title: Diabetes distress and neighborhood characteristics in people with type 2 diabetes.
abstract: OBJECTIVE
  Diabetes-specific distress is an important psychological issue in people with diabetes. The neighborhood environment has the potential to be an important factor for diabetes distress. This study investigates the associations between neighborhood characteristics and diabetes distress in adults with type 2 diabetes.
  
  
  METHODS
  We used cross-sectional data from a community-based sample of 578 adults with type 2 diabetes from Quebec, Canada. Information on perceived neighborhood characteristics and diabetes distress was collected from phone interviews. We used factor analysis to combine questionnaire items into neighborhood factors. Information on neighborhood deprivation was derived from census data. We performed linear regressions for diabetes distress and specific domains of diabetes distress (emotional, regimen-related, physician-related and interpersonal distress), adjusting for individual-level variables.
  
  
  RESULTS
  Factorial analysis uncovered 3 important neighborhood constructs: perceived order (social and physical order), culture (social and cultural environment) and access (access to services and facilities). After adjusting for individual-level confounders, neighborhood order was significantly associated with diabetes distress and all specific domains of distress; neighborhood culture was specifically associated with regimen-related distress; and neighborhood access was specifically associated with physician-related distress. The objective measure of neighborhood material deprivation was associated with regimen-related distress.
  
  
  CONCLUSIONS
  Neighborhood characteristics are associated with diabetes distress in people with type 2 diabetes. Clinicians should consider the neighborhood environment reported by their patients with diabetes when assessing and addressing diabetes-specific distress.
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada. genevieve.gariepy@mail.mcgill.ca
authors.forename: Genevieve
authors.initials: G
authors.lastname: Gariepy
authors.forename: Kimberley J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D004644:Emotions; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec; D012111:Residence Characteristics; D012931:Social Environment; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Diabetes; Diabetes, type 2; Distress; Epidemiology; Neighborhood; Stress