ASSESSMENT OF DIABETES-RELATED DISTRESS

OBJECTIVE - To describe a new measure of psychosocial adjustment speci fic to diabetes, thr Problem Areas in Diabetes Survey (PAID), and to p resent initial information on its reliability and validity. RESEARCH D ESIGN AND METHODS - Before their routine clinic appointments, 451 fema le patients with type I and type II diabetes, all of whom required ins ulin, completed a self-report sun ey. Included in the survey was the P AID, a 20-item questionnaire in which each item represents a unique ar ea of diabetes-related psychosocial distress, Each item is rated on a six-point Likert scale, reflecting the degree to which the item is per ceived as currently problematic. A total scale score, hypothesized to reflect the overall level of diabetes-related emotional distress, is c omputed by summing the total item responses. To examine the concurrent validity of the PAID, the survey also included a series of standardiz ed questionnaires assessing psychosocial functioning (general emotiona l distress, fear of hypoglycemia, and disordered eating), attitudes to ward diabetes, and self-care behaviors. All subjects were assessed for HbA(1) within 30 days of survey completion and again similar to 1-2 y ears later. Finally, long-term diabetic complications were determined through chart review. RESULTS - Internal reliability of the PAID was h igh, with good item-to-total correlations. Approximately 60% of the su bject sample reported at least one serious diabetes-related concern, A s expected, the PAID was positively associated with relevant psychosoc ial measures of distress, including general emotional distress, disord ered eating, and fear of hypoglycemia, short- and long-term diabetic c omplications, and HbA(1), and negatively associated with reported self -care behaviors. The PAID accounted for similar to 9% of the variance in HbA(1). Diabetes-related emotional distress, as measured by the PAI D, was found to be a unique contributor to adherence to self-cart beha viors after adjustment for age, diabetes duration, and general emotion al distress, In addition, the PAID was associated with HbA(1) even aft er adjustment for age, diabetes duration, general emotional distress, and adherence to self-cart behaviors. CONCLUSIONS - These findings sug gest that the PAID, a brief, easy-to-administer instrument, may be val uable in assessing psychosocial adjustment to diabetes. In addition to high internal reliability, the consistent pattern of correlational fi ndings indicates that the PAID is tapping into relevant aspects of emo tional distress and that its particular feature, the measurement of di abetes-related emotional distress, is uniquely associated with diabete s-relevant outcomes, These data are also consistent with the hypothesi s that diabetes-related emotional distress, separate from general emot ional distress, is an independent and major contributor to poor adhere nce. Given that the study was limited to female patients using insulin , further examination of the clinical usefulness of the PAID will need to focus on more heterogeneous samples.