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Diabetes and health-related quality of life among American Indians: the role of psychosocial factors



Little is known about the association of psychosocial factors with health-related quality of life (HRQoL) among American Indians with type 2 diabetes (T2D). This study described functional social support, emotional support, coping, resilience, post-traumatic stress disorder, and HRQoL, among American Indians by diabetes status and, among those with diabetes, examined the association of these factors with HRQoL.


Using data from the Cherokee Nation Health Survey collected between 2017 and 2019, we evaluated differences in each measure of interest according to diabetes status, using t-test and Chi-squared tests of association. We used weighted multiple logistic regression to examine associations between multiple psychosocial factors and HRQoL among those with diabetes.


Compared to individuals without diabetes, participants with diabetes rated their functional social support (4.62 vs. 4.56, respectively) and coping (2.65 vs. 2.61, respectively) slightly lower and were more likely to report ≥ 15 days of poor physical (14% vs. 26%, respectively) and mental health (14% vs. 17%, respectively) in the past month. Odds of reporting poor overall health increased more than sixfold for those who were dissatisfied/very dissatisfied with life (AOR = 6.70). Resilience scores reduced odds of reporting ≥ 15 days with poor physical health, while experiences of post-traumatic stress doubled these odds.


Our study yielded insights into the risk as well as protective factors associated with diabetes outcomes in a large sample of American Indians with T2D. Researchers should design pragmatic trials that deepen understanding of preventive as well as treatment leverage through greater attention to experiences that compromise HRQoL.

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This research is supported by the National Institute on Aging under award numbers P30AG059295 and P30AG15297, the National Center for Minority Health and Health Disparities under award number P60 MD000507, and by the National Institute of Diabetes, Digestive, and Kidney Diseases under award number P30DK092923. Dr. Sixia Chen was partially supported by the Oklahoma Shared Clinical and Translational Resources (U54GM104938) with and Institutional Development Award (IDeA) from National Institute of General Medical Sciences. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health.

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All the authors were involved in developing the manuscript. LS was the project leader and drafted the manuscript. LJ, LH, and AC participated in the data analysis. AW and SC contributed to data collection, the sampling design, and drafted parts of the manuscript. All the authors contributed to the content of the manuscript text and critically reviewed and approved the final version of the manuscript.

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Correspondence to Lisa Scarton.

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Scarton, L., Hebert, L.E., Goins, R.T. et al. Diabetes and health-related quality of life among American Indians: the role of psychosocial factors. Qual Life Res 30, 2497–2507 (2021).

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  • Type 2 diabetes
  • Health related quality of life
  • American Indian
  • Psychosocial