Association of Adverse Childhood Experiences and Perceived Autonomy Support with Diabetes-Related Distress among Adults with Diabetes Mellitus and Depressive Symptoms

Abstract

Purpose and Background/Significance: Diabetes is increasing rapidly in the U.S. and affects over one-third of the adult population. Depression, diabetes-related distress, and adverse early life events are associated with impaired diabetes self-management behaviors and poorer glycemic control. Research guided by Self-Determination Theory shows that higher perceived autonomy support is associated with better diabetes health outcomes. The purpose of this analysis was to test a model of the relationships among perceived autonomy support, adverse childhood experiences, and depressive symptoms as predictors of diabetes-related distress in a sample of adults (N=45) with type 2 diabetes mellitus and depressive symptoms who were participating in a randomized pilot study of a 12-week patient-centered decision support intervention for depressive symptoms.

Methods: Baseline (pre-intervention) data were analyzed for standardized measures that included the Diabetes Distress Scale (DDS), Adverse Childhood Experiences Questionnaire (ACE), Patient Health Questionnaire-9 (PHQ-9) depression screening measure, and the Important Other Climate Questionnaire (IOCQ) measure of perceived autonomy support. Multivariate regression analysis was used to model the relationships among variables, using DDS as the dependent variable, and ACE and IOCQ scores as independent variables, after initially controlling for PHQ-9 score, sociodemographic and clinical characteristics.

Results: Hypotheses about the direction and significance of associations between IOCQ, ACE, and DDS were supported; i.e., IOCQ and DDS were negatively correlated (r = - .364, p = 0.02), ACE and DDS were positively correlated (r = 0.46, p =.006), and IOCQ and ACE were negatively correlated (r = - .36, p = .05). The study model accounted for 48.9% of the variance in DDS.

Conclusion: This study contributes to the theoretical understanding of how adverse childhood experiences and perceived autonomy support may influence diabetes-related distress. This knowledge can inform improved health care interventions to reduce diabetes-related distress to lead to improved diabetes outcomes.