Evaluating social support and health outcomes in diabetes: Associations in community-based samples

Background: Diabetes is a severe chronic metabolic disorder. Adults with diabetes are more likely to have comorbid major depressive disorder (MDD) or generalized anxiety disorder (GAD) relative to the general population. Diabetes, MDD, and GAD are each related to increased functional disability, and may be particularly detrimental to functioning when individuals present with comorbidities. Social support has been proposed to buffer against the detrimental effects of both diabetes and these mental disorders on functioning. However, perceived social support has not been examined as a moderator of the relation between MDD and GAD and functional disability in adults with diabetes. Additionally, there is a dearth of studies examining longitudinal patterns of perceived social support in community-based sample of adults with type 2 diabetes (T2D).Aims: The aims of this thesis are: 1) to examine whether social support moderates the association between MDD, GAD, and functional disability in adults with diabetes; 2) to identify temporal trajectories of perceived social support in adults with T2D; and 3) to examine differences in depressive symptoms and functional disability across different social support trajectories. Methods: This thesis includes two manuscripts. The first study used data from the cross-sectional 2012 Canadian Community Health Survey-Mental Health. The sample was restricted to adult participants with diabetes (n=1,764). Separate linear regression analyses were conducted to examine perceived social support as a moderator of the association between MDD or GAD and functional disability. Models were adjusted for demographic characteristics. The second study used data from the longitudinal Evaluation of Diabetes Treatment study, a community-based survey of insulin-naïve adults with type 2 diabetes in Quebec. Latent class growth model analyses were conducted for all participants who completed at least 2 of 5 annual waves of assessment (n=1,077). Having identified distinct groups based on latent trajectories of perceived social support, separate analysis of variance models were then conducted to examine mean differences in levels of depressive symptoms and functional disability, respectively, across social support trajectory groups. Separate models were conducted for depressive symptoms and functional disability, adjusting for demographic and diabetes-related covariates, and baseline depressive symptoms and functional disability, respectively. Results: The first manuscript indicated that MDD, GAD, and perceived social support were each related to functional disability, such that adults with a mental disorder reported higher functional disability compared to those without a mental disorder. Participants with low perceived social support also showed higher functional disability relative to those with high social support. However, social support did not moderate the relation between mental disorders and functional disability. The second manuscript first identified four distinct groups based on latent trajectory of social support. However, each trajectory remained relatively stable over time. Moreover, there was a negative linear trend between social support and both depressive symptoms and functional disability, respectively. Specifically, as social support decreased, depressive symptoms and functional disability both increased.Conclusions: The findings of these two manuscripts indicate that cross-sectional and longitudinal assessments of perceived social support are negatively related to depression and functional disability in adults with diabetes. Health care providers may assess perceived social support when treating adults with diabetes, particularly those with comorbid MDD or GAD. Targeting and intervening in cases of low social support may be particularly important, in order to prevent the deterioration of functioning.

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