What are the combined effects of negative emotions and illness cognitions on self-care in people with type 2 diabetes? A longitudinal structural equation model

Joanna L Hudson, Christine Bundy, Peter Coventry, Chris Dickens, Alex Wood, Reeves David

Research output: Contribution to journalArticlepeer-review


Objective To explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care.
Design Longitudinal observational study in adults with Type 2 diabetes.
Main outcome measures Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling.
Results Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern’s effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion’s effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time.
Conclusions Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with Type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.
Original languageEnglish
Pages (from-to)873-890
Number of pages18
JournalPsychology & health
Issue number7
Publication statusPublished - 17 Mar 2016

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