Depression and self-care in Jordanian adults with diabetes : the POISE study

The global prevalence of diabetes mellitus in the developing world is reaching epidemic levels, with Type 2 Diabetes Mellitus (T2DM) being the most common form of this condition. In a developing country like Jordan, T2DM continues to escalate, with a current prevalence rate of approximately 17%. Compounding this condition is another debilitating and often co‐existing problem, depression. Although the cornerstone to T2DM management is adopting a healthy lifestyle and adhering to healthcare, the day‐to‐day self‐care of diabetes is often challenging, particularly for those with both diabetes and depression. Using Leventhal’s Common Sense Model (CSM) which focuses on patient’s perception of illness and the associated health‐related behaviour individuals use, the study examined self‐care management behaviour among Jordanians with T2DM, with particular focus on psychological status, social support, religiosity and self‐efficacy in order to predict health‐related behaviour. Hence, the purpose of this study was to examine the prevalence of depression among patients with T2DM in Jordan and the relationship between self‐care management behaviour and the following psychosocial aspects: illness perception, depression, social support, religiosity and spiritual coping, and self‐efficacy. The study explored the experience of those living with T2DM, with co‐existing depression. Six standardised scales translated into the Arabic language used in this study were: Brief illness perception questionnaire (BIPQ), Patients’ Health Questionnaire‐9 (PHQ‐9); ENRICH Social Support Instrument (ESSI); Religious and Spiritual Coping Subscale (RSC); Diabetes Management Self‐Efficacy Scale (DMSES); and Summary of Diabetes Self‐Care Activities (SDSCA). Using a sequential embedded mixed methods design, 220 patients with T2DM who were attending the Endocrinology Clinic at Jordan University Hospital between 10th of June and 30th of September 2013 were recruited and completed the study survey. Of these survey respondents, 15 participants were selected and interviewed. The selection criteria was based on their PHQ‐9 scores which indicated those with mild, moderate or moderately severe depressive symptoms. In addition to descriptive and inferential statistics, Structure Equation Modelling (SEM) was performed to test the proposed conceptual model based on CSM, and to examine the relationships among these constructs with self‐care management behaviour. Interviews were transcribed and translated, and textual analysis of the qualitative data was carried out using a thematic approach to elicit themes related to psychosocial factors, and self‐care management behaviour. Results of this study revealed that depressive symptoms were highly prevalent among the study population, with approximately 70% of the respondents having some form of depressive symptoms. The study also showed that depression negatively correlated with self‐efficacy (r=‐0.242; p <0.001), and self‐efficacy was positively correlated with self‐care management behaviour (r=0.405; p <0.001). Results of SEM analysis found that there was a direct relationship between selfefficacy and self‐care management behaviour (β=0.40; p<0.001). Depression was indirectly related to self‐care management behaviour through self‐efficacy (β =‐ 0.20; p=0.003). There was also an indirect relationship between self‐care management behaviour and social support, through depression (β = ‐0.18; p