Correlates of psychological outcomes in people with diabetes: results from the second Diabetes Attitudes, Wishes and Needs (DAWN2™) study. Issue 9 (15th July 2016)

• Record Type: Journal Article
• Authors: Nicolucci, A.; Kovacs Burns, K.; Holt, R. I. G.; Lucisano, G.; Skovlund, S. E.; Kokoszka, A.; Massi Benedetti, M.; Peyrot, M.
• Is Part Of: Diabetic medicine. Volume 33:Issue 9(2016:Sep.)
• Page Start: 1194
• Page End: 1203
• Publication Date: 2016-07-15
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13178
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To assess country‐ and individual‐level correlates of psychological outcomes, and differences among countries in the associations of individual characteristics with psychological outcomes among adults with diabetes. Methods: The second Diabetes Attitudes, Wishes and Needs (DAWN2 ™ ) study assessed self‐reported characteristics of people with diabetes in 17 countries, including 1368 adults with Type 1 diabetes and 7228 with Type 2 diabetes. In each country, a sample of 500 adults, stratified by diabetes type and treatment, completed a questionnaire incorporating the validated WHO‐5 wellbeing index, the WHOQOL‐BREF, and the five‐item Problem Areas in Diabetes Scale, as well as the newly developed Diabetes Impact on Life Dimensions that assessed impact ranging from very positive to very negative, with no impact as the midpoint. Multilevel regression analyses identified significant ( P < 0.05) independent correlates of psychological outcomes. Results: There were significant variations in all outcomes across countries before adjustment for individual‐level factors; adjustment reduced between‐country disparities. Worse psychological outcomes were associated with more complications, incidence of hypoglycaemia, hypoglycaemic medication, perceived burden of diabetes, family conflict and experience of discrimination. Better psychological outcomes were associated with higher self‐rated health, greater access to diabetes education and healthcare, and more psychosocial support from others. The associations of many factors with the outcomes were mediated by modifiable factors. The association of all factors with the outcomes varied across (interacted with) countries, highlighting the need for country‐specific analyses. Conclusions: Improvements in modifiable risk factors (reductions in burden and increases in support) may lead to better psychological outcomes in adults with diabetes. What's new?: The results of this study provide a comprehensive assessment of the risk and protective factors for psychological outcomes among adults with diabetes on a global scale. Modifiable risk/protective factors mediate the impact of demographic and clinical factors on psychological outcomes. Accounting for individual‐level risk and protective factors reduces between‐country disparities in psychological outcomes, but results show that risk/protective factors operate differently in different countries.