Depression and Diabetes in a Primarily African American Female Population

The Association Between General Self-Efficacy and Depressive Symptoms in People with Type 2 Diabetes Mellitus: The Mediating Role of Coping Styles Preference

Background

Depressive symptoms are prevalent in persons with type 2 diabetes mellitus and related with poor disease outcomes. Both general self-efficacy and coping style are associated with depressive symptoms. A model about proactive coping indicates that coping style plays a mediation role between general self-efficacy and depressive symptoms. But, empirical evidence is missing about this potential mediation relationship which may be a barrier of taking precise strategies for relieving depressive symptoms.

Objective

This study aims to investigate the prevalence of elevated depressive symptoms in persons with type 2 diabetes mellitus and explore whether coping style preference mediates the association between general self-efficacy and depressive symptoms.

Methods

This was a secondary data analysis of a cross-sectional survey (June-July 2017) among 721 persons with type 2 diabetes mellitus (45.4% male and 54.6% female) aged from 22 to 96 years old. Data on general self-efficacy, coping style preference and depressive symptoms were collected using validated questionnaires in hospital setting. The mediation model was tested using the bootstrapping (K=5000) in the MPlus program version 7.4. The results were reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results

The prevalence of elevated depressive symptoms was 58% (n = 418) among persons with type 2 diabetes mellitus at hospital setting. A higher level of general self-efficacy was related to less depressive symptoms via positive coping preference (p < 0.01).

Discussion

About two-thirds of persons with type 2 diabetes mellitus experienced elevated depressive symptoms during hospitalization. The intervention elements, including strengthening general self-efficacy and promoting positive coping, are promising to decrease their depressive symptoms.

Depressive Symptoms and Blood Pressure in African American Women: A Secondary Analysis From the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study

BACKGROUND

Depression is a risk factor for hypertension, yet few studies have been conducted in African American women.

OBJECTIVE

We conducted a secondary analysis of depressive symptoms and high blood pressure among African American women from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure longitudinal study (N = 250).

METHODS

Logistic regression was used to examine depressive symptoms and blood pressure, adjusting for education, employment, and racism/discrimination. Growth curve modeling was used to investigate longitudinal associations between depressive symptoms and systolic (SBP) and diastolic (DBP) blood pressures at 4 time points (T1-T4).

RESULTS

Depressive symptoms at baseline were not prospectively associated with hypertension prevalence. Participants with Beck Depression Inventory scores higher than 10 had higher estimated marginal SBP and DBP over time compared with participants with lower scores.

CONCLUSION

Depressive symptoms were not associated with hypertension prevalence at T4, but they were associated with higher estimated marginal SBP and DBP. Future research is needed to elucidate mechanisms and implications for clinical care and prevention.

Type 2 diabetes and depression in the African American population

BACKGROUND AND PURPOSE

Type 2 diabetes mellitus (T2DM) affects 30.3 million people (9.4%) in the United States. African Americans are twice as likely to be diagnosed with diabetes and have two to four times the rates of T2DM-associated complications. Depression has long been associated with poor outcomes of diabetic self-management and glycemic control. Comorbidity of T2DM and depression worsen effective self-management of these conditions in the African American population. The purpose of the study was to synthesize the literature with practice recommendations of care related to T2DM and depression in the African American population.

METHODS

A literature search was conducted using PRISMA in June 2018 with PubMed, Google Scholar, Cochrane, Scopus, Embase, and PsycINFO databases using the years from 2008 through 2018. The following terms and combination of terms were used to identify articles for the review: (a) diabetes mellitus, type 2, (b) diabetes type 2 and depression, and (c) diabetes mellitus type 2, depression, African America.

CONCLUSIONS

The overall prevalence of depression with T2DM in African Americans is about 25%. The quality of care received by African Americans is lower when compared with non-Hispanic Whites, resulting in more emergency department visits and fewer physician visits per year. African Americans require supportive and trusting collaboration with providers for the ongoing optimal management of these complex conditions.

IMPLICATION FOR PRACTICE

Culturally relevant education on lifestyle modification may help mitigate barriers to management of T2DM and depression in the African American population. Using the diabetes self-management education/support to help empower African Americans may be essential for effective self-management strategies of T2DM and depression.