Association between subthreshold depression and self-care behaviors in people with type 2 diabetes: a systematic review of observational studies

Abstract

Background: Self-care behaviors in people living with type 2 diabetes are important to achieving optimal glycemic control. Major depression in type 2 diabetes is associated with decreased adherence to self-care behaviors. The association between subthreshold depression and self-care behaviors, however, has not previously been systematically reviewed. The objective of this review is to determine the association between subthreshold depression and self-care behaviors. Methods: A systematic search was performed in five electronic databases that included MEDLINE, EMBASE, PsycINFO, Emcare, and CINAHL. Any observational studies in adults with type 2 diabetes, investigating the association between subthreshold depression and any self-care behaviors, were included in the review. Qualitative studies, review articles, and gray literature were excluded. Two reviewers independently completed the title and abstract and full-text screening, appraised the study quality, and extracted the data. A third reviewer resolved any discrepancies between the reviewers if needed. Included articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Meta-analyses were not conducted because criteria for conducting such analyses were not met. Results: A total of 6408 articles were identified through the database searching. After the abstract and full-text review, two articles met the inclusion criteria. One of the included study was cross-sectional while the other was a longitudinal study. Both studies showed inconsistent findings in the association between subthreshold depression and self-care behaviors. Important risks of bias were identified in the included studies. Discussion: The evidence from the two included studies on a possible association between subthreshold depression and self-care behaviors in adults with type 2 diabetes was not consistent and potentially biased. Our review established a gap in knowledge and suggests that further high-quality studies are needed to examine the association between subthreshold depression and self-care behaviors in people with type 2 diabetes. Systematic review registration: PROSPERO CRD42018116373

Meta-analysis with systematic review to synthesize associations between oral health related quality of life and anxiety and depression

“…The association between depression and OHQOL identified in the synthesized data may reflect amotivation regarding oral hygiene behaviors. Individuals with depression often decrease their engagement in daily activities, including self-care and hygiene behaviors [ 8 – 12 ], and a prominent characteristic of depression is amotivation [ 13 ]. However, given that studies were cross-sectional in nature, the extent to which poor OHQOL may induce depression or features of depression may promote poor OHQOL warrants additional investigation.…”

“…The association between anxiety and OHQOL may also be explained by disrupted oral hygiene behaviors. Given worries, individuals with anxiety may not engage habitually in daily activities, including self-care and hygiene behaviors [ 8 – 12 ].…”

“…OHQOL has been linked to depression and anxiety. Regarding potential etiologies, the individuals may not maintain good oral hygiene (e.g., tooth brushing) when depressed or anxious [ 8 – 12 ]. Depression may generate amotivation and interfere with performance of daily activities [ 13 ], including self-care behaviors and personal hygiene.…”

Association between subthreshold depression and self‐care behaviours in adults with type 2 diabetes: A cross‐sectional study

“…In summary, subthreshold depression is common in people with type 2 diabetes (T2D) and may be associated with poor self‐care behaviours (Albertorio‐Diaz et al, 2017). In a systematic review, we identified two previous studies that have examined the association between subthreshold depression and self‐care behaviours in people with T2D (Shrestha et al, 2020). The results of these studies were discrepant, and important sources of bias were identified; further research to test this association is warranted.…”

Relación entre depresión y adherencia al tratamiento en diabetes tipo 2, considerando la red de apoyo social, las estrategias de afrontamiento y el sexo

“…Existen pocos estudios para determinar la naturaleza de la relación de causalidad entre depresión y adherencia al tratamiento y algunos de ellos reportan resultados inconsistentes y de baja rigurosidad a nivel metodológico (Escobedo et al, 2007;Rivas-Acuña et al, 2011). Por lo expuesto, la presente investigación tratar de evaluar cuál sería el modelo más adecuado, aquel donde la depresión infl uye negativamente a la adherencia o la adherencia al tratamiento infl uye negativamente a la depresión (Moral de la Rubia & Cerda, 2015;Shrestha et al, 2020).…”