Effects of Depression and Antidepressant Use on Goal Setting and Barrier Identification Among Patients With Type 2 Diabetes

Diabetes self-care plays a vital role in achieving better diabetes outcomes. To enhance diabetes self-care, the strategies of goal setting and barrier identification are widely used to assist people in making behavior change. Depression is a common co-morbidity and a barrier to self-care in people with diabetes. The purpose of this study was to examine the effects of depression and antidepressant use on goal setting and barrier identification in patients with type 2 diabetes.In patients with type 2 diabetes enrolled in the American Association of Diabetes Educators (AADE) Outcomes System as part of their routine diabetes education, 778 patients were included into this analysis. Self-report depression, 7 self-identified behavior change goals, and 13 barriers to diabetes self-care were collected from the Diabetes Self-management Assessment Report Tool (D-SMART®); antidepressant use was determined from the Diabetes Educator Tool (D-ET®). Multiple linear regression was used for the number of goals and the number of barriers with controls for relevant covariates.Patients with and without depression had a similar number of self-identified behavior change goals (P = 0.47), whereas patients with depression had 1.01 barriers to diabetes self-care greater than those without depression (P = 0.0001). In the depressed subgroup, there was no significant difference between those with and without antidepressant use in the number of goals (model 3A, P = 0.18; model 3B, P = 0.35) and in the number of barriers (P = 0.99). Since depression was related to a greater number of barriers to self-care, depression screening is important in patients with diabetes. Although antidepressant use had no association with the number of goals or the number of barriers, antidepressants are still useful in treating depression in patients with diabetes. In addition, collaborative treatment should be integrated to provide maximal benefit to improve both diabetes and depression. These conclusions are of public health significance and can be used to develop behavior change strategies to improve diabetes self-care.