Academic journal article Research and Theory for Nursing Practice

Stressors, Depressive Symptoms, and Learned Resourcefulness among Taiwanese Adults with Diabetes Mellitus

Academic journal article Research and Theory for Nursing Practice

Stressors, Depressive Symptoms, and Learned Resourcefulness among Taiwanese Adults with Diabetes Mellitus

Article excerpt

Learned resourcefulness may be an important and necessary resource for people with diabetes to adequately manage their disease. This study used a cross-sectional, descriptive correlation design to examine the relationships of demographic characteristics, stressors, learned resourcefulness, and depressive symptoms among adult Taiwanese with diabetes mellitus. A convenience sample of 131 individuals recruited from outpatient primary care centers from two major hospitals in Taiwan participated in this study. Data were collected with a demographic questionnaire, blood tests, Rosenbaum's self-control schedule, and the Center for Epidemiological Studies depression scale. Data analysis consisted of descriptive statistics and regression analysis. Findings suggest that individuals with diabetes who had greater learned resourcefulness and better glycemic control also had fewer depressive symptoms. In addition, learned resourcefulness partially mediated the relationship between glycemic control and depressive symptoms.

Keywords: diabetes mellitus; stressors; learned resourcefulness; depressive symptoms; glycemic control

Diabetes mellitus is a chronic and costly disease affecting approximately 4% of the population in Taiwan (Department of Health Executive Yuan [DHEY], 2003). The disease may lead to major medical complications when people do not have a good glycemic control (Anderson, Freedland, Clouse, & Lustman, 2001; Chuang, Tsai, Huang, & Tai, 2001; Diabetes Control and Complications Trials Research Group, 1993; Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, 2000; Kovacs, Mukerji, Drash, & Iyengar, 1995; Lin, Chou, Lai, Tsai, & Tai, 2001; Ohkubo et al., 1995; United Kingdom Prospective Diabetes Study Group, 1998). These medical complications include retinopathies, nephropathies, neuropathies, coronary artery disease, cerebral vascular disease, and peripheral vascular disease. A good and acceptable level of glycemic control represents a glycosylated hemoglobin [HbA^sub 1^C] level of less than 7% (American Diabetes Association, 2004). Medical expenditure to manage individuals with diabetes accounted for 11.5% of all medical costs in Taiwan. The mean medical cost was approximately 4.3 times higher for people with diabetes than for those without the disease, and 75% of these expenses are used to treat the disease-related complications (DHEY, 2003; Lin et al., 2001).

To achieve good glycemic control and delay or prevent the disease-related medical complications, diabetes self-care management should be adopted as the main modality of care (Sousa, 2003). Diabetes self-care management includes adherence to diet and exercise, blood glucose monitoring, and compliance with medications (insulin and/or hypoglycemic agents). People with diabetes must be prepared to adopt self-care management through diabetes education and development of self-care skills, selfefficacy, self-care agency, social support, and lifestyle changes (Sousa, 2003; Sousa, Zauszniewski, Musil, McDonald, & Milligan, 2004). Learned resourcefulness appears to be an important factor as well; individuals with diabetes who had greater learned resourcefulness also had better health practices (Zauszniewski & Chung, 2001).

People with diabetes are also at risk for psychological disorders such as stress and depression (Eaton, 2002; Egede, Zheng, & Simpson, 2002; Lustman, Clouse, & Freeland, 1998; Musselman, Betan, Larsen, & Phillips, 2003). Diabetes and depression occur together quite often; however, there is no definitive answer as to whether diabetes or its complications cause depression or vice versa (Anderson et al., 2001; Eaton, 2002; Lustman, Griffith, Gavard, & Clouse, 1992). Diabetes may also cause biochemical changes that may influence an individual's psychosocial adjustment in the environment and their happiness for daily life (Talbot & Nouwen, 2000). Lack of diabetes control (higher levels of HbA^sub 1^C) may be a source of stress and a significant positive predictor of depressive symptoms (Chun, 2001; Gavard, Lustman, & Clouse, 1993; Sapolsky, Romero, & Munck, 2000). …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.