Role of depressive symptoms in mediating socioeconomic disparities in diabetes risk misperception

Objectives: In the U.S., type 2 diabetes awareness remains low among individuals at risk. Unawareness poses risk of developing comorbidities, commonly depression, which would harm physical and mental health and well-being. This study builds off previous findings identifying significant differences in accurate diabetes perception by race/ethnicity, sex, age, and self-rated health. This study explores depressive symptoms as a mediator and potential explanation for significant associations between determinants of risk and incorrect perception of risk when at risk. Methods: This study uses2011-2012 & 2013-2014 National Health and Nutrition Examination Survey data (NHANES). The sampling frame includes individuals identified with clinical risk of diabetes, who report not perceiving risk (N = 3238). Summary statistics, bivariates by outcome and mediator, unadjusted and adjusted logistic regression were conducted. The Sobel test was used for mediation analysis. Results: Depressive symptoms, female sex, Mexican American ethnicity or other/multiple race, younger age, or worse self-rated health were independently associated with lower odds of incorrectly perceiving no clinical risk. Depressive symptoms moderated most socioeconomic disparities. Conclusions: Findings demonstrate that depressive symptoms explain disparities in incorrectly perceiving no diabetes risk by sex, age, and selfrated health but not race/ethnicity.