Date of Award

1-1-2013

Document Type

Open Access Dissertation

Department

Psychology

First Advisor

Tawanda Greer

Abstract

Diabetes rates are on the rise, particularly among members of racial and ethnic minority groups. Individuals with diabetes are more vulnerable to developing depressive symptoms when compared to those without diabetes. While there appear to be no racial and ethnic differences in depression prevalence estimates among individuals with diabetes, members of racial and ethnic minority groups are less likely to achieve glycemic control over time, and may be at greater risk for diabetes related health issues. One such health issue is sexual dysfunction, with individuals with diabetes being more vulnerable to sexual dysfunction than those without diabetes. Sexual dysfunction may have significant biopsychosocial impacts on an individual's ability to manage their diabetes. However, the potential impact of sexual dysfunction on glycemic control is still unclear. Possible racial and ethnic differences in the prevalence of sexual dysfunction among individuals with diabetes are unknown. The relationship between, and potential long-term impact of, depression and sexual dysfunction on glycemic control has received very little attention in the diabetes research literature. This study sought to address this gap in the literature, as well as contribute more information regarding possible racial and ethnic differences in outcomes among individuals with diabetes by examining racial differences in glycemic control, the prevalence of depression and sexual dysfunction, and the longitudinal impact of these disorders on glycemic control among a national sample of veterans. Racial and ethnic differences in prevalence of depression and sexual dysfunction were expected. Additionally, significant individual and interactive impacts of race and depression/sexual dysfunction status on glycemic control over time were expected.

Data from 50,039 veterans with diabetes were included in the current investigation. Relevant data were extracted from the Veteran's Affairs (VA) Informatics and Computing Infrastructure (VINCI), which is partnered with the Corporate Data Warehouse (CDW) that manages VA patient health records. Veterans were classified as depressed or experiencing sexual dysfunction based on ICD-9 codes for depression and sexual dysfunction. General linear mixed model regression analyses were conducted examine changes over time, represented by age, in A1C levels among the different diagnostic groups. Post-hoc curvilinear analyses of longitudinal models were also conducted. The findings revealed racial and ethnic differences in the prevalence of depression and sexual dysfunction among veterans with diabetes, with White American veterans having higher percentage rates of depression (phi = .02) and Black American veterans having higher percentage rates of sexual dysfunction (phi = .12). Findings for both linear and curvilinear analyses of longitudinal models also revealed significant differences in A1C levels across racial and ethnic groups, as well as diagnostic groups, over time. Specifically, Black American veterans and veterans with sexual dysfunction exhibited decreasing mean A1C levels over time while White American veterans and veterans with no diagnosis exhibited gradually increasing mean A1C levels over time. Significant racial and ethnic differences in A1C levels were also present among veterans with depression. Findings suggest possible impact of race, sexual dysfunction, and depression on long-term glycemic control. Implications of the findings are discussed.

Rights

© 2013, Adrian Laseter

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