Marital Biography, Mental Health, and Diabetes

Diabetes and depression are both highly prevalent within the U.S. and it is worrisome that these two conditions are related. Several meta-analyses and studies using qualitative, clinical, and nationally representative cross-sectional quantitative data have shown that depression is associated with an increased risk of developing diabetes (Ducat et al. 2014; Lloyd, Hermanns, Nouwen, Pouwer, Underwood, and Winkley 2010; Katon et al. 2010; Mezuk et al. 2008) and/or those who are diabetic have a moderately increased risk of developing depression (Katon at al. 2010; Moulton, Pickup, and Ismail 2015). Controversy exists as to which way the association may be stronger and whether these conditions are causally related. Additionally, although research into the biological links between these diseases exists, little work has been done that examines the social conditions that link diabetes and poor mental health throughout the life course. Using the National Social Life, Health, and Aging Project (NSHAP), this dissertation examines the biopsychosocial connection between marital biography, mental health, and diabetes with an emphasis on gender differences. I examine 1) how mental health and diabetes are associated cross-sectionally and longitudinally; 2) how marital biography impacts the relationships between mental health and diabetes; and 3) how social mechanisms influence the previously established relationships between marital biography, mental health, and diabetes. Each relationship is examined for the women and men separately and compared to the overall sample. Results add to existing literature by demonstrating that diabetes and depressive symptomology are associated cross-sectionally when each health condition is examined as the dependent variable. Longitudinally, those who are diabetic report higher depressive symptoms over time than non-diabetics. Results vary in magnitude and significance based on gender. For women, those who were diabetic at baseline report higher depressive symptoms over time than non-diabetic women. Results also contribute to the field by showing that marital biography impacts the cross-sectional relationships between diabetes and depressive symptomology. Finally, results also demonstrate that social disconnectedness, social isolation, and perceived social stress mediate the association between diabetes and depressive symptoms. The findings highlight the complexity within diabetes-mental health relationship and demonstrate the importance of understanding the biopsychosocial connection throughout the life course between marital biography, mental health, and diabetes.