Depression, Distress, and Diabetes
Emerging Evidence and New Directions
September 2012
Volume 3, Issue 3

Association Between Spirituality and Depression in Adults with Type 2 Diabetes

Diabetes Educator. 2012;38(3):427-35

Introduction:  This study was undertaken in order to look at the connection between spirituality and depression in patients with type 2 diabetes.

Separately, these concepts have been studied:  religiousness and spirituality have been shown to improve glycemic control, as well as lower diabetes-related morbidity and mortality.  For patients with depression, it has been demonstrated that spirituality has a therapeutic benefit.

Combining these concepts, the study authors hypothesized that high levels of spirituality in low-income type 2 diabetes patients would be associated with lower depression scores.

Methods:  There were 201 adult participants in the study; they all had diabetes and came from an indigent clinic connected to an academic medical center.  They all completed 2 surveys—the Daily Spiritual Experience Scales (DSES) and the Center for Epidemiologic Studies-Depression scale (CES-D).

The DSES measures perception of the transcendent (God, the divine) in daily life.  It has 6 statements participants respond to:

  1. I feel God’s presence.
  2. I find strength and comfort in my religion.
  3. I feel deep inner peace or harmony.
  4. I desire to be closer to or in union with God.
  5. I feel God’s love for me, directly or through others.
  6. I am spiritually touched by the beauty of creation.

The CES-D measures depression in the general population and involves a self-report scale.  There are 20 items rated on a 4-point scale.

Results:  Females, non-Hispanic blacks, people with less education, and people with lower incomes reported greater spirituality, which was associated with less depression, according to an unadjusted regression model.  The final adjusted model slightly diminished this association, but it was still significant.

Additionally, females and unemployed people had higher depression scores, but they decreased with age and non-Hispanic black race/ethnicity.

Conclusions:  According to this study, faith-based diabetes education may improve self-care diabetes behaviors, as well as glycemic control.  When appropriate, it may be helpful to incorporate the spiritual beliefs of the patient when treating depression.


Spirituality is a dynamic, personal and experiential process that is as important to overall health as the physical, emotional, and social dimensions [12]. Studies have shown that spirituality is associated with improved health outcomes and providers are encouraged to incorporate the patient’s spiritual belief into the clinical encounter and plan for treatment. Spirituality appears to have some benefit in relieving symptoms of depression [18]. However, few studies have evaluated the association between spirituality and depression in individuals with depression. As outlined in the introduction, depression has detrimental effects in people with diabetes. This study evaluated a relationship between spirituality and depression in a low income population with diabetes and found an inverse relationship between spirituality and depression. This suggests that spirituality may serve as a buffer against the detrimental effects of depression. Of course, this study was a cross-sectional in nature and was conducted in the southeastern U.S. where spiritual beliefs are strong and part of daily existence, so the results have to be interpreted with caution. Nevertheless, it introduces the idea that spirituality may ameliorate the detrimental effects of depression in people with diabetes.

Next Article:
A Review of Treating Depression in Diabetes: Emerging Findings
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