Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Ann Behav Med. 2021 Oct 4;55(10):938-948. doi: 10.1093/abm/kaaa070.
Conflicting research emphasizes depression, diabetes distress, or well-being in relation to diabetes self-care and risk for poor health outcomes.
The purpose of this study was to test whether a latent variable for general psychological distress derived from shared variance of depression symptoms, diabetes distress, and well-being predicts a latent variable of diabetes self-care and to examine evidence for unique effects once shared effects are adjusted for.
Adults with suboptimally controlled diabetes were recruited from the South Bronx, NY, for a telephonic diabetes self-management support trial. Baseline diabetes self-care, medication adherence, depression symptoms, diabetes distress, and well-being were measured by validated self-report. Structural equation modeling specified a latent variable for general psychological distress derived from shared variance of depression symptoms, diabetes distress, and well-being. Diabetes self-care was a latent variable indicated by diet, glucose self-monitoring, and medication adherence.
Participants (N = 627, 65% female) were predominantly ethnic minority (70% Hispanic; 45% Black) and 77% reported household income <$20K/year. Mean (standard deviation) age = 56 (12) years; A1c = 9.1% (1.9%); body mass index = 32 (8) kg/m2. The latent variable for psychological distress was a robust predictor of poorer diabetes self-care (coefficient = -0.59 [confidence interval = -0.71, -0.46], p < .001) with good model fit. Unique paths from depression symptoms, diabetes distress, and well-being (all ps > .99) to self-care were not observed.
In this population of disadvantaged adults with suboptimally controlled diabetes, general psychological distress was strongly associated with poorer diabetes self-care and fully accounted for the effects of depression, diabetes distress, and positive well-being. This suggests that general distress may underlie previously reported associations between these constructs and diabetes self-care.
关于糖尿病自我护理和不良健康结果的风险，有研究强调抑郁、糖尿病困扰或幸福感，也有研究对此提出了质疑。
本研究旨在检验源于抑郁症状、糖尿病困扰和幸福感的共同方差的一般心理困扰的潜在变量是否可以预测糖尿病自我护理的潜在变量，并在调整了共同效应后，检验其独特效应的证据。
从纽约南布朗克斯招募了自我管理糖尿病支持电话试验的参与者，这些参与者患有控制不佳的糖尿病。使用经过验证的自我报告方法测量了基线糖尿病自我护理、药物依从性、抑郁症状、糖尿病困扰和幸福感。结构方程模型规定了一个源于抑郁症状、糖尿病困扰和幸福感的共同方差的一般心理困扰的潜在变量。糖尿病自我护理是由饮食、血糖自我监测和药物依从性表示的潜在变量。
参与者（N = 627，65%为女性）主要为少数民族（70%为西班牙裔；45%为黑人），77%的人报告家庭收入<20K/年。平均（标准差）年龄= 56（12）岁；A1c=9.1%（1.9%）；体重指数= 32（8）kg/m2。心理困扰的潜在变量是较差的糖尿病自我护理的有力预测指标（系数=-0.59[置信区间=-0.71，-0.46]，p<0.001），且模型拟合良好。未观察到抑郁症状、糖尿病困扰和幸福感（均p>0.99）到自我护理的独特路径。
在这一患有控制不佳的糖尿病的处境不利的成年人中，一般心理困扰与较差的糖尿病自我护理密切相关，并完全解释了抑郁、糖尿病困扰和积极幸福感的影响。这表明一般困扰可能是先前报告的这些结构与糖尿病自我护理之间关联的基础。
