title: Putting PAID to diabetes-related distress: the potential utility of the problem areas in diabetes (PAID) scale in patients with diabetes.
abstract: BACKGROUND
  Distress and depression are commonly reported negative affects in people with diabetes (PWD), and may influence glycemic control. 'Distress' can be measured as general or diabetes-related. 'Depression' is considered through symptom severity or episodes of depressive disorder, both potentially derived by the Patient Health Questionnaire (PHQ-9). While current depressive disorder is found to affect the course of diabetes mellitus (DM), past depressive disorder may have a similar impact.
  
  
  OBJECTIVE
  To test the relationships between DM-distress (measured by the Problem Areas in Diabetes instrument [PAID]) and glycemic control, while considering the effects of general distress; depression severity; and both current and previous depressive disorder.
  
  
  METHODS
  In a diabetic service, 184 type 1 (n = 51) and type 2 (n = 133) PWD completed the PAID, PHQ-9 depression scale from the Patient Health Questionnaire, Kessler-10 psychological distress (K10), and Short-Form Survey (SF-12) instruments. Glycosylated hemoglobin (HbA1c) levels measured on the day of recruitment were recorded from the case notes.
  
  
  RESULTS
  DM-related distress correlated positively with HbA1c, PHQ-9 depression, K10, and SF-12 MCS (mental component summary) scores, (all p < 0.01); and negatively with age (p < 0.01). Regression analysis revealed a significant association between PAID with PHQ-9 depression scores (p < 0.01) and with HbA1c (p < 0.01). PWD with past depressive disorder had higher PAID scores than those without (p < 0.05), and this was significant even after controlling for current depression scores (p < 0.05).
  
  
  CONCLUSIONS
  In PWD, DM-specific distress measured by the PAID correlated significantly with impaired glycemic control. Both past and current depressions are independently associated with DM-distress. The PAID is discussed as a potential screening tool.
authors.affiliation: School of Psychiatry, Faculty of Medicine and the Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia. jreddy68@yahoo.com
authors.forename: Jaya
authors.initials: J
authors.lastname: Reddy
authors.forename: Kay
authors.initials: K
authors.lastname: Wilhelm
authors.forename: Lesley
authors.initials: L
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000523:psychology*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human