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Diabetes distress linked to depression, low self-esteem in type 1 diabetes

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December 22, 2016

Patients with type 1 diabetes who experienced high levels of diabetes distress were more likely to have a high HbA1c level and overall poorer psychological health, a secondary analysis of survey data found.

 “Individuals with type 1 diabetes often report symptoms of depression, anxiety and distress; some individuals with diabetes may have diagnosable comorbid psychiatric conditions,” Margaret A. Powers, PhD, RD, of the International Diabetes Center at Park Nicollet, Minneapolis, and colleagues wrote. “While … higher diabetes distress is related to poorer metabolic outcomes, its relationship to a broader range of psychological health concerns in individuals with type 1 diabetes needs further evaluation.”

Powers and colleagues mailed a packet of seven questionnaires to patients aged 12 years and older who were treated for diabetes at an urban health care system during the past year. The questionnaires included the Diabetes Distress Screening Scale, as well as a series of psychometrically validated instruments that measured depression, perfectionism, life satisfaction, self-esteem, self-efficacy, eating, dietary restraint and weight concerns. The researchers compared each subscore across age groups (< 18 years vs. ≥ 18 years) and groups of diabetes distress level (low, moderate, high).

The study sample consisted of 274 patients with type 1 diabetes (women and girls, 57.7%; white, 90.9%; mean age at diagnosis, 8.9 years; mean HbA1c, 8.5%). One hundred twenty-two (44.5%) respondents reported high diabetes distress, whereas 86 (31.4%) reported moderate distress and 66 (24.1%) reported low or no distress. Powers and colleagues reported no differences in distress levels between age groups, number of years since diagnosis or age at diagnosis. However, those who reported higher levels of distress also had higher HbA1c levels than those with low or no distress. Participants with higher diabetes distress also scored higher for depression, had greater eating scores and were more concerned about body shape or weight in addition to having lower self-esteem than those who reported low or no distress.

Patients younger than 18 years who reported high diabetes distress had lower self-efficacy scores, larger current body shape, less satisfaction with their lives and higher scores for perfectionism in the area of parental criticism than those who reported low or no distress, the researchers wrote.

“A brief diabetes distress questionnaire can help to identify those who need additional screening,” Powers and colleagues wrote. “Furthermore, providing targeted education and support to reduce diabetes-related distress and treatment for psychological concerns is critical for improved overall and diabetes-specific health and psychological well-being.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.