Are Changes in Self-Care Behavior Frequency during Depression Care Associated with the Risk of Depression?

BACKGROUND: In several clinical trials testing the effectiveness of depression care, patients increased self-care behavior frequency. The increase in self-care behavior seems attributable to patient activities initiated during psychotherapy where emotional distress from diabetes management was addressed. However, it is not clear whether the increased self-care behavior has any effect on prospective depression risk. It is likely that more frequent self-care behavior might increase depression risk because patients may feel more distress from the additional self-care responsibilities, which may require cognitive self-regulatory resources or giving up pleasurable activities (e.g., avoiding meeting friends for exercise plan). Furthermore, previous studies have bolstered the significant effect of emotional distress on depression risk. However, better self-care behavior could also reduce the risk of depression because increased self-care behavior may reduce diabetes symptoms and the risk of complications. Also, some self-care behavior, such as exercise, was found to reduce depressive symptoms and has been implemented in depression care. To investigate which scenario was more likely, this study investigated whether more frequent self-care behavior achieved during depression care was associated with depression risk, concurrently and prospectively.

METHODS: Secondary analyses were conducted with data in the Multifaceted Diabetes and Depression Program (MDDP). The MDDP was a randomized clinical trial to test the effectiveness of a socio-culturally adapted collaborative depression model. The extent of self-care behavior adherence was measured weekly for factors including healthy diet, regular exercise, self-blood glucose monitoring (SBGM), foot care, and weight control. Changes in self-care diet, exercise, SBGM, foot care, and body mass index during 12 months since baseline were regressed on either clinical depression status, determined by the Patient Health Questionnaire (PHQ)-9, or depression severity, which was measured at the 12- (N = 281), 18- (N = 249), and 24-month follow-up (N = 235). By adding the baseline value of depression into the statistical models, we focused on the variations in depressive symptom changes since trial enrollment. A sensitivity analysis of continuous and categorical self-care behavior variables for three groups, including the lower, middle, and upper 33%, were examined.

RESULTS: Continuous predictor results found that one unit change in diet, during the previous 12 months, was associated with a 19% reduced risk of clinical depression at the 12-month follow-up (p < .05). A similar degree of reduced risk was found for the variable increased exercise, measured at the 18- (p < .05) and 24-month follow-up (p < .05). Categorical predictors results demonstrated consistent empirical findings.. More frequent exercise consistently predicted decreased depression, prospectively; only a concurrent effect of increased healthy diet on depression was found. Finally, significant associations between foot care and SBGM and depression outcomes were found inconsistently.

IMPLICATIONS: Increased frequency of exercise predicted a significant reduction in both the odds of clinical depression and depressive symptoms, prospectively. Results suggest dual benefits of exercise for both diabetes outcomes and depression. According to the findings, more frequent self-care behavior does not appear to be a risk factor for clinical depression risk or depression severity.