medwireNews: Depression and diabetes-related distress are associated with poor medication adherence, say researchers.
However, distress “specific to the stress of living with a chronic illness and a demanding self-management regimen,” assessed on the 17-item Diabetes Distress Scale (DDS), was much more common than depression, affecting 46% of the 104 study participants.
Depression, defined by 9-item Patient Health Questionnaire (PHQ-9) responses, was less frequent, occurring in 21% of patients, and only 23% of these had major depressive disorder (MDD) according to interview-based diagnosis on the Montgomery–Åsberg Depression Rating Scale (MADRS). A further 14% had past MDD.
Instead of “focusing exclusively on clinical depression”, the researchers therefore believe that doctors should be aware of “emotional distress that does not rise to the level of a psychiatric diagnosis [that] could nevertheless represent meaningful risk for problems with diabetes treatment adherence.”
They say: “As such, providers should be attuned to emotional distress in their patients during clinical encounters and consider specific depressive symptom presentations and diabetes-related distress as part of their further evaluation of positive screens to identify more accurately the nature of the problem and guide the selection of appropriate interventions.”
Over 3 months of electronic monitoring, medication adherence was significantly lower among patients with depression on the PHQ-9 than those without, at 62.5% versus 79.8%. There was a similar pattern for self-reported medication adherence, although adherence was higher by this measure than by electronic monitoring.
And higher scores for total DDS and the emotional burden subscale were also significantly associated with lower medication adherence, report Jeffrey Gonzalez (Yeshiva University, Bronx, New York, USA) and colleagues in Diabetes Care.
Diabetes distress remained associated with adherence after accounting for confounders including age and duration of electronic monitoring, but the association became nonsignificant after the team added PHQ-9 scores to the model, indicating overlap between the two.
By contrast, MADRS scores were not significantly associated with adherence and had a smaller effect on the relationship between diabetes distress and adherence. But the researchers found this was because only somatic-depressive symptoms (rather than cognitive-affective symptoms) were associated with adherence. These are more readily identified by the PHQ-9 than the MADRS, they note, but can also be confounded by symptoms related directly to the physical illness, such as fatigue.
“The lack of an independent role for cognitive-affective symptoms of depression reported by this study casts further doubt on whether clinical depression is the construct underlying the relationship between elevations on depressive symptom scales and diabetes treatment nonadherence,” the researchers conclude.
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