title: Correlates of psychological outcomes in people with diabetes: results from the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study.
abstract: To assess country- and individual-level correlates of psychological outcomes, and differences among countries in the associations of individual characteristics with psychological outcomes among adults with diabetes.
  
  
  
  The second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study assessed self-reported characteristics of people with diabetes in 17 countries, including 1368 adults with Type 1 diabetes and 7228 with Type 2 diabetes. In each country, a sample of 500 adults, stratified by diabetes type and treatment, completed a questionnaire incorporating the validated WHO-5 wellbeing index, the WHOQOL-BREF, and the five-item Problem Areas in Diabetes Scale, as well as the newly developed Diabetes Impact on Life Dimensions that assessed impact ranging from very positive to very negative, with no impact as the midpoint. Multilevel regression analyses identified significant (P < 0.05) independent correlates of psychological outcomes.
  
  
  
  There were significant variations in all outcomes across countries before adjustment for individual-level factors; adjustment reduced between-country disparities. Worse psychological outcomes were associated with more complications, incidence of hypoglycaemia, hypoglycaemic medication, perceived burden of diabetes, family conflict and experience of discrimination. Better psychological outcomes were associated with higher self-rated health, greater access to diabetes education and healthcare, and more psychosocial support from others. The associations of many factors with the outcomes were mediated by modifiable factors. The association of all factors with the outcomes varied across (interacted with) countries, highlighting the need for country-specific analyses.
  
  
  
  Improvements in modifiable risk factors (reductions in burden and increases in support) may lead to better psychological outcomes in adults with diabetes.
authors.affiliation: Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nicolucci
authors.affiliation: Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Kovacs Burns
authors.affiliation: Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: R I G
authors.initials: RI
authors.lastname: Holt
authors.affiliation: Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Lucisano
authors.affiliation: Novo Nordisk, Copenhagen, Denmark.
authors.forename: S E
authors.initials: SE
authors.lastname: Skovlund
authors.affiliation: Medical University of Warsaw, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Kokoszka
authors.affiliation: University of Perugia, Perugia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Massi Benedetti
authors.affiliation: Loyola University Maryland, Baltimore, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Peyrot
mesh_terms: D017281:Cost of Illness; D048909:Diabetes Complications / Q000523:psychology*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000523:psychology*; D054541:Family Conflict / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D055361:Multilevel Analysis; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D011287:Prejudice / Q000523:psychology; D011788:Quality of Life; D012044:Regression Analysis; D012944:Social Support; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents