Annals of Behavioral Medicine

, Volume 44, Issue 2, pp 192–206 | Cite as

A Psychoeducational Intervention (SWEEP) for Depressed Women with Diabetes

  • Sue M. Penckofer
  • Carol Ferrans
  • Patricia Mumby
  • Mary Byrn
  • Mary Ann Emanuele
  • Patrick R. Harrison
  • Ramon A. Durazo-Arvizu
  • Patrick Lustman
Original Article



Clinically significant depression is present in 25 % of individuals with type 2 diabetes, its risk being doubled in women.


To examine the effectiveness of the Study of Women’s Emotions and Evaluation of a Psychoeducational (SWEEP), a group therapy for depression treatment based on cognitive behavioral therapy principles that was developed for women with type 2 diabetes was conducted.


Women with significantly elevated depression symptoms (Center for Epidemiologic Studies Depression Scale ≥16) were randomized to SWEEP (n = 38) or usual care (UC, n = 36).


Multilevel modeling indicated that SWEEP was more effective than UC in reducing depression (mean difference of −15 vs. −7, p < .01), decreasing trait anxiety (mean difference of −15 vs. −5, p < .01), and improving anger expression (mean difference of −12 vs. −5, p < .05). Although SWEEP and UC had improvements in fasting glucose (mean difference of −24 vs. −1 mg/dl) and HbA1c (mean difference of −0.4 vs. −0.1 %), there were no statistically significant differences between groups.


SWEEP was more effective than UC for treating depressed women with type 2 diabetes. Addition of group therapy for depression meaningfully expands the armamentarium of evidence-based treatment options for women with diabetes.


Diabetes Depression Women 


  1. 1.
    Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002; 25: 464–470.PubMedCrossRefGoogle Scholar
  2. 2.
    Egede LE. Major depression in individuals with chronic medical disorders: Prevalence, correlates and association with health resource utilization, less productivity, and functional disability. Gen Hosp Psychiatry. 2007; 29: 409–416.PubMedCrossRefGoogle Scholar
  3. 3.
    Lustman PJ, Clouse RE, Nix BD, et al. Sertraline for prevention of depression recurrence in diabetes mellitus. Arch Gen Psychiatry. 2006; 63: 521–529.PubMedCrossRefGoogle Scholar
  4. 4.
    Lustman PJ, Williams, MM, Sayuk GS, Nix BD, Clouse RE. Factors influencing glycemic control in type 2 diabetes during acute-and maintenance-phase treatment of major depressive disorder with bupropion. Diabetes Care. 2007; 30: 459–466.PubMedCrossRefGoogle Scholar
  5. 5.
    Williams MM, Clouse RE, Nix BD, et al. Efficacy of sertraline in prevention of depression recurrence in older versus younger adults with diabetes. Diabetes Care. 2007; 30: 801–806.PubMedCrossRefGoogle Scholar
  6. 6.
    Lustman, PJ, Griffith, LS, Clouse, RE, et al. Effects of nortriptyline on depression and glycemic control in diabetes: Results of a double-blind, placebo-controlled trial. Psychosom Med. 1997; 59: 241–250.PubMedGoogle Scholar
  7. 7.
    Lisi DM. Diabetes and the psychiatric patient. US Pharmacist. 2010; 35: 62–79.Google Scholar
  8. 8.
    Amiel JM, Manguarian CV, Ganguli R, Newcomer JS. Addressing cardiometabolic risk during treatment with anti-psychotic medications. Curr Opin Psychiatry. 2008; 21(6): 613–618.PubMedCrossRefGoogle Scholar
  9. 9.
    Morrato EH, Newcomer JS, Kamat S, Baser O, Harnett J, Cuffel B. Metabolic screening after the American Diabetes Association’s consensus statement on antipsychotic drugs and diabetes. Diabetes Care. 2009; 32(6): 1037–1042.PubMedCrossRefGoogle Scholar
  10. 10.
    Derijks HJ, Meyboom RH, Heerdink ER, et al. The association between antidepressant use and the disturbance in glucose homeostasis: Evidence from spontaneous reports. Eur J Clin Pharmacol. 2008; 64(5): 531–538PubMedCrossRefGoogle Scholar
  11. 11.
    Bai YM, Lin CC, Chen JY, Chen TT, Su TP, Chou P. Association of weight gain and metabolic syndrome in patients taking clozapine: An 8-year cohort. J Clin Psychiatry. 2011; 72(6): 751–756.PubMedCrossRefGoogle Scholar
  12. 12.
    Torrent C, Amann B, Sanchez-Moreno J, et al. Weight gain in bipolar disorder: Pharmacological treatment as a contributing factor. Acta Psychiatr Scand. 2008; 118: 4–18.PubMedCrossRefGoogle Scholar
  13. 13.
    Schwartz TL, Nihalani N, Virk S, Jindal S, Chilton M. Psychiatric medication-induced obesity: Treatment options. Obes Rev. 2004; 5: 233–238PubMedCrossRefGoogle Scholar
  14. 14.
    Rubin, RR, Ma, Y, Marrero, DG, et al. Elevated depression symptoms, antidepressant medicine use, and risk of developing diabetes during the diabetes prevention program. Diabetes Care. 2008; 31: 420–426.PubMedCrossRefGoogle Scholar
  15. 15.
    Fournier JC, DeRubeis RJ, Hollon SD, et al. Antidepressant drug effects and depression severity: A patient-level meta-analysis. JAMA. 2010; 303: 47–53.PubMedCrossRefGoogle Scholar
  16. 16.
    Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: A meta-analysis of data submitted to the food and Drug Administration. PLOS Med. 2008; 5(2): e045.Google Scholar
  17. 17.
    Agency for Healthcare Research and Quality. Clinical practice guideline on the management of major depression in adults. National Guideline Clearing House, USDHHS. 2011.Google Scholar
  18. 18.
    Dozois DJ, Bieling PJ, Patelis-Siotis I, et al. Changes in self-schema structure in cognitive therapy for major depressive disorder: A randomized clinical trial. J Consult Clin Psychol. 2009; 77: 1078–1088.PubMedCrossRefGoogle Scholar
  19. 19.
    Beck AT, Dozois DJ. Cognitive therapy: Current status and future directions. Annu Rev Med. 2010; 62: 397–409.CrossRefGoogle Scholar
  20. 20.
    Lustman P, Griffith L, Freedand K, Kissel S, Clouse R. Cognitive behavior therapy for depression in type 2 diabetes mellitus: A randomized controlled trial. Ann Intern Med. 1998; 129: 613–621.PubMedGoogle Scholar
  21. 21.
    Penckofer S, Ferrans C, Velsor-Friedrich B, Savoy S. The psychological impact of living with diabetes: Women’s day to day experiences. Diabetes Educ. 2007; 33: 680–690.PubMedCrossRefGoogle Scholar
  22. 22.
    Whittemore R, Melkus G, Grey M. Self-report of depressed mood and depression in women with type 2 diabetes. Issues Ment Health Nurs. 2004; 25: 243–260.PubMedCrossRefGoogle Scholar
  23. 23.
    Chiu CJ, Wray LA, Beverly EA, Dominic OG. The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: A structural equation modeling approach. Soc Psychiatry Psychiatr Epidemiol. 2010; 45: 67–76.PubMedCrossRefGoogle Scholar
  24. 24.
    Peyrot M, Rubin R. Persistence of depressive symptoms in diabetic adults. Diabetes Care. 1999; 22: 448–452.PubMedCrossRefGoogle Scholar
  25. 25.
    Katon WJ, Von Korff M, Lin EHB, et al. The Pathways study: A randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004; 61: 1042–1049.PubMedCrossRefGoogle Scholar
  26. 26.
    Gonzalez JS, McCarl LA, Wexler DJ, et al. Cognitive-behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. J Cognit Psychother Int Q. 2010; 24(4): 329–343.CrossRefGoogle Scholar
  27. 27.
    Markowitz S, Gonzalez, Wilinson JL, Safren SA. Treating depression in diabetes: Emerging findings. Psychosomatics 2011; 52(1): 1–18.PubMedCrossRefGoogle Scholar
  28. 28.
    Khuwaja AK, Lalani S, Dhanani R, Azam IS, Rafique G, White F. Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors. Diabetol Metab Syndr. 2010; 2: 72.PubMedCrossRefGoogle Scholar
  29. 29.
    Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: A systematic review. J Psychosom Res. 2002; 53(6): 1053–1060.PubMedCrossRefGoogle Scholar
  30. 30.
    Lloyd, CE, Dyer, PH, Barnett, AH. Prevalence of symptoms of depression and anxiety in a diabetes clinic population. Diabet Med. 2000; 17(3): 198–202.PubMedCrossRefGoogle Scholar
  31. 31.
    Huang CJ, Chiu HC, Lee MH, Wang SY. Prevalence and incidence of anxiety disorders in diabetic patients: A national population-based cohort study. Gen Hosp Psychiatry. 2011; 33(1): 8–15.PubMedCrossRefGoogle Scholar
  32. 32.
    Anderson RJ, Grigsby AB, Freedland KE, et al. Anxiety and poor glycemic control: A meta-analytic review of the literature. Int J Psychiatry Med. 2002; 32(3): 235–247CrossRefGoogle Scholar
  33. 33.
    Pasquini M, Picardi A, Biondi M, Gaetano P, Morosini P. Relevance of anger and irritability in outpatients with major depressive disorder. Psychopathology. 2004; 37(4): 155–160.PubMedCrossRefGoogle Scholar
  34. 34.
    Yi JP, Yi JC, Vitaliano PP, Weinger K. How does anger coping style affect glycemic control in diabetes patents? Int J Behav Med. 2008; 15(3): 167–172.PubMedCrossRefGoogle Scholar
  35. 35.
    Wu SF, Huang YC, Liang SY, Wang TJ, Lee MC, Tung HH. Relationships among depression, anxiety, self-care behavior and diabetes education difficulties in patients with type 2 diabetes: A cross-sectional questionnaire survey. Int J Nurs Stud. 2011; 48:1376–1383PubMedCrossRefGoogle Scholar
  36. 36.
    Wolfgang L, Hogan B, Rutledge T, Chawla A, Lenz J, Leung D. There is more to anger coping than “in” or “out”. Emotion. 2003; 3(1): 12–29.CrossRefGoogle Scholar
  37. 37.
    Swenson SL, Rose M, Vittinghoff, E, Stewart A, Schillinger D. The influence of depressive symptoms on clinician-patient communication among patients with diabetes. Med Care. 2008; 46(3): 257–265.PubMedCrossRefGoogle Scholar
  38. 38.
    Epstein RM, Duberstein PR, Feldman MD, et al. “I didn’t know what was wrong”: How people with undiagnosed depression recognize, name and explain their distress. J Gen Intern Med. 2010; 25: 954–961.PubMedCrossRefGoogle Scholar
  39. 39.
    Gonzalez JS, Safren SA, Cagliero E, et al. Depression, self-care, and medication adherence in type 2 diabetes: Relationships across the full range of symptom severity. Diabetes Care. 2007; 30(9): 2222–2227.PubMedCrossRefGoogle Scholar
  40. 40.
    Egede LE, Grubaugh AL, Ellis C. The effect of major depression on preventive care and quality of life among adults with diabetes. Gen Hosp Psychiatr. 2010; 32(6): 563–569.PubMedCrossRefGoogle Scholar
  41. 41.
    Uden AL, Elofsson S, Andreasson A, Hillered E, Eriksson I, Brismar K. Gender differences in self-rated health, quality of life, quality of care, and metabolic control in patients with diabetes. Gend Med. 2008; 5(2): 162–180.CrossRefGoogle Scholar
  42. 42.
    Ali S, Stone M, Skinner TC, Robertson N, Davies M, Khunti K. The association between depression and health-related quality of life in people with diabetes: A systematic literature review. Diabetes Metab Res Rev. 2010; 26(2): 75–89.PubMedCrossRefGoogle Scholar
  43. 43.
    Grandy S, Chapman RH, Fox KM, SHIELD Study Group. Quality of life and depression of people living with type 2 diabetes mellitus and those at low and high risk for type 2 diabetes: Findings from the Study to Help Improve Early evaluation and management of risk factors leading to Diabetes. Int J Clin Pract. 2008; 62: 562–568.PubMedCrossRefGoogle Scholar
  44. 44.
    Kohen D, Burgess AP, Catalan J, Lant A. The role of anxiety and depression in quality of life and symptom reporting in people with diabetes mellitus. Qual Life Res. 1998; 7: 197–204.PubMedCrossRefGoogle Scholar
  45. 45.
    Surwit RS, van Tilburg MA, Zucker N, et al. Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care. 2002; 25: 30–34.PubMedCrossRefGoogle Scholar
  46. 46.
    Petrak F, Hautzinger M, Plack K, et al. Cognitive behavioural therapy in elderly type 2 diabetes patients with minor depression or mild major depression: Study protocol of a randomized controlled trial (MIND-DIA). BMC Geriatr. 2010; 10: 21.PubMedCrossRefGoogle Scholar
  47. 47.
    Schneider KL, Pagoto SL, Handschin B, et al. Design and methods for a pilot randomized clinical trial involving exercise and behavioral activation to treat comorbid type 2 diabetes and major depressive disorder. Mental Health Phys Act. 2011; 4(1): 13–21.CrossRefGoogle Scholar
  48. 48.
    Penckofer S, Byrn M, Mumby P, Ferrans C. Improving subject recruitment, retention, and participation in research through Peplau’s Theory of Interpersonal Relations. Nurs Sci Q. 2011; 24: 146–151.PubMedCrossRefGoogle Scholar
  49. 49.
    Hollon S, DeRubeis RJ, Shelton RC, et al. Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Arc Gen Psychiatry. 2005; 62: 417–422.PubMedCrossRefGoogle Scholar
  50. 50.
    Munoz RF, Ghosh Ippen C, Rao S, Le H-L, Dwyer EV. Manual for group cognitive behavioral therapy of major depression: A reality management approach [participant manual and instructor’s manual]. Retrieved March 12, 2012 from the University of California San Francisco/San Francisco General Hospital Latino Mental Health Research Program Website:
  51. 51.
    Muñoz RF, Ying YW, Bernal G, et al. Prevention of depression with primary care patients: A randomized controlled trial. Am J Community Psychol. 1995; 23: 199–222.PubMedCrossRefGoogle Scholar
  52. 52.
    Williams VP, Williams RB. Lifeskills: 8 simple ways to build stronger relationships, communicate more clearly, improve your health, and even the health of those around you. New York, NY: Times Books/Random House; 1997.Google Scholar
  53. 53.
    Kirby ED, Williams VP, Hocking MC, Lane JD, Williams RB. Psychosocial benefits of three formats of a standardized behavioral stress management program. Psychosom Med. 2006; 68: 816–823.PubMedCrossRefGoogle Scholar
  54. 54.
    Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol. 2008; 27: 379–387.PubMedCrossRefGoogle Scholar
  55. 55.
    Cowan MJ, Freedland KE, Burg MM, et al. Predictors of treatment response for depression and inadequate social support-the ENRICHD randomized clinical trial. Psychother Psychosom. 2008; 77(1): 27–37.PubMedCrossRefGoogle Scholar
  56. 56.
    Freedland KE, Mohr DC, Davidson KW, Schwartz JE. Usual and unusual care: Existing practice control groups in randomized controlled trials of behavioral interventions. Psychosom Med. 2011; 73: 324–336.CrossRefGoogle Scholar
  57. 57.
    Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1(3): 385–401.CrossRefGoogle Scholar
  58. 58.
    Zich JM, Attkinsson CC, Greenfield TK. Screening for depression in the primary clinics: The CES-D and the BDI. Int J Psychiatry Med. 1990; 20: 259–277.PubMedCrossRefGoogle Scholar
  59. 59.
    Roy T, Lloyd CE, Pouwer F, Holt RI, Sartorius N. Screening tools used for measuring depression among people with type 1 and type 2 diabetes: A systematic review. Diabet Med. 2012; 29:164–75. doi 10.1111/j.1464-5491.2011.03401.x.PubMedCrossRefGoogle Scholar
  60. 60.
    Speilberger C, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. State-trait anxiety inventory for adults. Menlo Park, CA: Mind Garden Inc.; 1977.Google Scholar
  61. 61.
    Barnes L, Harp D, Jung W. Reliability generalization of scores on the Spieberger state-trait anxiety inventory. Educ Psychol Meas. 2002; 62(4): 603–618.CrossRefGoogle Scholar
  62. 62.
    Spielberger C. State–trait anger expression inventory—2. Professional manual. Lutz: Psychological Assessment Resources; 1999.Google Scholar
  63. 63.
    Arean PA, Alvidrez J. The prevalence of psychiatric disorders and subsyndromonal mental illness in low-income, medically ill elderly. Int J Psychiatry Med. 2001; 31: 9–24.PubMedCrossRefGoogle Scholar
  64. 64.
    Aaron LA, Bradley LA, Alarcon GS, et al. Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than to illness. Arthritis Rheum. 1996; 39: 436–445.PubMedCrossRefGoogle Scholar
  65. 65.
    Ross HE, Swinson R, Doumani S, Larkin EJ. Diagnosing comorbidity in substance abusers: A comparison of the test–retest reliability of two interviews. Am J Drug Alcohol Abuse. 1995; 21: 167–185.PubMedCrossRefGoogle Scholar
  66. 66.
    Levitan RD, Blouin AG, Navarro JR, Hill J. Validity of the computerized DIS for diagnosing psychiatric inpatients. Can J Psychiatry. 1991; 36: 728–731.PubMedGoogle Scholar
  67. 67.
    Blouin AG, Perez EL, Blouin JH. Computerized administration of the diagnostic interview schedule. Psychiatry Res. 1988; 23: 335–344.PubMedCrossRefGoogle Scholar
  68. 68.
    Cholestech Corporation. The accuracy and reproducibility of a rapid, fingerstick method for measuring A1c certified by the NGSP. Technical brief. Hayward: Cholestech Corporation; 2002.Google Scholar
  69. 69.
    Ferrans C, Powers M. Quality of Life Index.
  70. 70.
    Quinn L, Poradzisz M, Ferrans C. Psychometric properties of the Quality of Life Index: Diabetes Version. Diabetes. 1999; 48 Supplement 1: A320.Google Scholar
  71. 71.
    Ware JE, Kosinski M, Keller SD. A 12-item short-from health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996; 34: 220–233.PubMedCrossRefGoogle Scholar
  72. 72.
    Ware JE, Kosinski M, Turner-Bowker DM, Gandek B. How to score version 2 of the SF-12 health survey. Lincoln RI: Quality Metric Incorporated; 2002.Google Scholar
  73. 73.
    Ware JE, Kosinski M, Kleer SD. SF-12: How to score the SF-12 physical and mental health summary scales. 3rd edn. Lincoln: Quality Metric Incorporated; 1998.Google Scholar
  74. 74.
    Fitzgerald JT, Davis WK, Connell CM, Hess GE, Funnell MM, Hiss RG. Development and validation of the diabetes care profile. Eval Health Prof. 1996; 19: 208–230.Google Scholar
  75. 75.
    Fitzgerald JT, Funnell MM, Hess GE, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care. 1998; 21: 706–710.PubMedCrossRefGoogle Scholar
  76. 76.
    Pan A, Lucas M, Sun Q, et al. Increased mortality risk in women with depression and diabetes mellitus. Arch Gen Psychiatr. 2011; 68(1): 42–50.PubMedCrossRefGoogle Scholar
  77. 77.
    Lustman PJ, Freedland KE, Griffith LS, Clouse RE. Predicting response to cognitive behavioral therapy of depression in type 2 diabetes. Gen Hosp Psychiatr. 1998; 20: 302–306.PubMedCrossRefGoogle Scholar
  78. 78.
    van Bastelaar KM, Pouwer F, Cuijpers P, Twisk JWR, Snoek FJ. Web-based cognitive behavioral therapy (W-CBT) for diabetes patients with co-morbid depression: Design of a randomised controlled trial. BMC Psychiatry. 2008; 8: 9 (doi:10.1186/1471-244X/8/9).PubMedCrossRefGoogle Scholar
  79. 79.
    Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illness. New Engl J Med. 2010; 363(27): 2611–2620.PubMedCrossRefGoogle Scholar
  80. 80.
    Lamers F, Jonkers CCM, Bosma H, Knotternerus JA, van Elijk JThM. Treating depression in diabetes patients: Does a nurse administered minimal psychological intervention affect diabetes-specific quality of life and glycaemic control. A randomized trial. J Adv Nurs. 2011; 67(4): 788–799.PubMedCrossRefGoogle Scholar
  81. 81.
    Orth-Gomer K, Schneiderman N, Wang HX, Walldin C, Blom M, Jernberg T. Stress reduction prolongs life in women with coronary disease: The Stockholm Women’s Intervention Trial for Coronary Heart Disease (SWITCHD). Circ Cardiovas Qual Outcomes. 2009; 2: 25–32.CrossRefGoogle Scholar
  82. 82.
    Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA. 2003; 289: 3106–3116.PubMedCrossRefGoogle Scholar
  83. 83.
    Skaff MM, Mullan JT, Hoffman L, et al. Daily negative mood affects fasting glucose in type 2 diabetes. Health Psychol. 2009; 28(3): 265–272.PubMedCrossRefGoogle Scholar
  84. 84.
    Rausch JR. Measures of glycemic variability and links with psychological functioning. Curr Diabetes Rep. 2010; 10(6): 415–421.PubMedCrossRefGoogle Scholar
  85. 85.
    Schneider KL, Bodenlos JS, Ma Y, et al. Design and methods for a randomized clinical trial treating comorbid obesity and major depressive disorder. BMC Psychiatry. 2008; 8: 77 doi:10.1186/1471-244X-8-77.PubMedCrossRefGoogle Scholar
  86. 86.
    Black SJ, Everhart DE, Durham TW, Walker M, Golden J, Demaree HA. The effects of anxiety on affective learning and serial position recall. Int J Neurosci. 2008; 118: 1269–1285.PubMedCrossRefGoogle Scholar
  87. 87.
    Baker JE, Shannon S. The reasoning in depression: Impairment on a concept discrimination learning task. Cognit Emot. 1995; 9: 579–597.CrossRefGoogle Scholar
  88. 88.
    Brand S, Reimer T, Opwis K. How do we learn in a negative mood? Effects of a negative mood on transfer and learning. Learn Instruct. 2007; 17: 1–16.CrossRefGoogle Scholar
  89. 89.
    Fredrickson BL, Branigan C. Positive emotions broaden the scope of attention and thought-action repertoires. Cognit Emot. 2005; 19: 313–332.CrossRefGoogle Scholar
  90. 90.
    Huang ES, Brown SE, Ewigman BG, Foley EC, Meltzer DO. Patient perceptions of quality of life with diabetes-related complications and treatments. Diabetes Care. 2007; 30: 2478–2483.PubMedCrossRefGoogle Scholar
  91. 91.
    Egede LE, Ellis C. The effects of depression on diabetes knowledge, diabetes self-management, and perceived control in indigent patients with type 2 diabetes. Diabetes Technol Thera. 2008; 10: 213–219.CrossRefGoogle Scholar
  92. 92.
    Ellis SE, Speroff T, Dittus RS, Brown A, Pichert JW, Elasy TA. Diabetes patient education: A meta-analysis and meta-regression. Patient Educ Couns. 2004; 52: 97–205.PubMedCrossRefGoogle Scholar
  93. 93.
    Pibernik-Okanovic M, Ajdukovic D, Lovrencic MV, Hermanns N. Does treatment of subsydromal depression improve depression and diabetes related outcomes: Protocol for a randomized controlled comparison of psycho-education, physical exercise and treatment as usual. Trials. 2011; 12: 17.PubMedCrossRefGoogle Scholar
  94. 94.
    Beverly EA, Hultgren BA, Brooks KNM, Ritholz MD, Abrahamson MJ, Weinger KW. Understanding physicians’ challenges when treating type 2 diabetic patients’ social and emotional difficulties. Diabetes Care. 2011; 34: 1086–1088.PubMedCrossRefGoogle Scholar
  95. 95.
    Vaccarino V. Depression in the cardiac patient: A call for action. American Heart Association Communities Learning Library. 2008; September 29th.;jsessionid=MGDbQhGJyW2RbKQkPkRC3QypqyPQR7PX8NTBGFTLzJhZq6RXQvpy!-2027397035!181195628!8091!-1.
  96. 96.
    McCollum M, Hansen LB, Lu L, Sullivan PW. Gender differences in diabetes mellitus and effects on self-care activity. Gend Med. 2005; 2(4): 246–254.PubMedCrossRefGoogle Scholar
  97. 97.
    Long CG, Fulton B, Hollin CR. The development of a ‘best practice’ service for women in medium-secure psychiatric setting: Treatment components and evaluation. Clin Psychol Psychother. 2008; 15: 304–319.PubMedCrossRefGoogle Scholar
  98. 98.
    Gucciardi E, Wang SC, DeMelo M, Amaral L, Stewart DE. Characteristics of men and women with diabetes: Observations during patients’ initial visit to a diabetes education centre. Can Fam Physician. 2008; 54: 219–227.PubMedGoogle Scholar
  99. 99.
    Kacerovsky-Bielesz G, Lienhardt S, Hagenhofer M, et al. Sex-related psychological effects on metabolic control in type 2 diabetes. Diabetologia. 2009; 52: 781–788.PubMedCrossRefGoogle Scholar
  100. 100.
    Barrera M, Toobert DJ, Strycker LA, Osuna D, King D, Glasgow RE. Multiple-behavior-change interventions for women with type 2 diabetes. Diabetes Spectrum. 2011; 24: 75–80.CrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2012

Authors and Affiliations

  • Sue M. Penckofer
    • 1
  • Carol Ferrans
    • 2
  • Patricia Mumby
    • 3
  • Mary Byrn
    • 4
  • Mary Ann Emanuele
    • 3
  • Patrick R. Harrison
    • 5
  • Ramon A. Durazo-Arvizu
    • 3
  • Patrick Lustman
    • 6
  1. 1.School of NursingLoyola University ChicagoMaywoodUSA
  2. 2.College of NursingUniversity of IllinoisChicagoUSA
  3. 3.School of MedicineLoyola University ChicagoMaywoodUSA
  4. 4.Saint Mary’s CollegeNotre DameUSA
  5. 5.College of Arts and SciencesLoyola University ChicagoChicagoUSA
  6. 6.School of MedicineWashington University St. LouisSt. LouisUSA

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