The Structure of depression and anxiety symptoms in diabetic

193 Pages·2017·0.51 MB·English

University of Iowa
Iowa Research Online
Theses and Dissertations
2008
The Structure of depression and anxiety symptoms
in diabetic patient and community adult samples
Elizabeth Anne McDade-Montez
University of Iowa
Copyright 2008 Elizabeth Anne McDade-Montez
This dissertation is available at Iowa Research Online: http://ir.uiowa.edu/etd/209
Recommended Citation
McDade-Montez, Elizabeth Anne. "The Structure of depression and anxiety symptoms in diabetic patient and community adult
samples." PhD (Doctor of Philosophy) thesis, University of Iowa, 2008.
http://ir.uiowa.edu/etd/209.
Follow this and additional works at:http://ir.uiowa.edu/etd
Part of thePsychology Commons
THE STRUCTURE OF DEPRESSION AND ANXIETY SYMPTOMS IN DIABETIC
PATIENT AND COMMUNITY ADULT SAMPLES

by

Elizabeth Anne McDade-Montez

An Abstract

Of a thesis submitted in partial fulfillment of the
requirements for the Doctor of Philosophy degree
in Psychology in
the Graduate College of
The University of Iowa

December 2008

Thesis Supervisor: Professor David Watson
1

ABSTRACT

Delineating and diagnosing depression and anxiety in the presence of a medical
condition, such as diabetes, is complicated by the presence of overlapping symptoms that,
therefore, are etiologically ambiguous. These overlapping symptoms include feelings of
fatigue, concentration difficulties, restlessness, changes in appetite, irritability and
autonomic arousal. The difficulty in understanding these overlapping symptoms has been
proposed to lead to an underdiagnosis of depression and anxiety disorders among adults
with diabetes, which is problematic given that such disorders are associated with poorer
health outcomes. The goal of the current study is to test whether or not these overlapping
symptoms are affected by the presence of diabetes by comparing structural models of
these symptoms in adults with diabetes versus those free of major medical conditions.
Participants include 226 adults with diabetes and 379 adults free of diabetes who
completed a series of questionnaires assessing symptoms of depression, anxiety and
health status. In addition, for adults with diabetes, the most recent hemoglobin A1c lab
result was collected from patient medical records. Results indicate that overlapping
symptoms were strongly related to mood for adults with and without diabetes. In
conclusion, it is recommended that when these overlapping symptoms are present in
adults with diabetes, depression and anxiety should be considered as possible contributors
to their presence.
Abstract Approved: _____________________________________
Thesis Supervisor

___________________________________
Title and Department

____________________________________
Date
THE STRUCTURE OF DEPRESSION AND ANXIETY SYMPTOMS IN DIABETIC
PATIENT AND COMMUNITY ADULT SAMPLES

by

Elizabeth Anne McDade-Montez

A thesis submitted in partial fulfillment of the
requirements for the Doctor of Philosophy degree
in Psychology in
the Graduate College of
The University of Iowa

December 2008

Thesis Supervisor: Professor David Watson
Copyright by

ELIZABETH ANNE MCDADE-MONTEZ

2008

All Rights Reserved
Graduate College
The University of Iowa
Iowa City, City

CERTIFICATE OF APPROVAL
______________________________

PH.D. THESIS
_________________

This is to certify that the Ph. D. thesis of

Elizabeth Anne McDade-Montez

has been approved by the Examining Committee
for the thesis requirement for the Doctor of
Philosophy degree in Psychology at the December 2008 graduation.

Thesis Committee: _____________________________________
David Watson, Thesis Supervisor

_____________________________________
Lee Anna Clark

_____________________________________
Michael O’Hara

_____________________________________
Jerry Suls

_____________________________________
Carolyn Turvey
To Hazel

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ACKNOWLEDGMENTS

Funding for this project was received from NIMH Grant R01-MH068472 to
David Watson and from UISG Research Grant Program to Elizabeth McDade-
Montez. I would like to thank Thomas O’Dorisio, M.D., William Sivitz, M.D. and
the Endocrinology faculty and staff at the University of Iowa Hospitals and Clinics
for their support of this project and participation. I would also like to thank John Ely,
M.D. and the Family Medicine faculty and staff at the University of Iowa Hospitals
and Clinics for their support and participation in this project. Thank you also to the
staff of the Iowa City VA Medical Center for their participation in and assistance with
this study. I am especially grateful to all the patients and community members who
agreed to participate in this study.
Thank you to the members of my dissertation committee, Lee Anna Clark,
Michael O’Hara, Jerry Suls, and Carolyn Turvey, for their guidance and feedback on
this project. A very special thank you is due to my advisor, David Watson, for his
ongoing support and assistance with my dissertation and graduate studies.
Finally, I would like to thank my husband for his continuous support, kindness
and patience throughout my graduate training.

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TABLE OF CONTENTS
LIST OF TABLES………………………………………………………………….........iv
INTRODUCTION...............................................................................................................1

The Comorbidity of Anxiety and Depression...................................................3
Structural Models of Anxiety and Depression..................................................4
The Two Factor Model..............................................................................4
The Tripartite Model.................................................................................5
Integrative Hierarchical Model of Anxiety and Depression......................6
Examining Structural Models of Anxiety and Depression in Medical
Patients..............................................................................................................8
Pathophysiology of Diabetes..........................................................................11
Studies of Specific and Nonspecific Symptoms of Depression and
Anxiety in Diabetes Samples..........................................................................17
Depressive Disorders, Anxiety Disorders and Correlates in
Diabetes Patients.....................................................................................17
Summary..................................................................................................26
Self-Report Measures of Depression and Anxiety and Their
Correlates.................................................................................................27
Summary and Conclusions......................................................................32
CURRENT STUDY...........................................................................................................35

Goals...............................................................................................................35
Hypotheses......................................................................................................39
Methods..........................................................................................................44
Participants..............................................................................................44
Measures..................................................................................................47
Procedure.................................................................................................63
Overview of Analyses.............................................................................64
Summary..................................................................................................68
RESULTS ………………………………………………………………………………70

Descriptive Statistics......................................................................................70
Test for Mean Level Differences in................................................................72
Depression and Anxiety Symptoms................................................................72
Structural Analyses.........................................................................................73
Elimination of Poor Markers...................................................................73
Preliminary Correlational Analyses........................................................74
Exploratory Factor Analyses...................................................................76
Initial Confirmatory Factor Analysis.......................................................77
Testing Model Constraints Within Samples............................................81
DISCUSSION....................................................................................................................85

Limitations......................................................................................................96
Future Directions............................................................................................98
APPENDIX A: TABLES................................................................................................101
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APPENDIX B: SELECTED MEASURES.....................................................................139
REFERENCES................................................................................................................175

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