'The chicken and egg thing': cognitive representations and self-management of multimorbidity in people with diabetes and depression

Psychol Health. 2013;28(1):103-19. doi: 10.1080/08870446.2012.716438. Epub 2012 Aug 28.


Objective: Diabetes with depression is common and can lead to poorer outcomes in both conditions. The existing literature has demonstrated that patients' single condition representations inform self-management, but less is known about the composition and impact of multimorbid representations. This study aimed to explore accounts of multimorbidity with a focus on the content of cognitive representations and reported management of diabetes and depression.

Design: Semi-structured qualitative interviews were carried out with 17 people with diabetes and depression. Data were audio-taped, transcribed and analysed using an inductive thematic analysis and elements of grounded theory.

Results: The nature of multimorbid representations varied and some participants, in particular those who prioritised other conditions, described diabetes and depression as unrelated and managed each separately. Others saw interactions between conditions, often in terms of causation, and described how diabetes and depression management could be either integrated or conflicting. Problems taking multiple-medications were frequently described, but participants differed in the confidence with which they described representations of multimorbidity.

Conclusion: People hold multimorbid representations that appear to impact on their preferred self-management. An awareness of patients' understanding of multimorbidity could have implications for the provision of care and intervention design in this population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cognition*
  • Comorbidity
  • Depression / epidemiology
  • Depression / psychology*
  • Depression / therapy*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / psychology*
  • Diabetes Mellitus / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Qualitative Research
  • Self Care / psychology*