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Diabetes-specific distress is defined as the emotional burden experienced by patients that is caused by concerns of disease management, support, and access to care. Distinct from depression, it’s a common condition often mistaken for major depressive disorder (MDD), which is typically treated with medications or a referral for behavioral, psychological, or psychosocial interventions. Unfortunately, many patients who experience diabetes-specific distress without clinical depression don’t benefit from MDD treatments because depression and this type of distress appear to be independent conditions.

Currently, screening for diabetes-specific distress occurs infrequently in clinical practice. In order to evaluate the linkage between this distress and diabetes management, my colleagues and I developed a brief diabetes-specific distress screening instrument for use in clinical settings. In the May/June 2008 Annals of Family Medicine, we published a study that reanalyzed the 17-item Diabetes Distress Scale (DDS17), a previously validated questionnaire that identifies patients with high levels of diabetes-specific distress. Our reanalysis of previous data was performed to extract fewer items that we can use for a screening tool that would be both valid and reliable.

A Shorter Screening Tool

A 2-item Diabetes Distress Screening Scale (DDS2) met stringent criteria for sensitivity and specificity in our investigation. It can effectively screen patients for distress, using the full 17-item scale as a criterion. The DDS2 asks respondents to rate on a 6-point scale the degree to which they feel overwhelmed by their diabetes and the degree to which they feel they’re failing with their diabetes regimens. If patients rate their distress as a 5 or 6 on the DDS2 screener, they should be administered the full-scale DDS17 in order to assure that the condition truly exists. Using the full DDS17 after a positive DDS2 screen is recommended so that clinicians can determine what kinds of specific distress patients are experiencing. In turn, this can direct subsequent interventions.

Diabetes-specific distress occurs in close to 20% of patients with diabetes, compared with MDD, which has been estimated to occur in 10% to 12% of patients with the disease. In light of the high prevalence of each condition, physicians should continue to screen for MDD and pay attention to diabetes-specific distress. It’s likely that distress can impact quality of life and adherence to treatments. Based on our findings, patients with diabetes should be given the DDS2 and should also receive the 2-item screener for clinical depression developed from the Patient Health Questionnaire 9.

Consider the Benefits

Questionnaires do not have to be administered by physicians only; nurses and other providers can help in these efforts. Furthermore, they can be administered in waiting or examination rooms so as not to interfere with busy clinician visits. Patient responses can be reviewed by physicians during visits and a dialogue can be initiated with patients if MDD or diabetes-specific distress is suspected. This conversation should further examine the specific sources of distress or depression in order to potentially improve outcomes. Utilizing helpful questionnaires like the DDS2 can aid clinicians in treating the whole patient by identifying sources of distress and tailoring interventions to address them.

Lawrence Fisher, PhD, ABPP, has indicated to Physician’s Weekly that he has or has had no financial interests to report.