The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: A structural equation modeling approach

Ching Ju Chiu, Linda A. Wray, Elizabeth A. Beverly, Oralia G. Dominic

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

Objectives: We investigated the longitudinal association between depressive symptoms and glycemic control (HbA1c) in adults with type 2 diabetes, and the extent to which that association was explained by health behaviors. Methods: This study assessed data on 998 adults (aged 51 and above) with type 2 diabetes in the US nationally representative Health and Retirement Study and its diabetes-specific mail survey. Participants' depressive symptoms and baseline health behaviors (exercise, body weight control, and smoking status) were collected in 1998. Follow-up health behaviors and the glycemic control outcome were measured at a 2- and 5-year intervals, respectively. Results: Nearly one in four of participants (23%) reported moderate or high levels of depressive symptoms at baseline (CES-D score ≥3). Adults with higher levels of depressive symptoms at baseline showed lower scores on baseline and follow-up health behaviors as well as higher HbA1c levels at a 5-year follow-up. Structural equation models (SEM) reveal that health behaviors accounted for 13% of the link between depressive symptoms and glycemic control. Conclusions: The long-term relationship between depressive symptoms and glycemic control was supported in the present study. Health behaviors, including exercise, body weight control, and smoking status, explained a sizable amount of the association between depressive symptoms and glycemic control. More comprehensive diabetes self-care behaviors should be examined with available data. Other competing explicators for the link, such as endocrinological process and antidepressant effects, also warrant further examination.

Original languageEnglish (US)
Pages (from-to)67-76
Number of pages10
JournalSocial psychiatry and psychiatric epidemiology
Volume45
Issue number1
DOIs
StatePublished - Jan 2010

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Health(social science)
  • Social Psychology
  • Psychiatry and Mental health

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