Social Psychiatry and Psychiatric Epidemiology

, Volume 45, Issue 1, pp 67–76

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
Original Paper

DOI: 10.1007/s00127-009-0043-3

Cite this article as:
Chiu, CJ., Wray, L.A., Beverly, E.A. et al. Soc Psychiat Epidemiol (2010) 45: 67. doi:10.1007/s00127-009-0043-3

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.

Keywords

Depressive symptomsHealth behaviorsType 2 diabetesHbA1cStructural equation models (SEM)

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ching-Ju Chiu
    • 1
  • Linda A. Wray
    • 1
  • Elizabeth A. Beverly
    • 2
  • Oralia G. Dominic
    • 3
  1. 1.Department of Biobehavioral HealthThe Pennsylvania State UniversityUniversity ParkUSA
  2. 2.Joslin Diabetes Medical CenterThe Harvard Medical SchoolBostonUSA
  3. 3.Hershey Medical CenterThe Pennsylvania State UniversityHersheyUSA