Diabetes Metab J.  2011 Apr;35(2):182-187. 10.4093/dmj.2011.35.2.182.

Evaluation of Stress in Korean Patients with Diabetes Mellitus Using the Problem Areas in Diabetes-Korea Questionnaire

• Eom YS
• Park HS
• Kim SH
• Yang SM
• Nam MS
• Lee HW
• Lee KY
• Lee S
• Kim YS
• Park IB

• KMID: 2281717
• DOI: http://doi.org/10.4093/dmj.2011.35.2.182

Abstract

BACKGROUND
It is known that diabetes and stress are directly or indirectly related, and that it is important to evaluate stress in patients with diabetes. The relationship between Korean diabetics and diabetes-related stress has never been reported. The objective of this study was to develop a stress questionnaire suitable for use with Korean diabetics and to evaluate its utility.
METHODS
This study subjects were 307 Korean diabetics, aged 40 to 74 years old, who visited the Department of Endocrinology and Metabolism at Gachon University Gil Hospital, Yeungnam University Medical Center, and Inha University Hospital in Korea between March 2006 and February 2008. We developed a Korean version of Polonsky's Problem Areas in Diabetes (PAID) stress questionnaire (PAID-K) and used it to assess degrees of stress in our sample of Korean patients. We evaluated the utility of the questionnaire and analyzed the relationships between clinical characteristics of the study subjects and degrees of stress.
RESULTS
Cronbach's alpha for PAID-K was 0.95, and PAID-K scores were significantly correlated with Hypoglycemia Fear Survey scores (r=0.44, P<0.05) and State Trait Anxiety Inventory-6 scores (r=0.21, P<0.05). PAID-K scores were significantly higher in patients with longer durations of diabetes, patients using insulin, and female patients (P=0.02, P=0.038, and P=0.001, respectively). The score also tended to increase as HbA1c levels increased, except for very high HbA1c levels (above 11%) (P for trend<0.05).
CONCLUSION
We developed the PAID-K questionnaire and demonstrated its utility to evaluate levels of stress in diabetic patients in Korea.

Keyword

Diabetes mellitus, type 2; Korean; Psychologic stress

MeSH Terms

Academic Medical Centers
Aged
Anxiety
Diabetes Mellitus
Diabetes Mellitus, Type 2
Endocrinology
Female
Humans
Hypoglycemia
Insulin
Korea
Stress, Psychological
Surveys and Questionnaires
Insulin

Figure

• 

  Fig. 1 Problem Areas in Diabetes (PAID)-K score per category of HbA1c level. aP<0.05.

Reference

1. Lloyd C, Smith J, Weinger K. Stress and diabetes: a review of the links. Diabetes Spectr. 2005. 18:121–127.

2. Vialettes B, Ozanon JP, Kaplansky S, Farnarier C, Sauvaget E, Lassmann-Vague V, Bernard D, Vague P. Stress antecedents and immune status in recently diagnosed type I (insulindependent) diabetes mellitus. Diabete Metab. 1989. 15:45–50.

3. Thernlund GM, Dahlquist G, Hansson K, Ivarsson SA, Ludvigsson J, Sjoblad S, Hagglof B. Psychological stress and the onset of IDDM in children. Diabetes Care. 1995. 18:1323–1329.

4. Kawakami N, Araki S, Takatsuka N, Shimizu H, Ishibashi H. Overtime, psychosocial working conditions, and occurrence of non-insulin dependent diabetes mellitus in Japanese men. J Epidemiol Community Health. 1999. 53:359–363.

5. Mooy JM, de Vries H, Grootenhuis PA, Bouter LM, Heine RJ. Major stressful life events in relation to prevalence of undetected type 2 diabetes: the Hoorn Study. Diabetes Care. 2000. 23:197–201.

6. Bjorntorp P. Body fat distribution, insulin resistance, and metabolic diseases. Nutrition. 1997. 13:795–803.

7. Bjorntorp P. Visceral fat accumulation: the missing link between psychosocial factors and cardiovascular disease? J Intern Med. 1991. 230:195–201.

8. Ismail K, Winkley K, Rabe-Hesketh S. Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet. 2004. 363:1589–1597.

9. The Education Committee of Korean Diabetes Association. Diabetes education program guidebook. 2006. 2nd ed. Seoul: Korean Diabetes Association;358.

10. Dunn SM, Smartt HH, Beeney LJ, Turtle JR. Measurement of emotional adjustment in diabetic patients: validity and reliability of ATT39. Diabetes Care. 1986. 9:480–489.

11. Herschbach P, Duran G, Waadt S, Zettler A, Amm C, Marten-Mittag B. Psychometric properties of the Questionnaire on Stress in Patients with Diabetes--Revised (QSD-R). Health Psychol. 1997. 16:171–174.

12. Welch G, Weinger K, Anderson B, Polonsky WH. Responsiveness of the Problem Areas In Diabetes (PAID) questionnaire. Diabet Med. 2003. 20:69–72.

13. Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan J, Jackson RA. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005. 28:626–631.

14. Cox DJ, Irvine A, Gonder-Frederick L, Nowacek G, Butterfield J. Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care. 1987. 10:617–621.

15. Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol. 1992. 31(Pt 3):301–306.

16. Nichols GA, Brown JB. Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes. Diabetes Care. 2003. 26:744–749.

17. Goldney RD, Phillips PJ, Fisher LJ, Wilson DH. Diabetes, depression, and quality of life: a population study. Diabetes Care. 2004. 27:1066–1070.

18. Joe SH. Stress assessment and management. J Korean Med Assoc. 2004. 47:226–234.

19. Rosmond R. Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology. 2005. 30:1–10.

20. Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res. 1967. 11:213–218.

21. Snoek FJ, Pouwer F, Welch GW, Polonsky WH. Diabetes-related emotional distress in Dutch and U.S. diabetic patients: cross-cultural validity of the problem areas in diabetes scale. Diabetes Care. 2000. 23:1305–1309.

22. Polonsky WH, Anderson BJ, Lohrer PA, Welch G, Jacobson AM, Aponte JE, Schwartz CE. Assessment of diabetes-related distress. Diabetes Care. 1995. 18:754–760.