Patient-Provider Communication, Illness Self-Care and Lifestyle Behaviors among
CR Bingham, Department of Veterans Affairs, JD Piette, Department of Veterans Affairs
Objectives: Many VA
diabetes patients also suffer from depression, and studies indicate that
depressive symptoms impair their adherence to treatment recommendations.
However, the mechanisms through which depression affects patientsí diabetes
self-care are poorly understood. We examined the direct and indirect (i.e.,
mediated) impact of depression on diabetes patientsí general communication
with clinicians, diabetes-specific communication, and two domains of
self-management: illness self-care (i.e., medication adherence, foot care, and
glucose testing) and life-style behaviors (i.e., diet and exercise).
Methods: 672 patients
enrolled from 3 VA, one county, and one university-based health care systems
were included in the study. Well-validated measures administered during
telephone surveys were used to assess patientsí depressive symptoms,
patient-provider communication, and self-care. Latent variable path analyses
were used to isolate direct effects of depressive symptoms on patientsí
self-care as well as indirect effects, mediated by impaired communication.
Results: In the model
predicting illness self-care, depressive symptoms were associated with poorer
general communication with clinicians. Poorer general communication predicted
less diabetes-specific communication, and consequently less adherence to illness
self-care recommendations. The model explained 23% of the variance in illness
self-care. In the model predicting
patientsí adherence to life-style behaviors, depression and its affect on
patient-provider communication accounted for 31% of the variance in behavior. In
contrast to the prior model, greater depressive symptoms had a large direct
impact on life style behaviors (accounting for 10% of the variance) as well as
an indirect effect mediated by patient-provider communication (accounting for
1.3% of the variance).
symptoms impact diabetes patientsí illness self-care and adherence to
lifestyle recommendations. However, the role of depression is distinct for these
two aspects of diabetes self-management. Depression does not predict illness
self-care directly, but rather impairs patientsí ability to communicate in a
productive way about these issues with clinicians. While depressive symptoms
have a similar, mediated, impact on life style behaviors, they also directly
impact patientsí ability to adhere to dietary and physical activity
Impact: Given the importance of depressive symptoms in determining diabetes patientsí self-care, VA should intensify depression management efforts for these patients and develop provider- and patient-focused interventions to improve their communication with clinicians.