Depressive symptomatology mediates the effect of socioeconomic disadvantage on HbA(1c) among rural African Americans with type 2 diabetes

J Psychosom Res. 2009 Oct;67(4):289-96. doi: 10.1016/j.jpsychores.2009.01.016. Epub 2009 Apr 1.


Objective: Rural African Americans with diabetes mellitus type 2 (T2D) represent a disadvantaged and understudied group who experience difficulties with maintaining glycemic control. Although mounting evidence has linked socioeconomic disadvantage to chronic disease morbidity, few studies have examined the mediating mechanisms that account for this effect. We hypothesized that rural African Americans' financial distress, community disadvantage, and educational attainment would predict glycemic control, indirectly, via effects on depressive symptoms.

Methods: Predictions were tested using data from 192 rural African American adults with T2D and data from community support persons the participants nominated. Participants completed an in-home interview and provided a blood sample at a local laboratory. Levels of glycosylated hemoglobin (HbA(1c)) constituted the criterion variable.

Results: Structural equation modeling analyses confirmed our hypotheses: financial distress, community disadvantage, and educational attainment demonstrated significant indirect effects on HbA(1c) via their influence on depressive symptoms.

Conclusions: The findings underscore the importance of targeting mental health in interventions to support glycemic control as well as tailoring interventions for individuals in difficult socioeconomic circumstances.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Black or African American / psychology*
  • Cross-Sectional Studies
  • Depressive Disorder / blood
  • Depressive Disorder / ethnology*
  • Depressive Disorder / psychology*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / ethnology*
  • Diabetes Mellitus, Type 2 / psychology*
  • Educational Status
  • Female
  • Georgia
  • Glycated Hemoglobin / analysis*
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Models, Psychological
  • Poverty / ethnology*
  • Poverty / psychology*
  • Psychosocial Deprivation
  • Risk Factors
  • Rural Population*
  • Statistics as Topic
  • Vulnerable Populations / ethnology*
  • Vulnerable Populations / psychology*


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human