Depression and diabetes treatment nonadherence: A meta-analysis

Jeffrey S. Gonzalez, Mark Peyrot, Lauren A. McCarl, Erin Marie Collins, Luis Serpa, Matthew J. Mimiaga, Steven Safren

Research output: Contribution to journalArticle

493 Citations (Scopus)

Abstract

OBJECTIVE-Depression is common in patients with diabetes and is associated with worse treatment outcomes. Its relationship to treatment adherence, however, has not been systematically reviewed. We used meta-analysis to examine the relationship between depression and treatment nonadherence in patients with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS - We searched MEDLINE and PsycINFO databases for all studies published by June 2007 and reviewed references of published articles. Meta-analytic procedures were used to estimate the effect size r in a random effects model. Significance values, weighted effect sizes, 95% CIs, and tests of homogeneity of variance were calculated. RESULTS-Results from 47 independent samples showed that depression was significantly associated with nonadherence to the diabetes treatment regimen (z = 9.97, P <0.0001). The weighted effect size was near the medium range (r = 0.21, 95% CI 0.17-0.25). Moderator analyses showed that the effect was significantly larger in studies that measured self-care as a continuous versus categorical variable (P = 0.001). Effect sizes were largest for missed medical appointments and composite measures of self-care (r values = 0.31, 0.29). Moderation analyses suggest that effects for most other types of self-care are also near the medium range, especially in studies with stronger methodologies. CONCLUSIONS - These findings demonstrate a significant association between depression and treatment nonadherence in patients with diabetes. Studies that used stronger methodologies had larger effects. Treatment nonadherence may represent an important pathway between depression and worse diabetes clinical outcomes.

Original languageEnglish (US)
Pages (from-to)2398-2403
Number of pages6
JournalDiabetes Care
Volume31
Issue number12
DOIs
StatePublished - Dec 2008
Externally publishedYes

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Meta-Analysis
Depression
Self Care
Patient Compliance
Therapeutics
Type 1 Diabetes Mellitus
MEDLINE
Type 2 Diabetes Mellitus
Appointments and Schedules
Research Design
Databases

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Gonzalez, J. S., Peyrot, M., McCarl, L. A., Collins, E. M., Serpa, L., Mimiaga, M. J., & Safren, S. (2008). Depression and diabetes treatment nonadherence: A meta-analysis. Diabetes Care, 31(12), 2398-2403. https://doi.org/10.2337/dc08-1341

Depression and diabetes treatment nonadherence : A meta-analysis. / Gonzalez, Jeffrey S.; Peyrot, Mark; McCarl, Lauren A.; Collins, Erin Marie; Serpa, Luis; Mimiaga, Matthew J.; Safren, Steven.

In: Diabetes Care, Vol. 31, No. 12, 12.2008, p. 2398-2403.

Research output: Contribution to journalArticle

Gonzalez, JS, Peyrot, M, McCarl, LA, Collins, EM, Serpa, L, Mimiaga, MJ & Safren, S 2008, 'Depression and diabetes treatment nonadherence: A meta-analysis', Diabetes Care, vol. 31, no. 12, pp. 2398-2403. https://doi.org/10.2337/dc08-1341
Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ et al. Depression and diabetes treatment nonadherence: A meta-analysis. Diabetes Care. 2008 Dec;31(12):2398-2403. https://doi.org/10.2337/dc08-1341
Gonzalez, Jeffrey S. ; Peyrot, Mark ; McCarl, Lauren A. ; Collins, Erin Marie ; Serpa, Luis ; Mimiaga, Matthew J. ; Safren, Steven. / Depression and diabetes treatment nonadherence : A meta-analysis. In: Diabetes Care. 2008 ; Vol. 31, No. 12. pp. 2398-2403.
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