EFFECT OF TREATMENT FOR DEPRESSION ON DIABETES SELF-EFFICACY (DIABETES MELLITUS).
Contributors: University of Colorado Health Sciences Center.
Published: 1996
Number of pages: 106
Subjects: Health Sciences, Nursing.; Psychology, Clinical.
Description: Statement of the problem. Depression is under diagnosed in the diabetes population. Depression and diabetes self-efficacy have been found to be negatively correlated; the higher the level of depression, the lower the self-efficacy. Diabetes self-efficacy is strongly correlated with diabetes self-care behaviors. Diabetes is a chronic disease; self-care behaviors are the cornerstone of the glycemic control that is needed to prevent or lessen the severity of debilitating long term complications. Identifying and treating depression may make efforts at helping clients with diabetes make lifestyle changes more cost effective.

Approach. Potential subjects were identified by chart review from the practices of six collaborating endocrinologists. Admission criteria were: diagnosed with Type II diabetes, glycosolated hemoglobin (GH) $>$10.0 percent, ages 20-64, no debilitating end stage complications from diabetes, no external insulin pump therapy. Subject completed the Zung Self-rating Depression Scale (SDS) and Crabtree's Diabetes Self-Efficacy Scale (DSES) by mail. Subjects were placed in not-depressed (n = 30) or depressed (n = 40) groups based on SDS index scores with a cut point of 50. Depressed subjects were offered treatment for depression. Those who accepted treatment (n = 19) became the treated subjects; subjects who did not accept treatment became controls. Treatment for depression was based on Calarco and Krone's nursing integrated model of depressive behaviors with biological, cognitive and interpersonal disruptions. The treatment protocol consisted of an antidepressant medication (unless contraindicated) prescribed by the endocrinologist and participation in a psycho-educational support group facilitated by the nurse researcher. Repeated measures of the SDS and the DSES were obtained after an eight week treatment period.

Results and implications. Fifty eight percent of subjects had initial SDS index scores of 50 or greater indicating depression. Depressed subjects had significantly lower (t = 14.0, p $<$.01) pretest DSES scores compared to not-depressed subjects. Treated subjects did not have significantly greater improvement in diabetes self-efficacy (posttest DSES scores) compared the controls. However, when depression (SDS) and self-efficacy (DSES) scores were analyzed together, all treatment types were equally effective in promoting score improvement. Gains in self-efficacy were smaller than those for depression and relatively independent of posttest depression status. These findings suggest that diabetic clients with elevated GH levels should be screened for depression at initial diabetes management visits. Clients with identified depression should be treated for depression following clinical practice guidelines before pursuing major efforts to modify self-care behaviors.
Notes: Source: Dissertation Abstracts International, Volume: 57-04, Section: B, page: 2481.

Thesis (PH.D.)--UNIVERSITY OF COLORADO HEALTH SCIENCES CENTER, 1996.

School code: 0831.