title: Understanding the sources of diabetes distress in adults with type 1 diabetes.
abstract: OBJECTIVE
  To identify the unique sources of diabetes distress (DD) for adults with type 1 diabetes (T1D).
  
  
  METHODS
  Sources of DD were developed from qualitative interviews with 25 T1D adults and 10 diabetes health care providers. Survey items were then developed and analyzed using both exploratory (EFA) and confirmatory CFA) analyses on two patient samples. Construct validity was assessed by correlations with depressive symptoms (PHQ8), complications, HbA1C, BMI, and hypoglycemia worry scale (HWS). Scale cut-points were created using multiple regression.
  
  
  RESULTS
  An EFA with 305 U.S. participants yielded 7 coherent, reliable sources of distress that were replicated by a CFA with 109 Canadian participants: Powerlessness, Negative Social Perceptions, Physician Distress, Friend/Family Distress, Hypoglycemia Distress, Management Distress, Eating Distress. Prevalence of DD was high with 41.6% reporting at least moderate DD. Higher DD was reported for women, those with complications, poor glycemic control, younger age, without a partner, and non-White patients.
  
  
  CONCLUSIONS
  We identified a profile of seven major sources of DD among T1D using a newly developed assessment instrument. The prevalence of DD is high and is related to glycemic control and several patient demographic and disease-related patient characteristics, arguing for a need to address DD in clinical care.
authors.affiliation: Department of Family & Community Medicine, UCSF, San Francisco, California. Electronic address: fisherl@fcm.ucsf.edu.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Fisher
authors.affiliation: Behavioral Diabetes Institute, San Diego, California.
authors.forename: William H
authors.initials: WH
authors.lastname: Polonsky
authors.affiliation: Department of Family & Community Medicine, UCSF, San Francisco, California.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Hessler
authors.affiliation: Department of Medicine, UCSF, San Francisco, California.
authors.forename: Umesh
authors.initials: U
authors.lastname: Masharani
authors.affiliation: Charles H. Best Diabetes Centre, Ontario, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Blumer
authors.affiliation: University of Southern California, Los Angeles, California.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: Oregon Research Institute, Eugene, Oregon.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Strycker
authors.affiliation: Department of Family & Community Medicine, UCSF, San Francisco, California.
authors.forename: Vicky
authors.initials: V
authors.lastname: Bowyer
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D002170:Canada / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000523:psychology; D007003:Hypoglycemia / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D012938:Social Perception; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: Assessing distress; Diabetes distress; Distress profile; Type 1 diabetes; Types of distress