Lee, Jusung (2019-08). Diabetes Management, Physical Activity, and Depression: Investigating the Nexus. Doctoral Dissertation.
Introduction: Diabetes is a pressing health issue both globally and in the US. Diabetes requires individual and social efforts for its successful management. This dissertation investigates how individuals' physical activity (PA) surrounded by social contexts affect persons' risk of depression in diabetes. Additionally, it evaluates the impact of the Medicaid expansion on diabetes management. Methods :A systematic review was conducted examining the association between depression and PA in type 2 diabetes from 2000 to 2018. Logistic regression was performed to examine for potential differences in reported depression associated with levels of PA across populations using the Behavioral Risk Factor Surveillance System (BRFSS). Additionally, this dissertation evaluated the impact of Medicaid expansion on diabetes management using the 2011 to 2016 BRFSS. Results: A systematic review found a significant association between PA and reported depression. A logistic regression analysis demonstrated that those older than age 65 had a lower risk of depression when engaging in PA, than those younger than 45. There was evidence of ethnic differences in the risk of depression associated with PA while there was no difference associated with one's genders. The evaluation of the Medicaid expansion showed significant improvements in access to healthcare, diabetes management, and health status in states that expanded Medicaid compared to those that did not. Discussion: This systematic review reveals is a significant association between reported depression and PA in persons with diabetes, suggesting positive effects of PA in reducing depression. Guidelines for objective measurements for depression and PA are needed to strengthen the evidence for this association and its directionality. The positive effects of PA in reducing the risk of depression is more marked among older adults than among younger adults. Medicaid expansion had a significant impact on successful diabetes management. Among states with high diabetes rates, the positive impact was substantially higher in Medicaid-expansion states than Medicaid non-expansion states, suggesting health disparities between states. Conclusion: The association between depression and PA is confirmed. Compared to younger adults, older adults may gain greater health benefits by adopting physically active lifestyles, while there was no gender difference. Diabetes management has substantially improved in Medicaid expansion states. However, non-Medicaid expansion states with higher rates of diabetes may be facing poorer health practices and outcomes compared to Medicaid expansion states, suggesting emerging health disparities between states.