Role of Motivation in the Relationship Between Depression, Self-care, and Glycemic Control in Adults With Type 2 Diabetes
Leonard E. Egede, MD1* and Chandra Y. Osborn, PhD, MPH2 The Diabetes Educator 2010;36:276.
Purpose: The researchers were testing whether depression is related to self-care behavior via social motivation and indirectly related to glycemic control via self-care behavior; the mechanism by which depression influences health outcomes in persons with diabetes is somewhat uncertain.
Methods: This article describes a study involving 126 adults with type 2 diabetes who were recruited as they came for appointments at an outpatient clinic in South Carolina. The researchers gathered information on demographics, depression and diabetes knowledge (information); diabetes fatalism (personal motivation); social support (social motivation); and diabetes self-care (behavior). Hemoglobin A1C values were extracted from the patient medical record.
Results: Higher levels of depressive symptoms were significantly related to having less social support and decreased performance of diabetes self-care behavior. In addition, when depressive symptoms were included in the model, fatalistic attitudes were no longer associated with behavioral performance.
Conclusions: Among adults with diabetes, depression impedes the adoption of effective self-management behaviors (including physical activity, appropriate dietary behavior, foot care, and appropriate self-monitoring of blood glucose behavior) through a decrease in social motivation.
Significance: This study shows that in this sample of adults with Type 2 diabetes, depression does not have a direct effect on glycemic control; rather, the relationship is indirect via self-care behaviors. While there is a direct relationship between depression and behavior, social motivation exists in this predicted pathway and is potentially modifiable through diabetes education efforts.
This article has been reviewed by the Washington State Diabetes Network Editorial Review Board.
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