Shame, depression and self-care in emerging adults with type 1 diabetes.

Abstract Objective: Consistent self-care is vital to maintaining good health and quality of life for people with type 1 diabetes (T1D), as well as avoiding life-limiting conditions. Evidence suggests depression impacts on T1D self-care, but research into what might influence this is lacking. The aim of the current study was to explore whether shame-proneness predicts diabetes self-care in an emerging adult population and whether this relationship is mediated by depression. Method: 292 participants between the ages of 16 and 25 and with T1D took part in an online survey. They completed measures of shame-proneness, depression and adherence to diabetes self-care activities, and provided their most recent HbA1c reading. Results: As hypothesised, all four shame subscales showed a significant correlation between high shame and low self-care. All four types of shame evidenced some partial mediation by depression, though this was only marginal for diabetes shame. There was evidence of stronger mediation by depression in the models of behavioural and character shame. For the models assessing diabetes-related and body shame on self-care outcomes, the direct effect of shame generally remained significant. HbA1c levels in the sample were high (mean=64 mmol/mol) and uptake of attendance at structured diabetes education courses was low (40%). Conclusion: Preliminary support was found for a model whereby diabetes and body shame directly affect T1D self-care in emerging adults. Depression remains an important factor in T1D self-care and for some may be influenced by character and behavioural shame. Potential ways of reducing shame for people with T1D are discussed. Further research is needed to establish causality and measure factors which may play a role in triggering and maintaining shame