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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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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References

  1. 1.

    Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report: estimates of diabetes and its burden in the United States, 2020. . U.S. Department of Health and Human Services.

    Google Scholar 

  2. 2.

    Rowley, W. R., Bezold, C., Arikan, Y., Byrne, E., & Krohe, S. (2017). Diabetes 2030: Insights from yesterday, today, and future trends. Population Health Management, 20(1), 6–12. https://doi.org/10.1089/pop.2015.0181.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Heron, M. (2018). Deaths: Leading causes for 2016. National Vital Statistics Reports, 67(6), 1–77.

    PubMed  Google Scholar 

  4. 4.

    Healthy People 2020 Foundation Health Measure Report Health-Related Quality of Life and Well-Being (2010). Retrived from https://www.healthypeople.gov/2020/about/foundation-health-measures/Health-Related-Quality-of-Life-and-Well-Being. Accessed 12 Jan 2020.

  5. 5.

    Chen, H. Y., Baumgardner, D. J., & Rice, J. P. (2011). Health-related quality of life among adults with multiple chronic conditions in the United States, Behavioral Risk Factor Surveillance System, 2007. Preventing Chronic Disease, 8(1), A09.

    PubMed  Google Scholar 

  6. 6.

    Jing, X., Chen, J., Dong, Y., Han, D., Zhao, H., Wang, X., et al. (2018). Related factors of quality of life of type 2 diabetes patients: A systematic review and meta-analysis. Health and Quality of Life Outcomes, 16(1), 189. https://doi.org/10.1186/s12955-018-1021-9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Rubin, R. R., & Peyrot, M. (1999). Quality of life and diabetes. Diabetes/Metabolism Research and Reviews, 15(3), 205–218. https://doi.org/10.1002/(SICI)1520-7560(199905/06)15:3%3c205::AID-DMRR29%3e3.0.CO;2-O.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Solli, O., Stavem, K., & Kristiansen, I. S. (2010). Health-related quality of life in diabetes: The associations of complications with EQ-5D scores. Health and Quaility of Life Outcomes, 8, 18–18. https://doi.org/10.1186/1477-7525-8-18.

    Article  Google Scholar 

  9. 9.

    Venkataraman, K., Wee, H. L., Leow, M. K. S., Tai, E. S., Lee, J., Lim, S. C., et al. (2013). Associations between complications and health-related quality of life in individuals with diabetes. Clinical Endocrinology, 78(6), 865–873. https://doi.org/10.1111/j.1365-2265.2012.04480.x.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Thommasen, H. V., Berkowitz, J., Thommasen, A. T., & Michalos, A. C. (2005). Understanding relationships between diabetes mellitus and health-related quality of life in a rural community. Rural and Remote Health, 5(3), 441.

    PubMed  Google Scholar 

  11. 11.

    Aschalew, A. Y., Yitayal, M., & Minyihun, A. (2020). Health-related quality of life and associated factors among patients with diabetes mellitus at the University of Gondar referral hospital. Health and Qualilty of Life Outcomes, 18(1), 62–62. https://doi.org/10.1186/s12955-020-01311-5.

    Article  Google Scholar 

  12. 12.

    McFall, S. L., Solomon, T. G. A., & Smith, D. W. (2000). Health-related quality of life of older Native American primary care patients. Research on Aging, 22(6), 692–714. https://doi.org/10.1177/0164027500226005.

    Article  Google Scholar 

  13. 13.

    Johnson, J. A., Nowatzki, T. E., & Coons, S. J. (1996). Health-related quality of life of diabetic Pima Indians. Medical Care, 34(2), 97–102. https://doi.org/10.1097/00005650-199602000-00001.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Goins, R. T., John, R., Hennessy, C. H., Denny, C. H., & Buchwald, D. (2006). Determinants of health-related quality of life among older American Indians and Alaska Natives. Journal of Applied Gerontology, 25(1_suppl), 73S-88S. https://doi.org/10.1177/0733464805283037.

    Article  Google Scholar 

  15. 15.

    Gilliland, F. D., Mahler, R., & Davis, S. M. (1998). Health-related quality of life for rural American Indians in New Mexico. Ethnicity and Health, 3(3), 223–229. https://doi.org/10.1080/13557858.1998.9961864.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Jiang, L., Beals, J., Whitesell, N. R., Roubideaux, Y., & Manson, S. M. (2009). Health-related quality of life and help seeking among American Indians with diabetes and hypertension. Quality of Life Research, 18(6), 709–718. https://doi.org/10.1007/s11136-009-9495-x.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Quandt, S. A., Graham, C. N., Bell, R. A., Snively, B. M., Golden, S. L., Stafford, J. M., et al. (2007). Ethnic disparities in health-related quality of life among older rural adults with diabetes. Ethnicity and Disease, 17(3), 471–476.

    PubMed  Google Scholar 

  18. 18.

    Young-Hyman, D., de Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., & Peyrot, M. (2016). Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(12), 2126–2140. https://doi.org/10.2337/dc16-2053.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Nawaz, A., Malik, J. A., & Batool, A. (2014). Relationship between resilience and quality of life in diabetics. Journal of College of Physicians Surgeons Pakistan, 24(9), 670–675.

    Google Scholar 

  20. 20.

    Bowen, P. G., Clay, O. J., Lee, L. T., Vice, J., Ovalle, F., & Crowe, M. (2015). Associations of social support and self-efficacy with quality of life in older adults with diabetes. Journal of Gerontological Nursing, 41(12), 21–31. https://doi.org/10.3928/00989134-20151008-44.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Zurita-Cruz, J. N., Manuel-Apolinar, L., Arellano-Flores, M. L., Gutierrez-Gonzalez, A., Najera-Ahumada, A. G., & Cisneros-Gonzalez, N. (2018). Health and quality of life outcomes impairment of quality of life in type 2 diabetes mellitus: A cross-sectional study. Health and Quality of Life Outcomes, 16(1), 94. https://doi.org/10.1186/s12955-018-0906-y.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Ali, S., Stone, M., Skinner, T., Robertson, N., Davies, M., & Khunti, K. (2010). The association between depression and health-related quality of life in people with type 2 diabetes: A systematic literature review. Diabetes/Metabolism Research and Reviews, 26, 75–89. https://doi.org/10.1002/dmrr.1065.

    Article  PubMed  Google Scholar 

  23. 23.

    Cal, S. F., Sá, L. R. D., Glustak, M. E., & Santiago, M. B. (2015). Resilience in chronic diseases: A systematic review. Cogent Psychology, 2(1), 1024928. https://doi.org/10.1080/23311908.2015.1024928.

    Article  Google Scholar 

  24. 24.

    Tang, T. S., Brown, M. B., Funnell, M. M., & Anderson, R. M. (2008). Social support, quality of life, and self-care behaviors among African Americans with type 2 diabetes. Diabetes Educator, 34(2), 266–276. https://doi.org/10.1177/0145721708315680.

    Article  Google Scholar 

  25. 25.

    Dixon, H. D., Michopoulos, V., Gluck, R. L., Mendoza, H., Munoz, A. P., Wilson, J. G., et al. (2020). Trauma exposure and stress-related disorders in African-American women with diabetes mellitus. Endocrinology, Diabetes and Metabolism,. https://doi.org/10.1002/edm2.111.

    Article  Google Scholar 

  26. 26.

    Miller, S. A., Mancuso, C. A., Boutin-Foster, C., Michelen, W., McLean-Long, C., Foote, B., et al. (2011). Associations between posttraumatic stress disorder and hemoglobin A1(C) in low-income minority patients with diabetes. General Hospital Psychiatry, 33(2), 116–122. https://doi.org/10.1016/j.genhosppsych.2010.12.005.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Trief, P. M., Ouimette, P., Wade, M., Shanahan, P., & Weinstock, R. S. (2006). Post-traumatic stress disorder and diabetes: Co-morbidity and outcomes in a male veterans sample. Journal of Behavorial Medicine, 29(5), 411–418. https://doi.org/10.1007/s10865-006-9067-2.

    Article  Google Scholar 

  28. 28.

    Aronson, B. D., Palombi, L. C., & Walls, M. L. (2016). Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes. Journal of Behavioral Medicine, 39(4), 694–703. https://doi.org/10.1007/s10865-016-9733-y.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Bassett, D., Buchwald, D., & Manson, S. (2014). Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: A review of the literature. Social Psychiatry and Psychiatric Epidemiology, 49(3), 417–433. https://doi.org/10.1007/s00127-013-0759-y.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Osiyo! (2020, November). Retrieved from https://www.cherokee.org/. Accessed 12 Jan 2020.

  31. 31.

    Lohr, S. (2010). Sampling: Design and analysis. . Cengage Learning.

    Google Scholar 

  32. 32.

    Cochran, W. G. (1977). Sampling Techniques. . Wiley.

    Google Scholar 

  33. 33.

    Deming, W. E., & Stephan, F. F. (1940). On a least squares adjustment of a sampled frequency table when the expected marginal totals are known. Annals of Mathematical Statistics, 11(4), 427–444. https://doi.org/10.1214/aoms/1177731829.

    Article  Google Scholar 

  34. 34.

    The American Association for Public Opinion Research. (2015). Standard definitions: Final dispositions of case codes and outcome rates for surveys. (8th ed.). AAPOR.

    Google Scholar 

  35. 35.

    Saracino, R., Kolva, E., Rosenfeld, B., & Breitbart, W. (2015). Measuring social support in patients with advanced medical illnesses: An analysis of the Duke-UNC functional social support questionnaire. Palliative Support Care, 13(5), 1153–1163. https://doi.org/10.1017/s1478951514000996.

    Article  Google Scholar 

  36. 36.

    Centers for Disease Control and Prevention. (2011). National Center for Chronic Disease Prevention and Health Promotion: Behavioral Risk Factor Surveillance System. . Centers for Disease Control and Preventio.

    Google Scholar 

  37. 37.

    Willet, M. N., Hayes, D. K., Zaha, R. L., & Fuddy, L. J. (2012). Social-emotional support, life satisfaction, and mental health on reproductive age women’s health utilization, US, 2009. Materneral Child Health Journal, 16(Suppl 2), 203–212. https://doi.org/10.1007/s10995-012-1096-6.

    Article  Google Scholar 

  38. 38.

    Ayers, T. S., Sandier, I. N., West, S. G., & Roosa, M. W. (1996). A dispositional and situational assessment of children’s coping: Testing alternative models of coping. Journal of Personality, 64(4), 923–958. https://doi.org/10.1111/j.1467-6494.1996.tb00949.x.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Buchwald, D., Goldberg, J., Noonan, C., Beals, J., & Manson, S. (2005). Relationship between post-traumatic stress disorder and pain in two American Indian tribes. Pain Medicine, 6(1), 72–79. https://doi.org/10.1111/j.1526-4637.2005.05005.x.

    Article  PubMed  Google Scholar 

  40. 40.

    Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15(3), 194–200. https://doi.org/10.1080/10705500802222972.

    Article  PubMed  Google Scholar 

  41. 41.

    Prins, A., & Ouimette, P. (2004). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9, 151–151.

    Article  Google Scholar 

  42. 42.

    Centers for Disease Control and Prevention. (2000). Measuring healthy days. . CDC.

    Google Scholar 

  43. 43.

    Moriarty, D. G., Kobau, R., Zack, M. M., & Zahran, H. S. (2005). Tracking healthy days: A window on the health of older adults. Preventing Chronic Disease, 2(3), A16.

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Zahran, H. S., Kobau, R., Moriarty, D. G., Zack, M. M., Holt, J., & Donehoo, R. (2005). Health-related quality of life surveillance–United States, 1993–2002. MMWR Surveillance Summaries, 54(4), 1–35.

    Google Scholar 

  45. 45.

    Holt, R., & Kalra, S. (2013). A new DAWN: Improving the psychosocial management of diabetes. Indian Journal of Endocrinology and Metabolism, 17(7), 95–99. https://doi.org/10.4103/2230-8210.119515.

    Article  Google Scholar 

  46. 46.

    Schure, M. B., Odden, M., & Goins, R. T. (2013). The association of resilience with mental and physical health among older American Indians: The Native Elder Care Study. American Indian Alaska Native Mental Health Research, 20(2), 27–41. https://doi.org/10.5820/aian.2002.2013.27.

    Article  PubMed  Google Scholar 

  47. 47.

    Zamora-Kapoor, A., Sinclair, K., Nelson, L., Lee, H., & Buchwald, D. (2019). Obesity risk factors in American Indians and Alaska Natives: A systematic review. Public Health, 174, 85–96. https://doi.org/10.1016/j.puhe.2019.05.021.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Grandbois, D. M., & Sanders, G. F. (2009). The resilience of Native American elders. Issues in Mental Health Nursing, 30(9), 569–580. https://doi.org/10.1080/01612840902916151.

    Article  PubMed  Google Scholar 

  49. 49.

    Denham, A. R. (2008). Rethinking historical trauma: Narratives of resilience. Transcultural Psychiatry, 45(3), 391–414. https://doi.org/10.1177/1363461508094673.

    Article  PubMed  Google Scholar 

  50. 50.

    Stumblingbear-Riddle, G., & Romans, J. S. (2012). Resilience among urban American Indian adolescents: Exploration into the role of culture, self-esteem, subjective well-being, and social support. American Indian Alaska Native Mental Health Research, 19(2), 1–19. https://doi.org/10.5820/aian.1902.2012.1.

    Article  PubMed  Google Scholar 

  51. 51.

    Vancampfort, D., Rosenbaum, S., Ward, P. B., Steel, Z., Lederman, O., Lamwaka, A. V., et al. (2016). Type 2 diabetes among people with posttraumatic stress disorder: Systematic review and meta-analysis. Psychosomatic Medicine, 78(4), 465–473. https://doi.org/10.1097/psy.0000000000000297.

    Article  PubMed  Google Scholar 

  52. 52.

    Moons, P., Budts, W., & De Geest, S. (2006). Critique on the conceptualisation of quality of life: A review and evaluation of different conceptual approaches. International Journal of Nursing Studies, 43(7), 891–901. https://doi.org/10.1016/j.ijnurstu.2006.03.015.

    Article  PubMed  Google Scholar 

  53. 53.

    Strine, T. W., Chapman, D. P., Balluz, L. S., Moriarty, D. G., & Mokdad, A. H. (2008). The associations between life satisfaction and health-related quality of life, chronic illness, and health behaviors among U.S. community-dwelling adults. Journal of Community Health, 33(1), 40–50. https://doi.org/10.1007/s10900-007-9066-4.

    Article  PubMed  Google Scholar 

  54. 54.

    Rosella, L. C., Fu, L., Buajitti, E., & Goel, V. (2018). Death and chronic disease risk associated with poor life satisfaction: A population-based cohort study. American Journal of Epidemiology, 188(2), 323–331. https://doi.org/10.1093/aje/kwy245.

    Article  PubMed Central  Google Scholar 

  55. 55.

    Haynes, S., Richard, D., & Kubany, E. (1995). Content validity in psychological assessment: A functional approach to concepts and methods. Psychological Assessment, 7, 238–247. https://doi.org/10.1037/1040-3590.7.3.238.

    Article  Google Scholar 

  56. 56.

    Pew Research Center. (2017). What low response rates mean for telephone surveys. . Pew Research Center.

    Google Scholar 

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Acknowledgements

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). https://doi.org/10.1007/s11136-021-02830-4

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Keywords

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