Assessing Psychosocial Distress in Diabetes

Assessing Psychosocial Distress in Diabetes Development of the Diabetes Distress Scale William H. Polonsky , PHD, CDE 1 , Lawrence Fisher , PHD 2 , Jay Earles , PSYD 3 , R. James Dudl , MD 4 , Joel Lees , MD 5 , Joseph Mullan , PHD 2 and Richard A. Jackson , MD 6 1 Department of Psychiatry, University of California, San Diego, California 2 Department of Family and Community Medicine, University of California, San Francisco, California 3 Tripler Army Medical Center, Honolulu, Hawaii 4 Kaiser Permanente, San Diego, California 5 Naval Medical Center, San Diego, California 6 Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts Address correspondence and reprint requests to William H. Polonsky, PhD, CDE, P.O. Box 2148, Del Mar, CA 92014. E-mail: whpolonsky{at}aol.com Abstract OBJECTIVE —The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. RESEARCH DESIGN AND METHODS —In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic ( n = 200), waiting room at a diabetes specialty clinic ( n = 179), a diabetes management study program ( n = 167), and an ongoing diabetes management program ( n = 158). RESULTS —Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high ( r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high ( r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (α > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenc