Skip to main content
SpringerLink
Log in

The differential associations of depression and diabetes distress with quality of life domains in type 2 diabetes

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

The present investigation aimed to understand quality of life domains relevant to adults with type 2 diabetes mellitus (T2DM), and the relative associations of depression and diabetes distress with these domains. Participants were 146 individuals with T2DM who were recruited for entry into a randomized controlled trial of cognitive behavioral therapy for adherence and depression. We conducted an exploratory factor analysis on the Quality of Life Inventory (QOLI) to establish domains of quality of life relevant to this patient population. Hierarchical multiple regression models were evaluated for each domain that emerged to determine independent associations of depression severity and diabetes distress with quality of life independent of demographic and illness factors. Results suggested four quality of life domains: achievement, psychosocial growth, interpersonal relationships, and environment, accounting for 60.1 % of variance in total QOLI scores. Depression severity was associated with poorer quality of life on the achievement, psychosocial growth, and environment domains (p’s < 0.01), while diabetes distress was associated with poorer quality of life on the achievement (p < 0.001) domain and marginally associated with quality of life on the psychosocial growth (p < 0.10) domain. Interventions designed to address both depression and diabetes distress may lead to better quality of life outcomes than a generalized depression intervention or an intervention for diabetes alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hoplessness depression: A theory-based subtype of depression. Psychological Review, 96, 358–372.

    Article  Google Scholar 

  • Ali, S., Stone, M. A., Peters, J. L., Davies, M. J., & Khunti, K. (2006). The prevalence of co-morbid depression in adults with type 2 diabetes: A systematic review and meta-analysis. Diabetic Medicine, 23, 1165–1173.

    Article  CAS  PubMed  Google Scholar 

  • Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., et al. (2004). Disability and quality of life impact of mental disorders in Europe: Results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109, 38–46.

    Article  Google Scholar 

  • Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes. Diabetes Care, 24, 1068–1078.

    Article  Google Scholar 

  • Bartlett, J. E., Kotrlik, J. W., & Higgins, C. C. (2001). Organizational research: Determining appropriate sample size in survey research. Information Technology, Learning and Performance, 19, 43–50.

    Google Scholar 

  • Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row.

    Google Scholar 

  • Bradley, C., Todd, C., Gorton, T., Symonds, E., Martin, A., & Plowright, R. (1999). The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: The ADDQoL. Quality of Life Research, 8, 79–91.

    Article  CAS  PubMed  Google Scholar 

  • deGroot, M., Anderson, R., Freedland, K., Clouse, R. E., & Lustman, P. J. (2001). Association of depression and diabetes complications: A meta-analysis. Psychosomatic Medicine, 63, 619–630.

    Article  CAS  Google Scholar 

  • El Achhab, Y., Nejjari, C., Chikri, M., & Lyoussi, B. (2008). Disease-specific health-related quality of life instruments among adults diabetic: A systematic review. Diabetes Research and Clinical Practice, 80, 171–184.

    Article  PubMed  Google Scholar 

  • Eng, W., Coles, M. E., Heimberg, R. G., & Safren, S. A. (2005). Domains of life satisfaction in social anxiety disorder: Relation to symptoms and response to cognitive-behavioral therapy. Anxiety Disorders, 19, 143–156.

    Article  Google Scholar 

  • Fisher, L., Mullan, J. T., Arean, P., Glasgow, R. E., Hessler, D., & Masharani, U. (2010). Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care, 33, 23–28.

    Article  PubMed Central  PubMed  Google Scholar 

  • Floyd, F. J., & Widaman, K. F. (1995). Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment, 7, 286–299.

    Article  Google Scholar 

  • Frisch, M. B. (1994). Quality of life inventory: Manual and treatment guide. Minneapolis, MN: NCS Pearson.

    Google Scholar 

  • Gonzalez, J. S., Delahanty, L. M., Safren, S. A., Meigs, J. B., & Grant, R. W. (2008a). Differentiating symptoms of depression from diabetes-specific distress: Relationships to self-care in type 2 diabetes. Diabetologia, 51, 1822–1825.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Gonzalez, J. S., Fisher, L., & Polonsky, W. H. (2011). Depression in diabetes: Have we been missing something important? Diabetes Care, 34, 236–239.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gonzalez, J. S., Peyrot, M., McCarl, L., Collins, E. M., Serpa, L., Mimiaga, M., et al. (2008b). Depression and diabetes treatment nonadherence: A meta-analysis. Diabetes Care, 31, 2398–2403.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gorusch, R. L. (1983). Factor analysis (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Katon, W. J., Rutter, C., Simon, G., Lin, E. H. B., Ludman, E., Ciechanowski, P., et al. (2005). The association of comorbid depression with mortality in patients with Type 2 diabetes. Diabetes Care, 28, 2668–2672.

    Article  PubMed  Google Scholar 

  • Kearns, N. P., Cruickshank, C. A., McGuigan, K. J., Riley, S. A., Shaw, S. P., & Snaith, R. P. (1982). A comparison of depression rating scales. British Journal of Psychiatry, 141, 45–49.

    Article  CAS  PubMed  Google Scholar 

  • Knol, M. J., Twisk, J. W. R., Beekman, A. T. F., Heine, R. J., Snoek, F. J., & Pouwer, F. (2006). Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia, 49, 837–845.

    Article  CAS  PubMed  Google Scholar 

  • Kraemer, H. C., Noda, A., & O’Hara, R. (2004). Categorical versus dimensional approaches to diagnosis: Methodological challenges. Journal of Psychiatric Research, 38, 17–25.

    Article  PubMed  Google Scholar 

  • Lustman, P. J., Anderson, R. J., Freedland, K. E., deGroot, M., Carney, R. M., & Clouse, R. E. (2000). Depression and poor glycemic control: A meta-analytic review of the literature. Diabetes Care, 23, 934–942.

    Article  CAS  PubMed  Google Scholar 

  • Markowitz, S., Gonzalez, J. S., Wilkinson, J. L., & Safren, S. A. (2011). Treating depression in diabetes: Emerging findings. Psychosomatics, 52, 1–18.

    Article  PubMed Central  PubMed  Google Scholar 

  • Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.

    Article  CAS  PubMed  Google Scholar 

  • Muller, M. J., Himmerich, H., Kienzle, B., & Szegedi, A. (2003). Differentiating moderate and severe depression using the Montgomery-Asberg Depression Rating Scale (MADRS). Journal of Affective Disorders, 77, 255–260.

    Article  PubMed  Google Scholar 

  • O’Cleirigh, C., & Safren, S. A. (2006). Domains of life satisfaction among patients living with HIV: A factor analytic study of the quality of life inventory. AIDS and Behavior, 10, 53–58.

    Article  PubMed  Google Scholar 

  • Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., et al. (2005). Assessing psychosocial distress in diabetes: Development of the diabetes distress scale. Diabetes Care, 28, 626–631.

    Article  PubMed  Google Scholar 

  • Rosenthal, M. J., Fajardo, M., Gilmore, S., Moreley, J. E., & Nabiloff, B. D. (1998). Hospitalization and mortality of diabetes in older adults: A three-year prospective study. Diabetes Care, 21, 231–235.

    Article  CAS  PubMed  Google Scholar 

  • Rubin, R. R., & Peyrot, M. (1999). Quality of life and diabetes. Diabetes/Metabolism Research and Reviews, 15, 205–218.

    Article  CAS  PubMed  Google Scholar 

  • Russell, L. B., Suh, D.-C., & Safford, M. M. (2005). Time requirements for diabetes self-management: Too much for many? Journal of Family Practice, 54, 52–56.

    PubMed  Google Scholar 

  • Safren, S. A., Gonzalez, J. S., & Soroudi, N. (2007). Coping with chronic illness: A cognitive behavioral therapy approach for adherence and depression: Therapist guide. New York: Oxford University Press.

    Google Scholar 

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.

    PubMed  Google Scholar 

  • Testa, M. A., & Simonson, D. C. (1998). Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: A randomized, controlled, double-blind trial. JAMA, 280, 1490–1496.

    Article  CAS  PubMed  Google Scholar 

  • Widiger, T. A. (1992). Categorical versus dimensional classifications: Implications from and for research. Journal of Personality Disorders, 6, 287–300.

    Article  Google Scholar 

Download references

Acknowledgments

The project described was supported by Award Number R01MH078571 to Dr. Steven A. Safren from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. This research was also conducted with support from the Investigator-Initiated Study Program of LifeScan, Inc in the form of donated glucometers and glucose test strips. This work was also conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (NIH Award #UL1 RR 025758 and financial contributions from Harvard University and its affiliated academic health care centers). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, the National Center for Research Resources, or the National Institutes of Health. JSG is also supported in part by award number NIDDK DK 020541 from the National Institute of Diabetes and Digestive and Kidney Diseases.

Author information

Authors and Affiliations

  1. Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA, USA

    Matthew M. Carper, Lara Traeger, Christina Psaros & Steven A. Safren

  2. Harvard Medical School, Boston, MA, USA

    Lara Traeger, Deborah J. Wexler, Christina Psaros & Steven A. Safren

  3. Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA

    Jeffrey S. Gonzalez

  4. Diabetes Research Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA

    Jeffrey S. Gonzalez

  5. Diabetes Research Center, Massachusetts General Hospital, Boston, MA, USA

    Deborah J. Wexler

  6. Child and Adolescent Anxiety Disorders Clinic, Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Matthew M. Carper

Authors
  1. Matthew M. Carper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lara Traeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey S. Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deborah J. Wexler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christina Psaros
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven A. Safren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew M. Carper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carper, M.M., Traeger, L., Gonzalez, J.S. et al. The differential associations of depression and diabetes distress with quality of life domains in type 2 diabetes. J Behav Med 37, 501–510 (2014). https://doi.org/10.1007/s10865-013-9505-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-013-9505-x

Keywords

Search

Navigation