Psychosocial predictors of self-care behaviors in type 2 diabetes mellitus patients: analysis of social support, self-efficacy, and depression
Skarbek, Edyta Anna
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Diabetes mellitus is a chronic medical illness presenting a potential risk for multiple life-threatening medical complications, including blindness, kidney failure, limb amputation, heart disease, and stroke. Empirical literature suggests that tight metabolic control achieved through the adequate execution of self-care behaviors on part of diabetes patients can significantly reduce the risk of developing such complications. Consequently, gaining a greater understanding of factors that influence diabetes self-care practices is of vital importance. In addition, there has been a growing interest in recent years in factors that may determine the psychological adjustment status of type diabetes mellitus patients. The empirical literature suggests that self-efficacy and social support are two significant variables determining the functioning of diabetes patients in terms of psychological adjustment (i.e., depressive symptomatology) and self-care. However, the specific mechanisms through which self-efficacy and social support influence depressive symptoms and self-care in diabetes mellitus patients have not been fully understood. Furthermore, empirical research is not always consistent in identifying which aspects of the social support system may facilitate or impede diabetes self-management or have an impact on depressive symptoms in the diabetes mellitus population. The purpose of the present study was to examine mechanisms through which self-efficacy, social support, and depression influence self-care behaviors in type 2 diabetes mellitus patients. The current study also explored which aspects of social support have the greatest impact in terms of diabetes self-management and depressive symptoms in a type 2 diabetes mellitus patient population. The sample consisted of 80 type 2 diabetes mellitus patients who were recruited through the Texas Tech University Health Science Center Internal Medicine Clinic. Participants completed measures of social support, self-efficacy, depressive symptoms, and diabetes self-management. The data were analyzed cross-sectionally using linear regression analyses. Results indicate that negative social support concerning the patients’ self-management (i.e., arguing and criticizing patient’s self-care) is a stronger and more significant predictor of depressive symptoms than positive social support provided by family and friends. Depressive symptoms, in turn, predict poorer diabetes self-management, including worse diet and exercise practices. In terms of positive social support, the results suggest that collaborative behaviors concerning patient’s self-care on the part of significant others predict better exercise self-care directly and indirectly, through their effects on self-efficacy judgments. Positive social support also enhances diet self-care among diabetes mellitus patients. However, the hypothesis that negative social support moderates the relationship between depressive symptomatology and self-care in type 2 diabetes mellitus patients, was not supported. Finally, the results of the present study suggest that psychiatric and medical comorbidity are two major challenges facing type 2 diabetes mellitus patient population. Over 41% of type 2 diabetes mellitus patients met possible criteria for significant depressive symptoms, and nearly 59% reported being diagnosed with another chronic illness. The clinical implications and directions for future research are discussed.