Social support as a mediator between depressive symptoms and self-care activities in adults patient with type 2 diabetes mellitus

ABSTRACT

Background: People with type 2 DM are at risk of experiencing depression, which in turn can affect their self-care activities. Recent evidence has shown that social support is beneficial in reducing the risk of depression and positively affecting increases in self-care activities. However, the role of social support in the relationship between depressive symptoms and self-care activities has not been studied. This study aims to determine the mediating effects of social support on the relationship between depressive symptoms and self-care activities of people with type 2 DM.
Design and methods: A cross-sectional consecutive sampling approach was used with 94 respondents with type 2 diabetes in East Jakarta, Indonesia, who were undergoing diabetes treatments during May–June 2020. The instruments used were the Centre for Epidemiologic Studies-Depression Scale (CES-D), Summary of Diabetes Self Care Activities (SDSCA), and Duke-UNC Functional Social Support Questionnaire (DUFSSQ). All three questionnaires have been tested for validity and reliability. Data analysis was carried out using multiple linear regression, path analysis, and the Sobel test.
Results: The results of multiple linear regression analysis on the variables age, sex, education level, socioeconomic status, duration of type 2 DM, and complications of type 2 DM showed that only complications of type 2 diabetes affected self-care activities (p = 0,000; R2 = 0.515). The results of the path analysis and Sobel test showed that social support significantly mediated the effects of the relationship between depressive symptoms and self-care activities (z = -0,162 > table 1.96; direct effect = -0,499; indirect effect = -0,0789; total effect = 40, 3%).
Conclusions: Screening for depressive symptoms and interventions involving social support are strongly suggested for patients with type 2 DM who are suspected of showing a decline in self-care activities.

REFERENCES

Zimbudzi E, Lo C, Ranasinha S, Kerr PG, et al. The association between patient activation and self-care practices: a cross-sectional study of an Australian population with comorbid diabetes and chronic kidney disease. Health Expect 2017;20:1375-84. DOI: https://doi.org/10.1111/hex.12577

World Health Organization. Global report on diabetes: executive summary. 2016. Available from: https://apps.who.int/iris/handle/10665/204874

International Diabetes Federation. IDF Diabetes Atlas Ninth Edition 2019. Available from: https://diabetesatlas.org/en/resources/

Papatheodorou K, Banach M, Bekiari E, et al. Complications of diabetes 2017. J Diabetes Res 2018;2018:3086167. DOI: https://doi.org/10.1155/2018/3086167

Tun NN, Arunagirinathan G, Munshi SK, Pappachan JM. Diabetes mellitus and stroke: a clinical update. World J Diabetes 2017;8:235-48. DOI: https://doi.org/10.4239/wjd.v8.i6.235

Atosona A, Larbie C. Prevalence and determinants of diabetic foot ulcers and lower extremity amputations in three selected tertiary hospitals in Ghana. J Diabetes Res 2019;2019:7132861. DOI: https://doi.org/10.1155/2019/7132861

American Diabetes Association. Standards of Medical Care in Diabetes-2017. Diabetes Care 2017;40:s1-135. DOI: https://doi.org/10.2337/dci17-0007

Chen B, Zhang X, Xu X, et al. Diabetes education improves depressive state in newly diagnosed patients with type 2 diabetes. Pak J Med Sci 2013;29:1147-52. DOI: https://doi.org/10.12669/pjms.295.3573

Jones A, Olsen MZ, Perrild HJD, Willaing I. The psychological impact of living with diabetes: descriptive findings from the DAWN2 study in Denmark. Prim Care Diabetes 2016;10:83-6. DOI: https://doi.org/10.1016/j.pcd.2015.03.008

Gonzales JS, Safren SA, Cagliero E, et al. Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diabetes Care 2007;30:2222-7. DOI: https://doi.org/10.2337/dc07-0158

Shao Y, Liang L, Shi L, Wan C, Yu S. The effect of social support on glycemic control in patients with type 2 diabetes mellitus: the mediating roles of self-efficacy and adherence. J Diabetes Res 2017;2017:2804178. DOI: https://doi.org/10.1155/2017/2804178

Mohebi S, Parham M, Sharifirad G, Gharlipour Z. Social support and self‑care behavior study. J Educ Health Promot 2018;7:48. DOI: https://doi.org/10.4103/jehp.jehp_73_17

Aflakseir A, Malekpour F. The role of self-efficacy and social support in predicting depression symptoms in diabetic patients. Iran J Diabetes Obesity 2014;6:126-30.

Lewinshon PM, Seeley JR, Roberts RE, Allen NB. Center for Epidemiological Studies-Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging 1997;12:277-87. DOI: https://doi.org/10.1037/0882-7974.12.2.277

Kusuma H. [Hubungan antara depresi dan dukungan keluarga dengan kualitas hidup pasien hiv/aids yang menjalani perawatan di RSUPN Cipto Mangunkusumo Jakarta (The relationship between depression and family support with the quality of life of HIV/AIDS patients undergoing treatment at Cipto Mangunkusumo General Hospital Jakarta)].[Thesis Indonesian]. Depok: Universitas Indonesia; 2011. Available from: lib.ui.ac.id/file?file=digital/20282772-T-Henni Kusuma.pdf

Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activites measure: results from 7 studies and a revised scale. Diabetes Care 2000;23:943-50. DOI: https://doi.org/10.2337/diacare.23.7.943

Broadhead WE, Gehlbach SH, de Gruy FV KB. The Duke-UNC functional social support questionnaire. Measurement of social support in family medicine patients. Med Care 1988;26:709-23. DOI: https://doi.org/10.1097/00005650-198807000-00006

Ahmed-mohamed K, Fernandez-Mayoralas G, Rojo-Perez Fet al. Perceived social support of older adults in Spain. Appliead Res Qual life 2013;8:183-200. DOI: https://doi.org/10.1007/s11482-012-9184-8

Mustipah O. [Analisis faktor-faktor intrinsik yang mempengaruhi self care pada pasien dm tipe2 di Puskesmas Depok III Sleman Yogyakarta (Analysis of intrinsic factors that affect self care in type 2 DM patients at Depok III Health Center, Sleman Yogyakarta)].[in Indonesian]. Yogyakarta: Universitas Aisyiyah Yogyakarta. 2019.. Available from: http://digilib.unisayogya.ac.id/4617/

Shrestha AD, Kosalram K, Gopichandran V. Gender difference in care of type 2 diabetes. J Nepal Med Assoc 2013;52:245-50. DOI: https://doi.org/10.31729/jnma.565

Rantung J, Yetti K, Herawati T. [Hubungan self-care dengan kualitas hidup pasien diabetes melitus (DM) di Persatuan Diabetes Indonesia (Persadia) Cabang Cimahi (The relationship of self-care with the quality of life of patients with diabetes mellitus (DM) at the Indonesian Diabetes Association (Persadia) Cimahi Branch)].[in Indonesian]. Jurnal Skolastik Keperawatan 2015;1:38-51. DOI: https://doi.org/10.35974/jsk.v1i01.17

Skinner TC, Hampson SE. Personal models of diabetes in relation to self-care, well-being, and glycemic control: a prospective study in adolescence. Diabetes Care 2001;24:828-33. DOI: https://doi.org/10.2337/diacare.24.5.828

Gurmu Y, Gela D, Aga F. Factors associated with self-care practice among adult diabetes patients in West Shoa Zone, Oromia Regional State, Ethiopia. BMC Health Serv Res 2018;18:732. DOI: https://doi.org/10.1186/s12913-018-3448-4

Van Bulck L, Claes K, Dierickx K, et al. Patient and treatment characteristics associated with patient activation in patients undergoing hemodialysis: a cross-sectional study. BMC Nephrol 2018;19:126. DOI: https://doi.org/10.1186/s12882-018-0917-2

Ministry of Health, Data and Information Center, Republic of Indonesia. [Hari Diabetes Sedunia Tahun 2018 (World Diabetes Day 2018)].[in Indonesian]. Jakarta: Ministry of Health; 2019. Available from: https://pusdatin.kemkes.go.id/article/view/19041500002/hari-diabetes-sedunia-2018.html

Kassahun CW, Mekonen AG. Knowledge, attitude, practices and their associated factors towards diabetes mellitus among non diabetes community members of Bale Zone administrative towns, South East Ethiopia. A cross-sectional study. PloS One 2017;12:e0170040. DOI: https://doi.org/10.1371/journal.pone.0170040

Grant JF, Hicks N, Taylor AW, et al. Gender-specific epidemiology of diabetes: A representative cross-sectional study. Int J Equity Health 2009;8:6. DOI: https://doi.org/10.1186/1475-9276-8-6

Bai YL, Chiou CP, Chang YY. Self-care behaviour and related factors in older people with Type 2 diabetes. J Clin Nurs 2009;18:3308-15. DOI: https://doi.org/10.1111/j.1365-2702.2009.02992.x

Wu Y, Ding Y, Tanaka Y, Zhang W. Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention. Int J Med Sci 2014;11:1185-200. DOI: https://doi.org/10.7150/ijms.10001

Rajasekharan D, Kulkarni V, Unnikrishnan B, et al. Self-care activities among patients with diabetes attending a tertiary care hospital in Mangalore Karnataka, India. Ann Med Health Sci Res 2015;5:59-64. DOI: https://doi.org/10.4103/2141-9248.149791

Song Y, Nam S, Park S, et al. The impact of social support on self-care of patients with diabetes: what is the effect of diabetes type? Systematic review and meta-analysis. Diabetes Educ 2017;43:396-412. DOI: https://doi.org/10.1177/0145721717712457

Bădescu SV, Tătaru C, Kobylinska L, et al. The association between diabetes mellitus and depression. J Med Life 2016;9:120-25.

Affusim CC, Francis E. The influence of family/social support on adherence to diabetic therapy. Int J Advs Sci Res Engineer 2018;4:71-80. DOI: https://doi.org/10.31695/IJASRE.2018.32712

Aschalew AY, Yitayal M, Minyihun A, Bisetegn TA. Self-care practice and associated factors among patients with diabetes mellitus on follow up at University of Gondar Referral Hospital, Gondar, Northwest Ethiopia. BMC Res Notes 2019;12:591. DOI: https://doi.org/10.1186/s13104-019-4630-4

Mehravar F, Mansournia MA, Holakouie-Naieni K, et al. Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. Epidemiol Health 2016;38:e2016004. DOI: https://doi.org/10.4178/epih.e2016004

Salinero-Fort MA, Gomez-Campelo P, Andrés-Rebollo FJS, et al. Prevalence of depression in patients with type 2 diabetes mellitus in Spain (the DIADEMA Study): results from the MADIABETES cohort. BMJ Open 2018;8:e020768. DOI: https://doi.org/10.1136/bmjopen-2017-020768

Ramkisson S, Pillay BJ, Sibanda W. Social support and coping in adults with type 2 diabetes. Afr J Prim Health Care Fam Med 2017;9:1405. DOI: https://doi.org/10.4102/phcfm.v9i1.1405