Joanna L Hudson1,2, Christine Bundy2, Peter Coventry2, Chris Dickens3, Alex Wood4,5, David Reeves6,7. 1. a Health Psychology Section, Psychology Department , Institute of Psychiatry, Psychology, and Neuroscience, King's College London , London , UK. 2. b NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) - Greater Manchester and Manchester Academic Health Science Centre, University of Manchester , Manchester , UK. 3. c Mental Health Research Group, Institute of Health Research , University of Exeter Medical School and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula (PenCLAHRC) , Exeter , UK. 4. d Behavioral Science Centre, Stirling Management School , University of Stirling . Stirling , Scotland. 5. e Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester , Manchester , UK. 6. f Centre for Primary Care , NIHR School for Primary Care Research, University of Manchester , Manchester , UK. 7. g Centre for Biostatistics , University of Manchester , Manchester , UK.
Abstract
OBJECTIVE: To explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care. DESIGN: Longitudinal observational study in adults with type 2 diabetes. MAIN OUTCOME MEASURES: Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling. RESULTS: Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern's effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion's effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time. CONCLUSIONS: Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.
OBJECTIVE: To explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care. DESIGN: Longitudinal observational study in adults with type 2 diabetes. MAIN OUTCOME MEASURES: Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling. RESULTS: Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern's effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion's effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time. CONCLUSIONS: Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.