title: Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India.
abstract: OBJECTIVE
  We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies.
  
  
  METHODS
  A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms.
  
  
  RESULTS
  The prevalence of high/very high stress was 35% among DM patients. Age 30-40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself.
  
  
  CONCLUSIONS
  This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity.
authors.affiliation: Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
authors.forename: Muthappan
authors.initials: M
authors.lastname: Sendhilkumar
authors.affiliation: International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi, India.
authors.forename: Jaya Prasad
authors.initials: JP
authors.lastname: Tripathy
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
authors.forename: Amol R
authors.initials: AR
authors.lastname: Dongre
authors.affiliation: Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
authors.forename: Mohan
authors.initials: M
authors.lastname: Deepa
authors.affiliation: Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Vidyulatha
authors.affiliation: Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Poongothai
authors.affiliation: Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
authors.forename: Ulaganathan
authors.initials: U
authors.lastname: Venkatesan
authors.affiliation: Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
authors.forename: Ranjit Mohan
authors.initials: RM
authors.lastname: Anjana
authors.affiliation: Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
keywords: Diabetes mellitus; India; perceived stress score; physical activity