What characterises diabetes distress and its resolution? A documentary analysis

Objective Cross-sectional studies show that diabetes distress (DD) is associated with HbA1c and depressive symptoms in individuals with Type 1 and Type 2 diabetes. Evidence of association with self-management behaviour is contradictory. Little qualitative evidence exists to understand the manifestation of DD. Our objective was to understand the documented experience of DD and its resolution. Methods A psycho-social care clinic using evidence-based approaches was developed in a hospital diabetes centre serving Type 1 and Type 2 diabetes populations. People were referred by specialist diabetes clinicians when they were ‘struggling to cope’ with their diabetes. Detailed clinical notes captured the origins, characteristics and process of resolution of referred patients’ DD. Documentary clinical notes retrospective analysis used directed content analysis. DD was assessed by the Problem Areas in Diabetes Scale (PAID) at referral. Results Eighty-two people were referred and 70 people attended 202 consultations. Forty-one sets of case notes were included where people attended ≥2 appointments; of whom, 24 experienced elevated DD, 13 had elevated DD plus established psychological morbidity and 4 had general distress unrelated to their diabetes. Mean PAID score was 53. Individuals with DD only experienced mastery of their diabetes, using the psycho-social care service to increase self-care behaviours. Individuals with DD plus established psychological morbidity were unable to increase their self-care. Conclusions People ‘struggling to cope’ are most likely to be experiencing elevated DD only. People with DD only were able to resolve this through access to clinic-run psycho-social care. Practice Implications Health professionals should routinely assess for coping and distress in their care planning. Psycho-social care pathways are important for people with elevated DD