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Depression treatment and diabetic treatment outcomes among older Mexican Americans

TitleDepression treatment and diabetic treatment outcomes among older Mexican Americans
Publication TypeThesis
Year of Publication2009
AuthorsCurll, MG
DegreePh.D.
Number of Pages128 p
UniversityTUI University
ISBN Number978-1-109-38641-7
KeywordsAged, Analysis of Covariance, Bivariate Statistics, Depression -- Therapy -- In Old Age, Diabetic Patients -- Psychosocial Factors, Human, Mexico, Regression, Repeated Measures, Retrospective Design, Treatment Outcomes
AbstractThis study examined the relationship between depression treatment and diabetic treatment outcomes (DTO) among older Mexican American patients. The design for the study was retrospective, cohort comparative and focused on a sample of n=416 older Mexican Americans with depression and DM2. The study looked at the influence of variables such as age, insurance status, and marital status, smoking, alcohol consumption, BMI and the type of diabetic medications prescribed to treat diabetes.
Research question one examined whether depression treatment improved diabetic treatment outcomes (DTO) over time. A 2 X 3 repeated measures analysis of covariance (ANCOVA) was conducted for each of the dependent variables to determine whether depression treatment improved diabetic treatment outcomes (DTO). Results revealed an overall decrease in HbA1C values over time. More importantly, however, was the interaction between time and the acceptance or rejection of depression treatment. Patients who rejected treatment for depression showed no change in HbA1C values over time (means = 8.68 at baseline, 8.63 at 3 months, 8.87 at 6 months). In contrast, patients who accepted depression treatment showed a decrease in HbA1C values (8.58 at baseline, 8.23 at 3 months, 7.77 at 6 months), a trend that seems to progress in a linear manner over the 6 month period. Total cholesterol levels had modest declines over time for patients who rejected (240.31mg/dl at baseline, 238.29mg/dl at 3months, and 230.25mg/dl at 6 months) and accepted (228.59mg/dl at baseline, 224.14 at 3 months, 214.61mg/dl at 6 months) treatment for depression. Low density lipoproteins did not change over time and there was no interaction between treatment group and time by treatment group. Triglycerides in the group rejecting depression treatment showed little change over time while the group who accepted depression treatment demonstrated a decrease in triglycerides. The between-subjects effects indicated that although systolic blood pressure and diastolic blood pressure did not change over time for either group, the groups themselves were different. The group of patients who rejected treatment for depression had a higher systolic blood pressure at all levels.
Research question two, using regression analysis, was conducted to determine the relationship between study variables (age, years with diabetes, BMI, gender, marital status, insurance status, smoking status, alcohol consumption, diabetes medications, depression treatment group) and Diabetes Treatment Outcomes ((HbA1C, lipoproteins measures, blood pressure measures) among older Mexican Americans with depression and DM2. Multiple regression analysis was conducted to determine which of the study variables predicted HbA1C measures. After the baseline measure, three predictors contributed significantly statistically. The three predictors were being male, being married, and a willingness to be treated for depression. Regression analysis identified only one study variable of accepting treatment for depression predicted total cholesterol. Results of analysis indicated that none of the independent variables predicted high density lipoproteins or low density lipoproteins. Measures of triglycerides were found to predict significantly with compliance with treatment for depression and the number of years with DM2. Regression analysis indicated that was no significance to systolic or diastolic blood pressure.
Results of the bivariate analyses provided direction for interpreting outcome analysis. Bivariate analyses assisted in identifying how diabetic treatment outcomes (DTO) were influenced by demographics and whether a patient accepted or rejected treatment for depression. Baseline differences between treatment groups suggest that gender may influence whether or not an individual accepts or rejects treatment for depression. Results indicated that patients who accepted treatment for depression were significantly female and non-consumers of alcohol, while those who rejected treatment were male and married.
Results of this study suggest that depression treatment had a positive influence on diabetic treatment outcomes (DTO) among older Mexican American patients. HbA1C demonstrated significant drops when patients accepted treatment for depression. Regression analysis and repeated measures analysis of covariance (ANCOVA) found modest results on lipoproteins and blood pressure readings in patients who accepted or rejected treatment for depression in patients with DM2. (Abstract shortened by UMI.)