Depressive symptom dimensions and medication non-adherence in suboptimally controlled type 2 diabetes

• Published in: Journal of diabetes and its complications 2019-03, Vol.33 (3), p.217-222
• Main Authors: Hoogendoorn, Claire J., Shapira, Amit, Roy, Juan F., Walker, Elizabeth A., Cohen, Hillel W., Gonzalez, Jeffrey S.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cardiovascular disease; Cognitive-affective symptoms; Depression; Depression - epidemiology; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - psychology; Drug administration; Ethnic Groups; Fatigue - epidemiology; Female; Glycated Hemoglobin A - analysis; Health behavior; Hospitalization; Humans; Low income groups; Male; Medication adherence; Mental depression; Middle Aged; Mortality; Odds Ratio; Patient compliance; Patient Compliance - psychology; Patient Compliance - statistics & numerical data; Somatic symptoms; Surveys and Questionnaires; Treatment Outcome; Type 2 diabetes
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2018.12.001

Research suggests differential effects for somatic and cognitive-affective depressive symptoms in predicting health outcomes. This study evaluated differential relations with medication non-adherence among disadvantaged, and predominantly immigrant adults with sub-optimally controlled type 2 diabetes (T2D). Health plan members taking oral diabetes medication and who had A1c ≥ 7.5% were recruited for a trial of telephonic self-management support. A subset (n = 376; age, M = 55.6 ± 7.2 years; A1c M = 9.1% ± 1.6) completed the Patient Health Questionnaire-8 (PHQ-8). Diabetes medication adherence was measured by self-report and claims-based records. Multivariable logistic regression modeled depressive symptoms and odds of non-adherence using pre-intervention data. A positive PHQ-8 screen (OR = 2.72 [95%CI: 1.56–4.73]) and each standard deviation increase in PHQ-8 score (OR = 1.40 [95%CI: 1.11–1.75]) were associated with non-adherence, with no independent effects for somatic versus cognitive-affective symptoms. Exploration of individual symptoms identified three significantly associated with non-adherence in covariate-adjusted models; after adjustment for likely presence of clinical depression, only fatigue was independently associated with non-adherence (OR = 1.71 [95%CI: 1.06–2.77]). Findings support depression symptom severity as a significant correlate of medication non-adherence among disadvantaged adults with T2D. Support was limited for differential associations for symptom dimensions, but findings suggest that fatigue may be associated with non-adherence independent of the likely presence of depression.