Assessing Psychosocial Distress in Diabetes

Abstract

OBJECTIVE -The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples.RESEARCH DESIGN AND METHODS -In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n ϭ 200), waiting room at a diabetes specialty clinic (n ϭ 179), a diabetes management study program (n ϭ 167), and an ongoing diabetes management program (n ϭ 158).RESULTS -Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r ϭ 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r ϭ 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (␣ Ͼ 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P Ͻ 0.001).CONCLUSIONS -The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice. Diabetes Care 28:626 -631, 2005L iving with diabetes can be tough. In the face of a complex, demanding, and often confusing set of self-care directives, patients may become frustrated, angry, overwhelmed, and/or discouraged. Diabetes-related conflict with loved ones may develop, and relationships with health care providers may become strained. The risk of depression is elevated (1,2). As a result, motivation for self-care may be impaired. To investigate the nature and breadth of such distress, a number of self-report instruments have been developed, including the ATT39 (3), Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R) (4), and Problem Areas in Diabetes scale (PAID) (5). These measures aim to tap the range of emotional responses to diabetes and to serve as screening measures for clinical and research use. The PAID has been the most widely used of the measures and has been recently translated into several other languages (6 -8). PAID scores have ...

The Relationship Between Food Insecurity and Depression, Diabetes Distress and Medication Adherence Among Low-Income Patients with Poorly-Controlled Diabetes

“…Participants whose scores placed them in the Bmoderate diabetes distress^or Bhigh diabetes distressĉ ategories were labeled as having diabetes distress, and those with Bno or low diabetes distress^were labeled as not having diabetes distress. 14,25 Medication adherence was evaluated through a composite score of an eight-question survey, with participants classified as having low adherence or moderate/ high adherence. 26 We assessed diet through two measures: the Summary of Diabetes Self-Care Activities (SDSCA) diet score and the Starting the Conversation tool, which assesses the quantity and frequency of consumption of specific foods such as fruits, vegetables, fast food and sugary beverages.…”

What is diabetes distress and how can we measure it? A narrative review and conceptual model

“…Three full measures and three sub-scales had sufficient face validity to be considered measures of DD:  PAID (Polonsky et al, 1995)  DDS (Polonsky et al, 2005)  Type I Diabetes Distress Scale (T1-DDS) (Fisher, Polonsky, et al, 2014;Fisher et al, 2015)  'Diabetes-specific Well-being' sub-scale of the Well-Being Questionnaire 28 (W-BQ28) (Bradley, 2000;Speight & Bradley, 2002;Speight, Khagram, & Davies, 2012)  'Burdens and Restrictions -Daily Hassles' sub-scale of the Diabetes-specific Quality of Life Scale (DSQoLs-R) (Bott, Muhlhauser, Overmann, & Berger, 1998;Cooke et al, 2013 (Rubin & Peyrot, 2010) captures only worry related to hypo-and hyperglycemia and long-term complications. Some Diabetes Symptom Checklist-Revised (DSC-R) sub-scales (Arbuckle et al, 2009;Grootenhuis, Snoek, Heine, & Bouter, 1994) capture the emotional distress associated with diabetes symptoms.…”

“…Table 3 illustrates the aspects of DD included in each measure. Items were tabulated into categories based on distinct aspects of living with and managing diabetes, initially borne out of consideration of the empirically established DDS sub-scales (Polonsky et al, 2005). Sub-categories were then distinguished using a bottom up approach.…”

“…The TI-DDS, and the W-BQ 28 and DSQoLs-R sub-scales, capture treatment burden-related distress and the DSQoLs-R sub-scale has a narrow focus specifically on this. Indeed, treatment-regimen distress is frequently endorsed as a serious problem by diabetes research participants, especially those using insulin (Delahanty et al, 2007;Fisher, Polonsky, et al, 2014;Tanenbaum et al, 2016), and research has shown that it may have the largest and most uniform effect upon diabetes outcomes relative to other aspects of DD, especially in type 1 diabetes (Polonsky et al, 2005;Strandberg et al, 2014). Developed specifically for people with type 1 diabetes, it is unsurprising that the T1-DDS and the DSQoLs-R sub-scale focus on these aspects of DD.…”

“…Thus, the PAID is widely considered a suitable measure of DD. The more recently developed Diabetes Distress Scale (DDS) (Polonsky et al, 2005) is also gaining traction as a measure of DD in adults. Recent research has suggested that there are important content differences between the PAID and the DDS (Schmitt, Reimer, Kulzer, Haak, Ehrmann, et al, 2015).…”