Does diabetes-related distress explain the presence of depressive symptoms and/or poor self-care in individuals with Type 1 diabetes?

Aims To examine the relationship between depressive symptomatology, diabetes-related distress and aspects of diabetes self-care in a cohort of individuals with Type 1 diabetes. Methods Individuals with Type 1 diabetes taking part in the Pittsburgh Epidemiology of Diabetes Complications Study completed the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression (CES-D) Scale and the Problem Areas in Diabetes (PAID) scale. Self-care was measured by physical activity in the past week and over the previous year, frequency of blood glucose ⁄ urine testing, smoking status and alcohol intake. Results Clinically significant levels of depressive symptomatology (i.e. scores ‡ 16) were reported by 14% of the study population on the BDI and by 18% on the CES-D. There were strong correlations between depressive symptoms and diabetes related distress (PAID scores) and physical activity. Multivariate analyses indicated that depression was independently associated with diabetes-related distress scores and with physical activity, but not with frequency of blood glucose testing. Conclusions These findings have implications for clinical practice and treatment of both psychological morbidity and diabetes. There may be significant effects of depression on aspects of diabetes self-care. Further prospective studies are required to confirm these findings

Cross-cultural comparisons of anxiety and depression in adults with type 1 diabetes

Background Symptoms of depression and anxiety may be more prevalent in individuals with diabetes; however, little is known about possible differences with respect to social or cultural environment. The aim of this study was to examine cross-cultural differences in prevalence and correlates of symptoms of anxiety and depression in two studies, one in the United Kingdom and one in the United States. Methods Adults with type 1 diabetes participating in two studies in Birmingham, UK, and Pittsburgh, US, completed psychosocial questionnaires including the Beck Depression Inventory and the Beck Anxiety Scale. Results UK subjects were significantly more likely to report moderate-severe levels of anxiety compared to US subjects (17% vs 5%; p < 0.001). Similar proportions of UK and US subjects reported moderate-severe levels of depressive symptomatology (9% vs 7%). Gender differences in symptomatology were more apparent in the US sample than in the UK study population. Multiple regression analysis demonstrated that for the UK study, symptoms of depression, less physical activity and greater frequency of blood glucose monitoring were significantly associated with symptoms of anxiety. Symptoms of depression were also significantly associated with anxiety in the US sample. For UK subjects, depressive symptoms were significantly associated with higher anxiety scores, whereas in the US subjects, anxiety and smoking were significant independent correlates of depression. Conclusions These data suggest that there may be cultural and/or gender differences in the experience of symptoms of anxiety and depression, and also differences in the relationship between psychological symptomatology and diabetes self-care. Our findings have implications for the understanding of the role psychosocial factors play in the management of diabetes