Social Support, Depression and Treatment Adherence Among Type 2 Diabetes Patients

Abstract

Background: Research indicates that depression in patients with diabetes is related to increased morbidity, mortality, and lack of adherence to diabetes treatment; it is also established that social support is linked to both adherence behaviors and depression. However, the relationships between depression, social support and diabetes treatment adherence have not been fully understood. This study examined: 1) interrelationships among social support, depression, and diabetic treatment adherence, 2) independent effects of depression and social support predicting diabetes treatment adherence, and 3) evidence for a mediating versus moderating role of depression in explaining the relationship between social support and diabetes treatment adherence. Methods: The sample consisted of 147 participants with type 2 diabetes mellitus who were recruited through Massachusetts General Hospital. Participants completed measures of social support, depressive symptoms, and diabetes self-management. The data were analyzed cross-sectionally. Results: Correlational analyses indicate that depression symptoms are associated with poorer diabetes self-management, including worse diet (r = -.22, p = .008). Hierarchical regression analyses demonstrated that depression moderates the relationship between perceived satisfaction with support and medication adherence (beta = -.195 p = .02). Post-hoc analyses showed that, at low levels of depression, there was a nonsignificant positive relationship between perceived satisfaction with support and medication adherence (beta = .198, t = 1.7, p = .100). At high levels of depression, participants with a greater perceived satisfaction with support reported less treatment adherence (beta = -.17, t = -1.6, p = .122), although the relationship fell short of significance. Similarly, a hierarchical regression analysis demonstrated that perceived satisfaction with support moderates the relationship between depression and medication adherence. At low levels of perceived satisfaction with support there is no relationship between depression and treatment adherence (beta = -.002, t = -.023, p = .982), and at high levels of perceived satisfaction, there is a negative relationship between depression and medication adherence (beta = -.36, t = -3.1, p = .003). Conclusions: The present findings suggest that it is important to consider psychosocial factors, such as depression and social support, when treating type 2 diabetes patients. Our study found that the relationship between social support and diabetes medication adherence depends on the level of depression. Clinicians should, therefore, attend to both social support satisfaction and depression when evaluating diabetes patients who may be nonadherent to treatment.