Depression remission, receipt of problem-solving therapy, and self-care behavior frequency among low-income, predominantly Hispanic diabetes patients

Abstract

Objective This study explored whether depression remission and problem-solving therapy (PST) receipt are associated with more frequent self-care behaviors via cross-sectional and prospective analyses. Method We analyzed data from a randomized clinical trial (N = 387) that tested collaborative depression care among predominantly Hispanic patients with diabetes in safety-net clinics. Data at 12-month follow-up, measured with the Patient Health Questionnaire-9 and Hopkins Symptom Checklist-20, were used to define depression remission. PST was provided by a bilingual social worker. Multivariate regression analysis was used to examine associations between predictors and frequency change of each self-care behavior (healthy diet, exercise, self-blood glucose monitoring, and foot care between baseline and 12-month (N = 281), 18-month (N = 249), and 24-month (N = 235) follow-up surveys. Results Inconsistent relationships were observed depending on the instrument to identify depression remission, type of self-care behaviors, and time when self-care behavior was measured. Significant associations were more likely to be observed in cross-sectional analyses. PST receipt was not associated with self-care behaviors. Conclusions Depression remission or the receipt of PST may not be a reliable antecedent for more frequent self-care behaviors among this group. A few recommendations for studies were offered to enhance existing depression care for diabetes patients.

Effect of Study Design and Survey Instrument to Identify the Association Between Depressive Symptoms and Physical Activity in Type 2 Diabetes, 2000-2018: A Systematic Review

“…Only 3 clearly described completeness or loss of follow-up, 48,50,51 and while the follow-up time ranged from 6 months to 24 months, only 3 had 1 year, a time frame suggested in recent literature on the effect of PA on depressive symptoms, although it has not been established. 48,50,51,80,81 Only 1 study had a strategy to address study dropouts, 19 while 5 studies were either unclear or did not mention any strategy. 47-51…”

“…Of the 6 longitudinal studies retained in the study, 5 measured both explanatory 19,47-49,51 and outcome variables 19,47,48,50,51 in a valid and reliable way. All studies identified confounders and addressed those using appropriate statistical methods.…”

“…48,50,51,80,81 Only 1 study had a strategy to address study dropouts, 19 while 5 studies were either unclear or did not mention any strategy. 47-51…”

Self-care behavior change and depression among low-income predominantly Hispanic patients in safety-net clinics

“…A randomized controlled trial testing the effectiveness of integrated self-management training for patients with diabetes or heart illness and mental comorbidity demonstrated that integrating therapeutic activities to either improve self-care behaviors or treat depression demonstrated significant benefits regarding self-care behaviors, physical health outcomes, and depression (Katon et al, 2010). Another study found that depression remission in depression care doesn’t necessarily improve self-care behaviors (Oh & Ell, 2016). Thus additional studies with samples gathered from different populations and secondary analyses of data collected in clinical trials are imperative (Sumlin et al, 2014).…”

“…This study focused on whether changes observed in self-care behavior are predictive of changes in depressive symptoms using prospective data from a clinical trial testing effectiveness of collaborative depression care among low-income Hispanic patients with diabetes (Ell, Katon et al, 2010). In another study, we investigated whether depression remission observed at 12-month follow-up was associated with more frequent self-care behaviors 6 and 12 months later (Oh & Ell, 2016). Based on previous studies supporting the bidirectional nature of this relationship, we expect to see that better self-care behaviors would correlated with lower depressive symptoms.…”