Depression and Diabetes Treatment Nonadherence: A Meta-Analysis

Diabetes Care - Tập 31 Số 12 - Trang 2398-2403 - 2008
Jeffrey S. Gonzalez1,2, Mark Peyrot3,4, Lauren A. McCarl1, Erin Collins1, Luis Serpa1, Matthew J. Mimiaga1,2, Steven A. Safren1,2
1Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital Boston, Boston, Massachusetts
2Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
3Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
4Department of Sociology, Loyola College, Baltimore, Maryland

Tóm tắt

OBJECTIVE—Depression is common in patients with diabetes and is associated with worse treatment outcomes. Its relationship to treatment adherence, however, has not been systematically reviewed. We used meta-analysis to examine the relationship between depression and treatment nonadherence in patients with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS—We searched MEDLINE and PsycINFO databases for all studies published by June 2007 and reviewed references of published articles. Meta-analytic procedures were used to estimate the effect size r in a random effects model. Significance values, weighted effect sizes, 95% CIs, and tests of homogeneity of variance were calculated. RESULTS—Results from 47 independent samples showed that depression was significantly associated with nonadherence to the diabetes treatment regimen (z = 9.97, P < 0.0001). The weighted effect size was near the medium range (r = 0.21, 95% CI 0.17–0.25). Moderator analyses showed that the effect was significantly larger in studies that measured self-care as a continuous versus categorical variable (P = 0.001). Effect sizes were largest for missed medical appointments and composite measures of self-care (r values = 0.31, 0.29). Moderation analyses suggest that effects for most other types of self-care are also near the medium range, especially in studies with stronger methodologies. CONCLUSIONS—These findings demonstrate a significant association between depression and treatment nonadherence in patients with diabetes. Studies that used stronger methodologies had larger effects. Treatment nonadherence may represent an important pathway between depression and worse diabetes clinical outcomes.

Từ khóa


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Diabetes Care

Tập 31 Số 12

2398-2403

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