Diabetes self‐management during the COVID‐19 pandemic and its associations with COVID‐19 anxiety syndrome, depression and health anxiety

Abstract

Introduction The effects of the COVID‐19 pandemic on mental health have been profound. Mental health and diabetes self‐care are inter‐related. We examined whether COVID‐19 anxiety, depressive symptoms and health anxiety were associated with domains of diabetes self‐management and investigated whether greater COVID‐19 anxiety syndrome would independently contribute to suboptimal diabetes self‐care. Research design and methods Surveys were sent to people attending diabetes clinics of three London hospitals. Participants completed the Diabetes Self‐Management Questionnaire (DSMQ), the COVID‐19 Anxiety Syndrome Scale (C‐19 ASS), which measures perseveration and avoidant maladaptive coping behaviour, assessed with measures of co‐existent depressive symptoms and anxiety, controlling for age, gender and social deprivation. Clinical data, including pre‐ and post‐lockdown HbA 1c measures, were obtained from hospital records for 369 respondents, a response rate of 12.8%. Results Depressive symptom scores were high. Both pre‐existing health anxiety and depressive symptoms were independently linked to improvable measures of diabetes care, as was lower socio‐economic rank. However, avoidant COVID‐19 anxiety responses were independently associated with higher diabetes self‐care scores. HbA 1c levels improved modestly over the year of UK lockdown in this cohort. Conclusion During the height of lockdown, avoidant coping behaviours characteristic of the COVID‐19 anxiety syndrome may in fact work to improve diabetes self‐care, at least in the short term. We recommend screening for depressive symptoms and being aware of the significant minority of people with COVID‐19 anxiety syndrome who may now find it difficult to re‐engage with face‐to‐face clinic opportunities.

Psychometric properties and psychological correlates of the COVID‐19 Anxiety Syndrome Scale: A comprehensive systematic review and meta‐analysis

“…The C‐19ASS total score was positively and significantly associated with attentional bias ( r = 0.13, N = 286; Albery et al, 2021); burnout ( r = 0.42, N = 251; Asl, Boostani, et al, 2021); attachment style (RQ‐fearful attachment, r = 0.201; RQ‐preoccupied attachment, r = 0.14; RQ‐dismissing attachment, r = 0.022; N = 330; Vismara et al, 2022); loneliness ( r = 0.149, N = 330; Vismara et al, 2022); mental health problems ( r = 0.240, N = 330; Vismara et al, 2022); mask effectiveness , a component of mask‐wearing ( B = 0.08, SE = 0.23, p = 0.718, N of Study 1a = 147, Study 1b = 150; Krishna et al, 2021); communication difficulties , a component of mask‐wearing ( B = 0.20, SE = 0.17, p = 0.237, N of Study 1a = 147, Study 1b = 150; Krishna et al, 2021); clinic nonattendance (odds ratio [ OR ] = 1.106, 95% CI [1.047–1.17], p = 0.001); burnout ( r = 0.37, N = 251; Asl, Boostani, et al, 2021); psychological behavioural responses ( r = 0.767, N = 926; Sharif Nia et al, 2022); dietary control (glucose management, r = 0.01; N = 314; Distaso, Malik, et al, 2022); pandemic fatigue ( OR = 1.030, 95% CI [1.010–1.051], p = 0.003); and perceived COVID‐19 threat ( r = 0.48, N = 426; Nikčević & Spada, 2020).…”

“…Also, the C‐19ASS total score was negatively associated with vigilance to threat (vigilance to threat, r = −0.03); slowed disengagement ( r = −0.12, N = 286; Albery et al, 2021); compassion ( r = −0.035, N = 251; Asl, Boostani, et al, 2021); attachment style (RQ‐secure attachment, r = −0.215, N = 330; Vismara et al, 2022); explicit evaluation of (masked) faces ( B = −0.45, SE = 1.97, p = 0.819; N of Study 1a = 147, Study 1b = 150; Krishna et al, 2021); mask‐related worrying , a component of mask‐wearing ( B = −0.04, SE = 0.23, p = 0.854, N of Study 1a = 147, Study 1b = 150; Krishna et al, 2021); aesthetic appeal , a component of mask‐wearing ( B = −0.06, SE = 0.18, p = 0.746, N of Study 1a = 147, Study 1b = 150; Krishna et al, 2021); resilience ( r = −0.110, N = 203; Oducado et al, 2021); organizational change ( b = −0.27, SE = 0.10, N = 112; Larasatie et al, 2022); perception of organizational politics ( B = −0.91, SE = 0.32, N = 112; Larasatie et al, 2022); and the Diabetes Self‐Management Questionnaire (DSMQ global, r = −0.06; physical activity, r = −0.10; physician contact, r = −0.13; N = 314; Distaso, Malik, et al, 2022).…”

“…The C‐19ASS avoidance factor was positively associated with attentional bias‐general (attentional bias‐general, r = 0.09, N = 286; Albery et al, 2021), peritraumatic distress (COVID‐19 Peritraumatic Distress Index [CPDI], r = 0.142, p = 0.018; N = 276; Muthiah et al, 2022), fear of COVID‐19 ( r = 0.503, N of Study 1 = 271, Study 2 = 484; Mansueto et al, 2022), dietary control ( r = 0.03; glucose management , r = 0.05, N = 314; Distaso, Malik, et al, 2022), health anxiety ‘Short Health Anxiety Inventory‐5’ ( r = 0.196, p = 0.001, N of Study 1 = 404, Study 2 = 903; Alhakami et al, 2023) and perceived COVID‐19 threat ( r = 0.47, N = 426; Nikčević & Spada, 2020).…”

“…Also, it was negatively associated with attentional bias (vigilance to threat, r = −0.01; slowed disengagement, r = −0.10; N = 286; Albery et al, 2021), diabetes self‐management (physical activity, r = −0.06; physician contact, r = −0.15; N = 314; Distaso, Malik, et al, 2022) and social adaptation ( r = −0.01, N = 296; Obuća et al, Unpublished).…”

Anxiety, Distress and Stress among Patients with Diabetes during COVID-19 Pandemic: A Systematic Review and Meta-Analysis

“…Regarding the negative results of the pandemic involving mental health, other related factors were the fear of contagion by COVID-19 [82,83] and COVID-19 anxiety syndrome [84]. Studies reported that up to 27.3% of people with DM experienced stress due to the spread of the COVID-19 pandemic and 20% experienced stress due to fear of drug shortages [85].…”