2053. Depression, Patient-Provider Communication, Illness Self-Care and Lifestyle Behaviors among Diabetes Patients
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). 

Conclusions: Depressive 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 recommendations.

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.