BACKGROUND
Type 2 diabetes mellitus (T2D), like many other chronic conditions including cardiovascular disease, requires effective self-management to ensure optimal outcomes and reduce associated complications.1 Mastery is a recognised health protective factor among those with chronic conditions, with higher levels of mastery associated with better control of chronic conditions, treatment adherence, and improved health behaviours.2,3
The literature generally highlights the individual impact of psychosocial factors on effective self-management of chronic conditions. Depression is associated with poorer clinical outcomes, medication adherence, and motivation impacting negatively on self-management.4 Disempowerment is associated with poorer outcomes.5 Diabetes distress is negatively associated with self-management, glycaemic control, and adherence.5 However, little is known about how these psychosocial factors impact mastery.
METHODS
This study used baseline data drawn from a randomised controlled trial (RCT) of a structured diabetes education intervention. The sample comprised 131 participants with T2D aged 39–85 years (median: 62.3; standard deviation: 8.8), of whom 59.5% were male. Participants were assessed using: Problem Areas in Diabetes (PAID) scale, measuring diabetes related distress;6 Pearlin Mastery (PM) scale;7 Hospital Anxiety and Depression Scale (HADS);8 and the Diabetes Empowerment Scale-Short Form (DES-SF).9
The purpose of this study was to evaluate the moderating role of diabetes empowerment and depression in the relationship between diabetes distress and mastery. To test this, a moderated model was specified and tested in SPSS using PROCESS, a “logistic regression-based path analytical framework for estimating direct and indirect effects in simple and multiple moderation models.”10
RESULTS
All variables were statistically significant predictors of mastery. Diabetes distress (b: -0.249; t(5,112): -3.71; p<0.005) and depression (b: -0.980; t(5,112): -5.73; p<.005) were negatively associated with mastery; with diabetes empowerment (b: 0.280; t(5,112): 3.02; p<.005) positively associated. A significant interaction between diabetes-specific distress and depression was found, (b: 0.024; t(112): 3.79; p<.005), indicating that the magnitude of the diabetes distress effect on mastery depends on the level of depression. There was a significant increase in the variance in mastery explained because of the diabetes distress and depression interaction (F[1,112]: 14.40; p<.005; coefficient of determination [∆R2]: 0.06). A further increase in the mastery variance explained was found when the interaction was expanded to involve both moderators (F[2,112]: 16.88; p<.005; ∆R2: 0.14). The results highlight, at low levels of empowerment, increasing depression in the presence of increasing levels of distress predicted lower levels of mastery. This held true at both moderate and high levels of empowerment.
CONCLUSIONS
The significant interaction between diabetes distress and depression highlights how the negative impact of diabetes distress on mastery is heightened by increasing levels of depression, with this interaction creating greater reduction in mastery. Additionally, it appears that any positive effect of diabetes empowerment on mastery is eroded in the presence of diabetes distress and depression. The evidence suggests that the psychosocial interventions likely to have greatest impact on mastery are those that do not only focus on condition-specific distress, but also recognise and target key moderators, particularly depression.
