TY - JOUR

T1 - Symptoms of depression and anxiety in adults with type 1 diabetes

T2 - Associations with self-care behaviour, glycaemia and incident complications over four years – Results from diabetes MILES–Australia

AU - Schmitt, A

AU - McSharry, J

AU - Speight, J

AU - Holmes-Truscott, E

AU - Hendrieckx, C

AU - Skinner, Timothy

AU - Pouwer, F

AU - Byrne, M

PY - 2021/3/1

Y1 - 2021/3/1

N2 - ObjectiveTo examine whether symptoms of depression or anxiety predict glycaemia and incident diabetes complications four years later, and whether diabetes self-care behaviours mediate these associations, in adults with type 1 diabetes (T1DM).MethodsData of 205 adults with T1DM from the 2011 and 2015 Diabetes MILES–Australia surveys were analysed. Variables of interest were: baseline depression and anxiety (PHQ-8 and GAD-7, respectively) symptoms; HbA1c and incident complications at four-year follow-up; and self-care behaviours at both time points. Longitudinal associations were analysed using structural equation modelling.ResultsForty-two participants (20.6%) reported incident complications. Baseline depressive symptoms predicted higher HbA1c at follow-up indirectly via less optimal self-care at follow-up (β = 0.19, P = 0.011). Baseline anxiety was not independently associated with HbA1c or self-care at follow-up (P ≥ 0.64). Neither depressive nor anxiety symptoms predicted incident complications, although depressive symptoms were associated with less optimal self-care at baseline (β = -0.67, P < 0.001), and this predicted microvascular complications (β = -0.38, P = 0.044); however, the indirect association via self-care was not significant (β = 0.25, P = 0.067).LimitationsParticipants were self-selected; all study variables were assessed using self-report measures; and adjusting for baseline HbA1c was not possible.ConclusionsDepressive symptoms predicted suboptimal self-care behaviour and glycaemic outcome four years later, while anxiety symptoms did not. The findings suggest that tailored diabetes care should take the potential impact of comorbid depression into consideration to help people improve their diabetes self-care and achieve best possible health outcomes.

AB - ObjectiveTo examine whether symptoms of depression or anxiety predict glycaemia and incident diabetes complications four years later, and whether diabetes self-care behaviours mediate these associations, in adults with type 1 diabetes (T1DM).MethodsData of 205 adults with T1DM from the 2011 and 2015 Diabetes MILES–Australia surveys were analysed. Variables of interest were: baseline depression and anxiety (PHQ-8 and GAD-7, respectively) symptoms; HbA1c and incident complications at four-year follow-up; and self-care behaviours at both time points. Longitudinal associations were analysed using structural equation modelling.ResultsForty-two participants (20.6%) reported incident complications. Baseline depressive symptoms predicted higher HbA1c at follow-up indirectly via less optimal self-care at follow-up (β = 0.19, P = 0.011). Baseline anxiety was not independently associated with HbA1c or self-care at follow-up (P ≥ 0.64). Neither depressive nor anxiety symptoms predicted incident complications, although depressive symptoms were associated with less optimal self-care at baseline (β = -0.67, P < 0.001), and this predicted microvascular complications (β = -0.38, P = 0.044); however, the indirect association via self-care was not significant (β = 0.25, P = 0.067).LimitationsParticipants were self-selected; all study variables were assessed using self-report measures; and adjusting for baseline HbA1c was not possible.ConclusionsDepressive symptoms predicted suboptimal self-care behaviour and glycaemic outcome four years later, while anxiety symptoms did not. The findings suggest that tailored diabetes care should take the potential impact of comorbid depression into consideration to help people improve their diabetes self-care and achieve best possible health outcomes.

KW - Faculty of Social Sciences

KW - Diabetes mellitus

KW - Depression

KW - Anxiety

KW - Self-management behaviour

KW - Health outcomes

KW - Complications

U2 - 10.1016/j.jad.2020.12.196

DO - 10.1016/j.jad.2020.12.196

M3 - Journal article

C2 - 33601721

VL - 282

SP - 803

EP - 811

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -