Background Few studies have examined protective factors for diabetes distress. Purpose To examine the moderating role of social support in the relationship between the burden of diabetes and diabetes distress. Methods Adults with type 2 diabetes (N=119; 29% Latino, 61% Black, 25% White) completed validated measures of diabetes distress and social support. Multiple linear regression evaluated the moderating role of social support in the relationship between diabetes burden, indicated by prescription of insulin and presence of complications, and distress. Results Greater support satisfaction was significantly associated with lower distress after controlling for burden. Support satisfaction and number of supports significantly moderated the relationship between diabetes burden and distress. Post-hoc probing revealed a consistent pattern: Insulin was significantly associated with more diabetes distress at low levels of support but was not at high levels of support. Conclusion Findings support the stress-buffering hypothesis and suggest that social support may protect against diabetes distress.
Background Depression has increased prevalence and consistently predicts poor health outcomes among patients with diabetes. The impact of stressors related to diabetes and its treatment on depression assessment is infrequently considered. Methods We used mixed methods to evaluate depressive symptoms in adults with type 2 diabetes. We categorized responses related to diabetes and its treatment during interviews (n = 70) using the Montgomery–Åsberg Depression Rating Scale (MADRS) and administered questionnaires to measure diabetes-related distress and depressive symptoms. Results Participants (M age = 56, SD = 7; 67% female; 64% Black; 21% Latino) had mild depression on average (MADRS M = 10, SD = 9). Half of those with symptoms spontaneously mentioned diabetes context; 61% said diabetes contributed to their symptoms when questioned directly. Qualitative themes included: overlapping symptoms of diabetes and depression; burden of diabetes treatment; emotional impact of diabetes; and the bidirectional influence of depression and diabetes. Diabetes was mentioned more often at higher levels of depression severity (r = .38, p = .001). Higher HbA1c was associated with mentioning diabetes as a context for depressive symptoms (r = .32, p = .007). Insulin-users mentioned diabetes more often than those on oral medications only (p = .005). Limitations MADRS is not a traditional qualitative interview so themes may not provide an exhaustive view of the role of diabetes context in depression assessment. Conclusions and clinical implications The burden of type 2 diabetes and its treatment often provide an explanatory context for depressive symptoms assessed by structured clinical interviews, the gold standard of depression assessment. Diabetes context may influence accuracy of assessment and should inform intervention planning for those needing treatment.
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