The mediating role of health beliefs in the relationship between depressive symptoms and medication adherence in persons with diabetes.
The mediating role of health beliefs in the relationship between depressive symptoms and medication adherence in persons with diabetes.
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DOI：
10.1016/j.sapharm.2005.09.002
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发表时间：
2005-12-01
期刊：
影响因子：
--
通讯作者：
Taylor, Stephanie D
中科院分区：
文献类型：
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作者：
Chao, Jingdong;Nau, David P;Taylor, Stephanie D
背景技术背景：虽然抑郁症状、健康信念和药物依从性之间的双变量关系已经被确定，但这3个结构之间的复杂关系尚未被阐明。目的：本研究探讨患者对糖尿病和糖尿病药物的信念在抑郁症状和糖尿病药物依从性之间的中介作用。一项调查被发送到1700人与2型糖尿病谁参加了管理式护理组织在美国。评估抑郁症状、糖尿病相关健康信念和糖尿病药物依从性之间的双变量关系。一个结构方程模型，以确定是否健康信念介导的抑郁症状和药物adherence.RESULTS之间的关系：收到445名受试者的可用响应。抑郁症状越严重，糖尿病药物依从性越低。结构方程模型表明，抑郁症状对服药依从性的影响是通过知觉副作用障碍，知觉一般障碍和自我效能介导的。严重抑郁症状的患者认为更多的障碍，坚持治疗，并在他们的能力坚持药物治疗信心不足。反过来，降低自我效能感和提高感知障碍与患者对糖尿病药物治疗方案的依从性呈负相关。结论：糖尿病和抑郁症状患者对糖尿病药物治疗的依从性降低，可能部分原因是抑郁症与患者对糖尿病药物治疗的信念和药物使用的自我效能感有关。
BACKGROUND: Although bivariate relationships between depressive symptoms, health beliefs, and medication adherence have been identified, the complex relationship among these 3 constructs has not been explicated.OBJECTIVE: This study examines the mediating role of patients' beliefs about diabetes and diabetes medications in relation to depressive symptoms and diabetes medication adherence.METHODS: A survey was sent to 1700 persons with type 2 diabetes who were enrolled in a managed care organization in the United States. The bivariate relationships between depressive symptoms, diabetes-related health beliefs, and diabetes medication adherence were assessed. A structural equation model was developed to determine if health beliefs mediated the relationship between depressive symptoms and medication adherence.RESULTS: Usable responses were received from 445 subjects. Greater depressive symptoms were associated with lower adherence to diabetes medications. The structural equation model indicated that the effect of depressive symptoms on medication adherence was mediated through perceived side effect barriers, perceived general barriers, and self-efficacy. Patients with severe depressive symptoms perceived more barriers to treatment adherence and were less confident in their ability to adhere to medication. In turn, reduced self-efficacy and heightened perceived barriers had a negative association with patients' adherence to diabetes medication regimens.CONCLUSIONS: Decreased adherence to diabetes medications in patients with both diabetes and depressive symptoms may be partly explained by the association of depression with patients' beliefs about diabetes medications and their self-efficacy for medication use.