Abstract
This study aimed at investigating the relation between psychological distress, diabetes-related health behavior, and metabolic aspects of diabetes. Fifty-one adult patients with type I diabetes mellitus took part in the study. Psychological status, health, and self-care behavior were assessed by means of questionnaires. Level of glycosylated hemoglobin (HbAtc) served as the index of metabolic control. Depression was slightly elevated among women as was trait anxiety and blood-injury phobia or fear of medical interventions in all patients. Depression and anxiety were not related to duration of diabetes or presence of diabetes complications. As could be expected, patients who frequently checked their blood glucose level had a significantly lower level of HbAtc than those with infrequent checks. Patients with a marked blood-injury phobia carried out fewer daily checks of blood glucose level than those without, but blood-injury phobia was not directly related to HbAtc. level. A higher level of HbAtc was, however, associated with mood deterioration. As depression was not related to health behavior, its effect on metabolic control is likely to be mediated via endocrine rather than behavioral variables.
Similar content being viewed by others
References
Carroll, B. J., Feinberg, M., Greden, J. F., Tarika, J., Alhala, A., Haskett, R., James, N., Kronfol, Z., Lohr, N., Steiner, M., deVigne, J., & Young, E. (1981). A specific laboratory test for the diagnosis of melancholia. Archives of General Psychiatry, 38, 15–22.
Conget, J. I., Esmatjes, E., Ferrer, J., DePablo, J., & Gomis, R. (1990). Emotional side effects of diabetes educational program [Letter]. Diabetes Care, 13, 901–902.
Eiser, C., Flynn, M., Green, E., Havermans, T., Kirby, R., Sandeman, D., & Tooke, J. E. (1992). Quality of life in young adults with type 1 diabetes in relation to demographic and disease variables. Diabetic Medicine, 9, 375–378.
Gries, F. A. (1988). Der Kranke mil Diabetes mellitus: Überblick aus klinischer Sicht mit besonderer Berücksichtigung psycholngischer Probleme [The patient with diabetes mellitus: Clinical survey with special reference In psychological problems]. In R. Klu\mann (Ed.), Stoffwechsel: Der Kranke mil Adipositas. Anorexia nervosa, Bulimie, Diabetes mellirus, Gtcht (pp. 77–86). Berlin: Springer.
Halm, W., & Pfingsten, U. (1990). Psychological stress, coping and metabolic control in adults with insulin-dependent diabetes mellitus. Psychotherapie, Psychosomatik, Medizinische Psychologie, 40, 299–306.
Helz, J. W., & Templeton, B. (1990). Evidence of the role of psychosocial factors in diabetes mellilus. A review, American Journal of Psychiatry, 147, 1275–1282.
Jensen, S. B. (1988). Sexual relationship in couples with a diabetic partner. Journal of Sex & Marital Therapy, 11, 259–270.
Kemmer, F. W., Bisping, R., Steingrüber, H. J., Baar, H., Hardtmann, F., Schlaghecke, R., & Berger, M. (1986). Psychological stress and metabolic control in patients with type 1 diabetes mellitus. The New England Journal of Medicine, 314, 1078–1084.
Klorman, R., Weerls, T. C., Hastings, J. E., Melamed, B. G., & Lang, P. J. (1974). Psychometric description of some specific-fear questionnaires. Behavior Therapy, 5, 401–409.
Köpp, W. (1989). Bedeutung seelischer Faktoren bei der Behandlung des Diabetes mellitus. Münchner medizinische. Wochenschrift, 131, 58–62.
Krampen, G. (1981). IPC-Fragebogen zu Kontrollüberzeugungen (“locus of control”) HPC questionnaire of locus of controll (H. Levenson, Trans). Göttingen Hogrel’e.
Kulzer, B. (1992), Psychologische Interventionskonzepte in der Therapie des Diabetes mellitus [Concepts of psychological interventions in diabetes mellilus]. in H. Weber-Falkensammer (Ed.), Psychologische Therapieansätze in der Rehabilitation (pp. 104-l62). Stuttgart: Fischer.
Laux, L., Glanzmann, P., Schaffner, P., & Spielberger, C. D. (1981). Das State-Tratt-Angstinventar [The state-trait inventory of anxrely]. Weinheim, Germany Beltz.
Lehrl, S. & Gallwitz, A. (1977). Erlanger Depressions-Skala EDS [The Erlangen depression scale]. Vaterstetten and München: Vless.
Lindsay, S. J. E. (1984). The fear of dental treatment: A critical and theoretical analysis. In S. Rachman (Ed.), Contributions to medical psychology.III, Oxford, England: Pergamon.
Lindsay, S. J. E., & Jackson, C. (1993). The fear of dental treatment in adults: Its nature and management. Psychology and Health, 8, 135–154.
Lilliker, S. L. (1980). Prevalence of diabetes in a manic-depressive population. Comprehensive Psychiatry, 21. 270–275.
Lloyd, C. E., Matthews, K. A., Wing, R. R., & Orchard, T. J. (1992). Psychosocial factors and complications of IDDM. The Pittsburgh epidemiology of diabetes complications study. VIII. Diabetes Care, 15. 166–172.
Lustman, P. J., & Clouse, R. E.(1990). Relationship of psychiatric illness to impotence in men with diabetes. Diabetes Care. 13, 893–895.
Lustman, P. J., Griffith, L. S., & Clouse, R. E. (1988). Depression in adults with diabetes: Results of 5-yr follow-up study. Diabetes Care. 11, 605–612.
Lustman, P. J., Griffith, L. S., Clouse, R. E., & Cryer, P. E. (1986). Psychiatric illness in diabetes mellitus: Relationship to symptoms and glucose control. The Journal of Nervous and Mental Disease. 174. 736–742.
Lustman, P. J., Griffith, L. S., Gavard, J. A., & Clouse, R. E. (1992). Depression in adults with diabetes. Diabetes Care. 15, 1631–1639.
Mazze, R. S., Lucido, D., & Shamoon, H. (1984). Psychological and social correlates of glycemic control. Diabetes Care, 7, 360–366.
Niemeryc, S. J., Speers, M. A., Travis, L. B., & Gary, H. E. (1990). Psychosocial correlates of hemoglobin A lc in young adults with type I diabetes. Journal of psychosomatic Research. 34, 617–627.
Petzold, R. (1984). Sozialmedizinische Aspekte [Aspects of social medicine]. In H. Mehnert & K. Schöffling (Eds.), Diabetologte in Klinik and Praxis (pp. 616–636). Stuttgart: Thieme.
Popkin, M. K.,Callies, A. L., Lentz, R. D., Colon, E. A., & Sutherland, D. E. (1988). Prevalence of major depression, simple phobia, and other psychiatric disorders in patients with long-standing type I diabetes mellitus. Archives of General Psychiatry, 45, 64–68.
Rubin, R. R., & Peyrol, M. (1992). Psychosocial problems and interventions in diabetes. A review of the literature. Diabetes Care, 15. 1640–1657.
Sartory, G., & Brandl, A. (1992). Psychodiagnostische Erfassung von Krebspatienten in der Nachversorgung [Psychological assessment of cancer patients in aftercare]. Zeitschrift für Klinische Psychologic, 21, 239–250.
Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970), STAI manual for the State-Trait Anxiety Inventory. Palo Alto. CA: Consulting Psychologists Press.
Spitzer, W. O., Dobson, A. J., Hall, J., Chesterman, E., Levi, J., Sheperd, R., Battista, R. N., & Catchlove, B. R. (198l). Measuring the quality of life of cancer patients: A concise QL-Index for use by physicians. Journal of Chronic Diseases, 34, 585–597.
Toeller, M. (1990). Diabetesschulung [Teaching in diabetes]. Internist, 31, 208–217
Trence, D. L., Will, T. E., Mensing, C. R., & Lindgren, B. R. (1990). Differences in occurrence of depression among diabetics versus other chronic disease patients [Abstract]. Diabetes, 39(Suppl. 1), 167A.
Turkat, I. D. (1982). Glycosylated hemoglobin levels in anxious and nonanxious diabetic patients. Psychosomatic, 23, 1056–1058.
Waadt, S., Duran, G., & Strian, F. (1993). Psychosocial problems in diabetes mellitus. In C. E. Mogensen & E. Standl (Eds.), Concepts for the ideal diabetes clinic. Diabetes Forum Series (Vol. IV. pp. 361–374). Berlin: de Gruyter.
Waadt, S., Herschbach, P., Duran, G., Henrich, G., Hillebrand, B., & Strian, F. (1992). Entwicklung eines Fragebogens zu Behandlungsproblemen und Therapiezuweisung bei Patienten mit Diabetes mellitus [Developing a questionnaire of treatment problems and the therapeutic interventions in patients with diabetes mellilus]. Praxis der klinischen Verhaltensmedizin und Rehabilitation, 20, 306–312.
Author information
Authors and Affiliations
Additional information
H. Tillil was supported by a grant from the Paul-Kuth-Stiftung, Wuppertal, Germany.
We thank the diabetic patients for participating in the study and the technologists of the Department of Clinical Chemistry of the Ferdinand-Sauerbruch-Klinikum Elberfeld for performing the HbAk determinations. We are indebted to S. Waadt for allowing us to use the questionnaire of daily problems with diabetes and to Gerhard Arminger for his help with the data analysis.
Rights and permissions
About this article
Cite this article
Metsch, J., Tillil, H., Köbberling, J. et al. On the relation among psychological distress, diabetes-related health behavior, and level of glycosylated hemoglobin in type I diabetes. Int. J. Behav. Med. 2, 104–117 (1995). https://doi.org/10.1207/s15327558ijbm0202_2
Issue Date:
DOI: https://doi.org/10.1207/s15327558ijbm0202_2