The Mediating Role of Sedentary Behaviour in the Relationship Between Social Support and Depression Among Individuals with Diabetes

Adekola Babatunde Ademoyegun, Olubukola Esther Afolabi, Ishanosen Abidemi Aghedo, Omotola Ibitayo Adelowokan, Chidozie Emmanuel Mbada, Taofeek Oluwole Awotidebe


Background and objective: The underlying mechanisms for the well-established link between social support and depression remain less understood. This study examined the mediating role of sedentary behaviour (SB) in the relationship between social support (SS) and depression among individuals with diabetes.

Methods: A total of 250 consenting individuals with diabetes attending endocrinology clinic in a Nigerian tertiary hospital were recruited. The International Physical Activity Questionnaire Short Form, Multidimensional Scale of Perceived Social Support, and Center for Epidemiologic Studies Depression Scale were used to collect data on SB, SS and depression respectively. Mediation analysis was performed with hierarchical multiple regression and PROCESS Macro for SPSS. Alpha level was set at p < 0.05.

Results: The prevalence of depression among diabetic patients was 30.8%. Social support had a significant negative association with depression and SB, while SB was positively associated with depression (P < 0.001). The results showed that SB was a mediator between social support and depression (a*b = -0.151; BCa 95% CI: -0.207 ~ -0.102).

Conclusion: The prevalence of depression was high among Nigerian diabetic patients. In addition, SB has a mediating role in the relationship between social support and depression indicating that SB could reinforce the positive effect of social support on depression.


Mediation; Diabetes; Depression; Sedentary behaviour.

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Aaron Kandola, Gemma Lewis, David P J Osborn, Brendon Stubbs, Joseph F Hayes (2020). Depressive symptoms and objectively measured physical activity and sedentary behaviour throughout adolescence: a prospective cohort study. Lancet Psychiatry, 7: 262–71.

Ainsworth BE, Macera CA, Jones DA, Reis JP, Addy CL, Bowles HR, Harold WK (2006). Comparison of the 2001 BRFSS and the IPAQ Physical Activity Questionnaires. Med Sci Sports Exerc. 38(9): 1584–1592.

Alosaimi, F.D., Labani, R., Almasoud, N., Alhelali, N., Althawadi, L., AlJahani, D.M., (2019). Associations of foot ulceration with quality of life and psychosocial determinants among patients with diabetes; a case-control study. J. Foot Ankle Res. 12 (1), 57.

Anderson, R. J., Grigsby, A. B., Freedland, K. E., De Groot, M., McGill, J. B., Clouse, R. E., &Lustman, P. J. (2002). Anxiety and poor glycemic control: a meta-analytic review of the literature. The International Journal of Psychiatry in Medicine, 32(3), 235-247.

Andrew E Springer, Steven H Kelder and Deanna M Hoelscher (2006). Social support, physical activity and sedentary behavior among 6th-grade girls: a cross-sectional study. Inter J BehavNutr Phys Act, 3:8.

Baek, R. N., Tanenbaum, M. L., and Gonzalez, J. S. (2014). Diabetes burden and diabetes distress: the buffering effect of social support. Ann. Behav. Med. 48, 145–155.

Bailey DP, Locke CD (2015). Breaking up prolonged sitting with light intensity walking improves postprandial glycemia, but breaking up sitting with standing does not. J. Sci. Med. Sport. 18:294–8.

Bélair M-A, Kohen DE, Kingsbury M, Colman I (2018). Relationship between leisure time physical activity, sedentary behaviour and symptoms of depression and anxiety: evidence from a population based sample of Canadian adolescents. BMJ Open 8(10):e021119.

Barone, M., Savarese, L., & Freda, M. F. (2019). Living with a chronic disease: the role of maternal mediation in the meaning-making process of their children’s Type 1 Diabetes. Mediterranean Journal of Clinical Psychology, 7(3).

Biddle SJ, Asare M (2011). Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med, 45(11):886–95.

Brendon Stubbs, Davy Vancampfort, Joseph Firth, Felipe B. Schuch, Mats Hallgren, Lee Smith, Benjamin Gardner, Kai. G. Kahl, Nicola Veronese, Marco Solmi, André F. Carvalho and Ai Koyanagi (2018). Relationship between sedentary behavior and depression: a mediation analysis of influential factors across the lifespan among 42,469 people in low- and middle-income countries, J Affect Disord. 15(229):231-238.

Cabanas-Sanchez V, Garcia-Cervantes L, Esteban-Gonzalo L, Girela-Rejon MJ, Castro-Pinero J, Veiga OL (2020). Social correlates of sedentary behavior in young people: The UP&DOWN study. J Sport Health Sci. 9(2):189-196.

Chiang, C. C., Chiou, S. T., Liao, Y. M., &Liou, Y. M. (2019). The perceived neighborhood environment is associated with health-enhancing physical activity among adults: a cross-sectional survey of 13 townships in Taiwan. BMC Public Health, 19, 524.

Cohen, S. (2004). Social relationships and health. Am Psychol. 59(8): 676–684.

Chris Garrett and Anne Doherty (2014). Diabetes and mental health. Clinical Medicine, 14(6): 669–72.

Dahlem N, Zimet G, Walker R (1991). The multidimensional scale of perceived social support: a confirmation study. J Clin Psychol. 47(6):756-61.;2-L

Dambi, J.M., Corten, L., Chiwaridzo, M. Helen J., Tecla M. & Jennifer J (2018). A systematic review of the psychometric properties of the cross-cultural translations and adaptations of the multidimensional scale of perceived social support (MSPSS). Health Qual Life Outcomes, 16:80.

David W. Dunstan and Neville Owen (2021). Less Sitting for Preventing Type 2 Diabetes. Diabetes Care, 44:2194–2196.

Egede L, Zheng D and Simpson K (2002). Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care 25(3):464–470.

Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, Bauman A, Lee IM (2016). For the lancet physical activity series 2 executive committee and the lancet sedentary behaviour working group. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 388(10051):1302–10.

Fisher L, Gonzalez JS, Polonsky WH (2014). The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med. 31(7):764–772.

Fisher L, Hessler DM, Polonsky WH, Mullan J (2012). When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale. Diabetes Care. 35(2):259–264.

Fisher L, Skaff MM, Mullan JT, Arean P, Glasgow R, Masharani U (2008). A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes. Diabet Med. 25(9):1096–1101.

Forouhi, N. G., & Wareham, N. J. (2019). Epidemiology of diabetes. Medicine, 47(1), 22-27.

George Ekem-Ferguson, John Tetteh, Emilia A Udofia, Alfred Doku, Swithin M Swaray, Sheriff Mohammed, Alfred E Yawson (2020). Impact of perceived social support on depression among Type 2 diabetic patients. HSI Journal,1(2): 93-104.

Glonti K, Mackenbach JD, Ng J, Lakerveld J, Oppert JM, BárdosH, Mckee M, Rutter H (2016). Psychosocial environment: definitions, measures and associations with weight status – a systematic review. Obes Rev. 17 Suppl 1: 81–95.

Gonzalez, J.S., Peyrot, M., McCarl, L.A., Collins, E.M., Serpa, L., Mimiaga, M.J., Safren, S.A., (2008). Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 31 (12): 2398–2403.

Hannan J, Alce M, Astros A (2016). Psychometric properties of the newly translated creole multidimensional scale of perceived social support (MSPSS) and perceived adequacy of resource scale (PARS) and the relationship between perceived social support and resources in Haitan mothers in the US. BMC Psychol. 4:7.

Harding JL, Pavkov ME, Magliano DJ, Shaw JE, Gregg EW (2019). Global trends in diabetes complications: A review of current evidence. Diabetologia, 62: 3-16.

HenokMulugeta Teshome, Getenet Dessie Ayalew, Fasil Wagnew Shiferaw, CheruTesemaLeshargie , and Dube JaraBoneya (2018). The Prevalence of Depression among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis. Depression Research and Treatment Volume 2018, Article ID 6135460, 8 pages.

Henson J, Yates T, Biddle SJ, Edwardson CL, Khunti K, Wilmot EG, Gray LJ, Gorely T, Nimmo MA, Davies MJ (2013). Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health. Diabetologia. 56(5): 1012–1020.

Hidde P. van der Ploeg and Melvyn Hillsdon (2017). Is sedentary behaviour just physical inactivity by another name? Int J Behav Nutr and Phys Act, 14:142.

HT Ilori, AT Salawu and OI Fawole (2021). Depression and anxiety among patients with type 2 diabetes mellitus in Ibadan, Oyo State. Afr. J. Med. Med. Sci. 50:189-197.

Hyunju Park, Tam Nguyen, Hyunjeong Park (2012). Validation of multidimensional scale of perceived social support in middle-aged Korean women with diabetes. Asia Pacific Journal of Social Work and Development. 22(3):202-213.

International Physical Activity Questionnaire. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ)–Short Form. Version 2.0. 2004.


Jananezwary Kanapathy and Vanessa Bogle (2019). The effectiveness of cognitive behavioural therapy for depressed patients with diabetes: A systematic review. J Health Psychol. 00(0):1–13. 10.1177/1359105317713360.

Janssen, I., Katzmarzky, P. T. & Ross, R (2002). Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch. Intern. Med. 162(18): 2074-9.

Jody C. Hoenink, Jeroen Lakerveld, Harry Rutter, SofieCompernolle, Ilse De Bourdeaudhuij, Helga Bárdos, Helene Charreire, Jean Michel Oppert, Joreintje D. Mackenbach (2019). The Moderating Role of Social Neighbourhood Factors in the Association between Features of the Physical Neighbourhood Environment and Weight Status. Obes Facts. 12(1):14–24.

Joseph Henson, David W. Dunstan, Melanie J. Davies, Thomas Yates (2016). Sedentary behaviour as a new behavioural target in the prevention and treatment of type 2 diabetes. Diabetes Metab Res Rev 2016; 32(Suppl. 1): 213–220.

Kalra S, Jena BN, Yeravdekar R (2018). Emotional and psychological needs of people with diabetes. Indian J EndocrMetab. 22:696-704.

Kasiulevicius V, Sapoka V, Filipaviciute R (2006). Sample size calculation in epidemiological studies. Gerontologija,7(4): 225-231.

Katon WJ, Russo JE, Heckbert SR, Lin EHB, Ciechanowski P, Ludman E, Young B, Von Korff M (2010). The relationship between changes in depression symptoms and changes in health risk behaviors in patients with diabetes. Int J Geriatr Psychiatry. 25(5):466–475.

Kraut R, Patterson M, Lundmark V, Kiesler S, Mukopadhyay T, Scherlis W (1998). Internet paradox. A social technology that reduces social involvement and psychological well-being? Am Psychol. 53(9):1017–31.

Lakey B, Orehek E (2011). Relational regulation theory: a new approach to explain the link between perceived social support and mental health. Psychol Rev. 118(3): 482–495.

Lina Darwish, Erika Beroncal, Ma Veronica Sison, Walter Swardfager (2018). Depression in people with type 2 diabetes: current perspectives. DiabetesMetabSyndr, Obes.11: 333–343.

Maddalena De Maria, Ercole Vellone, Angela Durante, Valentina Biagioli, Maria Matarese (2018). Psychometrics evaluation of the multidimensional scale of perceived social support (MSPSS) in people with chronic disease. Ann 1st Super Sanita 54(4):308-315. 10.4415/ANN_18_04_07.

Marchini, F., Caputo, A., Napoli, A., Balonan, J. T., Martino, G., Nannini, V., & Langher, V. (2018). Chronic illness as loss of good self: underlying mechanisms affecting diabetes adaptation. Mediterranean Journal of Clinical Psychology, 6(3).

Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, Pate RR, Troiana RP (2008). Amount of time spent in sedentary behaviors in the United States, 2003- 2004. Am J Epidemiol. 167(7): 875–881.

Mohammad Khaledi, FahimehHaghighatdoost, AwatFeizi, Ashraf Aminorroaya (2019). The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol. 56 (6): 631–650.

Morres, I. D.,Touloudi, E., Hatzigeorgiadis, A., Jamurtas, A. Z., Androutsos, O., & Theodorakis, Y (2021). Daily Life Physical Activity, Quality of Life and Symptoms of Depression and Anxiety in Adult Patients with Type 2 Diabetes: A Preliminary Study. Psychology, 12:1277-1286.

Moroianu, L. A., Motofei, I. G., Cecilia, C., Barbu, R. E. & Toma, A. (2020). The impact of anxiety and depression on the pediatric patients with diabetes. Mediterranean Journal of Clinical Psychology, 8(2).

Natalie Nanayakkara, Anthony Pease, SanjeevaRanasinha, Natalie Wischer, SofianosAndrikopoulos, Jane Speight5, Barbora de Courten& Sophia Zoungas (2018). Depression and diabetes distress in adults with type 2 diabetes: results from the Australian National Diabetes Audit (ANDA) 2016. SCIenTIfICREPOrts. 8:7846.

Ogbera AO, Ekpebegh C (2014). Diabetes mellitus in Nigeria: The past, present and future. World J Diabetes, 5(6):905-911.

Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C (2004). Combined pharmacotherapy and psychological treatment for depression. Arch Gen Psychiatry 61(7):714-9.

Papelbaum M, Moreira RO, Coutinho W, Kupfer R, Zagury L, Freitas S, Appolinairo JC (2011). Depression, glycemic control and type 2 diabetes. DiabetolMetabSyndr. 3(1):26.

Pascoe MC, Thompson DR, Castle DJ, Jenkins ZM and Ski CF (2017). Psychosocial Interventions and Wellbeing in Individuals with Diabetes Mellitus: A Systematic Review and Meta-Analysis. Front. Psychol. 8:2063.

Paul D. Loprinzi, and Elizabeth A. Crush (2017). Source and Size of Social Support Network on Sedentary Behavior Among Older Adults. Am J Health Promot. 32(1):28-31.

Preacher KJ, Hayes AF (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 40:879–91.

Preacher, K.J.; Hayes, A.F (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav. Res. Methods Instrum. Comput. 36, 717–731.

S. Solomon (2017). “Depression: Let’s talk,” J Curr Res Sci Med, 3:1-2.

Sacco, W. P., and Beck, A. T. (1995). Cognitive theory and therapy. In Edward Beckham, E., and Leber William, R. (Eds.), Handbook of Depression: Treatment, Assessment and Research (2nd. ed.), Guilford Press, New York, pp. 329–351.

Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, Colagiuri S, Guariguata L, Motala A A, Ogurtsova K, Shaw J E, Bright D, Williams R (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 157:107843.

Sawka KJ, McCormack GR, Nettel-Aguirre A, Hawe P, Doyle-Baker PK (2013). Friendship networks and physical activity and sedentary behavior among youth: a systematized review. Int J BehavNutr Phys Act 10:130.

Scholes S, Bridges S, Ng Fat L, Mindell JS (2016). Comparison of the Physical Activity and Sedentary Behaviour Assessment Questionnaire and the Short-Form International Physical Activity Questionnaire: An Analysis of Health Survey for England Data. PLoS ONE 11(3): e0151647.

Settineri, S., Frisone, F., Merlo, E. M., Geraci, D., & Martino, G. (2019). Compliance, adherence, concordance, empowerment, and self-management: five words to manifest a relational maladjustment in diabetes. Journal of multidisciplinary healthcare, 12, 299.

Shuyun Chen, Amaia Calderón-Larrañaga, Marguerita Saadeh, Ing-Mari Dohrn, and Anna-Karin Welmer (2021). Correlations of Subjective and Social Well-Being With Sedentary Behavior and Physical Activity in Older Adults—A Population-Based Study. J Gerontol A Biol Sci Med Sci, 76(10):1789–1795.

Southwick, S. M., Vythilingam, M., Charney, D. S. (2005). The psychobiology of depression and resilience to stress: Implications for prevention and treatment. Annu. Rev. Clin. Psychol. 1: 255–291.

Sport & Recreation New Zealand (SPARC) (2004). The New Zealand Physical Activity Questionnaires. Report on the validation and use of the NZPAQ-LF and NZPAQ-SF self-report physical activity survey instruments. Sport & Recreation New Zealand (SPARC).

Strom, J. L., and Egede, L. E. (2012). The impact of social support on outcomes in adult patients with type 2 diabetes: a systematic review. Curr. Diab. Rep. 12: 769–781.

T. Tiki (2017). Prevalence and Associated Factors of Depression among Type 2 DiabetesMellitus Patients on Follow up at Ambo General Hospital, Oromia Regional State, Ethiopia, Institutional Based Cross Sectional Study, J Psychiatry Depress Anxiety 3: 007.

Teychenne M, Ball K, Salmon J (2010). Sedentary behavior and depression among adults: a review. Int J Behav Med. 17(4):246–54.

Thivel D, Tremblay A, Genin PM, Panahi S, Rivière D and Duclos M (2018). Physical Activity, Inactivity, and Sedentary Behaviors: Definitions and Implications in Occupational Health. Front. Public Health 6:288.

van Dijk SEM, Adriaanse MC, van der Zwaan L, Bosmans JE, van Marwijk H, van Tulder MW, Terwee CB (2018). Measurement properties of depression questionnaires in patients with diabetes: a systematic review. Qual Life Res. 27(6):1415–1430.

van Dooren, F.E., Nefs, G., Schram, M.T., Verhey, F.R., Denollet, J., Pouwer, F., (2013). Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PloS One 8 (3), e57058.

van Poppel MNM, Chinapaw MNJ, Mokkink LB, van MechelenW, Terwee CB (2010). Physical activity questionnaires for adults: A systematic review of measurement properties. Sports Med. 40(7):565-600.

Wasserman LI, Trifonova EA (2006). Diabetes mellitus as a model of psychosomatic and somatopsychic interrelationships. Span J Psychol. 9(1): 75–85.

William P. Sacco and Tovah Yanover (2006). Diabetes and Depression: The Role of Social Support and Medical Symptoms. J Behav Med. 29(6):523-31.

World Health Organisation. Global recommendations on physical activity for health. Geneva: World Health Organisation; 2010.

World Health Organization (WHO). Physical ac­tivity [Internet]. 2020. Avail­able from:

Yuchai Huang, Liqing Li, Yong Gan, Chao Wang, Heng Jiang, Shiyi Cao and Zuxun Lu (2020). Sedentary behaviors and risk of depression: a meta-analysis of prospective studies. Transl Psychiatry 10:26.

Zhai L, Zhang Y, Zhang D (2015). Sedentary behaviour and the risk of depression: a meta-analysis. Br J Sports Med. 49(11):705-9.

Zhang Y, Ting RZW, Lam MHB, Lam S-P, Yeung RO, Nan H, Ozaki R, Luk A, Kong A, Wing Y, Sartorious N, Chan J (2015). Measuring depression with CES-D in Chinese Patients with type 2 diabetes: the validity and its comparison to PHQ-9. BMC Psychiatry 15:198.

Zimet GD, Dahlem NW, Zimet SG, Farley GK (1988). The multidimensional scale of perceived social support. J Pers Assess. 52:30-41.



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