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Stress, depression and medication nonadherence in diabetes: test of the exacerbating and buffering effects of family support

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Abstract

Stressors and depressive symptoms have been associated with medication nonadherence among adults with type 2 diabetes (T2DM). We tested whether these associations were exacerbated by obstructive family behaviors or buffered by supportive family behaviors in a sample of 192 adults with T2DM and low socioeconomic status using unadjusted and adjusted regression models. We found support for the exacerbating hypothesis. Stressors and nonadherence were only associated at higher levels of obstructive family behaviors (interaction AOR = 1.12, p = .002). Similarly, depressive symptoms and nonadherence were only associated at higher levels of obstructive family behaviors (interaction AOR = 3.31, p = .002). When participants reported few obstructive family behaviors, neither stressors nor depressive symptoms were associated with nonadherence. We did not find support for the buffering hypothesis; stressors and depressive symptoms were associated with nonadherence regardless of supportive family behaviors. Nonadherent patients experiencing stressors and/or major depressive symptoms may benefit from interventions that reduce obstructive family behaviors.

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Acknowledgments

The authors would like to acknowledge Cecilia C. Quintero, Sahbina Ebba, Karen Calderon, Leo Cortes, Anne Crook, Carmen Mekhail, the Vine Hill Community Clinic personnel, and the participants for their contributions to this research. This research study was funded with support the National Center for Research Resources, Grant UL1 RR024975-01, which is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06. This study was supported in part by grant P30DK092986 (PI: Elasy). C. Y. O. was supported by an NIH/NIDDK Career Development Award (K01DK087894) and R01 (R01DK100694-01A1). L. S. M. was supported by an NIH/NIDDK National Research Service Award (F32DK097880) and AHRQ (K12 HS022990). J. A. W. was supported by the NIH/NIMHD (R01 MD005879), the NIH/NIDDK (DP3 DK097705), the American Diabetes Association (7-13-TS-31), and the Chicago Center for Diabetes Translation Research. L. E. E. was supported by NIH/NIDDK (K24DK093699) and NIH/NIDDK (R01DK098529). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Conflict of interest

Lindsay Satterwhite Mayberry declares that she has no conflict of interest. Leonard E. Egede declares that he has no conflict of interest. Julie A. Wagner declares that she has no conflict of interest. Chandra Y. Osborn declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000(5). Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Lindsay Satterwhite Mayberry & Chandra Y. Osborn

  2. Center for Diabetes Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA

    Lindsay Satterwhite Mayberry & Chandra Y. Osborn

  3. Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA

    Lindsay Satterwhite Mayberry & Chandra Y. Osborn

  4. Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA

    Leonard E. Egede

  5. Division of General Internal Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA

    Leonard E. Egede

  6. Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA

    Julie A. Wagner

  7. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA

    Chandra Y. Osborn

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  1. Lindsay Satterwhite Mayberry
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Mayberry, L.S., Egede, L.E., Wagner, J.A. et al. Stress, depression and medication nonadherence in diabetes: test of the exacerbating and buffering effects of family support. J Behav Med 38, 363–371 (2015). https://doi.org/10.1007/s10865-014-9611-4

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