Objective: Diabetes distress and depression are associated with treatment nonadherence among adults with T2D. Evidence for the independence of these effects has been mixed. Whether perceived stress, or the degree to which situations in life in general are appraised as stressful, can account for these effects has not been examined. We tested whether perceived stress was associated with objective T2D medication adherence and whether effects of diabetes distress and depression showed independence from perceived stress.
Methods: Participants (N = 104, Age = 56.57 ± 9.32; A1C = 7.75 ± 1.55; 39% insulin use; 24% Latino, 24% White, 62.5% Black, 5.7% Other) completed validated self-reports of perceived stress, diabetes distress and depression and had oral medication adherence electronically monitored (EM) over 3 months. Multiple regression evaluated the association between perceived stress and EM medication adherence when modeled with covariates as well as with diabetes distress and depression.
Results: Perceived stress was correlated with lower EM adherence (r = -.24, p = .013) ; however, when accounting for age, insulin use, and days of EM monitoring, the association was attenuated (β = -.14, p = .109) . Diabetes distress (β = -.29, p = .001) and depression (β = -.34, p < .001) were associated with lower adherence after covariate adjustment, when each were adjusted for perceived stress (diabetes distress: β = -.32, p = .005; depression: β = -.48, p < .001) , and when both were modeled together with perceived stress (diabetes distress: β = -.22, p = .044; depression: β = -.41, p = .002) . In this final model, perceived stress showed an unexpected positive association with adherence (β = .27, p = .035) .
Conclusion: The associations of diabetes distress and depression with treatment nonadherence were not accounted for by perceived stress in this diverse sample of adults with T2D. Their independent associations with treatment nonadherence support both constructs as important targets for intervention.
F. Mustafiz: None. C. J. Hoogendoorn: None. J. S. Gonzalez: Consultant; Virta Health Corp.