Association between subthreshold depression and self-care behaviours in people with type 2 diabetes: a systematic review of observational studies
Abstract Background Self-care behaviours in people living with type 2 diabetes are important to achieving optimal glycemic control. Major depression in type 2 diabetes is associated with decreased adherence to self-care behaviours. The association between subthreshold depression and self-care behaviours, however, has not previously been systematically reviewed. The objective of this review is to determine the association between subthreshold depression and self-care behaviours. Methods A systematic search was performed in five electronic databases that included MEDLINE, EMBASE, PsycINFO, Emcare, and CINAHL. Any observational studies in adults with type 2 diabetes, investigating the association between subthreshold depression and any self-care behaviours were included in the review. Qualitative studies, review articles and grey literatures were excluded. Two reviewers independently completed title and abstract and full-text screening, appraised study quality, and extracted the data. A third reviewer resolved any discrepancies between the reviewers if needed. Included articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Meta-analyses were not conducted, because criteria for conducting such analyses were not met. Results A total of 6,408 articles were identified through the database searching. After the abstract and full-text review, two articles met the inclusion criteria. One of the included study was cross-sectional while the other was a longitudinal study. The two studies showed inconsistent findings on the association between subthreshold depression and self-care behaviours. Important risks of bias were identified in both the included studies. Discussion The evidence from the two included studies on a possible association between subthreshold depression and self-care behaviours in adults with type 2 diabetes was not consistent and potentially biased. Our review established a gap in knowledge and suggests that further high-quality studies are needed to examine the association between subthreshold depression and self-care behaviours in people with type 2 diabetes. Systematic review registration: PROSPERO CRD42018116373 Keywords: Subthreshold depression, Depression, Self-care behaviour, Self-Management, type 2 diabetes, Systematic Review
