Comparative study of the influence of diabetes distress and depression on treatment adherence in Chinese patients with type 2 diabetes: a cross-sectional survey in the People’s Republic of China

Abstract

Jie Zhang,1 Cui-ping Xu,2 Hong-xia Wu,2 Xiu-juan Xue,2 Ze-jun Xu,3 Yan Li,4 Qing Gao,2 Qing-zhi Liu5 1Shandong Medical College, Jinan, People’s Republic of China; 2Qianfoshan Hospital, Shandong University, Jinan, Shandong, People’s Republic of China; 3Sichuan Provincial People’s Hospital, Chengdu, Sichuan, People’s Republic of China; 4Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China; 5QiLu Hospital, Shandong University, Jinan, Shandong, People’s Republic of China Background: The purpose of this study was to explore diabetes-related distress and depression and their influence on treatment adherence in Chinese patients with type 2 diabetes. Methods: We surveyed 200 type 2 diabetic patients from two public hospitals using the Diabetes Distress Scale (DDS), Zung Self-rating Depression Scale, and Revised Treatment Adherence in Diabetes Questionnaire (RADQ). A multiple regression model was used to explore the relationship between diabetes distress, depression, and treatment adherence. Results: In the 200 eligible patients, the incidence of depression and diabetes distress was approximately 24% and 64%, respectively. The mean score on the RADQ was 23.0 ± 6.0. Multiple regression analysis showed that DDS scores (β = 5.34, P = 0.000), age (β = 0.15, P = 0.014), and family history (β = 3.2, P = 0.016) had a positive correlation with depression. DDS scores (β = −2.30, P = 0.000) and treatment methods (β = −0.93, P = 0.012) were risk factors for poor treatment adherence, whereas age (β = 0.089, P = 0.000) and cohabitation (β = 0.93, P = 0.012) increased treatment adherence. The independent-samples t-test showed that depression also affected treatment adherence (t = 2.53, P < 0.05). Conclusion: These findings suggest that the DDS is a predictor of depression and that diabetes distress plays a more important part than depression in treatment adherence. Screening for diabetes distress may be useful for primary prevention of psychologic problems; however, some form of specialized psychologic intervention should be incorporated to promote patient adherence with treatment. Keywords: distress, depression, type 2 diabetes, treatment, adherence, People’s Republic of China