Deconstructing distress: the contribution of cognitive patterns to elevated distress among people with type 2 diabetes

Abstract

Background: While the prevalence of diabetes-related distress is now well recognised, less is known about how best we might intervene to reduce distress. Effective clinical interventions require a good understanding of the factors responsible for creating elevated distress about diabetes. At present there is a dearth of scientific information in this area. Aims: The aim of the present study was to identify cognitive patterns that may contribute to elevated distress among people with type 2 diabetes. It was predicted that cognitive illness perceptions would explain variance in diabetes-related distress. Participants: Research participants were randomly selected from a medical database held in Wellington, New Zealand. Method: Data was collected via mailed questionnaire survey (n=113). Results: It was hypothesised that cognitive illness perceptions would account for a significant proportion of the variance in diabetes-related distress. Results supported this hypothesis. Cognitive variables were found to explain approximately 34% of the variability in diabetes distress (p<0.001), when controlling for age. Conclusions: Research findings highlight two cognitive variables that may play an important role in diabetes distress: (1) a perception that diabetes symptoms fluctuate in cycles, and (2) an expectation that diabetes will have serious life consequences. These findings identify particular cognitive patterns that could form the basis for intervention targets, and might be useful for clinicians and researchers with an interest in reducing the incidence of diabetes-related distress. Findings also highlight the need for careful discussion of diabetes complications in clinical practice.

Predictors of anxiety and depression among people attending diabetes screening: A prospective cohort study embedded in the ADDITION (Cambridge) randomized control trial

“…This is consistent with the assumption that symptom appraisal is a key determinant of cognitive, emotional, and behavioural outcomes in the CSM of illness self-regulation (Leventhal, Cameron, Leventhal, & Ozakinci, 2005;Leventhal et al, 1984). These results concur with previous research highlighting the relationship between self-reported symptoms and diabetesrelated distress (Lange & Piette, 2006;Paddison et al, 2007;Paschalides et al, 2004), and are supported by a systematic review suggesting symptom experiences influence emotional responses to the diagnosis of diabetes (Thoolen et al, 2008).…”

“…The widely used common sense model (CSM) of illness self‐regulation (Leventhal, Diefenbach, & Leventhal, 1992; Leventhal, Nerenz, & Steele, 1984) identifies key illness‐related beliefs that are predicted to influence psychological health outcomes. For example, studies of people with established diabetes have shown that greater perceived consequences and higher self‐reported symptoms are associated with anxiety, depression (Paschalides et al , 2004), and diabetes‐related distress (Paddison, Alpass, & Stephens, 2007).…”

Diabetes distress and related factors in South African adults with type 2 diabetes

“…18,19 Younger age was linked to higher distress, which is consistent with other studies. 12,19,20 An unexpected diagnosis of diabetes at an early age and the lack of coping mechanisms in dealing with a debilitating chronic condition contribute to high distress levels. 20 Additional stressors are financial, family and work related.…”

“…12,19,20 An unexpected diagnosis of diabetes at an early age and the lack of coping mechanisms in dealing with a debilitating chronic condition contribute to high distress levels. 20 Additional stressors are financial, family and work related. 19 Health care providers should therefore take cognisance of the younger patient's needs for support in terms of accepting and coping with the emotional distress accompanying the disease.…”

Illness perception clusters and relationship quality are associated with diabetes distress in adults with Type 2 diabetes

“…Among individuals with Type 2 diabetes, illness perceptions (beliefs) contribute as much as 34% to the variance in diabetes distress (Paddison & Alpass 2007). More specifically illness perceptions relating to diabetes consequences are associated with poorer emotional wellbeing (Hudson, Bundy, Coventry & Dickens 2014), and personal control mediates the relationship between diabetes distress and HbA1c (Gonzalez, Shreck, Psaros & Safren 2015).…”