Structural equation modeling of the effects of psychological distress and a fear of coronavirus disease 2019 on diabetes care in Japan

Abstract

Abstract This study aimed to examine the effects of psychological distress and a fear of coronavirus disease 2019 (COVID-19) on diabetes care in Japan. We used data from a 2020 nationwide internet survey in Japan involving 28,000 respondents aged 15–79 years. The question items included psychological factors (Kessler psychological distress scale and fear of COVID-19), employment, trust in neighbors, informal caregiving, and history of diabetes care. After excluding respondents with comorbidities and those who had not visited the hospital, 625 patients with diabetes were analyzed. Statistical mediation was then examined through a path analysis using structural equation modeling. Discontinued diabetes care was independently associated with psychological distress (risk ratio = 1.44, 95% confidence interval [1.01–2.06]) and a fear of COVID-19 (1.41 [1.01–1.95]). The results of the structural equation modeling indicated that a fear of COVID-19, employment, trust in neighbors, and informal caregiving were indirectly associated with continued diabetes care via psychological distress. These findings suggest that a fear of COVID-19 is associated with continued diabetes care via psychological distress. COVID-19 pandemic may affect psychological distress and lead to refrained diabetes care among Japanese patients with diabetes. Moreover, employment, trust in neighbors, and family caregiving were also found to buffer refrained diabetes care. As psychological factors and socioeconomic status can affect diabetes care, a fear of COVID-19 should be considered in patients with diabetes to help ensure the continuation of diabetes treatment.