Insulin-treated diabetes patients with fear of self-injecting or fear of self-testing - Psychological comorbidity and general well-being

Objective: To examine psychological functioning and selfmanagement behaviou rs of Dutch adult patients with insulin-requiring diabetes mellitus sufferi ng from extreme fear of self-injecting (FSI) and/or fear of self-testing (F ST). Methods: A cross-sectional survey was performed in a sample of insulin -treated diabetes patients (n=1275; 51.1% male; age 49.7 +/- 15.8 years; 58 .0% Type 1 diabetes), assessing FSI and FST. Patients completed the questio nnaires concerning trait/state anxiety, depression, fear of hypoglycemia, d iabetes-related distress, diabetes self-care activities, and general well-b eing. Comparisons were made on these measures between patients with extreme ly high scores on FSI and/or FST (greater than or equal to 95th percentile) and the other patients. Patients with extreme scores on FSI and/or FST wer e invited to take part in a second survey to assess the prevalence of major depression, common fears/phobias, and psychoneuroticism. Results: People w ith extreme FSI/FST scores, as compared to the other patients, reported hig her levels of trait/state anxiety and depression. This group also reported more fear of hypoglycaemia. and diabetes-related distress, had lower levels of general wellbeing, and reported less frequent self-monitoring of blood glucose. The second survey showed 11.1% of patients with extreme FSI/ FST r eporting scores indicating major depression. Prevalence of scores greater t han or equal to the high scores on phobias (38.063.3%) and psychoneuroticis m (27.8%) were consistently higher than norm group prevalences. Discussion: Extreme levels of FSI and/or FST are associated with high diabetes-related distress, poor general well-being, and psychological comorbidity, as well as poorer adherence to the diabetes treatment regimen. It is concluded that patients with extreme FSI/FST are often burdened with more than this speci fic phobia. (C) 2001 Elsevier Science Inc. All rights reserved.