Distress and Living with Diabetes: Defining Characteristics Through an Online Survey

Journal article

INTRODUCTION: There is considerable evidence for diabetes reducing quality of life. The impact of such a diagnosis on mental health is less well understood and was subsequently explored here. METHODS: Online PHQ-9 scores (which calculate the severity of depression), Diabetes Distress Screening Scale (DDSS) and EQ-5D-5L (quality-of-life) questionnaires were completed by patients with diabetes, followed by the extraction of data where possible from responders’ clinical records. RESULTS: A total of 133 people submitted questionnaires. However, not all data items could be completed by each patient; 35% (45/130) had type I diabetes mellitus (T1DM); 55% (64/117) were women. The overall median age of 117 responders was 60 (IQR 50–68 years). The median aggregated response scores were: EQ-5D-5L 0.74 (IQR 0.64–0.85) (lower quality of life than UK population median of 0.83), DDSS 1.9 (IQR1.3–2.7) (≥ 2 indicates moderate distress) and PHQ-9 5 (IQR2-11) (≥ 5 indicates depression). Higher diabetes distress (DDSS)/lower quality of life EQ-5D-5L/higher depressive symptoms (PHQ-9) linked to female sex (DDSS 0.5/25% above median), younger age ( 35 DDSS 0.6/30% above median). Additionally, a HbA1c reading of ≤ 48 mmol/mol was associated with higher DDSS scores, as did a reduction of more than 5 mmol/mol in HbA1c over the last three HbA1c measurements. The 30 individuals with a history of prescribed antidepressant medication also showed higher diabetes distress scores (DDSS 0.9, equating to 45% above the median). The DDSS score elevation came from an increase in emotional burden and regimen-related distress. DDSS scores were not significantly linked to diabetes type, insulin use, absolute level/change in blood glucose HbA1c. Physician-related distress showed a similar pattern. CONCLUSIONS: A low level of stress in relation to diabetes management may be associated with lower HbA1c. The larger impact of diabetes on mental health in younger women/people with shorter diabetes duration should be noted when considering psychosocial intervention/behavior change messaging. Physician-related distress is a potentially remediable factor. However, this sample was self-selecting, limiting generalization to other samples

Authors: Waheed, U; Heald, AH; Stedman, M; Solomon, E; Rea, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: Diabetes Therapy: Research, treatment and education of diabetes and related disorders
• Volume: 13
• Issue: 9
• Pages: 1585-1597
• Publication date: 2022-07-13
• DOI: 10.1007/s13300-022-01291-3
• EISSN: 1869-6961
• ISSN: 1869-6953
• Language: English
• Keywords: Type 1 diabetes; Endocrinology; Medicine; Clinical psychology; Depressive symptoms; Depression (economics); Quality of life (healthcare); Patient Health Questionnaire; Population; Distress; Diabetes mellitus; Internal medicine