Korean J Health Promot.  2015 Dec;15(4):235-243. 10.15384/kjhp.2015.15.4.235.

Mediating Effects of Perceived Barriers on the Relationship between Depression and Diabetes Management Self-efficacy in Type 2 Diabetes Patients

• Hur H
• Choi J
• Choi E
• Koh J
• Moon H

• KMID: 2247050
• DOI: http://doi.org/10.15384/kjhp.2015.15.4.235

Abstract

BACKGROUND
Diabetes mellitus is a life threatening disease that one out of ten Korean adults aged over 30 has it. Depression of diabetes patients affects the perception on their health negatively and self-management inefficiently, and then leads to a failure in blood sugar control. Therefore, it is necessary to investigate the relationships among depression, perceived barriers and self-efficacy on diabetes management in depth.
METHODS
This descriptive study was undertaken to identify the mediating effects of perceived barriers on the relationship between depression and self-efficacy on diabetes management among type 2 diabetes patients. 173 patients with type 2 diabetes were recruited from an out-patient clinic of Y university hospital. Data were collected from June 26 to July 18, 2014 using a structured self-report questionnaire, and analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, multiple regressions, and Sobel test.
RESULTS
Among173 participants, 12.1% were classified as depressed group. Self-efficacy on diabetes management was found to be significantly associated with education level and the presence of complications. Depression and perceived barriers were positively related to each other, but both were negatively related to self-efficacy on diabetes management. In addition, perceived barriers were found to mediate the relationship between depression and diabetes management self-efficacy.
CONCLUSIONS
Strategic nursing interventions based on considerations of the relationship between perceived barriers and self-efficacy on diabetes management need to be provided for type 2 diabetes patients with depression.

Keyword

Type 2 Diabetes; Depression; Perceived barriers; Self-efficacy

MeSH Terms

Adult
Blood Glucose
Depression*
Diabetes Mellitus
Education
Humans
Negotiating*
Nursing
Outpatients
Self Care
Blood Glucose

Figure

• 

  Figure 1. Mediation model

Reference

1.National Health Insurance Service, Health Insurance Review & Assessment Service. 2012 National Health Insurance Statistacl Yearbook. Seoul: National Health Insurance Service, Health Insurance Review & Assessment Service;2013.

2.Jang YS., Ham SY. Comparison of cause-specific death rate among the OECD countries. Issue & Focus. 2014. 257:1–8.

3.Park IB., Baik SH. Epidemiologic characteristics of diabetes mellitus in Korea: current status of diabetic patients using Korean health insurance database. Korean Diabetes J. 2009. 33(5):357–62.

4.Köster I., von Ferber L., Ihle P., Schubert I., Hauner H. The cost burden of diabetes mellitus: the evidence from Germany--the CoDiM study. Diabetologia. 2006. 49(7):1498–504.

5.Wu SF., Huang YC., Lee MC., Wang TJ., Tung HH., Wu MP. Self-efficacy, self-care behavior, anxiety, and depression in Taiwanese with type 2 diabetes: a cross-sectional survey. Nurs Health Sci. 2013. 15(2):213–9.

6.Löfman S., Hakko H., Mainio A., Timonen M., Räsänen P. Characteristics of suicide among diabetes patients: a population based study of suicide victims in Northern Finland. J Psycho-som Res. 2012. 73(4):268–71.

7.Anderson RJ., Freedland KE., Clouse RE., Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001. 24(6):1069–78.

8.Egede LE., Ellis C. The effects of depression on diabetes knowledge, diabetes self-management, and perceived control in indigent patients with type 2 diabetes. Diabetes Technol Ther. 2008. 10(3):213–9.

9.Tovar E., Rayens MK., Gokun Y., Clark M. Mediators of adherence among adults with comorbid diabetes and depression: the role of self-efficacy and social support. J Health Psychol. 2015. 20(11):1405–15.

10.Siebolds M., Gaedeke O., Schwedes U. SMBG Study Group. Self-monitoring of blood glucose--psychological aspects relevant to changes in HbA1c in type 2 diabetic patients treated with diet or diet plus oral antidiabetic medication. Patient Educ Couns. 2006. 62(1):104–10.

11.Aljasem LI., Peyrot M., Wissow L., Rubin RR. The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. Diabetes Educ. 2001. 27(3):393–404.

12.Park JY., Ko IS. Development of a comprehensive self-management program promoting self efficacy for type 2 diabetic patients. J Korean Acad Fundam Nurs. 2012. 19(1):74–86.

13.Chao J., Nau DP., Aikens JE., Taylor SD. The mediating role of health beliefs in the relationship between depressive symptoms and medication adherence in persons with diabetes. Res Social Adm Pharm. 2005. 1(4):508–25.

14.Cherrington A., Wallston KA., Rothman RL. Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. J Behav Med. 2010. 33(1):81–9.

15.Nam SI., Choi KH., Yi HJ. Self-perceived health status, depression, and suicidal behavior among people with diabetes. Korean J Social Welfare Studies. 2014. 45(1):231–54.

16.Jeong Y., Kim M. Comparative study on HbA1C, self-care behavior, and quality of life by depression status in type II diabetic patients. J Korean Acad Fundam Nurs. 2012. 19(3):353–62.

17.DiMatteo MR., Lepper HS., Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000. 160(14):2101–7.

18.Robertson SM., Amspoker AB., Cully JA., Ross EL., Naik AD. Affective symptoms and change in diabetes self–efficacy and gly-caemic control. Diabet Med. 2013. 30(5):e189–96.

19.An JY., Seo ER., Lim KH., Shin JH., Kim JB. Standardization of the Korean version of screening tool for depression(Patient Health Questionnaire-9, PHQ-9). J Korean Soc Biol Ther Psychiatry. 2013. 19(1):47–56.

20.Tan MY. The relationship of health beliefs and complication prevention behaviors of Chinese individuals with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2004. 66(1):71–7.

21.Kartal A., Ozsoy SA. Validity and reliability study of the Turkish version of health belief model scale in diabetic patients. Int J Nurs Stud. 2007. 44(8):1447–58.

22.Bijl JV., Poelgeest-Eeltink AV., Shortridge-Baggett L. The psychometric properties of the diabetes management self-efficacy scale for patients with type 2 diabetes mellitus. J Adv Nurs. 1999. 30(2):352–9.

23.Baron RM., Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986. 51(6):1173–82.

24.Cho YG. The interrelationship between diabetes and depression. Korean J Fam Med. 2014. 35(3):109–10.

25.Nicolau J., Masmiquel L. Diabetes mellitus and depressive disorder, an undesirable association. Endocrinol Nutr. 2013. 60(10):583–9.

26.Lee CW. Health status and self-management barriers in people with diabetes -a comparison by medicaid beneficiary status. Korean J Social Welfare Studies. 2008. 60(4):231–51.

27.Hur HK., Park SM. Difference of decisional balance and confidence in the stage of adoption for breast self exam in married women. J Korean Acad Adult Nurs. 2004. 16(3):493–501.