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

Moderating effect for illness uncertainty on the relationship of depressive and anxiety symptoms among patients with type 1 diabetes in Taif region, Saudi Arabia

Background

Illness uncertainty was found to be associated with the development of depressive and anxiety symptoms among patients with type 1 diabetes and chronic illness in general. However, the moderating effect of illness uncertainty was not examined in sufficient depth. The current study evaluates how the path from diabetes distress to depression and anxiety is mediated by illness uncertainty, ambiguity, symptoms and course predictability, and illness complexity.

Method

Descriptive cross-sectional survey of a large-scale sample of patients living with type one diabetes in Saudi Arabia. We utilized structural equation modelling mediation analysis to examine the effect of illness uncertainty and its subcategories (illness-related ambiguity, symptoms and course predictability, and illness complexity) on depressive and anxiety symptoms.

Results

The current survey analyzed data pertaining to (n = 536) type one diabetes patients. Mean Mishel Uncertainty of Illness Scale score was 80.8 points (Cronbach's α = 0.91) signifying moderate uncertainty among our patients. Diabetes-related uncertainty was associated with marriage (t = 3.337, P = 0.0009937), diabetes complications (t = 5.257, P < 0.00001), pain (r = 0.2247, P < 0.00001), and children count (correlation coefficient r = 0.195, P < 0.00001). The prevalence of depression was (n = 367, 68.5%) and for anxiety was (n = 173, 30.3%). Illness uncertainty correlated with depressive (r = 0.2484, P < 0.00001) and anxiety (r = 0.2548, P < 0.00001) symptoms' scores. Illness uncertainty exerted a partial moderating effect on both anxiety (β = 0.060, P < 0.001) and depressive symptoms (β =0.056, P < 0.001). We observed a partial moderating effect for diabetes-related ambiguity and diabetes-related symptom unpredictability in terms of depressive and anxiety symptoms. However, for diabetes-related course unpredictability, the moderating effect was significant only for anxiety. Diabetes-related complexity did not exert a significant moderating effect on either depressive or anxiety symptoms.

Discussion

We confirmed high levels of depression and anxiety among patients with type one diabetes in Saudi Arabia. Our findings suggest that illness uncertainty affects both diabetes-related distress and depression constructs and is likely to be affected by them.

Putting person-centred psychosocial diabetes care into practice: two psychosocial care pathways based on outcome preferences of people with diabetes and healthcare professionals

BACKGROUND

Diabetes increases the risk of psychosocial health problems. Person-centred psychosocial care is therefore advocated. However, several barriers to implementation exist, including uncertainty about how to approach psychosocial problems in consultations.

OBJECTIVE

We aimed to explore which psychosocial outcomes patients and healthcare professionals consider important and whether certain characteristics are associated with this. We propose strategies for facilitating psychosocial diabetes care on this basis.

METHODS

The results of an international Delphi study aimed at achieving multi-stakeholder consensus on a diabetes outcome set were analysed. We compared the importance ratings of the two stakeholder groups for each psychosocial outcome. A multivariable linear regression analysis tested whether certain characteristics would predict the importance attributed to outcomes that were not generally considered important.

FINDINGS

Patients and healthcare professionals agreed on the importance of regularly assessing psychological well-being, diabetes distress and diabetes-specific quality of life, while they regarded it as less important to monitor depression, anxiety, eating problems, social support and sexual health. Being a woman, younger and living with type 1 diabetes were associated with considering it important to assess eating problems.

CONCLUSIONS

We propose two psychosocial care pathways that reflect the outcome preferences of patients and healthcare providers. They follow a stepped approach, starting with the assessment of psychological well-being and quality of life and proceeding from there.

CLINICAL IMPLICATIONS

Adopting this approach can facilitate the implementation of person-centred psychosocial diabetes care by reducing the burden and making psychosocial issues more accessible. This approach should be tested for feasibility, safety and effectiveness.

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.