Development of a Brief Diabetes Distress Screening Instrument

Abstract

PURPOSE Previous research has documented that diabetes distress, defi ned as patient concerns about disease management, support, emotional burden, and access to care, is an important condition distinct from depression. We wanted to develop a brief diabetes distress screen instrument for use in clinical settings. METHODSWe assessed 496 community-based patients with type 2 diabetes on the previously validated, 17-item Diabetes Distress Scale (DDS17) and 6 biobehavioral measures: glycated hemoglobin (HbA 1c ); non-high-density-lipoprotein (non-HDL) cholesterol; kilocalories, percentage of calories from fat, and number of fruit and vegetable servings consumed per day; and physical activity as measured by the International Physical Activity Questionnaire.RESULTS An average item score of ≥3 (moderate distress) discriminated highfrom low-distressed subgroups. The 4 DDS17 items with the highest correlations with the DDS17 total (r = .56-.61) were selected. Composites, comprised of 2, 3, and 4 of these items (DDS2, DDS3, DDS4), yielded higher correlations (r = .69-.71). The sensitivity and specifi city of the composites were .95 and .85, .93 and .87, and .97 and .86, respectively. The DDS3 had a lower sensitivity and higher percentages of false-negative and false-positive results. All 3 composites significantly discriminated subgroups on HbA 1c , non-HDL cholesterol, and kilocalories consumed per day; none discriminated subgroups on fruit and vegetable servings consumed per day; and only the DDS3 yielded signifi cant results on the International Physical Activity Questionnaire. Because of its psychometric properties and brevity, the DDS2 was selected as a screening instrument.CONCLUSIONS The DDS2 is a 2-item diabetes distress screening instrument asking respondents to rate on a 6-point scale the degree to which the following items caused distress: (1) feeling overwhelmed by the demands of living with diabetes, and (2) feeling that I am often failing with my diabetes regimen. The DDS17 can be administered to those who have positive fi ndings on the DDS2 to defi ne the content of distress and to direct intervention.

Short-form measures of diabetes-related emotional distress: the Problem Areas in Diabetes Scale (PAID)-5 and PAID-1

“…Ten items loaded above 0.50, all of which were from the Diabetesrelated Negative Emotions subscale (items 3,6,7,8,9,10,12,16,19,20). We removed three items rated on average by respondents as less than a 'minor problem' (items 8, 10, 20) and the remaining seven items were subjected to a reliability analysis.…”

“…Recently, a two-item screening version of the Diabetes Distress Scale (DDS) was validated and showed good sensitivity (95%) and specificity (85%) [8]. However, as the PAID remains a more widely used instrument, we aimed to develop a five-item short form for routine clinical and research use and a single-item measure that may be used as a rapid screen for diabetes-related emotional distress.…”

Barriers to Addressing Psychological Problems in Diabetes: Perspectives of Diabetologists on Routine Diabetes Consultations in Denmark

“…Compared with the general population, clinical depression and anxiety occur about twice as often among persons with both type 1 and type 2 diabetes [3][4][5][6], and the risk of eating disorders is also increased [7]. Furthermore, a large number of persons with diabetes suffer from diabetes distress, the semi-chronic stress condition resulting from the strains of living with diabetes [8][9][10].…”

Web-Based Interventions for Depression in Individuals with Diabetes: Review and Discussion (Preprint)

“…A review of web-based interventions for comorbid depression and chronic illness showed that participants valued psychoeducation with illness-specific examples [55]. Furthermore, because of the positive results in face to-face psychotherapy efficacy when there is inclusion of diabetes self-management interventions [18,19], and the close association between diabetes distress and depression [2], we can think that the inclusion of diabetes-specific topics is desirable.…”

“…There is substantial evidence that depression among individuals with diabetes is associated with poorer diabetes outcomes [1] and higher levels of diabetes distress (emotional burdens, stresses and worries associated with diabetes) [2]. When depressed, patients with diabetes show a higher frequency of hypoglycemia, higher levels of glycosylated hemoglobin (HbA1c) and their risk of developing diabetes-related complications increases [3][4][5].…”