Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Psychooncology. 2024 Sep;33(9):e9309. doi: 10.1002/pon.9309.
Breast cancer survivors (BCS) have higher rates of depression which is associated with lower adherence to medications, diet, and physical activity. Managing diabetes (DM) requires adherence to several of these self-management behaviors (SMB), and BCS have an increased risk of DM. We investigated whether depressive symptoms were associated with adherence to DM SMB in a cohort of BCS.
BCS with DM were surveyed semiannually for 2 years. Depression was assessed with the Hospital Anxiety and Depression Scale (HADS). Adherence to DM medication, diet, and physical activity was self-reported using the Medication Adherence Report Scale (MARS), Summary of Diabetes Self-Care Activities Assessment (SDSCA), and International Physical Activity Questionnaire (IPAQ), respectively. Using generalized linear equation modeling, the association of depressive symptoms with nonadherence to SMB was assessed, adjusting for age, race, marital status, education level, and beliefs about cancer and DM risk.
Among 244 BCS with DM, those who were nonadherent to medication, diet, and/or physical activity had higher depression scores (p < 0.01). In adjusted analyses, higher depression scores were independently associated with dietary (OR = 1.16, p < 0.001) and physical activity nonadherence (OR = 1.18, p < 0.001) but not with medication nonadherence. Concerns about medications was independently associated with medication nonadherence (OR = 1.17, p = 0.024).
Higher depression scores are associated with nonadherence to DM SMB in this cohort of BCS. These findings highlight the importance of addressing depressive symptoms in BCS to help improve adherence to DM medications, diet, and physical activity.
乳腺癌幸存者（BCS）的抑郁发生率较高，而抑郁与药物、饮食和身体活动的依从性降低有关。糖尿病（DM）的管理需要遵循这些自我管理行为（SMB）中的几个，而 BCS 患 DM 的风险增加。我们研究了在 BCS 队列中，抑郁症状是否与 DM SMB 的依从性相关。
对患有 DM 的 BCS 进行了为期 2 年的半年度调查。使用医院焦虑和抑郁量表（HADS）评估抑郁。使用药物依从性报告量表（MARS）、糖尿病自我护理活动评估摘要（SDSCA）和国际身体活动问卷（IPAQ）分别报告 DM 药物、饮食和身体活动的依从性。使用广义线性方程模型，在调整年龄、种族、婚姻状况、教育水平以及对癌症和 DM 风险的信念后，评估抑郁症状与 SMB 不依从的关联。
在 244 名患有 DM 的 BCS 中，那些药物、饮食和/或身体活动不依从的人抑郁评分较高（p<0.01）。在调整后的分析中，较高的抑郁评分与饮食（OR=1.16，p<0.001）和身体活动不依从（OR=1.18，p<0.001）独立相关，但与药物不依从无关。对药物的担忧与药物不依从独立相关（OR=1.17，p=0.024）。
在本队列的 BCS 中，较高的抑郁评分与 DM SMB 的不依从相关。这些发现强调了在 BCS 中解决抑郁症状的重要性，以帮助提高 DM 药物、饮食和身体活动的依从性。
