Depression and diabetes distress (DD) are both important features of diabetes in China, as in other countries. A study of Chinese adults with type-2 diabetes, e.g., found 42% prevalence of moderate/high levels of DD. Here we examine whether peer support may increase neighborhood support and whether changes in neighborhood support may be associated with changes in depression and DD in Shanghai. In extension of the Shanghai Integration Model that links specialty/hospital care with primary care, trained volunteer peer leaders (PL) implemented varied supportive activities in 9 Community Health Centers (CHCs). In addition to diabetes education, PLs led activities to increase sense of solidarity among participants, such as walking or dance clubs. Neighborhood support for diabetes management was measured by 8 items (e.g., “other people understand the importance of diabetes management”) in an evaluation sample of 1284 before and after 12 months’ PL activity. Research staff unaware of outcomes rated the number of PLs working from each CHC and the extent to which they led activities and contacted individuals. Combining these ratings, PL activity predicted increased neighborhood support (ß = 0.187, p < 0.001, controlling for baseline neighborhood support, gender, age, education, years with diabetes, and clustering within sites). Increases in neighborhood support in turn were associated with decreased DD and depression (partial correlations = -0.170 and -0.161, ps < 0.001, controlling for gender, etc., baseline neighborhood support and baseline DD and depression, respectively). Neighborhood support may be an important path through which peer support programs reduce DD and depression. Research suggests Chinese individuals with diabetes experience DD in culturally unique ways. Further research might examine how benefits of peer and neighborhood support for DD and depression may also reflect Chinese culture and suggest approaches to tailoring peer support for other cultures.


E.B. Fisher: Research Support; Self; Merck Foundation, Sanofi China. Y. Qian: None. P.Y. Tang: Research Support; Self; Merck Foundation. Y. Liu: None. M.M. Coufal: None. W. Jia: None.


Shanghai Municipal Grants (GWIV-3.1 to W.J.); Shanghai 6th People’s Hospital (YNLC201812 to Y.L.); Shanghai Municipal Health Commission (20194Y0141 to Y.L.); Merck Foundation; Sanofi China; Michigan Center for Diabetes Translational Research; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)

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