| Studies have documented an elevated prevalence of depressive symptoms and an impaired Health-related Quality of Life (HRQoL) in patients with type 2 diabetes mellitus. However, the factors contributing to these outcome measures are not well understood. Objective. To assess the relationship between diabetes-related stress, coping, depressive symptoms and HRQoL using the Transactional Model of Stress and Coping as the theoretical framework for the study. Methods. Patients with type 2 diabetes mellitus were recruited from three primary care clinics. Informed consent was obtained and a self-administered questionnaire was used to elicit data on demographics, diabetes-related stress, appraisal of diabetes, coping, depressive symptoms, social support and HRQoL. Patient charts were reviewed to obtain data on HbA1C values and comorbid conditions. Path analysis via the hierarchical multiple regression analysis technique was used to assess the relationships between study variables. Results. A total of 217 patients were recruited for this study. Patients with depressive symptoms reported higher diabetes-related stress [t (127) = 7.74, p<0.001] and a significantly more negative appraisal of diabetes [t (199) = -6.86, p<0.001]. Additionally, patients with depressive symptoms had significantly higher scores on the avoidance [t (122) = 2.96, p<0.004], passive resignation [t (135) = 5.63, p<0.001] and diabetes integration coping subscales [t (199) = 3.87, p<0.001]. Further, patients with depressive symptoms reported significantly poorer physical [t (199) = -6.66, p<0.001] and mental HRQoL [t (165) = -8.07, p<0.001]. Similar results were obtained in the path analytic model using depressive symptoms as the outcome measure. In the path analytic model using physical component score (PCS8) as the outcome measure, passive resignation coping (beta = -0.20, p<0.01) was the only significant coping variable. In the mental component score (MCS-8) path analytic model, passive resignation (beta = -0.21, p<0.01) and diabetes integration (beta = -0.20, p<0.01) were found to be significant predictors. Conclusions. The overall findings suggest that patients who experience elevated levels of diabetes-related stress may be at risk for depression. Patients with elevated stress levels have a negative view of their diabetes and are more likely to use coping strategies that predispose them to depression and a substandard HRQoL. Stress management and coping skills training programs may help patients to effectively manage the demands of living with diabetes. |
