Background: High levels of depression and poor self-efficacy and self-management are associated with worse glycemic control, but the linkage and pathway between these variables are poorly understood. We conducted this study to investigate the hypothesis that self-efficacy and self-management mediate the influence of depression on poor glycemic control. Methods: We studied a purposive sample of 142 adults with type 2 diabetes attending a public clinic in Ilam, Iran. Hierarchical linear regression analysis and structural equation modeling were used to explore the relationships among the variables of interest. Result: Depression directly and negatively affects self-efficacy and indirectly affects self-management behaviors, which in turn have direct effects on hemoglobin A1c (HbA1c). Self-efficacy mediates the relationship between depression and self-management behaviors. Self-efficacy and self-management behaviors partially mediate the effect of depression on HbA1c. These results confirmed that the data fit the hypothesized model very well. Conclusion: Careful monitoring of glycemic control might be important in those individuals who exhibit clinical signs of depression. Effective treatment programs should probably pay close attention to not only screening and treatment of depression but also skills training to enhance patient self-efficacy and self-management of diabetes to improve HbA1c.

中文翻译：

---

抑郁症对成人 2 型糖尿病血糖控制不佳的影响：自我效能和自我管理行为的中介作用

背景：高度抑郁和较差的自我效能和自我管理与较差的血糖控制有关，但这些变量之间的联系和途径知之甚少。我们进行这项研究是为了调查自我效能和自我管理介导抑郁症对血糖控制不佳的影响的假设。方法：我们研究了 142 名在伊朗伊拉姆公共诊所就诊的 2 型糖尿病成人的有目的的样本。使用分层线性回归分析和结构方程建模来探索感兴趣的变量之间的关系。结果：抑郁症直接和负面地影响自我效能感，并间接影响自我管理行为，进而对血红蛋白 A1c (HbA1c) 产生直接影响。自我效能在抑郁与自我管理行为之间的关系中起中介作用。自我效能感和自我管理行为部分介导了抑郁症对 HbA1c 的影响。这些结果证实数据与假设模型非常吻合。结论：对于那些表现出抑郁临床症状的个体，仔细监测血糖控制可能很重要。有效的治疗计划可能不仅应密切关注抑郁症的筛查和治疗，还应密切关注技能培训，以提高患者的自我效能和糖尿病的自我管理，以改善 HbA1c。对于那些表现出抑郁临床症状的个体，仔细监测血糖控制可能很重要。有效的治疗计划可能不仅应密切关注抑郁症的筛查和治疗，还应密切关注技能培训，以提高患者的自我效能和糖尿病的自我管理，以改善 HbA1c。对于那些表现出抑郁症临床症状的人，仔细监测血糖控制可能很重要。有效的治疗计划可能不仅应密切关注抑郁症的筛查和治疗，还应密切关注技能培训，以提高患者的自我效能和糖尿病的自我管理，以改善 HbA1c。