Diabetes affects 24 million people and is the 7th leading cause of death in the United States. Individuals with diabetes are at the highest risk of developing depression, and symptoms of depression may interfere with adherence to diabetes health maintenance. However, there is a gap in the literature in understanding the psychosocial impact of depression on adherence to diabetes health maintenance. Accordingly, the purpose of this study was to examine the relationship between depression and indicators of adherence among African-American adults with diabetes. Drawing from Hernandez’s theory of integration, this study employed a mixed methods research design including 187 African-Americans living with diabetes. Standardized instruments measured the constructs of integration, depression, and adherence in a cross-sectional survey. Statistical analyses included descriptive, comparisons of means, correlation, and multiple regressions. Findings indicated that integration, gender, and depression were factors that contributed to adherence. To further expand the results, 7 qualitative telephone interviews were conducted. The qualitative analysis identified 6 themes: initial diagnosis, support system, health education/information, family history, spirituality, and personal growth. Conclusions of the study are that there is an inverse relationship between depression and adherence, and a positive linear relationship between years living with diabetes and integration. Recommendations include patient evaluations for depression, provision of culture-specific health education programs, and further research with African Americans with diabetes. Social change implications include informing training of practitioners to better understand the impact of emotion in the integration of a chronic disease into the self-concept of the patient, thus leading to an improved quality of life.