activity, blood glucose self-monitoring and foot care in type 2 diabetic patients. Materials and methods: A randomly selected sample of 172 type 2 outpatients (55% female, aged 63±8, educated for 10.5±4 yrs., with diabetes duration of 10±8 yrs., 29% insulin-treated, with 6.5%±0.9 HbA1C and 30±4 kg/m2 BMI) was interviewed for psychological anamnesis and examined for depressive symptoms and personal model of diabetes. Respondents’ mood and illness representations were assessed by The Patient Health Questionnaire-Depression (PhQ-9) and the 8-item Personal Model of Diabetes Questionnaire (PM), and their self-care behaviours were approximated by the Summary of Diabetes Self-Care Activities (SDSCA). Participants were divided into three groups: without depressive symptoms (PhQ<5), with minimal symptoms (PhQ=5-9) and with moderate to severe depressive symptoms (PhQ≥10), which were compared as to personal model, self-reported self-care and disease-related characteristics. Kruskal-Wallis ANOVA was used to compare psychological and disease-related variables in the groups with different depressive symptom levels, and ordinal multinomial regression model to assess to what degree depressive symptoms and personal model of diabetes predicted particular self-care behaviours. Results: Minimal depressive symptoms were reported by 20% of the patients, and moderate to severe symptoms by another 9%. No differences in age, diabetes duration, type of therapy, HbA1C and BMI were found between the non-depressed group and patients with depressive symptoms (all p>0.05). Self-reported eating behaviour, exercise and foot care were comparable across the groups (all p>0.05). Blood glucose self-monitoring was most frequent in patients with minimal depressive symptoms, followed by non-depressed and moderately to severely depressed ones (H=5.80 p=0.05). Diabetes impact on daily life as measured by PM was reported greater by both depressed groups compared to the non-depressed one (H=6.18 p=0.04), while other domains - seriousness, diabetes control and prevention of complications - did not differ across the groups. Non-linear regression model indicated that the control beliefs independently predicted patients’ eating behaviour and physical activity as measured by SDSCA (Wald Stat=9.3 p=0.002 and Wald Stat=7.4 p=0.006, respectively). Foot care was predicted by seriousness beliefs (Wald Stat=4.6 p=0.03), while depressive symptoms were the only independent predictor of blood glucose self-monitoring (Wald Stat=7.9 p=0.01). Conclusion: Even mild depressive symptoms were found to be associated with illness representations in type 2 diabetic patients, implying a more highly perceived impact of diabetes on daily activities. Beliefs that self care controlled diabetes were the best predictors of eating behaviour and exercise, while feelings about diabetes seriousness and worry predicted foot care. Depressive symptoms rather than personal model domains predicted blood glucose self-monitoring, showing a positive effect in mild depressive symptoms and adverse in moderate to severe ones.

depressive symptoms; illness representations; type 2diabetes

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