Serious Psychological Distress and Diabetes: A Review of the Literature

In 2002, Kessler et al developed a measure of serious psychological distress (SPD).  Therefore, it is now possible to study the association of SPD and diabetes outcomes and processes of care.

This literature review was undertaken for the period of 2010 to 2011, and it noted the following about SPD and diabetes outcomes and processes of care:

Prevalence of SPD in People with Diabetes
The prevalence of SPD is estimated at 7.6% in people with diabetes; in the general population, it’s 3.6%.

Factors that Increase Likelihood of SPD in People with Diabetes
There was significant correlation between SPD and diabetes when considering the following factors:  younger age, lower education level, low household income, obesity, smoking, no physical activity in leisure time, presence of at least one microvascular or macrovascular diabetes complication, and disability.

Conclusions about SPD and Diabetes
The literature reviewed suggests that SPD does have a significant negative impact on diabetes outcomes and processes of care.  Since the development of the SPD measure is relatively recent, there isn’t sufficient data to understand this relationship or the long-term impact of SPD on diabetes.  The authors recommend additional research in the clinical setting and using large administrative datasets in order to better understand SPD and its effect on diabetes.

Commentary by Leonard E. Egede MD, MS

The article reviewed the literature on the relationship between serious psychological distress and diabetes outcomes and found that SPD was associated with poor outcomes similar to what obtains for depression. Within mental health, serious psychological distress (SPD) has recently received increased attention with respect to its impact on health outcomes. SPD is a nonspecific measure of psychological distress and typically involves presence of at least 1 psychiatric disorder or its major symptoms, such as major depressive disorder, generalized anxiety disorder, or schizophrenia, with concomitant impairment in functioning [19]. Unlike depression, it captures global psychological distress that is serious enough to impair functioning. What this review article shows is that SPD has detrimental effects on diabetes outcomes and need to be taken into account in clinical encounters. More research is needed to understand how the effect of SPD differs from that of depression and whether reducing overall psychological distress will lead to improvements in outcomes for diabetes.