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Lifting depressive symptoms promotes diabetes self-management in Hispanics
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U.S. Hispanic adults with diabetes and comorbid depression who participated in a promotora-led or patient-centered medical home intervention experienced an increase in self-efficacy and adherence to diabetes management at 6 and 12 months as depressive symptoms declined, according to findings published in Diabetes Care.
The study, which also assessed the relationships between social support and diabetes management, showed that social support variables were not associated with self-efficacy or adherence to diabetes management at 12 months.
“Despite our findings supporting significance of treating comorbid depression to self-efficacy and adherence to diabetes management, our study is unable to provide evidence that promotora-led intervention can enhance diabetes management by virtue of treated depressive symptoms,” wrote Hyunsung Oh, PhD, an assistant professor in the School of Social Work at Arizona State University, and Kathleen Ell, DSW, the Ernest P. Larson professor of poverty, ethnicity and health at USC School of Social Work.
In a secondary analysis of study data, Oh and Ell analyzed data from 251 Hispanic patients with previously diagnosed diabetes and comorbid depression enrolled in A Helping Hand, a randomized controlled trial examining the effectiveness of a promotora-led self-management support program compared with a standard patient-centered medical home model that included a physician, nurse and medical assistant. A promotora is a community health worker for Hispanic patients who continues to practice indigenous customs and conform to cultural norms. Patients were recruited from three safety-net clinics in East Los Angeles, California, between April 2014 and May 2015. Depressive symptoms were assessed via the nine-item Patient Health Questionnaire, perceived social support was assessed with the eight-item Modified Medical Outcomes Study (MOS) Social Support Survey, adherence to self-care behavior was measured with the MOS Specific Adherence Recommendations, and self-efficacy was measured with the Self-Efficacy for Managing Chronic Disease scale. Researchers used hierarchical regression models to examine the correlations between changes in depressive symptoms and social support variables from baseline to 6 months, and self-efficacy and adherence to recommend self-care behaviors at 6 and 12 months.
In the original analysis of A Helping Hand, researchers found no between-program differences in terms of depression outcomes, psychological health, self-care management, physical condition, stress and social support, or glycemic control.
From baseline to 6 months, average depressive symptom scores fell from 15.77 to 8.56 for participants in the promotora-led and standard care programs. Scores for total social support rose from a mean of 52.66 to 74.09, scores for instrumental social support rose from a mean of 50.03 to 68.55 and scores for emotional social support rose from a mean of 55.29 to 79.63.
Researchers found that changes in depressive symptoms at 6 months was correlated with self-efficacy at 6 months (P < .001). Effect sizes of changes in depressive symptoms were 0.4, meaning that when patients with diabetes experienced a 1-standard deviation decline in depressive symptoms, self-efficacy increased by 0.4 standard deviation, they noted. Changes in total social support were correlated with self-efficacy (P < .01).
Researchers also found that changes in depressive symptoms predicted differences in adherence to diabetes management across three regression models (P < .001). There was no correlation between any social support variable with adherence to diabetes management at 6 or 12 months (P > .05 for both), according to researchers, and no social support variables were correlated with self-efficacy related to diabetes management at 12 months.
The researchers noted that the strength of the association between changes in social support and diabetes management could be too negligible to detect in a low-powered study, and that it is possible that social support only works as a “buffer” to negatives from social and diabetes-related stressors.
“Lastly, it is possible that measuring social support may not capture nuanced mechanisms by which social support facilitates self-efficacy and behavioral modification regarding chronic illness management,” the researchers wrote.
The researchers wrote that studies using different methodologic approaches to measure different functions of social networks are needed. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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