Depression in adults with type 2 diabetes: the role of adherence, body mass index, and self-efficacy.

Considerable evidence links depression with the development and worsening of diabetes, but the factors contributing to this link have not been established. The authors examined the role of adherence, body mass index (BMI), and self-efficacy. Adult patients with Type 2 diabetes (N = 56) completed self-report measures of diet and exercise adherence, diet and exercise self-efficacy, and depression. BMI was obtained from medical records. Path and mediation analyses indicated that both adherence and BMI independently contributed to self-efficacy. Self-efficacy mediated both the association between adherence and depression and the association between BMI and depression. These findings are consistent with the proposal that lower self-efficacy in reaction to adherence failure and higher BMI contributes to depression in adults with diabetes.     

Relations of diabetes intrusiveness and personal control to symptoms of depression among adults with diabetes.

The generalizability of a model linking illness characteristics to psychosocial well-being was tested in a cross-sectional study of 237 adults with type 2 diabetes. It was hypothesized that diabetic complications increase illness intrusiveness, which in turn increases depressive symptomatology either directly or indirectly by reducing personal control over health outcomes. Illness intrusiveness was defined as the result of disruptions of valued activities and interests due to constraints imposed by the illness. An excellent fit of this model to the data was found using structural equation modeling. The model explained 65% of the variance in depressive symptomatology. Assessment of an alternative model excluding personal control suggested that the extent to which diabetes intrudes in life, rather than diabetic complications per se or personal control, is a key factor in relation to depressive symptomatology in individuals with diabetes.     

Higher body mass index is associated with episodic memory deficits in young adults

Obesity has become an international health crisis. There is accumulating evidence that excess bodyweight is associated with changes to the structure and function of the brain and with a number of cognitive deficits. In particular, research suggests that obesity is associated with hippocampal and frontal lobe dysfunction, which would be predicted to impact memory. However, evidence for such memory impairment is currently limited. We hypothesised that higher body mass index (BMI) would be associated with reduced performance on a test of episodic memory that assesses not only content, but also context and feature integration. A total of 50 participants aged 18–35 years, with BMIs ranging from 18 to 51, were tested on a novel what–where–when style episodic memory test: the “Treasure-Hunt Task”. This test requires recollection of object, location, and temporal order information within the same paradigm, as well as testing the ability to integrate these features into a single event recollection. Higher BMI was associated with significantly lower performance on the what–where–when (WWW) memory task and all individual elements: object identification, location memory, and temporal order memory. After controlling for age, sex, and years in education, the effect of BMI on the individual what, where, and when tasks remained, while the WWW dropped below significance. This finding of episodic memory deficits in obesity is of concern given the emerging evidence for a role for episodic cognition in appetite regulation.     

Writing self-efficacy changes after cognitive strategy intervention in students with learning disabilities: the mediational role of gender in calibration

This study examines the mediational role of gender in the effects of two patterns of cognitive and self-regulatory strategy interventions in the writing self-efficacy calibration of students with learning disabilities (LD). 121 5th and 6th Primary grade students with LD (43 girls and 78 boys), ranging in age from 10 to 12 years old were randomly allocated either to one of the experimental intervention groups, (n=48, 19 girls and 29 boys), and followed a intervention program based on the Self-Regulated Strategy Development Model, or they received training based on the Social Cognitive Model of Sequential Skill Acquisition (n=31, 15 girls and 26 boys), or alternatively they were allocated to the ordinary instruction group (n=32, 9 girls and 23 boys). Writing performance was assessed using two types of writing evaluation: a reader-based score concerned with structure, coherence and quality, and a text based score regarding productivity, coherence and structure. Writing self-efficacy beliefs were also assessed using a self-report scale including eight items about the students' confidence in completing a writing task and to gain specific writing skills. The results suggest that the miscalibration of writing self-efficacy in girls with LD was significantly modified to a more realistic calibration of their writing competence after experimental intervention. However, the findings do not confirm the same clear statement for boys.     

Associations of blood glucose control with self-efficacy and rated anxiety/depression in type II diabetes mellitus patients

We investigated the possible relations of hemoglobin A1c (HbA1c) level, a parameter of blood glucose control with scores on anxiety, depression, and self-efficacy for 113 outpatients (55 men and 58 women) with type II diabetes mellitus. The relation between the HbA1c level and the self-efficacy scores as well as with the ratings of anxiety and depression was evaluated. A significant relation was found for the HbA1c level with the scores; however, self-efficacy and anxiety and depression showed no association. These results suggest that HbA1c can be maintained at better levels by increasing self-efficacy of diabetic patients.     

Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes

This cross-sectional study examined the joint effects of self-efficacy and illness representations on dietary self-care and diabetes distress in adolescents with type 1 diabetes by comparing two theoretical models: the Self-regulation Model (Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common-sense representations of illness danger. In S. Rachman (Ed.), Medical Psychology (Vol. 2, pp. 7–30). New York: Pergamon.) and Social Cognitive Theory (Bandura, A. (1997). Self efficacy: The exercise of control. New York: W.H. Freeman.). One hundred and fifty-one adolescents with type 1 diabetes completed self-report measures of dietary self-efficacy, illness representations, dietary self-care and diabetes distress. Data were analysed using structural equation modelling. The model best supported by the data (Leventhal's Self-regulation Model) showed that dietary self-efficacy, perceived consequences and treatment effectiveness had direct and independent effects on both dietary self-care and diabetes distress. Together with dietary self-efficacy, perceived short-term treatment effectiveness was a significant predictor of dietary self-care. Age was found to be a negative predictor of short-term treatment effectiveness beliefs. Diabetes distress was best predicted by self-efficacy and perceived consequences. It can be concluded that to target effectively dietary self-care and distress, clinicians should focus on key illness representation variables (perceived short-term treatment effectiveness and perceived consequences) in conjunction with self-efficacy.     

Diabetes distress,illness perceptions and glycaemic control in adults with type 2 diabetes

The emotional distress associated with adjusting to and living with diabetes has been termed diabetes distress. Diabetes distress is associated with glycaemic control but interventions to reduce diabetes distress have failed to consistently improve diabetes control. Various illness perceptions have previously been linked with both diabetes distress and glycaemic control but interrelationships between these features have not been previously investigated. We hypothesised that illness perceptions mediate the relationship between diabetes distress and glycaemia. Participants with type 2 diabetes attending diabetes outpatient clinics (n = 84) provided demographic and clinical information and completed the Diabetes Distress Scale-17 and the Brief Illness Perceptions Questionnaire. Using regression analysis we demonstrated that the illness perceptions of personal control, regimen-related distress, socioeconomic status and insulin use were significant contributors in the final model predicting HbA_1c. Higher levels of personal control were associated with better glycaemic control. Conversely, regimen-related distress was associated with hyperglycaemia. Mediation analyses showed that the relationship between regimen-related distress and HbA_1c was mediated by personal control. Our work suggests that psychological interventions designed to reduce diabetes distress may be more efficacious in improving glycaemic control if they address an individual’s perception of personal control.     

The role of depression symptoms in dialysis withdrawal.

Among end-stage renal disease (ESRD) patients on hemodialysis, death from withdrawal from life-sustaining dialysis is increasingly common. The present study's objective was to examine depression as a potential risk factor for hemodialysis withdrawal. Two hundred forty ESRD hemodialysis (133 male and 107 female) patients were followed for an average of 4 years after depression symptom assessment. Of these, 18% withdrew from dialysis. Using multivariate survival analysis and after controlling for the effects of age (p < .001) and clinical variables, the authors found that level of depression symptoms was a unique and significant predictive risk factor for the subsequent decision to withdraw from dialysis (p < .05). The potential impact that depression may have on the decision to withdraw from hemodialysis should be considered by health care providers, patient families, and patients.     

The role of body mass index,weight change desires and depressive symptoms in the health-related quality of life of children living in urban disadvantage: Testing mediation models

Objectives: This study was undertaken to ascertain whether or not the body mass index (BMI) of urban disadvantaged children indirectly affects their health-related quality of life (HRQoL) through weight change desires and depressive symptoms and whether such mediation is conditional upon age and gender.

Design: A total of 255 children aged 7–12 years (50% male) were recruited from 7 schools in urban disadvantaged districts in Ireland using consecutive sampling. A prospective longitudinal design was employed whereby children completed, at two time points, the Kidscreen-27, the Children’s Depression Inventory, and the Health Related Behaviour Questionnaire, and had their BMI measured. The analyses involved multiple-, half-longitudinal- and moderated-mediation.

Results: Results showed that the depressive symptoms of children wanting to change their weight may have lead, in large part, to poorer HRQoL (specifically psychological well-being when considering longitudinal data) rather than weight status per se. The mediation effect of weight change desires occurred regardless of age or gender.

Conclusions: Childhood obesity programmes that traditionally focus on the negatives of obesity and the need to control weight may need to take a more positive approach to health and well-being by, for example promoting intuitive eating, an active lifestyle, body acceptance and good mental health.     

Comorbidity of substance dependence and depression: role of life stress and self-efficacy in sustaining abstinence.

The authors examined life stress and self-efficacy as predictors of time to relapse for 113 adults with comorbid major depressive disorder and alcohol and/or substance dependence in a randomized clinical trial comparing 2 psychotherapy interventions (integrated cognitive- behavioral therapy and 12-step facilitation therapy). Life stress, self-efficacy, and substance use were assessed at treatment entry, 12 weeks (mid-treatment), and 24 weeks (end of treatment). Time to relapse was defined as the number of days from treatment initiation until first alcohol and/or drug use. Half of the sample relapsed within the study period of 24 weeks. There was no significant difference between treatment groups. Individuals experiencing life stressors were more likely to relapse early than those not experiencing life stressors. Lower self-efficacy also predicted earlier relapse. Chronic stress levels and self-efficacy were stable across time for most individuals. In contrast, acute stress events occurred at differing times, and survival analyses provided evidence of heightened relapse risk in the month following acute stressors. The interaction of self-efficacy and life stress was not significant. The results highlight the significance of life stress and self-efficacy as predictors of early relapse.     

Affluent adolescents, depression, and drug use: the role of adults in their lives

The present study examined the association between adult supports to whom affluent youth turn when personally troubled or upset and their self-reported depression and drug use. The sample consisted of 374 affluent seventh graders. Perceived parental closeness played a mediating role in reducing depressive symptomology and drug use. Contrary to hypothesized predictions, other adult supports showed neither mediating nor moderating effect on adjustment. The data show that the presence of other adult supports in the context of low parental closeness actually exacerbates, not moderates, maladjustment. Since this finding is contradictory to the support literature with various populations, which shows the importance of social supports for psychological well-being, the particularity of this population and their potential challenges are highlighted.     

Predicting posttraumatic growth among Hurricane Katrina survivors living with HIV: the role of self-efficacy,social support,and PTSD symptoms

Abstract

The study tested the model of adaptation after trauma by Benight and Bandura (2004) indicating that posttraumatic recovery may be predicted directly by coping self-efficacy (CSE) and indirectly by social support. These relations were investigated in the context of posttraumatic growth (PTG) among Hurricane Katrina survivors living with HIV. Additionally, it was hypothesized that among individuals with more intensive Posttraumatic Stress Disorder (PTSD) symptoms, those with strong CSE would experience the strongest PTG. Cross-sectional data were collected among 90 patients with HIV who reinitiated care at the HIV outpatient clinic. Questionnaires were administered approximately 14 months after the hurricane. Higher CSE was related to higher PTG among the survivors who suffered from more intensive PTSD symptoms. Received social support was directly related to only one index of PTG, relating to others. Furthermore, although there was a significant relationship between social support and CSE, the indirect conditional effect of received social support on PTG was not confirmed. Similar results were obtained across the indices of PTG, controlling for the level of exposure to hurricane-related trauma. Cross-sectional design and convenience character of the sample warrants replications.     

Regulatory focus and adherence to self-care behaviors among adults with type 2 diabetes

The aims of this study were, first, to test the association between regulatory focus of adults with type 2 diabetes and their adherence to two types of self-care behaviors – lifestyle change (e.g. physical activity and diet) and medical care regimens (blood-glucose monitoring, foot care and medication usage). Second, to explore whether a fit between the message framing and patients’ regulatory focus would improve their intentions to adhere specifically when the type of behavior fits the patients’ regulatory focus as well. A cross-sectional study was conducted among 130 adults with type 2 diabetes who were hospitalized in an academic medical center. The patients completed a set of questionnaires that included their diabetes self-care activities, regulatory focus, self-esteem and demographic, socioeconomic and clinical data. In addition, participants were exposed to either a gain-framed or a loss-framed message, and were then asked to indicate their intention to improve adherence to self-care behaviors. A multivariable linear regression model revealed that promoters reported higher adherence to lifestyle change behaviors than preventers did (B = .60, p = .028). However, no effect of regulatory focus on adherence to medical care regimens was found (B = .46, p = .114). In addition, preventers reported higher intentions to adhere to medical care behaviors when the message framing was congruent with prevention focus (B = 1.16, p = .023). However, promoters did not report higher intentions to adhere to lifestyle behaviors when the message framing was congruent with promotion focus (B = ?.16, p = .765). These findings justify the need to develop tailor-made interventions that are adjusted to both patients’ regulatory focus and type of health behavior.     

College drinking behaviors: mediational links between parenting styles, parental bonds, depression, and alcohol problems.

Mediational links between parenting styles (authoritative, authoritarian, permissive), parental bond (positive, negative), depression, alcohol use and abuse were tested. A 2-group, multiple-indicator, multiple-cause structural equation model with 441 (216 female, 225 male) college students was examined. In general, a poor parental bond with one's father was highly predictive of depression, a well-known predictor of alcohol abuse and related problems for both genders. In contrast, a positive parental bond with one's father significantly mediated the positive effects of authoritative fathering on depression, which then decreased alcohol use problems for both genders. For women, a negative parental bond with one's father significantly mediated the effect of having an authoritarian father on depression, which increased alcohol use problems. These findings suggest that parental influences on pathways to alcohol abuse through depression (primarily through fathers for both genders) are distinct from pathways stemming from poor impulse control (with influences primarily from the same-sex parents for both genders).     

Accelerometer feedback to promote physical activity in adults with type 2 diabetes: a pilot study

This study examined whether giving activity feedback to obese, sedentary adults with Type 2 diabetes would improve their adherence to a home-based walking program. 49 subjects were recruited. Ten failed a treadmill cardiovascular test. Another 9 dropped out before the intervention, and 4 dropped out during the intervention. The remaining 26 adults (14 women, 12 men; age M = 48.1 yr., SD = 7.1) received behavioral counseling monthly for 3 mo. regarding exercise. All subjects wore a triaxial accelerometer during these 3 months. Randomly, half of the subjects were blind to the data from the accelerometers, i.e., no feedback, and had counseling based on their self-report diaries. The other half had access to the accelerometer data, got a computerized graph of their physical activity for the period between counseling sessions, and had counseling based on these objective data, i.e., feedback. The feedback group showed an increase in exercise over the 3 mo. The nonfeedback group showed an increase in activity at 1.5 mo. but reverted to their baseline exercise levels at 3 mo. However, analysis of variance showed there was at least an 8% probability that this effect was due to chance, so the hypothesis that feedback would improve exercise adherence could not be supported. Further studies with larger sample sizes and greater control of experimental conditions are needed to determine the utility of objective activity feedback.     

Motivation and dietary self-care in adults with diabetes: are self-efficacy and autonomous self-regulation complementary or competing constructs?

This study examined constructs drawn from social-cognitive theory (A. Bandura, 1986) and self-determination theory (E. L. Deci & R. M. Ryan, 1985, 1991) in relation to dietary self-care and life satisfaction among 638 individuals with diabetes. A motivational model of diabetes dietary self-care was proposed, which postulates direct links between self-efficacy/autonomous self-regulation, and adherence/ life satisfaction. Structural equation modeling showed that both self-efficacy and autonomous self-regulation were associated with adherence (betas = .54 and .21, respectively) and with life satisfaction (betas = .15 and .34, respectively). Constraint analyses confirmed that self-efficacy was significantly more associated with adherence, whereas autonomous self-regulation was significantly more associated with life satisfaction. According to the model, interventions for dietary self-care and life satisfaction should focus on increasing self-efficacy and autonomous self-regulation.     

Attachment relationships and health behavior: the mediational role of self-esteem

Many young adults exhibit poor preventive health behavior (e.g., exercise, diet), thereby increasing their long-term risk to health. Recent research has focused on factors related to the development of health behavior in an effort to design effective early interventions. The present study evaluates how attachment styles are related to health behavior in young adults, and the potential mediational role of self-esteem. University students (N = 793) completed surveys assessing attachment style, self-esteem, and health behavior. Results showed that those with secure attachment styles participated in healthier preventive health behavior and had higher self-esteem than those with insecure styles (all ps < 0.05). Self-esteem partially mediated the relation between attachment styles and health behavior (p < 0.01). These results suggest that the development of self-esteem may represent a pathway by which individual styles of interaction with significant others, acquired early in life, can significantly impact key long-term preventive health behaviors.     

The association of anxiety,depression, and worry symptoms on cognitive performance in older adults

Emerging research suggests that a relationship exists between the cognitive aspects of anxiety (e.g. worry) and cognitive decline in older adults. The current study examined the association between anxiety, depressive, and worry symptoms on cognitive performance. Participants were 156 older adults enrolled in the Nathan Kline Institute-Rockland Sample Study (NKI-RS). Hierarchical linear regression analysis was used to determine the unique associations of anxiety, depressive, and worry symptoms on cognitive performance as measured by the Penn Computerized Neurocognitive Battery (Penn CNB), the Delis-Kaplan Executive Function System (D-KEFS), and the Rey Auditory Verbal Learning Test (RAVLT). Worry symptoms were a significant predictor of Penn CNB social cognition, complex cognition, executive function, and episodic memory performance as well as RAVLT immediate and short-delay recall, but not of D-KEFS performance or RAVLT long-delay recall. In contrast, anxiety and depressive symptoms had few unique associations with cognitive performance. Given that worry symptoms have a negative impact on many aspects of neurocognitive performance, they may have utility in predicting and preventing cognitive decline in older adults.     

Social cognitive theory correlates of moderate-intensity exercise among adults with type 2 diabetes

The purpose of this study was to identify social cognitive theory (SCT) correlates of moderate- to vigorous-intensity exercise (MVPA) among adults with type 2 diabetes. Adults with type 2 diabetes (N = 181) participated in the study. Participants were recruited through ResearchMatch.org to complete an online survey. The survey used previously validated instruments to measure dimensions of self-efficacy, self-regulation, social support, outcome expectations, the physical environment, and minutes of MVPA per week. Spearman Rank Correlations were used to determine the relationship between SCT variables and MVPA. Classification and Regression Analysis using a decision tree model was used to determine the amount of variance in MVPA explained by SCT variables. Due to low levels of vigorous activity, only moderate-intensity exercise (MIE) was analyzed. SCT variables explained 42.4% of the variance in MIE. Self-monitoring, social support from family, social support from friends, and self-evaluative outcome expectations all contributed to the variability in MIE. Other contributing variables included self-reward, task self-efficacy, social outcome expectations, overcoming barriers, and self-efficacy for making time for exercise. SCT is a useful theory for identifying correlates of MIE among adults with type 2 diabetes. The SCT correlates can be used to refine diabetes education programs to target the adoption and maintenance of regular exercise.