Influence of perceived social support on depression among Type 2 diabetes patients: a concurrent cross-sectional mixed-method study

Abstract

Background: There is an established relationship between the concept of social support (SS) and depression among Type 2 diabetes mellitus (T2DM) patients, however, the magnitude, direction, and outcomes of the relationship are not well established in Ghana. Objective: This study was conducted to assess the factors influencing social support and further quantify its association with depression among Type 2 diabetic patients. Methods: Three hundred and seven adults diagnosed with T2DM were sampled from four public healthcare facilities in Ghana. Ten respondents from the sample were further selected for in-depth interviews using the convenience sampling technique. A modified negative binomial model was used to determine significant factors influencing SS scores, while the influence of SS on scores for depression was assessed using a modified generalized negative binomial model. All analyses were performed using Stata 15. The qualitative arm of the study was also analyzed using thematic inductive analyses. Results: Overall, the mean[ ±standard deviation (SD)]of SS scores among participants was 46.24(±20.57), while SS domains had mean(±SD) values of 17.69(±9.23), 11.57(±8.93),and 16.97(±9.88) respectively for family support, friends support and significant others. The SS equality of variance test indicated a significant mean difference by sex, educational background, and self-reported income differentials[F-test=6.46, 6.64,and 4.23 respectively; p<0.05]. A unit increase in SS score had a significant negative relationship with depression across all domains. For the focus model, social support significantly decreased the log count score by 0.002 {β[95%confidence interval (CI)]= -0.002(-0.002-0.000). A unit increase of SS significantly decreased the probability count of depression. Themes from the qualitative data also revealed that participants received SS from family and significant others, but not from friends. Support received from family included emotional support and financial aid. Conclusion: Among T2DM patients with depression, SS had a significant decremental association that could contribute to improved health outcomes. Sex, marital status, educational level, working status, and self-rated income level influenced the SS. We recommend routine screening for psychological symptoms and the involvement of psychologists and counselors in T2DM patient management.