Major depression: Effect on self-care behavior of adults with diabetes

Major depression (MD) often coincides with diabetes and may dramatically affect self-care behavior. Depression induced behavioral changes might be the main obstacle for self-management and cause of increasing long-term complications and mortality among individuals with diabetes type II. The Canadian Diabetes Association (CDA) updated guidelines for prevention and management of diabetes and established standards for self-care where glycemic and foot self-care are cornerstones of diabetes self-management.

Objectives: to assess effect of MD on diabetes self-care according to CDA recommendations.

Study sample: The analysis was conducted using the 2007-08 Canadian Community Health Survey data. In addition to core survey, modules on depression and diabetes care were administered in health regions of Nova Scotia and New Brunswick. The final study sample contained 932 adults with non-gestational diabetes.

Results: The rate of MD was almost 3 times higher among females than males (11.2% versus 3.5%). By age group, the highest percentage of MD was among adults 30-39 year old (23.6%). More than half of study participants in each demographic subgroup were noncompliant with the guidelines. Males were less likely to be compliant than females (57.5% and 54.3%). MD was significantly associated with increased rate of noncompliance (OR=1.76; 95% CI =1.02; 3.32) after adjusting for age, sex, and education. Although females had higher prevalence of MD compared with males, being a female had a protective effect against noncompliance in patients with diabetes type II.

Conclusion: Major depression almost doubled the rate of noncompliance with self-care practices recommended by CDA guidelines. Major depression should be considered by health practitioners as the key challenge in diabetes self-care and depression management must be taken into account for healthcare planning to prevent diabetes complications.