Gender Differences in Adherence and Metabolic Control in Urban Youth with Poorly Controlled Type 1 Diabetes: The Mediating Role of Mental Health Symptoms

Naar‐King, Sylvie; Idalski, April; Ellis, Deborah A.; Frey, Maureen A.; Templin, Thomas; Cunningham, Phillippe B.; Cakan, Nedim

doi:10.1093/jpepsy/jsj090

Cited by 86 publications

(71 citation statements)

References 40 publications

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“…If sample sizes differed for different measures, we used the measures that had a larger sample size (10,11). 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).…”

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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Section: Study Proceduresmentioning

confidence: 99%

Depression and Diabetes Treatment Nonadherence: A Meta-Analysis

et al. 2008

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“…Results of a population based study by Kanton et al suggest that independent factors are associated with higher chance of meeting criteria for major depression. The criteria for developing major depression are younger age, smoking, and female, less education, unmarried, with BMI 30. In men major depression was found to be a result of similar factors including higher number of of diabetic complications.…”

Section: Clinical Diabetic Depression and Sociological Involvementmentioning

confidence: 96%

“…Findings in 1,223 adults with diabetes-depression suggest that depression symptoms make it harder to reach optimal A1c levels, but anti-depressive treatment may ameliorate this effect [29]. Studies report a clear link between mental health symptoms and poor metabolic control (high levels of HbA1c) without gender differences in youths with poorly controlled type I diabetes [30]. Also, unlike blood pressure, depression seems to make it harder to obtain the target values for lipids [29].…”

Section: Setting Clinical Goals For Depressed Diabetic Patientsmentioning

confidence: 99%

Examination of the Synergistic Relationship of Diabetes and Depression

Galinski¹

2013

Biochem Physiol

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“…[20][21][22] In particular, there is evidence that symptoms of depression and anxiety may disrupt adherence through decreased concentration, impact on judgment ability, memory impairment, and decreased motivation and energy, which are all symptoms of the disorders themselves. [23][24][25] Additional psychological characteristics that have been found to be related to diabetes adherence and subsequent glycemic control are maladaptive eating attitudes and behaviors, including the potential for insulin omission for the purposes of weight control.…”

Section: Individualmentioning

confidence: 99%

Behavioral Factors Influencing Health Outcomes in Youth with Type 1 Diabetes

Kichler¹,

Moss²,

Kaugars³

2012

US Endocrinology

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Adherence to medical regimen is often identified as a hallmark modifiable factor that impacts health outcomes for those with chronic medical illnesses. Rapoff suggests that adherence to medical regimens is estimated to be between 50-55 % for all chronically ill patients. 1 He describes a number of patient and family (e.g., demographic, adjustment/coping, family involvement), disease-and regimen-related correlates to adherence; however, correlates do not imply causation and should be interpreted cautiously.1 Researchers have rated non-adherence rates to be between 20 to 93 % 1-3 for youth with type 1 diabetes and have found that adherence is widely accepted as related to diabetes control. 4In a recent review article, Modi et al. make a distinction between two constructs: self-management (i.e., the interactions of health behaviors and related processes that patients and families engage in to carefor chronic medical conditions) and adherence (i.e., the extent to which a person's behavior coincides with medical or health advice). 5 In their Pediatric Self-Management Model, self-management influences adherence, which then affects outcomes, including health outcomes. The authors also suggest that there may be certain self-management factors that impact outcomes without the mediating role of adherence in pediatric conditions. 5This present review article will focus on the first two of three stages in the Pediatric Self-Management Model, self-management and adherence, to discuss the behavioral factors that may influence health outcomes for youth with type 1 diabetes during adolescence (see Figure 1). Findings from individual, family, peer, and group therapy interventions that have targeted these behavioral factors in order to improve health outcomes will then be outlined. Self-managementModi et al. describe the construct of self-management as having three components. 5 The first component is self-management behaviors, which are the actual behaviors performed by the youth and/or family in order to care for a chronic medical illness. Secondly, there are contextual variables, which are four systems that impact how the self-management behaviors occur. These include individual, family, community, and healthcare domains. Finally, there are processes that link the self-management behaviors with the contextual systems.These processes include individuals' cognitive, emotional, and social perceptions. Three components of self-management, self-management behaviors, contextual variables, and processes as they relate to youth with type 1 diabetes, will be reviewed below (see Table 1). Self-management BehaviorsSelf-management behaviors, defined as examples of the 'neutral'behaviors that are employed to help manage a chronic medical illness, have been widely examined in youth with type 1 diabetes.Some examples of self-management behaviors that researchers have repeatedly identified as relevant to the management of diabetes are parental involvement and collaboration, the division of diabetes responsibility in the family and subsequent ...

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Gender Differences in Adherence and Metabolic Control in Urban Youth with Poorly Controlled Type 1 Diabetes: The Mediating Role of Mental Health Symptoms

Abstract: Results suggest that gender differences in adherence may be attributed, in part, to gender differences in externalizing symptoms in urban youth with poor metabolic control. Interventions targeting these symptoms may be necessary to improve adherence and HbA1C in both boys and girls.

Cited by 86 publications

References 40 publications

Depression and Diabetes Treatment Nonadherence: A Meta-Analysis

Depression and Diabetes Treatment Nonadherence: A Meta-Analysis

Examination of the Synergistic Relationship of Diabetes and Depression

Behavioral Factors Influencing Health Outcomes in Youth with Type 1 Diabetes

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