The Effects of Health Behaviors on the Depression Trajectory of Middle-Aged and Older Adults with Diabetes

Background and Purpose: The prevalence of depression in middle-aged and older adults with Type 2 diabetes is high (Ali et al., 2006), and research has shown that health behaviors are significantly associated with depression in cross-sectional studies (Shrestha et al., 2020). However, few studies have focused on the effects of health behaviors on depression over time in this population. The study’s aim was to describe the depression trajectory of middle-aged and older adults with diabetes and examine the effect of health behaviors on this trajectory.

Methods: Data from the Health and Retirement Study (HRS) were analyzed for this project. The HRS is a longitudinal panel study that uses a multi-stage area probability sample in the United States. Study respondents were drawn from four waves (2012, 2014, 2016, 2018), aged 50 and older, and diagnosed with diabetes (N=4,821). Descriptive analyses were conducted to summarize the sociodemographic characteristics of the sample. Next, latent growth modeling analyses were performed. First, unconditional modeling was conducted to explore the depression trajectory and examine the variances of the trajectory in the sample. Second, a conditional model with health behaviors (cigarette smoking, alcohol use, and physical activities) and covariates (age, race, assets, marriage, social network, physical health, self-efficacy) was developed to examine if health behaviors significantly affect the variances of the depression trajectory.

Results: The respondents’ mean age was 69.5 years. About 55% were women, 54% were White, 24% were Black, and 18% were Hispanic. In unconditional modeling, the linear model was more adequate compared to the quadratic model based on a statistically nonsignificant reduction in χ² (χ²=6.125, df=5, p>.05; χ²=.269, df=1, p>.05). The overall depression trajectory declined over a 6-year period and the variances of the intercept (β=1.916, SE=.031, p<.001) and slope (β=-.014, SE=.006, p=<.05) of the trajectory were significant. The conditional growth model fit well overall (χ²=.269, df=1, p>.05; RMSEA=.049, CFI=.955, TLI=.906). Middle-aged and older adults with diabetes who smoked more cigarettes (B=.052, p<.05), engaged in less physical activity (B=-.069, p<.001), were female (B=.076, p<.001), and had a smaller social network (B=-.219, p<.001) were more likely to have a higher depression level at baseline, but the rate of decrease in depression was non-significant. White (B=-.113, p<.01) and Black respondents (B=-.093, p<.05) were more likely to have a lower depression level at baseline compared to Asian and Native Americans. Respondents who were older (B=-.121, p<.001; B=.236, p<.001), married (B=-.157, p<.001; B=.210, p<.001), reported better physical health status (B=-.417, p<.001; B=.127, p<.01), and had higher self-efficacy (B=-.219, p<.001; B=.181, p<.01) were more likely to have a lower depression level at baseline, but the rate at which depression decreased over time was significantly smaller as compared to others.

Conclusions and Implications: The findings underscore the need for public health social work interventions that reduce cigarette smoking and increase physical activity behaviors of adults with diabetes. Primary and secondary prevention efforts are particularly important in Asian and Native American communities in which adults with diabetes report higher levels of depression than their white and African American counterparts.