Is It Distress, Depression, or Both? Exploring Differences in the Diabetes Distress Scale and the Patient Health Questionnaire in a Diabetes Specialty Clinic

Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes

Background

People living with diabetes often encounter psychosocial challenges, including diabetes distress and depression. Despite this, little research has focused on the co-occurrence of these conditions. This study aimed to explore the prevalence of depressive symptoms and diabetes distress in people with type 1 diabetes in Kuwait and to identify clinical and demographic factors associated with these conditions.

Methods

A total of 832 people with type 1 diabetes (females: 54.1%, mean age: 29 ± 8.5 years), were invited to participate in Dose Adjustment for Normal Eating (DAFNE) course. Diabetes distress was measured using the Problem Areas in Diabetes (PAID) scale and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Depressive symptoms were defined as PHQ-9 scores ≥10. Data on biomedical outcomes, lifestyle factors, and sociodemographic information were collected.

Results

The prevalence rates of diabetes distress and depressive symptoms were 27.8% and 38.3%, respectively. Notably, 19.6% of people experienced both conditions. In the regression analysis, PAID scale and PHQ-9 scores were significantly associated, patients with higher score on depressive symptoms scale were more likely to suffer diabetes distress (B= 2.65, p < 0.001). Female sex (odds ratio [OR]= 2.2, 95% CI= 1.5, 3.2), higher hemoglobin A1c levels (OR= 1.6, 95% CI= 1.0, 2.5), obesity (OR= 1.7, 95% CI= 1.1, 2.8), inactivity (OR= 2.4, 95% CI= 1.6, 3.6), microvascular complications (OR= 2.8, 95% CI= 1.5, 5.4), and lipohypertrophy (OR= 1.7, 95% CI= 1.1, 2.5) were associated with greater odds for the co-occurrence of diabetes distress and depressive symptoms (p< 0.05 for all).

Conclusion

The majority of people with type 1 diabetes in Kuwait experience both diabetes distress and depressive symptoms. The strong correlation between diabetes distress and depressive symptoms suggests mutual predictability. The co-occurrence of both symptoms is associated with many sociodemographic and clinical factors.

Diabetes distress, emotional regulation, HbA1c in people with diabetes and A controlled pilot study of an emotion-focused behavioral therapy intervention in adults with type 2 diabetes

AIM

One potential barrier for people with diabetes to reach glycemic goals is diabetes distress. Accumulating evidence suggests diabetes distress may be linked to individuals' emotion regulation capacities. Thus, we conducted two studies to elucidate a model for how emotion regulation impacts diabetes distress and A_1c levels and determine preliminary effect size estimates for an intervention targeting poor emotion regulation on glycemic control.

METHODS

Study I used structural equation modeling to assess the cross-sectional relationships between these variables in a sample of 216 individuals with Type 1 and Type 2 diabetes. Study II built on findings from Study I that highlighted the role of emotion regulation capacities in diabetes distress and A_1c by conducting a pilot study of an emotion-focused behavioral intervention compared to treatment as usual in a sample of individuals with Type 2 diabetes.

RESULTS

Study I examined two potential explanatory models with one of the models (Model II) showing a more comprehensive view of the data revealing a total effect of poor emotional regulation of 42% of all effects on A_1c levels. Study II tested an emotion-focused behavioral intervention in patients with Type 2 diabetes compared to treatment as usual and found medium sized reductions in A_1c levels and smaller reductions in diabetes distress that correlated with changes in emotion regulation.

CONCLUSIONS

These studies suggest that, in people with diabetes, elevated A_1c levels and diabetes distress are linked with poor emotion regulation. While the effect sizes from Study 2 are preliminary, an emotion-focused behavioral intervention may reduce both A_1c and diabetes distress levels, through improvements in emotion regulation. Overall, these data suggest that targeting difficulties in emotion regulation may hold promise for maximizing improvement in diabetes distress and A_1c in individuals with diabetes.