title: Insulin-treated diabetes patients with fear of self-injecting or fear of self-testing: psychological comorbidity and general well-being.
abstract: OBJECTIVE
  To examine psychological functioning and self-management behaviours of Dutch adult patients with insulin-requiring diabetes mellitus suffering from extreme fear of self-injecting (FSI) and/or fear of self-testing (FST).
  
  
  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 questionnaires concerning trait/state anxiety, depression, fear of hypoglycemia, diabetes-related distress, diabetes self-care activities, and general well-being. Comparisons were made on these measures between patients with extremely high scores on FSI and/or FST (> or = 95th percentile) and the other patients. Patients with extreme scores on FSI and/or FST were invited to take part in a second survey to assess the prevalence of major depression, common fears/phobias, and psychoneuroticism.
  
  
  RESULTS
  People with extreme FSI/ FST scores, as compared to the other patients, reported higher levels of trait/state anxiety and depression. This group also reported more fear of hypoglycaemia and diabetes-related distress, had lower levels of general well-being, and reported less frequent self-monitoring of blood glucose. The second survey showed 11.1% of patients with extreme FSI/FST reporting scores indicating major depression. Prevalence of scores greater than or equal to the high scores on phobias (38.0-63.3%) and psychoneuroticism (27.8%) were consistently higher than norm group prevalences.
  
  
  CONCLUSIONS
  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 specific phobia.
authors.affiliation: Institute for Research in Extramural Medicine (EMGO Institute), Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. es.mollema.emgo@med.vu.nl
authors.forename: E D
authors.initials: ED
authors.lastname: Mollema
authors.forename: F J
authors.initials: FJ
authors.lastname: Snoek
authors.forename: H J
authors.initials: HJ
authors.lastname: Adèr
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: H M
authors.initials: HM
authors.lastname: van der Ploeg
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D005239:Fear; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012646:Self Administration; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D007328:Insulin