Skip to main content

Advertisement

SpringerLink
Log in

Diabetes Distress Among Adolescents with Type 1 Diabetes: a Systematic Review

  • Psychosocial Aspects (S Jaser and KK Hood, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Diabetes distress (DD) refers to the negative emotions arising from living with diabetes and the burden of self-management. Among adults, the prevalence and significance of DD are well established, but this is not the case among adolescents. This systematic review investigated among adolescents with type 1 diabetes: the prevalence of DD; demographic, clinical, behavioral and psychosocial correlates of DD and interventions that reduce DD. Consistent with adult studies, around one third of adolescents experience elevated DD and this is frequently associated with suboptimal glycemic control, low self-efficacy and reduced self-care. Three measures of DD have been developed specifically for adolescents, as those designed for adults may not be sufficiently sensitive to adolescent concerns. Interventions reducing DD in the short term include strategies such as cognitive restructuring, goal setting and problem solving. Further work is needed to investigate sustainability of effect. Rigorous research is needed to progress this field among adolescents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Esbitt S, Tanenbaum M, Gonzalez JS. Disentangling clinical depression from diabetes-specific distress: making sense of the mess we’ve made. In: Lloyd CE, Hermanns N, Pouwer F, editors. Screening for depression and other psychological problems in diabetes. A practical guide. London: Springer; 2013. p. 27–46.

    Chapter  Google Scholar 

  2. Pallayova M, Taheri S. Targeting diabetes distress: the missing piece of the successful type 1 diabetes management puzzle. Diabetes Spectr. 2014;27(2):143–9.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Polonsky WH, Fisher L, Earles J, et al. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005;28(3):626–31.

    Article  PubMed  Google Scholar 

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th Edition: DSM-5. Arlington, VA: Author; 2013. DOI: 10.1176/appi.books.9780890425596.807874

  5. Fisher L, Gonzalez JS, Polonsky WH. The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med. 2014;31(7):764–72. doi:10.1111/dme.12428.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Hood KK, Huestis S, Maher A, et al. Depressive symptoms in children and adolescents with type 1 diabetes: association with diabetes-specific characteristics. Diabetes Care. 2006;29(6):1389–91.

    Article  PubMed  Google Scholar 

  7. Reynolds KA, Helgeson VS. Children with diabetes compared to peers: depressed? Distressed? A meta-analytic review. Ann Behav Med. 2011;42(1):29–41.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Bernstein CM, Stockwell MS, Gallagher MP, et al. Mental health issues in adolescents and young adults with type 1 diabetes: prevalence and impact on glycemic control. Clin Pediatr. 2013;52(1):10–5.

    Article  Google Scholar 

  9. Helgeson VS, Siminerio L, Escobar O, et al. Predictors of metabolic control among adolescents with diabetes: a 4-year longitudinal study. J Pediatr Psychol. 2009;34(3):254–70.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Herzer M, Hood KK. Anxiety symptoms in adolescents with type 1 diabetes: association with blood glucose monitoring and glycemic control. J Pediatr Psychol. 2010;35(4):415–25.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Johnson B, Eiser C, Young V, et al. Prevalence of depression among young people with type 1 diabetes: a systematic review. Diabet Med. 2013;30(2):199–208.

    Article  CAS  PubMed  Google Scholar 

  12. Davidson M, Penney ED, Muller B, et al. M. Stressors and self-care challenges faced by adolescents living with type 1 diabetes. Appl Nurs Res. 2004;17(2):72–80.

    Article  PubMed  Google Scholar 

  13. Sturt J, Dennick K, Due-Christensen M, et al. Detection and management of diabetes distress in type 1 diabetes. Curr Diab Rep. 2015;15(11):101. doi:10.1007/s11892-015-0660-z. This paper is a recent review of DD among adults with T1D.

    Article  PubMed  Google Scholar 

  14. Reddy J, Wilhelm K, Campbell L. Putting PAID to diabetes-related distress: the potential utility of the problem areas in diabetes (PAID) scale in patients with diabetes. Psychosomatics. 2013;54(1):44–51.

    Article  PubMed  Google Scholar 

  15. Strandberg RB, Graue M, Wentzel-Larsen T, et al. Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA1c in adult persons with type 1 diabetes. J Psychosom Res. 2014;77(3):174–9.

    Article  PubMed  Google Scholar 

  16. Fisher L, Skaff MM, Mullan JT, et al. Clinical depression versus distress among patients with type 2 diabetes: not just a question of semantics. Diabetes Care. 2007;30(3):542–8.

    Article  PubMed  Google Scholar 

  17. Georgiades A, Zucker N, Friedman KE, et al. Changes in depressive symptoms and glycemic control in diabetes mellitus. Psychosom Med. 2007;69(3):235–41.

    Article  CAS  PubMed  Google Scholar 

  18. Markowitz SM, Gonzalez JS, Wilkinson JL, et al. A review of treating depression in diabetes: emerging findings. Psychosomatics. 2011;52(1):1–18.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Byrne M, Newell J, Coffey N, et al. Predictors of quality of life gains among people with type 1 diabetes participating in the dose adjustment for normal eating (DAFNE) structured education programme. Diabetes Res Clin Pract. 2012;98(2):243–8.

    Article  CAS  PubMed  Google Scholar 

  20. Hopkins D, Lawrence I, Mansell P, et al. Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: the U.K. DAFNE experience. Diabetes Care. 2012;35(8):1638–42.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Snoek FJ, van der Ven NC, Lubach CH, et al. Effects of cognitive behavioural group training (CBGT) in adult patients with poorly controlled insulin-dependent (type 1) diabetes: a pilot study. Patient Educ Couns. 2001;45(2):143–8.

    Article  CAS  PubMed  Google Scholar 

  22. Sturt J, Dennick K, Hessler D, et al. Effective interventions for reducing diabetes distress: systematic review and meta-analysis. Int Diab Nurs. 2015;12(2):40–55. This is the first meta-analysis of effective interventions for reducing DD among adults.

    Article  Google Scholar 

  23. Farrell S, Hains AA, Davies W, et al. The impact of cognitive distortions, stress, and adherence on metabolic control in youths with type 1 diabetes. J Adolesc Health. 2004;34(6):461–7.

    Article  PubMed  Google Scholar 

  24. Weissberg-Benchell J, Antisdel-Lomaglio J. Diabetes-specific emotional distress among adolescents: feasibility, reliability, and validity of the problem areas in diabetes-teen version. Pediatr Diabetes. 2011;12(4):341–4. This paper reports development and psychometric assessment of the PAID-Teen scale, an age-specific measure of DD.

    Article  PubMed  Google Scholar 

  25. Ellis D, Frey M, Naar-King S, et al. The effects of multisystemic therapy on diabetes stress among adolescents with chronically poorly controlled type 1 diabetes: findings from a randomized, controlled trial. Pediatrics. 2005;116(6):e826–32.

    Article  PubMed  Google Scholar 

  26. Serlachius A, Scratch S, Northam E, et al. A randomized controlled trial of cognitive behaviour therapy to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes. J Health Psychol. 2014. doi:10.1177/1359105314547940.

    PubMed  Google Scholar 

  27. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283(15):2008–12.

    Article  CAS  PubMed  Google Scholar 

  29. DCCT Research Group. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: diabetes control and complications Trial. J Pediatr. 1994;125:177–88.

    Article  Google Scholar 

  30. Polonsky WH, Anderson BJ, Lohrer PA, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18(6):754–60.

    Article  CAS  PubMed  Google Scholar 

  31. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Vacha-Haase T, Thompson B. How to estimate and interpret various effect sizes. J Couns Psychol. 2004;51(4):473–81.

    Article  Google Scholar 

  33. Cohen, J., Statistical power analysis for the behavioral sciences. 1988: Routledge.

  34. Hains AA, Davies WH, Parton E, et al. A stress management intervention for adolescents with type I diabetes. Diabetes Educ. 2000;26(3):417–24.

    Article  CAS  PubMed  Google Scholar 

  35. Hains AA, Davies WH, Parton E, et al. Brief report: a cognitive behavioral intervention for distressed adolescents with type I diabetes. J Pediatr Psychol. 2001;26(1):61–6.

    Article  CAS  PubMed  Google Scholar 

  36. Silverman AH, Hains AA, Davies WH, et al. A cognitive behavioral adherence intervention for adolescents with type 1 diabetes. J Clin Psychol Med Settings. 2003;10(2):119–27.

    Article  Google Scholar 

  37. Salamon KS, Hains AA, Fleischman KM, et al. Improving adherence in social situations for adolescents with type 1 diabetes mellitus (T1DM): a pilot study. Prim Care Diabetes. 2010;4(1):47–55.

    Article  PubMed  Google Scholar 

  38. Murphy HR, Wadham C, Rayman G, et al. Approaches to integrating paediatric diabetes care and structured education: experiences from the families, adolescents, and children’s teamwork study (FACTS). Diabet Med. 2007;24(11):1261–8.

    Article  CAS  PubMed  Google Scholar 

  39. Brierley S, Johnson B, Young V, et al. The importance of measuring diabetes distress in young people with type 1 diabetes. In diabetes UK professional conference 2012. Glasgow Scotland. Diabet Med. 2012;29(Suppl1):59.

    Google Scholar 

  40. Young V, Johnson B, Brierley S, et al. Using a diabetes-specific measure to predict disordered eating in adolescents with type 1 diabetes. EHPS 2013 Abstracts. Psychol Health. 2013;28 Suppl 1:1–335.

    Google Scholar 

  41. Gregory J, Robling M, Bennert K, et al. Development and evaluation by a cluster randomised trial of a psychosocial intervention in children and teenagers experiencing diabetes: the DEPICTED study. Health Technol Assess. 2011;15(29):1–202.

    Article  PubMed  Google Scholar 

  42. McNamara R, Robling M, Hood K, et al. Development and evaluation of a psychosocial intervention for children and teenagers experiencing diabetes (DEPICTED): a protocol for a cluster randomised controlled trial of the effectiveness of a communication skills training programme for healthcare professionals working with young people with type 1 diabetes. BMC Health Serv Res. 2010;10:36–36.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Robling M, McNamara R, Bennert K, et al. The effect of the talking diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study). BMJ. 2012;344:e2359–e2359.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Hains AA, Berlin KS, Davies H, et al. Attributions of adolescents with type 1 diabetes related to performing diabetes care around friends and peers: the moderating role of friend support. J Pediatr Psychol. 2007;32(5):561–70.

    Article  PubMed  Google Scholar 

  45. Hains AA, Berlin KS, Davies WH, et al. Attributions of teacher reactions to diabetes self-care behaviors. J Pediatr Psychol. 2009;34(1):97–107.

    Article  PubMed  Google Scholar 

  46. Farrell, S. The impact of stress, adherence, and cognitive errors on metabolic control in youths with type I diabetes, 2000, Thesis, University of Wisconsin, MKE.

  47. Serlachius, A., The best of coping: a randomised trial to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes, 2011. Thesis, The University of Melbourne.

  48. Boland EA, Grey M, Mezger J, et al. A summer vacation from diabetes: evidence from a clinical trial. Diabetes Educ. 1999;25(1):31–40.

    Article  CAS  PubMed  Google Scholar 

  49. Boland EA, Grey M, Oesterle A, et al. Continuous subcutaneous insulin infusion: a new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes. Diabetes Care. 1999;22(11):1779–84.

    Article  CAS  PubMed  Google Scholar 

  50. Grey M, Boland EA, Davidson M, et al. Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr. 2000;137(1):107–13.

    Article  CAS  PubMed  Google Scholar 

  51. Grey M, Boland EA, Davidson M, et al. Short-term effects of coping skills training as adjunct to intensive therapy in adolescents. Diabetes Care. 1998;21(6):902–8.

    Article  CAS  PubMed  Google Scholar 

  52. Grey M, Boland EA, Davidson M, et al. Coping skills training for youths with diabetes on intensive therapy. Appl Nurs Res. 1999;12(1):3–12.

    Article  CAS  PubMed  Google Scholar 

  53. Grey M, Boland EA, Tamborlane WV. Use of lispro insulin and quality of life in adolescents on intensive therapy. Diabetes Educ. 1999;25(6):934–41.

    Article  CAS  PubMed  Google Scholar 

  54. Grey M, Boland EA, Yu C, et al. Personal and family factors associated with quality of life in adolescents with diabetes. Diabetes Care. 1998;21(6):909–14.

    Article  CAS  PubMed  Google Scholar 

  55. Berlin KS, Rabideau EM, Hains AA. Empirically derived patterns of perceived stress among youth with type 1 diabetes and relationships to metabolic control. J Pediatr Psychol. 2012;37(9):990–8.

    Article  PubMed  Google Scholar 

  56. Delamater AM, Patiño-Fernández AM, Smith KE, et al. Measurement of diabetes stress in older children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes. 2013;14(1):50–6. This study reports the psychometric properties and factor analysis for the DSQY scale, an age-specific measure of DD.

    Article  PubMed  Google Scholar 

  57. Franklin MD. The relationship between psychosocial factors, self-care behaviors, and metabolic control in adolescents with Type 1 Diabetes, 2008, Thesis, Vanderbilt University, TN.

  58. Hains AA, Berlin KS, Davies WH, et al. Attributions of adolescents with type 1 diabetes in social situations: relationship with expected adherence, diabetes stress, and metabolic control. Diabetes Care. 2006;29(4):818–22.

    Article  PubMed  Google Scholar 

  59. Wagner JA. Response shift and glycemic control in children with diabetes. Health Qual Life Outcomes. 2005;3(1):38. doi:10.1186/1477-7525-3-38.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Law GU, Walsh J, Queralt V, et al. Adolescent and parent diabetes distress in type 1 diabetes: the role of self-efficacy, perceived consequences, family responsibility and adolescent-parent discrepancies. J Psychosom Res. 2013;74(4):334–9.

    Article  PubMed  Google Scholar 

  61. Nouwen A, Law GU, Hussain S, et al. Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes. Psychol Health. 2009;24(9):1071–84.

    Article  PubMed  Google Scholar 

  62. Lerman-Garber I, Barrón-Uribe C, Calzada-León R, et al. Emotional dysfunction associated with diabetes in Mexican adolescents and young adults with type-1 diabetes. Salud Publica de Mexico. 2003;45(1):13–8.

    Article  PubMed  Google Scholar 

  63. Singh E, Farruggia SP, Peterson ER. Adolescents with diabetes: support from healthcare teams and families. Int J Adolesc Med Health. 2013;25(1):91–6.

    Article  PubMed  Google Scholar 

  64. Speight J, Browne JL, Holmes-Truscott E, et al, on behalf of the Diabetes MILES – Australia reference group. Diabetes MILES—Australia 2011 Survey Report. Diabetes Australia—Vic, Melbourne. 2011.

  65. Hood KK, Butler DA, Anderson BJ, et al. Updated and revised diabetes family conflict scale. Diabetes Care. 2007;30(7):1764–9.

    Article  PubMed  Google Scholar 

  66. Williams LB, Laffel LMB, Hood KK. Diabetes-specific family conflict and psychological distress in paediatric type 1 diabetes. Diabet Med. 2009;26(9):908–14.

    Article  CAS  PubMed  Google Scholar 

  67. Van Bastelaar KMP, Pouwer F, Geelhoed-Duijvestijn PHLM, et al. Diabetes-specific emotional distress mediates the association between depressive symptoms and glycaemic control in type 1 and type 2 diabetes. Diabet Med. 2010;27(7):798–803.

    Article  PubMed  Google Scholar 

  68. Twenge JM, Nolen-Hoeksema S. Age, gender, race, socioeconomic status, and birth cohort difference on the children’s depression inventory: a meta-analysis. J Abnorm Psychol. 2002;111(4):578.

    Article  PubMed  Google Scholar 

  69. Kibbey K, Speight J, Wong J, et al. Diabetes care provision: barriers, enablers and service needs of young adults with type 1 diabetes from a region of social disadvantage. Diabetic Med. 2013;30(7):878–84.

    Article  CAS  PubMed  Google Scholar 

  70. Brewin CR, Bradley C. Patient preferences and randomised clinical trials. BMJ. 1989;299(6694):313–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  71. Murphy HR, Rayman G, Skinner TC. Psycho-educational interventions for children and young people with type 1 diabetes. Diabet Med. 2006;23(9):935–43.

    Article  CAS  PubMed  Google Scholar 

  72. Hermanns N, Schmitt A, Gahr A, et al. The effect of a diabetes-specific cognitive behavioral treatment program (DIAMOS) for patients with diabetes and subclinical depression: results of a randomized controlled trial. Diabetes Care. 2015;38(4):551–60.

    CAS  PubMed  Google Scholar 

  73. Ellis D, Templin T, Naar-King S, et al. Multisystemic therapy for adolescents with poorly controlled type I diabetes: stability of treatment effects in a randomized controlled trial. J Consult Clin Psychol. 2007;75(1):168–74.

    Article  PubMed  Google Scholar 

  74. Gage H, Hampson S, Skinner TC, et al. Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness. Patient Educ Couns. 2004;53(3):333–46.

    Article  PubMed  Google Scholar 

  75. Hampson SE, Skinner TC, Hart J, et al. Behavioral interventions for adolescents with type 1 diabetes: how effective are they? Diabetes Care. 2000;23(9):1416–22.

    Article  CAS  PubMed  Google Scholar 

  76. Hendrieckx C, Halliday JA, Bowden JP, et al. Severe hypoglycaemia and its association with psychological well-being in Australian adults with type 1 diabetes attending specialist tertiary clinics. Diabetes Res Clin Pract. 2014;103(3):430–6.

    Article  CAS  PubMed  Google Scholar 

  77. Fisher L, Glasgow RE, Mullan JT, et al. Development of a brief diabetes distress screening instrument. Ann Fam Med. 2008;6(3):246–52.

    Article  PubMed Central  PubMed  Google Scholar 

  78. Boardway RH, Delamater AM, Tomakowsky J, et al. Stress management training for adolescents with diabetes. J Pediatr Psychol. 1993;18(1):29–45.

    Article  CAS  PubMed  Google Scholar 

  79. Delamater AM, Smith JA, Lankester L, et al. Stress and metabolic control in diabetic adolescents. 9th Annual Meeting of Behavioral Medicine; 1988; Boston, MA.

  80. Kovacs M, Brent D, Steinberg T, et al. Children’s self-reports of psychologic adjustment and coping strategies during first year of insulin-dependent diabetes mellitus. Diabetes Care. 1986;9(5):472–9.

    Article  CAS  PubMed  Google Scholar 

  81. Welch GW, Jacobson AM, Polonsky WH. The problem areas in diabetes scale. An evaluation of its clinical utility. Diabetes Care. 1997;20(5):760–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

VH, JSp, CH and JSt planned the review. VH conducted the search, screened and reviewed studies, extracted and analysed the data and drafted the manuscript. JSp also screened studies, and JSp and CH co-reviewed full-text papers for inclusion and provided substantial contributions to the manuscript. All authors contributed to the search strategy and drafts, and read and approved the final manuscript. The authors did not receive funding to undertake this study.

Author information

Authors and Affiliations

  1. The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne, 3000, VIC, Australia

    Virginia Hagger, Christel Hendrieckx & Jane Speight

  2. Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Burwood, VIC, Australia

    Virginia Hagger, Christel Hendrieckx & Jane Speight

  3. Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, 57 Waterloo Road, London, SE1 8WA, UK

    Jackie Sturt

  4. School of Psychological and Clinical Sciences, Charles Darwin University, Casuarina 0811, Northern Territory, Australia

    Timothy C. Skinner

  5. AHP Research, Hornchurch, UK

    Jane Speight

Authors
  1. Virginia Hagger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christel Hendrieckx
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jackie Sturt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timothy C. Skinner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jane Speight
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Virginia Hagger.

Ethics declarations

Conflict of Interest

Virginia Hagger, Christel Hendrieckx, Jackie Sturt, Timothy Skinner and Jane Speight declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This manuscript represents the authors’ own work, and the work of others’ is acknowledged appropriately. This article does not contain any studies with human or animal subjects performed by any of the authors. As this study is a review of the published literature, ethical committee approval was not required.

Additional information

This article is part of the Topical Collection on Psychosocial Aspects

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 16.7 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hagger, V., Hendrieckx, C., Sturt, J. et al. Diabetes Distress Among Adolescents with Type 1 Diabetes: a Systematic Review. Curr Diab Rep 16, 9 (2016). https://doi.org/10.1007/s11892-015-0694-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-015-0694-2

Keywords

Search

Navigation