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 ...

Rapid and far-reaching technological advances are revolutionizing the ways in which people relate, communicate, and live their daily lives. Technologies that were hardly used a few years ago, such as the Internet, e-mail, and video teleconferencing, are becoming familiar methods for modern communication. Telecommunications will continue to evolve quickly, spawning telehealth applications for research and the provision of clinical care in communities, university settings, clinics, and medical facilities. The impact on psychology will be significant. This article examines the application of developing technologies as they relate to psychology and discusses implications for professional research and practice.

OBJECTIVE -This study evaluated the Diabetes Outpatient Intensive Treatment (DOIT) program, a multiday group education and skills training experience combined with daily medical management, followed by case management over 6 months. Using a randomized control design, the study explored how DOIT affected glycemic control and self-care behaviors over a short term. The impact of two additional factors on clinical outcomes were also examined (frequency of case management contacts and whether or not insulin was started during the program).RESEARCH DESIGN AND METHODS -Patients with type 1 and type 2 diabetes in poor glycemic control (A1c Ͼ8.5%) were randomly assigned to DOIT or a second condition, entitled EDUPOST, which was standard diabetes care with the addition of quarterly educational mailings. A total of 167 patients (78 EDUPOST, 89 DOIT) completed all baseline measures, including A1c and a questionnaire assessing diabetes-related self-care behaviors. At 6 months, 117 patients (52 EDUPOST, 65 DOIT) returned to complete a follow-up A1c and the identical self-care questionnaire.RESULTS -At follow-up, DOIT evidenced a significantly greater drop in A1c than EDUPOST. DOIT patients also reported significantly more frequent blood glucose monitoring and greater attention to carbohydrate and fat contents (ACFC) of food compared with EDUPOST patients. An increase in ACFC over the 6-month period was associated with improved glycemic control among DOIT patients. Also, the frequency of nurse case manager follow-up contacts was positively linked to better A1c outcomes. The addition of insulin did not appear to be a significant contributor to glycemic change.CONCLUSIONS -DOIT appears to be effective in promoting better diabetes care and positively influencing glycemia and diabetes-related self-care behaviors. However, it demands significant time, commitment, and careful coordination with many health care professionals. The role of the nurse case manager in providing ongoing follow-up contact seems important. Diabetes Care 26:3048 -3053, 2003D ay-to-day clinical care in diabetes is driven by the understanding that long-term complications can be delayed and/or prevented by improving metabolic control early in the disease course (1-6). Appropriate medical management is a critical intervention for success but may not be sufficient by itself over the long term. Due to the nature of diabetes, ongoing self-care is also essential, and so efforts must be made to help the patient become knowledgeable about his or her disease, skilled in selfmanagement, and enthused about pursuing effective self-care. Structured diabetes self-management training has been shown to be of value in each of these areas (7), but it is typically separated in time and place from medical management. This can be problematic, especially when different or even contradictory recommendations about diabetes and diabetes care are presented by the various health care providers.As a first step toward addressing this issue, clinicians at the Joslin Diabetes Center develope...

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The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed.