Background and Aims : There is a higher prevalence of depression in people with type 2 diabetes, however, there have been mixed reports of whether depression is associated with impaired self-management and worse glucose control. The relationship of depression with attitudes toward diabetes, self-efficacy, care ability, self-care adherence, patient personality and A1c is of interest.
Methods : As part of the Journey for Control of Diabetes IDEA Study, 623 consented subjects with pre-existing type 2 diabetes and A1c>=7% at sites in New Mexico (Lovelace Clinic Foundation, LCF) and Minnesota (HealthPartners Research Foundation, HPRF) were randomized to group or individual education or to usual care (no education). At the baseline and randomization visit, patients completed a survey that included PHQ9 screening for depression as well as behavioral and emotional outcomes, including the DES (Diabetes Empowerment Scale), DCP (Diabetes Care Profile) scores for positive and negative attitude, care ability, self-care adherence, and the Big Five Personality Inventory. Frequencies of depression categorized by PHQ9 score (none 0-4, mild 5-9, moderate 10-14, and moderately severe to severe 15+) were evaluated and compared across study sites. Relationships of PHQ9 scores with A1c, personality, and behavioral and emotional scores at baseline were estimated by Spearman and Pearson correlations.
Results : 53.1% of subjects had no depression (57.6% HP, 47.9% LCF), 26.7% had mild depression (24.3% HP, 29.4% LCF), 13.3% had moderate depression (11.6% HP, 15.4% LCF), and 6.90% had moderately severe to severe depression (6.52% HP, 7.35% LCF). Adjusted spearman and pearson correlations showed moderate relationships between PHQ9 score and attitudes (positive, -0.49, p<0.0001 and negative, 0.44, p<0.0001), selfefficacy (-0.29, p<0.0001), care ability (-0.42, p<0.0001), self-care adherence (-0.37. p<0.0001), and personality qualities of extraversion -0.18, agreeableness -0.25, conscientiousness -0.30, emotional stability -0.41, and openness -0.25 (all p<0.0001). Correlation to A1c was 0.13 (p=0.001) overall, 0.26 (p<0.0001) for men, and 0.15 (p=0.007) for women.
Conclusions : Depression is moderately correlated with personality, attitudes, self-efficacy, care ability, and selfcare adherence, but only weakly with A1c. Depression is more correlated with A1c in males than females. More research is needed to evaluate the relationships between depression, gender and personality in patients with type 2 diabetes.