Diabetes as a source of stress

Abstract

This study investigated diabetes as a source of psychological stress, and the threat of diabetic complications was addressed as a potential major stressor. Perceived susceptibility to diabetic complications was assessed to determine whether perceived threat functions as a source of motivation as is hypothesized by the Health Belief Model. Two other issues relevant to stress in the diabetic population--perceived control and self-blame--were also examined.;Seventy-one insulin-treated, non-obese diabetic individuals volunteered to participate in this study. Metabolic control and the psychological variables--including emotional distress and coping strategies--were assessed at regularly scheduled medical appointments. Metabolic control, as measured by glycosylated hemoglobin, a laboratory blood test of average blood glucose levels, was assessed at a second time point, approximately 2-3 months later.;Perceived susceptibility to complications was generally associated with negative outcomes: Greater anxiety and diabetes-related perceived stress and poor metabolic control. Perceived control was found to operate as a moderator of stress. At higher levels of perceived susceptibility, those subjects who perceived greater control over diabetes issues and outcomes experienced significantly less stress and depression.;Self-blame was not associated with metabolic control or emotional distress. Perceived responsibility and causality, however, were related to better metabolic control.;Multiple regression analyses were utilized to determine predictors of the outcomes of metabolic control and emotional distress. Anxiety and perceived susceptibility were net predictors of poor metabolic control, and perceived responsibility was a net predictor of better metabolic control. Two diabetes-specific factors--perceived stress and avoidant coping--were net predictors for anxiety and depression.;There are several implications for future research and clinical practice. One would be to recognize and address diabetes as a source of psychological stress in educational interventions and stress management programs for the diabetic population. Another implication is that the relevance of the threat component of the Health Belief Model may need to be re-evaluated as a source of motivation for the diabetic population.