Association of Resilience and Depression with Self-care Competence in Adult Patients with Diabetes Mellitus

Youngrye Park; Eun Hee Jang; Ji Ok Kim

doi:10.7475/kjan.2018.30.5.555

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Park, Jang, and Kim: Association of Resilience and Depression with Self-care Competence in Adult Patients with Diabetes Mellitus

Original Article

Korean J Adult Nurs 2018;30(5):555-564.

Published online: 21 October 2018

DOI: https://doi.org/10.7475/kjan.2018.30.5.555

Association of Resilience and Depression with Self-care Competence in Adult Patients with Diabetes Mellitus

Youngrye Park¹, Eun Hee Jang^2,, Ji Ok Kim³

¹Professor, Department of Nursing, Kunsan National University, Gunsan, Korea

²Assistant Professor, Department of Nursing, Incheon Catholic University, Incheon, Korea

³Head Nurse, Gunsan Medical Center, Gunsan, Korea

Corresponding author: Jang, Eun Hee https://orcid.org/0000-0002-8380-9694 Department of Nursing, Incheon Catholic University, 12 Haesong-ro, Yeonsu-gu, Incheon 22000, Korea. Tel: +82-32-830-7093, Fax: +82-32-830-7059, E-mail: cartooneh@hanmail.net

Received 10 August 201827 September 2018 Accepted 1 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purposes of this study were to examine the relationships between resilience, depression, and self-care competence and identify factors associated with self-care competence in patients with type 1 and type 2 diabetes mellitus.

Methods

This study was a descriptive research. Structured questionnaire on patients'sociodemographic and clinical characteristics, resilience, depression, and self-care competence was used for survey with a convenience sample of 152 patients with diabetes mellitus. Data were collected from July to December 2016. Data were analyzed using descriptive statistics, independent t-test, one way ANOVA, Pearson's correlation co-efficient, and multiple regression with SPSS/WIN 21.0 program.

Results

The mean scores on resilience, depression, and self-care competence were 2.86±0.42, 18.11±10.05, and 4.27±0.78, respectively. Self-care competence showed a statistically significant positive correlation with resilience (r=.47, p<.001), and negative correlation with depression (r=-.29, p<.001). Resilience showed a negative correlation with depression (r=-.53, p<.001). Resilience (β=.38, p<.001) was significantly associated with factors of self-care competence in patients with diabetes mellitus.

Conclusion

The results of the study indicate that factor influencing self-care competence was resilience in patients with diabetes mellitus. Therefore, nursing intervention programs for increasing the self-care competence should include regular assessments and strategies for improving resilience in patients with diabetes mellitus. It is recommended that the studies should be performed to confirm the relationship between resilience and self-care competence by using resilience instrument developed for adults.

Keywords: Diabetes mellitus, Resilience, Depression, Self-care, Outpatients

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Table 1.

Sociodemographic and Clinical Characteristics of Patients (N=152)

Characteristics	Categories	n (%)
Gender	Men	74 (48.7)
Gender	Women	78 (51.3)
Age (year)	40	17 (11.2)
	40~64	83 (54.6)
	≥65	52 (34.2)
Religion	Yes	67 (44.1)
Religion	No	85 (55.9)
Education	Below elementary school	25 (16.5)
	Middle school	25 (16.5)
	High school	65 (42.7)
	Above college	37 (24.3)
Living status	With family	125 (82.2)
Living status	Alone	27 (17.8)
Alcohol consumption	Never	94 (61.8)
	1~3/week	46 (30.3)
	≥4/week	12 (7.9)
Smoking	Never	111 (73.0)
	Quit	7 (4.6)
	Smoking	34 (22.4)
Duration of diagnosis (year)	5	57 (37.5)
	5~＜10	62 (40.8)
	10~＜20	19 (12.5)
	≥20	14 (9.2)
Experience of hospitalization with DM	Yes	39 (25.7)
	No	113 (74.3)

Experience of DM education	Yes	74 (48.7)
Experience of DM education	No	78 (51.3)
DM management^†	Diet	68 (26.4)
	Exercise	83 (32.2)
	Oral medication	72 (27.9)
	Insulin	12 (4.7)
	Oral medication & insulin	23 (8.9)
Complication of DM	Yes	37 (24.3)
Complication of DM	No	115 (75.7)
Experience of hypoglycemia	Yes	38 (25.0)
Experience of hypoglycemia	No	114 (75.0)
Self monitoring of blood glucose	Regular	33 (21.7)
	Sometimes	85 (55.9)
	Never	34 (22.4)

DM=diabetes mellitus;

^† Multiple responses.

Table 2.

Level of Resilience, Depression, and Self-care Competence of Patients (N=152)

Variables	M±SD	Min	Max
Resilience	2.86±0.42	1.81	4.00
Interpersonal characteristics	2.94±0.52	1.70	4.00
Characteristics of coping	2.81±0.45	1.67	4.00
Intrapersonal characteristics	2.84±0.46	1.80	4.00
Depression	18.11±10.05	1.00	51.00
Depressed group (＞16)^†	25.13±7.15	16.00	51.00
None-depressed group (≤16)^†	8.71±3.62	1.00	15.00
Self-care competence	4.27±0.78	2.00	5.88
Cognitive aspects of self-care	4.24±0.82	2.08	5.92
Physical skills	4.16±0.89	2.00	5.89
Judgement & dicisional making process	4.15±0.88	1.80	5.80
Information-seeking behaviors	4.33±0.87	2.00	6.00
Perception of self-monitoring	4.41±1.19	1.00	6.00
Attention to self-management	4.27±0.78	1.67	6.00

^† Cut-off point.

Table 3.

Differences in Self-care Competence according to Patients' Characteristics (N=152)

Characteristics		Categories	M± SD	t or F	p
Gender		Men	4.39±0.63	1.92	.057
Gender		Women	4.15±0.88
Age (year)		40	4.56±0.81	1.75	.178
		40~64	4.28±0.70
		≥65	4.16±0.86
Religion		Yes	4.29±0.80	0.23	.817
Religion		No	4.26±0.76
Education^†		Below elementary school ^a	3.92±0.61	3.20	.025
		Middle school ^b	4.22±0.92	a, b, c＜ d
		High school ^c ^d	4.27±0.81
		Above college ^d	4.53±0.62
Living status		With family	4.31±0.76	1.53	.127
Living status		Alone	4.06±0.80
Alcohol consumption^†		Never ^a	4.50±0.75	4.09	.019
		1~3/week ^b	4.49±0.80	a, b＞ c
		≥4/week ^c	4.13±0.66
Smoking		Never	4.25±0.84	1.34	.265
		Quit	4.74±0.47
		Smoking	4.23±0.57
Duration of diagnosis (year)^†		5 ^a	4.41±0.68	3.96	.009
		5~＜10 ^b	4.22±0.78	a, c＞ b, d
		10~＜20 ^c	4.44±0.66
		≥20 ^d	3.68±1.03
Experience of hospitalization with DM		Yes	4.08±0.69	1.78	.077
Experience of hospitalization with DM		No	4.33±0.79
Experience of DM education		Yes	4.21±0.85	0.96	.337
Experience of DM education		No	4.33±0.69
DM management	Diet	Yes	4.41±0.74	-2.08	.039
	Diet	No	4.15±0.78
	Exercise	Yes	4.31±0.77	-0.75	.453
	Exercise	No	4.22±0.79
	Oral medication	Yes	4.21±0.79	0.96	.339
	Oral medication	No	4.33±0.76
	Insulin	Yes	3.95±0.61	1.48	.140
	Insulin	No	4.30±0.78
	Oral medication	Yes	4.50±0.71	-1.55	.123
	& insulin	No	4.23±0.78
Complication of DM		Yes	4.04±0.89	2.11	.037
Complication of DM		No	4.34±0.72
Experience of hypoglycemia		Yes	4.30±0.71	-0.24	.814
Experience of hypoglycemia		No	4.26±0.80
Self monitoring of blood glucose^†		Regular ^a	4.64±0.48	7.24	.001
		Sometimes ^b	4.24±0.77	a＞ b, c
		Never ^c	3.98±0.78

DM=diabetes mellitus,

^† Scheffé test.

Table 4.

Correlation among Resilience, Depression, and Self-care Competence of Patients (N=152)

Variables	Resilience	Depression
Variables	r (p)	r (p)
Depression	-.53 (＜.001)
Self-care competence	.47 (＜.001)	-.29 (＜.001)

Table 5.

Factors Influencing Self-care Competence of Patients (N=152)

Variables	B	SE	β	t (p)	95% CI
(Constant)	2.50	.56		4.49 (＜.001)	1.40~3.60
Resilience	0.69	.16	.38	4.24 (＜.001)	0.37~1.02
Depression	-0.03	.01	-.04	-0.42 (.677)	-0.02~0.01
Education (1=Above college)	0.08	.14	.05	0.58 (.560)	-0.19~0.35
Duration of diagnosis (1=≥20)	-0.36	.20	-.14	-1.80 (.074)	-0.76~0.04
Self monitoring of blood glucose (1=Regular)	0.23	.14	.12	1.61 (.111)	-0.05~0.51
Alcohol consumption (1=≥4/week)	-0.15	.12	-.10	-1.25 (.212)	-0.39~0.09
DM management (Diet) (1=Yes)	0.05	.12	.03	0.42 (.676)	-0.29~0.19
Complication of DM (1=Yes)	-0.05	.14	-.03	-0.33 (.743)	-0.32~0.23
		R²=.28, Adj. R²=.24, F=7.03, p＜.001

DM=diabetes mellitus; SE=stand error; CI=confidence interval.

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