Psychosocial Factors and Complications of IDDM. The Pittsburgh Epidemiology of Diabetes Complications Study. VIII

Abstract

Objective — To investigate whether psychosocial factors are associated with diabetic complications. Research Design and Methods — Questionnaires on quality of life, depressive symptomatology, and personality type were completed and a clinical assessment was performed. The study population was an incident cohort of childhood-onset insulin-dependent diabetic (IDDM) subjects whose duration of IDDM was ≥ 25 yr (n = 175). Results — Patients with macrovascular disease (P < 0.01) or nephropathy (P < 0.05) reported significantly poorer quality of life compared with those who were free from all complications. Patients with macrovascular disease also reported greater depressive symptomatology (P < 0.05). Quality of life significantly deteriorated according to the presence of multiple (≥ 4) complications (P < 0.001). Higher depression symptom scores were also related to the presence of ≥4 complications (P < 0.001). Those with multiple complications reported less type A behavior than those without any complications (P < 0.05). Conclusions — This study shows that psychosocial differences exist according to both the number and the type of diabetic complications present. Because poorer quality of life and symptoms of depression may both result form complications, prospective follow-up is needed to clarify their temporal interrelationships, and to determine whether type A personality affords any protection against complications or is diminished as a result of developing complications.