Graduation Year

2006

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Psychology

Major Professor

William P. Sacco, Ph.D.

Committee Member

Thomas H. Brandon, Ph.D.

Committee Member

Paul B. Jacobsen, Ph.D.

Committee Member

Frances Sahebzamani, Ph.D., ARNP

Committee Member

Kristen Salomon, Ph.D.

Keywords

Income, Education, Ethnicity, Perceptions of control, Blood glucose

Abstract

People in low socioeconomic status groups are at increased risk for diabetes mellitus, a group of diseases associated with high levels of blood glucose. High rates of depression have been found in people with diabetes. The study examined the relationship between stress, depression, and glycemic control in low-income type 2 diabetes patients. Participants were recruited at two community health centers that provide free medical care. The following hypotheses were examined: (1) experiencing stressful life events is positively correlated with blood glucose level; (2) negative stressful events have a greater association with glucose level than positive stressful events; (3) depression mediates the relationship between negative stressful events and glucose level (mediation model); (4) the effect of experiencing both negative stressful events and depression is predictive of glucose level (additive model); (5) the interaction between negative stressful events and depression is predictive of glucose level (interactive model); and (6) perceptions of control moderates the relationship between stress and depression.

Stressful life events and depression were not related to blood glucose levels in bivariate correlations. The data did not support any of the three models of the relationship between stress, depression, and glycemic control. The strongest predictor of glycemic control was Hispanic ethnicity, however, income and education appear to confound this relationship.

Depression was positively correlated with the total number of stressful events and negative stressful events and negatively correlated with perceptions of control. Participants in the study with less than a high school education had the highest amount of depression. In post-hoc analyses, four variables (education, perceptions of control, stressful life events, blood glucose) predicted 58% of the variance in depression, and education and perceptions of control were the strongest predictors. Perceptions of control was a significant partial mediator of the relationship between education and depression and also partially mediated the relationship between stress and depression.

The results of the study indicate that decreasing stressful life events and increasing perceptions of control is important in reducing low-income diabetes patients’ level of depression.

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