Assessing Psychosocial Distress In Diabetes
Development of the Diabetes Distress Scale 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 = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 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 = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 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 (α > 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 die Continue reading >>
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Development Of A Brief Diabetes Distress Screening Instrument
Go to: Abstract PURPOSE Previous research has documented that diabetes distress, defined 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. METHODS We 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 (HbA1c); 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 high- from 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 specificity 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 HbA1c, non-HDL cholesterol, and kilocalories consumed per day; none discriminated subgroups on fruit and vegetable servings consumed per day; and only the DDS3 yielded significant 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 respo Continue reading >>
Scales And Measures Bdi
The DDS is a 17-item scale that captures four critical dimensions of distress:emotional burden, regimen distress, interpersonal distress and physician distress. First published in2005, ithas been used widely around the world as a clinicalinstrument for opening conversation with ones patients aswell as a critical outcome measures in numerous studies. This copyrighted scale is available free of chargeto non-profit institutions for use in clinical careand research.However, payment of a per use licensing fee is required for all for-profit companies and other for-profitinstitutions. To find out more about licensing procedures and fees in regards to for-profit organizations, pleasecontact us [email protected]. A caution regarding subscale scoring: It has come to our attention that several of the translated versions have changed the order and some content of the DDS items. This may make the order and content of the subscales unreliable. We caution anyone who is using translated versions and who wishes to make use of the subscales to make certain that the order and content of the items match the original English version. Continue reading >>
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Depression And Diabetes Distress In Adults With Type 2 Diabetes: Results From The Australian National Diabetes Audit (anda) 2016
Depression and diabetes distress in adults with type 2 diabetes: results from the Australian National Diabetes Audit (ANDA) 2016 Scientific Reportsvolume8, Articlenumber:7846 (2018) | Download Citation This study explores the prevalence of, and factors associated with, likely depression and diabetes distress in adults with type 2 diabetes in a large, national sample. Australian National Diabetes Audit data were analysed from adults with type 2 diabetes attending 50 diabetes centres. The Brief Case find for Depression and Diabetes Distress Score 17 were administered to screen for likely depression and diabetes-related distress, respectively. A total of 2,552 adults with type 2 diabetes participated: (mean SD) age was 63 13 years, diabetes duration was 12 10 years, and HbA1c was 8 2%. Twenty-nine percent of patients had likely depression, 7% had high diabetes distress, and 5% had both. Difficulty following dietary recommendations, smoking, forgetting medications, and diabetes distress were all associated with greater odds of depression whereas higher own health rating was associated with lower odds (all p < 0.02). Female gender, increasing HbA1c, insulin use, difficulty following dietary recommendations and depression were all associated with greater odds of diabetes distress & older age, higher own health rating and monitoring blood glucose levels as recommended were associated with lower odds (all p < 0.04). Depression was associated with sub-optimal self-care, while diabetes distress was associated with higher HbA1c and sub-optimal self-care. Driven by ageing, obesity and sedentary lifestyles, type 2 diabetes mellitus (T2DM) currently affects just under 400 million individuals worldwide and is expected to rise exponentially, affecting 592 million by 2035 1 . Globally, Continue reading >>
What Is The Best Measure For Assessing Diabetes Distress? A Comparison Of The Problem Areas In Diabetes And Diabetes Distress Scale: Results From Diabetes Miles–australia
This study used Rasch analysis to examine the psychometric validity of the Diabetes Distress Scale and the Problem Areas in Diabetes scale to assess diabetes distress in 3338 adults with diabetes (1609 completed the Problem Areas in Diabetes scale (n = 675 type 1 diabetes; n = 934 type 2 diabetes) and 1705 completed the Diabetes Distress Scale (n = 693 type 1 diabetes; n = 1012 type 2 diabetes)). While criterion and convergent validity were good, Rasch analysis revealed suboptimal precision and targeting, and item misfit. Unresolvable multidimensionality within the Diabetes Distress Scale suggests a total score should be avoided, while suboptimal precision suggests that the Physician-related and Interpersonal distress subscales should be used cautiously. Bech, P (2004) Measuring the dimension of psychological general well-being by the WHO-5. Quality of Life Newsletter 32: 15–16. Google Scholar Bond, TG, Fox, CM (2001) Applying the Rasch Model: Fundamental Measurement in the Human Sciences. London: Lawrence Erlbaum Associates. Google Scholar Boone, W, Staver, J, Yale, M (2014) Rasch Analysis in the Human Sciences. Dordrecht: Springer. Google Scholar, Crossref Borsboom, D (2006) The attack of the psychometricians. Psychometrika 71: 425–440. Google Scholar, Crossref, Medline Cappelleri, JC, Jason Lundy, J, Hays, RD (2014) Overview of classical test theory and item response theory for the quantitative assessment of items in developing patient-reported outcomes measures. Clinical Therapeutics 36: 648–662. Google Scholar, Crossref, Medline Egede, LE, Zheng, D, Simpson, K (2002) Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care 25: 464–470. Google Scholar, Crossref, Medline Fisher, L, Glasgow, Continue reading >>
Translation, Revision, And Validation Of The Diabetes Distress Scale For Indonesian Type 2 Diabetic Outpatients With Various Types Of Complications☆
Abstract To translate, revise, and validate the Diabetes Distress Scale (DDS) instrument for Indonesian type 2 diabetes mellitus (T2DM) outpatients with various complications. Participants were recruited from four hospitals and two primary health care centers. The study was performed with forward and backward translations, an adaptation testing with a small subset of participants, and validation analysis. Factor analysis with maximum likelihood estimation and promax rotation was then used to investigate the instrument structure. Internal consistency among the items was estimated using Cronbach α for each domain of the DDS. In total, 324 participants (246 from the hospitals and 78 from the primary health care centers) were involved in this study. To improve participant comprehension of the exact meaning of questions, examples of daily activities for patients with T2DM (e.g., diet, exercise, and adherence to therapy) were added to some questions after the translation and revision procedures. The factor analysis revealed a correlation among the four factors ranging from 0.40 to 0.67. The factor loadings of selected items from the four factors ranged from 0.41 to 0.98. The order of the four factors in the factor analysis was as follows: interpersonal distress, emotional burden, physician distress, and regimen distress. The internal consistency for the four domains ranged from 0.78 to 0.83. The instrument resulting from this study was labeled “DDS17 Bahasa Indonesia.” The DDS17 Bahasa Indonesia provides an initial psychometric validation study, factor structure, and internal consistency for assessing the distress of Indonesian T2DM outpatients. Use of this instrument in future research and clinical trials is recommended for the Indonesian context. Continue reading >>
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An Useful Toolf For Diabetes Emotional Distress Assessment: Validation Of The Romanian Version Of Diabetes Distress Scale
Background and Aims: The aim of the present study was to validate the Diabetes Distress Scale (DDS) on Romanian diabetes patients. Material and Methods: A total number of 529 type 1 and type 2 diabetes outpatients were included in the study. Exploratory and confirmatory factor analyses were used to assess the construct validity, Cronbach’s Alpha for internal consistency and Pearson’s correlation for predictive properties. Results: Distress level was lower in Romanian diabetes patients when compared to other studies. Model fit for the scale was moderate. The four factor structure of the original scale was maintained, with a good internal consistency for the entire scale (0.824) and for the four subscales: emotional burden (0.775), distress related to the physician (0.798), distress related to diabetes regimen (0.708), and interpersonal distress (0.733). Regarding predictive properties, DDS-Ro was positively correlated to depressive symptoms measured with the Beck Depression Inventory (r = 0.415, p < 0.05) and to diabetes self-care activities measured with the Summary of Diabetes-Self-Care Activities, with the strongest correlation between diabetes regimen distress and physical activities (r = - 0.358, p < 0.01). Conclusions: DDS-Ro has good psychometric properties in Romanian diabetes patients and can be used when diabetes emotional impact is assessed. Continue reading >>
When Is Diabetes Distress Clinically Meaningful?
Abstract OBJECTIVE To identify the pattern of relationships between the 17-item Diabetes Distress Scale (DDS17) and diabetes variables to establish scale cut points for high distress among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Recruited were 506 study 1 and 392 study 2 adults with type 2 diabetes from community medical groups. Multiple regression equations associated the DDS17, a 17-item scale that yields a mean-item score, with HbA1c, diabetes self-efficacy, diet, and physical activity. Associations also were undertaken for the two-item DDS (DDS2) screener. Analyses included control variables, linear, and quadratic (curvilinear) DDS terms. RESULTS Significant quadratic effects occurred between the DDS17 and each diabetes variable, with increases in distress associated with poorer outcomes: study 1 HbA1c (P < 0.02), self-efficacy (P < 0.001), diet (P < 0.001), physical activity (P < 0.04); study 2 HbA1c (P < 0.03), self-efficacy (P < 0.004), diet (P < 0.04), physical activity (P = NS). Substantive curvilinear associations with all four variables in both studies began at unexpectedly low levels of DDS17: the slope increased linearly between scores 1 and 2, was more muted between 2 and 3, and reached a maximum between 3 and 4. This suggested three patient subgroups: little or no distress, <2.0; moderate distress, 2.0–2.9; high distress, ≥3.0. Parallel findings occurred for the DDS2. CONCLUSIONS In two samples of type 2 diabetic patients we found a consistent pattern of curvilinear relationships between the DDS and HbA1c, diabetes self-efficacy, diet, and physical activity. The shape of these relationships suggests cut points for three patient groups: little or no, moderate, and high distress. RESEARCH DESIGN AND METHODS Subjects Baseline samples f Continue reading >>
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Diabetes Distress Scale-17 Implementation Among Patients With Diabetes: Turkish Validity And Reliability Study
June, 2016 >> Goksen Erkin, Haluk Mergen, Tevfik Tanju Yilmazer ( Department of Family Medicine, Izmir Tepecik Training & Research Hospital, Turkey. ) Kurtulus Ongel ( Faculty of Medicine, Department of Family Medicine, Izmir Katip Celebi University, Turkey. ) Berna Erdogmus Mergen ( Department of Family Medicine, Izmir Karabaglar Community Health Center, Izmir, Turkey. ) Read PDF Abstract Objective: To prove reliability and validity of the Turkish version of diabetes distress scale. Methods: The cross-sectional study was conducted at Tepecik Training and Research Hospital, Izmir, Turkey, from July 2011 to February 2012, and comprised diabetics whose ages ranged from 25 to 86 years who voluntarily participated in the study. Descriptive statistics, exploratory and confirmatory factor analyses were used for reliability and validity evaluations. SPSS 21 was used for data analysis. Results: Of the 165 patients, 87(52.7%) were women and 78(47.3%) were men. Overall, 32(19.4%) patients had normal weight, 52(31.5%) were overweight, 74(44.8%) were obese and 7(4.2%) were morbid obese. Mean age was 53.69±11.39 years. Mean score was 50.87±11.53 points (range: 23 to 84). As for distress distribution, 15(9.1%) patients had no problem (0-34 points), 141(85.5%) moderate (35-68 points) and 9(5.5%) had high (>68 points).Fasting blood glucose was higher than 200 mg/dl in 22(13.2%) patients. Conclusion: Turkish diabetes distress scale-17 was found to be valid and reliable and had satisfying fit-index parameters. Keywords: Diabetes, Distress, Validity, Reliability. (JPMA 66: 662; 2016) Introduction Diabetes Mellitus (DM) is a metabolic and endocrinologic disease originating from lack of insulin and/or impairment of effect or both.1 It is a metabolic disorder with chronic progress,2,3 and Continue reading >>
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Diabetes Distress Scale-17 Implementation Among Patients With Diabetes: Turkish Validity And Reliability Study.
Type: Validation Studies, Journal Article To prove reliability and validity of the Turkish version of diabetes distress scale.The cross-sectional study was conducted at Tepecik Training and Research Hospital, Izmir, Turkey, from July 2011 to February 2012, and comprised diabetics whose ages ranged from 25 to 86 years who voluntarily participated in the study. Descriptive statistics, exploratory and confirmatory factor analyses were used for reliability and validity evaluations. SPSS 21 was used for data analysis.Of the 165 patients, 87(52.7%) were women and 78(47.3%) were men. Overall, 32(19.4%) patients had normal weight, 52(31.5%) were overweight, 74(44.8%) were obese and 7(4.2%) were morbid obese. Mean age was 53.6911.39 years. Mean score was 50.8711.53 points (range: 23 to 84). As for distress distribution, 15(9.1%) patients had no problem (0-34 points), 141(85.5%) moderate (35-68 points) and 9(5.5%) had high (>68 points).Fasting blood glucose was higher than 200 mg/dl in 22(13.2%) patients.Turkish diabetes distress scale-17 was found to be valid and reliable and had satisfying fit-index parameters. Continue reading >>
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Translation, Adaptation And Validation Of The Diabetes Distress Scale For Indonesian Diabetic Outpatients With Various Types Of Complications
Translation, Adaptation And Validation Of The Diabetes Distress Scale For Indonesian Diabetic Outpatients With Various Types Of Complications Translation, Adaptation And Validation Of The Diabetes Distress Scale For Indonesian Diabetic Outpatients With Various Types Of Complications Translation, Adaptation And Validation Of The Diabetes Distress Scale For Indonesian Diabetic Outpatients With Various Types Of Complications A900VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 A 9 1 8EQ-5D during 2016. A visual analog scale (VAS) score and health index score were co... VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 A 9 1 8 EQ-5D during 2016. A visual analog scale (VAS) score and health index score were computed, and the difference was measured for P4P and non-P4P participants (selected by propensity score matching). This study uses linear regression models to determine the change in the EQ-5D score, controlling for age, gender, A1C, LDL, body mass index (BMI), duration, comorbidity, and severity. Results: There is an insignificant increase in the EQ-5D index score in the P4P group (0.002 [SE 0.03], P= 0.93), compared with the non-P4P group after controlling for patient factors. The between-group difference in the EQ-5D VAS score is not significant after controlling for patient factors (-1.63 [SE 2.42], P= 0.50). Conclusions: There is no difference in health status and health-related quality of life among patients participating in the newly featured P4P program versus non-participants. PDB30 Estimating the Economic Burden of Hypoglycemia in Patients with Type 1 and Type 2 Diabetes Mellitus in Austria Neubauer S1, Koenig C1, Krahluec E2, Pieber TR3, Schmidt LJ1 1Joanneum Research, Graz, Austria, 2Joanneum Research, Wien, Austria, 3Medical University of Graz, Graz, Austria O Continue reading >>
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Psychometric Properties Of The Thai Version Of The Diabetes Distress Scale In Diabetic Seniors
Kattika Thanakwang, Wantana Thinganjana, Roumporn Konggumnerd Institute of Nursing, Suranaree University of Technology, Nakhon Ratchasima, Thailand Background: The Diabetes Distress Scale (DDS) is an important measure of diabetes-related emotional distress that has been widely used in the Western world. In Thailand, there is a lack of reliable and valid scales for assessing distress levels in diabetes patients, specifically in older adults. Objectives: The main objectives of this study were to adapt the DDS for use in Thai diabetic elderly and to evaluate its psychometric properties. Methods: The 17-item DDS was linguistically adapted using forward–backward translation and administered to 170 diabetic patients ≥60 years selected from diabetes outpatient clinics of four hospitals in Buriram, Thailand. Statistical analyses included exploratory factor analysis, internal consistency, convergent validity, and test–retest reliability. Results: During factor analysis, a three-factor solution was found to be reasonable for the sub-dimensions of emotional and regimen-related burden (ten items), physician- and nurse-related distress (four items), and diabetes-related interpersonal distress (three items). The Cronbach’s alpha coefficient for the total score was 0.95 and varied between 0.85 and 0.96 in the three subscales. The results provided evidence that supports the convergent validity of the Thai version of the DDS as well as its stability. Conclusion: The Thai version of the DDS has acceptable psychometric properties. It enables assessment of diabetes-specific distress in elderly patients and has the advantage of being easy to use in both clinical and research settings. Keywords: diabetes distress scale, psychometric properties, diabetes-related stress, diabetic elder Continue reading >>
The Validity And Reliability Of The English Version Of The Diabetes Distress Scale For Type 2 Diabetes Patients In Malaysia
Abstract Several disease specific instruments have been developed to identify and assess diabetes distress. In Malaysia, the Problem Areas in Diabetes Scale has been validated in Malay, but it does not have specific domains to assess the different areas of diabetes-related distress. Hence, we decided to use the Diabetes Distress Scale instead. To date, only the Malay version of the Diabetes Distress Scale has been validated in Malaysia. However, English is widely spoken by Malaysians, and is an important second language in Malaysia. Therefore, our aim was to determine the validity and reliability of the English version of the Diabetes Distress Scale among patients with type 2 diabetes in Malaysia. The Diabetes Distress Scale was administered to 114 patients with type 2 diabetes, who could understand English, at baseline and 4 weeks later, at a primary care clinic in Malaysia. To assess for convergent validity, the Depression Anxiety Stress Scale was administered at baseline. Discriminative validity was assessed by analysing the total diabetes distress scores of participants with poor (HbA1c > 7.0%) and good glycaemic control (HbA1c ≤ 7.0%). The majority of our participants were male 65(57.0%), with a median duration of diabetes of 9.5 years. Exploratory factor analysis showed that the Diabetes Distress Scale had 4 subscales, as per the original Diabetes Distress Scale. The overall Cronbach’s α was 0.920 (range = 0.784–0.859 for each subscale). The intraclass correlation ranged from 0.436 to 0.643 for test-retest. The Diabetes Distress Scale subscales were significantly correlated with the different subscales of the Depression Anxiety Stress Scale (spearman’s rho range = 0.427–0.509, p < 0.001). Patients with poor glycaemic control had significantly higher dia Continue reading >>
Original Paper - An Useful Toolf For Diabetes Emotional Distress Assessment: Validation Of The Romanian Version Of Diabetes Distress Scale - Abstract
Original paper - AN USEFUL TOOLF FOR DIABETES EMOTIONAL DISTRESS ASSESSMENT: VALIDATION OF THE ROMANIAN VERSION OF DIABETES DISTRESS SCALE - ABSTRACT Authors: Andreia ?tefana Mocan, Adriana B?ban Department of Psychology, Babe?-Bolyai University Cluj, Cluj Napoca, Romania Background and Aims: The aim of the present study was to validate the Diabetes Distress Scale (DDS) on Romanian diabetes patients. Material and Methods: A total number of 529 type 1 and type 2 diabetes outpatients were included in the study. Exploratory and confirmatory factor analyses were used to assess the construct validity, Cronbachs Alpha for internal consistency and Pearsons correlation for predictive properties. Results: Distress level was lower in Romanian diabetes patients when compared to other studies. Model fit for the scale was moderate. The four factor structure of the original scale was maintained, with a good internal consistency for the entire scale (0.824) and for the four subscales: emotional burden (0.775), distress related to the physician (0.798), distress related to diabetes regimen (0.708), and interpersonal distress (0.733). Regarding predictive properties, DDS-Ro was positively correlated to depressive symptoms measured with the Beck Depression Inventory (r = 0.415, p < 0.05) and to diabetes self-care activities measured with the Summary of Diabetes-Self-Care Activities, with the strongest correlation between diabetes regimen distress and physical activities (r= - 0.358, p < 0.01). Conclusions: DDS-Ro has good psychometric properties in Romanian diabetes patients and can be used when diabetes emotional impact is assessed Key words: diabetes distress, depression, Romania Continue reading >>
Diabetes Distress: A Real And Normal Part Of Diabetes
CLINICAL CARE 28 Diabetes Voice 29Diabetes VoiceVolume 62 - Issue 3 September 2016 Volume 62 - Issue 3 September 2016 28 Diabetes Voice 29Diabetes VoiceVolume 62 - Issue 3 September 2016 Volume 62 - Issue 3 September 2016 EXPERT INTERVIEW Elizabeth Snouffer with Lawrence Fisher Living successfully with type 1 or type 2 diabetes requires the very large task of managing a serious chronic condition. The tasks associated with diabetes can be complex and demanding and most people in their life journey with diabetes report great frustration with the burden of the disease. These physical and emotional demands generate emotional distress that can include worry, fear, sadness and anger regarding the emergence of complications, hypoglycaemic episodes, unpredictable blood glucose and feelings of ‘diabetes burnout’. Diabetes Distress is distinct from clinical depression, but high levels of distress are linked to poor glycaemic “management†and problematic self- care behaviours. Diabetes Distress often leads to the thought pattern of “I just can’t do this anymore†and for the primary diabetes healthcare provider, this is a signal that an open discussion can help individuals connect all the things they must ‘do’ with all of the emotions a person living with diabetes ‘feels’. Lawrence Fisher, PhD, from the Department of Family and Community Medicine and the University of California, San Francisco and William Polonsky, PhD, at the Department of Psychiatry, University of San Diego California developed the Diabetes Distress Scales (DDS) for people with type 2 diabetes and the T1DDS for people with type 1 diabetes to help providers and their patients gain a better understanding of the emotional side of diabetes, recognize b Continue reading >>
