Bernard and Angelucci, Endocrinol Diabetes Res 2020, 6:2
DOI: 10.37532/ecdr.2020.6(2).148
Research Article
Relationship between Depression
and Treatment Adherence in
Diabetes, Considering Social
Support, Coping Skills and Sex
José Eduardo Rondón Bernard* and Luisa Angelucci
Universidad Católica Andrés Bello, Universidad Central de Venezuela, Caracas
1000, Capital District, Venezuela
*Corresponding author: José Eduardo Rondón Bernard, Universidad Católica
Andrés Bello, Universidad Central de Venezuela, Caracas 1000, Capital District,
Venezuela; E-mail: bernard85@gmail.com
Received date: May 28, 2020; Accepted date: June 12, 2020; Published date:
June 19, 2020
Introduction
People with diabetes have a double risk of depression than the
general population, which can worsen their health status [1,2], not
only due to their chronic complications, but also due to changes in
eating habits, of physical exercises, foot and hand care, in addition to a
rigorous adjustment to pharmacological treatment [3]. In this sense,
Castillo and Aguilar argue that depression represents a therapeutic
barrier to adequate metabolic control, but depression can also be
considered to be the result of the impact of the condition, that is, by
the change in the style of life that this implies [4]. Regarding the
relationship between depression and treatment adherence, some
authors state that greater adherence to treatment, greater probability of
developing symptoms of depression, while others consider that the
relationship is opposite, that is, less adherence, greater probability of
developing depression [5-8].
The relationship between treatment adherence and depression can
be altered by other variables such as sex, coping strategies, and the
social support network of people with diabetes, due to the close link
that exists between them [9,6,10]. In this sense, recent studies argue
that women with diabetes are more likely to have depression compared
to diabetic men [7,6,11-13]. Furthermore, it is argued that it is these
that tend to use more emotion-focused coping strategies such as
resignation and isolation compared to men with diabetes [14].
For their part, Salcedo-Rocha et al. state that women with diabetes
participate to a lesser extent in recreational activities compared to men,
and therefore are more prone to present depressive emotional states
[15].
Rondón and Lugli maintain that the active role that the person may
have in the face of the threats posed by having diabetes, is extremely
important for the control of the condition and its better adjustment,
that is, absence of depression, because it facilitates the social support
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and this represents a protective factor of health in diabetes since it
allows a higher quality of life [16,17].
Derived from the previous problem, the present investigation
sought to determine the model in diabetes that presents a better fit to
the data in the relationship between depression and treatment
adherence, taking into account the social support network, coping
strategies and sex as factors Influential.
Method
A cross-sectional - causal design was implemented in a sample of
278 patients with an average of 59 years of age. The following
instruments were administered: The Three-Dimensional Questionnaire
for Depression, the Instrument to Measure Diabetic Lifestyles
(IMEVID), the Coping Strategies Questionnaire and The Interview
Schedule for Social Interaction.
For the data analysis, the structural analysis of the covariance was
used, specifically two, the first where adherence to treatment predicts
depression, and the second where the opposite relationship is
proposed, considering in both models the social support network,
strategies coping and sex. For each model, the relationship model
composed of the coefficients "ß" for each of the predictor variables
involved in the study, and the measurement model made up of the
factor loads and the error variance of each construct studied were
obtained. After obtaining the rival models, we proceeded to contrast
them with the ones proposed and among them by means of the quality
of fit measures: Chi square of the estimated model (Chi2), goodness of
fit index (GFI), the mean square error of approximation (RMSEA),
adjusted goodness-of-fit index (AGFI), parsimony standardized
adjustment index (PNFI) and comparative adjustment index (CFI).
Results
Both models presented the same goodness-of-fit indexes X2 (484,
N=62) p<0.05; GFI=0,97; RMSEA=0,10; AGFI=0,95; NFI=0,63;
PNFI=0,51; y CFI=0,69, reason why it is stated that both models have
an acceptable fit and are statistically equivalent, highlighting that the
relationship between depression and treatment adherence is 0.55
(Figure 1).
Due to the fact that some indicators of the construct treatment
adherence (physical activity and tobacco consumption) and avoidance
strategies (blaming others) turned out to be unreliable, the procedure
was repeated, eliminating these factors and registering the following
goodness-of-fit: X2(301, N=55), p<0.05; GFI=0,97; RMSEA=0,10;
AGFI=0,95; NFI=0,66; PNFI=0,49; y CFI=0,72. Many relationships
were found to change their nature, highlighting that the relationship
between depression and treatment adherence disappears entirely
(Figure 2).
Citation: Rondón JE and Angelucci L (2020) Relationship between Depression and Treatment Adherence in Diabetes, Considering Social Support, Coping
Skills and Sex. Endocrinol Diabetes Res 6:2.

doi: 10.37532/ecdr.2020.6(2).148

Figure 1: Goodness-of-fit indexes 1.

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Citation: Rondón JE and Angelucci L (2020) Relationship between Depression and Treatment Adherence in Diabetes, Considering Social Support, Coping
Skills and Sex. Endocrinol Diabetes Res 6:2.
Figure 2: Goodness-of-fit indexes 2.
Conclusions
At a conceptual level, the relationship between treatment adherence
and depression will depend on the definition made of each construct.
On a methodological level, the relevance of third variables in the
understanding of causal relationships in psychology is revealed. On a
technological level, it is considered that programs aimed at promoting
the treatment adherence must take into consideration the
particularities of the subject receiving the treatment.
Limitations
One of the limitations of the present study was the use of a
transitional design and the same technique of the Structural Equation
Models since, despite its benefits, it only seems to allow establishing a
temporal order when the causal relationship involves several variables,
not being sensitive when only two variables are considered as in the
present study, therefore it is recommended to replicate the study using
a longitudinal panel design in order to verify the temporal order
between these constructs.
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Skills and Sex. Endocrinol Diabetes Res 6:2.
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