Adherence, body mass index, and depression in adults with type 2 diabetes: The mediational role of diabetes symptoms and self-efficacy.

Sacco, William P.; Wells, Kristen J.; Friedman, Andrea; Matthew, Rebecca; Perez, Sylvia; Vaughan, Christine Anne

doi:10.1037/0278-6133.26.6.693

Cited by 61 publications

(50 citation statements)

References 67 publications

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“…This has important clinical implications as interventions designed to bolster selfefficacy may be more effective than those which target depressive symptoms alone. These findings are consistent with previous findings by Sacco et al (2005Sacco et al ( , 2007, which found similar relationships. Future studies should aim to further refine our understanding of the interactions between self-efficacy and adherence and the role that depression plays.…”

Section: Discussionsupporting

confidence: 95%

Mediators of adherence among adults with comorbid diabetes and depression: The role of self-efficacy and social support

et al. 2013

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Depression and diabetes have been linked in a variety of ways, and the presence of depression in those with diabetes can negatively affect adherence to care recommendations. A sample of 201 participants with Type 2 Diabetes completed a cross-sectional survey that assessed depressive symptoms, adherence, self-efficacy, social support, and personal characteristics. Multiple regression analysis was used to test whether self-efficacy and social support mediate the relationship between depressive symptoms and adherence. The findings suggest complete mediation via self-efficacy and some types of social support. Intervening to bolster self-efficacy and social support may decrease the negative effect of depression on adherence.

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Section: Discussionsupporting

confidence: 95%

Mediators of adherence among adults with comorbid diabetes and depression: The role of self-efficacy and social support

et al. 2013

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“…An equally plausible interpretation of these findings is that poor health and lower levels of positive medication beliefs contribute to depressive symptoms (Sacco et al, 2007). It is possible that individuals with a history of poor adherence may develop less positive beliefs about their ability to adhere to prescribed medications and the health benefits of adherence, which may generalize to more global feelings of discouragement, frustration, and depressed mood.…”

Section: Discussionmentioning

confidence: 99%

Medication beliefs mediate between depressive symptoms and medication adherence in cystic fibrosis.

Hilliard¹,

Eakin²,

Borrelli³

et al. 2015

Health Psychology

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Objective Depression is a known barrier to regimen adherence for chronic conditions. Despite elevated depression rates and complex regimens for people with cystic fibrosis (CF), little is known about associations between depressive symptoms and CF adherence. One possibility is that depressive symptoms distort beliefs about medications, which may influence adherence. Method Adolescents and adults (N = 128; mean age = 29 ± 11 years, range = 16–63, 93% Caucasian) with CF reported on depressive symptoms and medication beliefs (self-efficacy, motivation, perceived importance, and outcome expectancies related to taking medications). Medication adherence was assessed objectively through pharmacy refill data. Cross-sectional structural equation models evaluated medication beliefs as a mediator between depressive symptoms and medication adherence. Results Twenty-three percent of participants exceeded clinical cutoffs for depressive symptoms. Participants took less than half of prescribed pulmonary medications (mean adherence rate = 44.4 ± 26.7%). Depressive symptoms were correlated with adherence (r = −.22, p < .05), and medication beliefs (b = −0.13, 95% CI [−0.24, −0.03]) significantly mediated this relation. Higher depressive symptoms were associated with less positive medication beliefs (b = −0.27, p < .01), which were associated with lower medication adherence (b = 0.49, p < .01). Conclusions Depressive symptoms are related to beliefs about and adherence to CF medications. Monitoring depressive symptoms and medication beliefs in routine CF care may help identify risks for nonadherence and facilitate interventions to reduce depression, adaptive medication beliefs, and ultimately improve adherence and CF management.

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“…One study reported both selfreported and caregiver reported data for depression and self-care; we used selfreported data for the analysis (12). Where two papers were published from samples that were not independent, we included the article with the stronger design: longitudinal over cross-sectional (13,14) or larger sample (15,16). Finally, one study measured depression as both a diagnosis based on structured interview and as a comparison based on the total score from the Centers for Epidemiological Studies Depression Scale (CESD) using two different cutoffs (16 or 22) (17).…”

Section: Study Proceduresmentioning

confidence: 99%

Depression and Diabetes Treatment Nonadherence: A Meta-Analysis

et al. 2008

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OBJECTIVE -Depression is common in patients with diabetes and is associated with worse treatment outcomes. Its relationship to treatment adherence, however, has not been systematically reviewed. We used meta-analysis to examine the relationship between depression and treatment nonadherence in patients with type 1 and type 2 diabetes.RESEARCH DESIGN AND METHODS -We searched MEDLINE and PsycINFO databases for all studies published by June 2007 and reviewed references of published articles. Meta-analytic procedures were used to estimate the effect size r in a random effects model. Significance values, weighted effect sizes, 95% CIs, and tests of homogeneity of variance were calculated.RESULTS -Results from 47 independent samples showed that depression was significantly associated with nonadherence to the diabetes treatment regimen (z ϭ 9.97, P Ͻ 0.0001). The weighted effect size was near the medium range (r ϭ 0.21, 95% CI 0.17-0.25). Moderator analyses showed that the effect was significantly larger in studies that measured self-care as a continuous versus categorical variable (P ϭ 0.001). Effect sizes were largest for missed medical appointments and composite measures of self-care (r values ϭ 0.31, 0.29). Moderation analyses suggest that effects for most other types of self-care are also near the medium range, especially in studies with stronger methodologies.CONCLUSIONS -These findings demonstrate a significant association between depression and treatment nonadherence in patients with diabetes. Studies that used stronger methodologies had larger effects. Treatment nonadherence may represent an important pathway between depression and worse diabetes clinical outcomes.

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Adherence, body mass index, and depression in adults with type 2 diabetes: The mediational role of diabetes symptoms and self-efficacy.

Cited by 61 publications

References 67 publications

Mediators of adherence among adults with comorbid diabetes and depression: The role of self-efficacy and social support

Mediators of adherence among adults with comorbid diabetes and depression: The role of self-efficacy and social support

Medication beliefs mediate between depressive symptoms and medication adherence in cystic fibrosis.

Depression and Diabetes Treatment Nonadherence: A Meta-Analysis

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