1. CRICOS Provider Code: 00126G Method: 1,551 community-dwelling patients with type 2 diabetes were recruited to the Fremantle Diabetes Study-Phase II (FDS2) between 2008-2011. At study entry, 1,285 patients completed a comprehensive physical and biochemical assessment, in addition to: Depression assessment: Patient Health Questionnaire (PHQ-9) and Brief Lifetime Depression Scale (BLDS) Anxiety assessment: Generalized Anxiety Disorder Scale (GADS) and Generalized Anxiety Disorder Scale-Lifetime (GAD-LT) ANCOVA assessed contribution of L-MDD and L-GAD to current mood symptoms, controlling for age, gender, marital status, and diabetes duration. Multiple mediation models examined effect of L-MDD and L-GAD on self- management and health outcomes, and whether current mood symptoms mediated this relationship. Data are presented as proportions (%), median [interquartile range], and standardized regression coefficient (B). Background: Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are highly prevalent in type 2 diabetes 1,2, and present together in approximately 17% of patients 3. Both disorders significantly impact on engagement with self-management behaviour and health outcomes 1,4. Whilst current mood symptoms have been widely studied, the consequence of lifetime MDD and GAD requires further clarification. Aims: This study determined the separable and combined impact of Lifetime Major Depressive Disorder (L-MDD) and Lifetime Generalized Anxiety Disorder (L-GAD) on current affective symptoms, glycemic control, and self-management behaviours in a large, type 2 diabetes cohort. Stephanie R. Whitworth 1, David G. Bruce 2, Sergio S. Starkstein 3, Wendy A. Davis 2, Timothy M.E. Davis 2, & Romola S. Bucks 3 1 School of Psychology, University of Western Australia, Crawley, Australia; 2 School of Medicine & Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Australia; 3 School of Psychiatry & Clinical Neuroscience, University of Western Australia, Fremantle Hospital, Fremantle, Australia 2. Lifetime history, glycemic control and self-management behaviour: multiple mediation models Results: 1. Lifetime history and current symptoms L-MDD was associated with more severe, current depression (PHQ-9) and anxiety (GADS) symptoms (Table 1). L-GAD, was associated with more severe current anxiety and depressive symptoms. A history of both L-MDD and L-GAD was associated with more severe PHQ-9 and GADS scores, than either disorder alone. Lifetime depression and anxiety: Risk factors for symptom severity and inappropriate self-management in Type 2 diabetes Correspondence to: stephanie.whitworth@research.uwa.edu.au Table 1. Mood characteristics by lifetime history of depression and/or anxiety (N = 1285) a b c c’ Current depression/anxiety severity (Mediator) Lifetime History (Predictor) Self-management/health outcome (DV) L-MDD: L-MDD directly (path c’): Increased BMI: B = 1.14, p < 0.05 Increased likelihood of currently smoking: B = 0.81, p < 0.05 Via current depression severity (fully mediated, path ab), L-MDD: Increased HbA 1c : B = 0.13, p < 0.05 Reduced blood glucose self-monitoring: B = -0.29, p < 0.05 L-GAD: Via current depression severity (fully mediated, path ab), L-GAD: Increased BMI: B = 0.30, p < 0.05 L-MDD+L-GAD: Via current depression severity (fully mediated, path ab) L-MDD+L-GAD: Increased HbA 1c : B = 0.19, p < 0.05 Reduced blood glucose self-monitoring: B = -0.36, p < 0.05 Increased BMI: B = 1.56, p < 0.05 Increased likelihood of currently smoking: B = 0.47, p < 0.05 Conclusion: These findings highlight that L-MDD, and to a lesser extent L-GAD, are important predictors of later psychological symptom severity and self-management behaviour in type 2 diabetes. Comorbid L-MDD+L-GAD had the greatest negative impact on diabetes self-management, and indirectly led to poor glycemic control, reduced blood-glucose self-monitoring, higher BMI, and current smoking status. Screening for L-MDD and L-GAD at diabetes diagnosis may allow for earlier identification and psychosocial intervention for those at increased risk of later affective and self-management difficulties. References: 1.de Groot M et al. Psychosom Med 63: 619-30, 2001 2.Grigsby AB et al. J Psychosm Res 53: 1053-60, 2002 3.Collins MM et al. Diabet Med 26: 153-61, 2009 4.Anderson RJ et al. Int J Psych Med 32: 235-47, 2002 VA-0797 L-MDD onlyL-GAD onlyL-MDD+L-GAD YesNop-valueYesNop-valueYesNop-value Number (%) 170 (17.6) 796 (82.4) 65 (7.5) 796 (92.5) 254 (24.2) 796 (75.8) PHQ-9 total score 4.0 [2.0-8.0] 1.0 [0.0-3.0]<0.001 3.0 [1.0-5.0] 1.0 [0.0-3.0]<0.001 8.0 [4.0-13.0] 2.0 [0.0-4.0]<0.001 GADS total score 6.0 [4.0-9.0] 3.0 [1.0-5.0]<0.001 7.0 [4.0-10.0] 3.0 [1.0-5.0]<0.001 10.0 [6.3-16.0] 3.0 [1.0-6.0]<0.001 Figure 1. Multiple mediation models testing direct (c’) and indirect (ab) relationship between lifetime history, current mood, and self-management/health outcomes Conflict of Interest Disclosure: None to declare This poster does not contain any trade names, or cover any unapproved uses of specific drugs, other products or devices