Cited by 470Diabetes Management and EducationCancer survivorship and careAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision

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Fisher, L., Gonzalez, J. S., Polonsky, W. H.·2014·Diabetic Medicine

DOI 10.1111/dme.12428PMC PMC4065190

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Abstract

Studies have identified significant linkages between depression and diabetes, with depression associated with poor self‐management behaviour, poor clinical outcomes and high rates of mortality. However, findings are not consistent across studies, yielding confusing and contradictory results about these relationships. We suggest that there has been a failure to define and measure ‘depression’ in a consistent manner. Because the diagnosis of depression is symptom‐based only, without reference to source or content, the context of diabetes is not considered when addressing the emotional distress experienced by individuals struggling with diabetes. To reduce this confusion, we suggest that an underlying construct of ‘emotional distress’ be considered as a core construct to link diabetes‐related distress, subclinical depression, elevated depression symptoms and major depressive disorder ( MDD ). We view emotional distress as a single, continuous dimension that has two primary characteristics: content and severity; that the primary content of emotional distress among these individuals include diabetes and its management, other life stresses and other contributors; and that both the content and severity of distress be addressed directly in clinical care. We suggest further that all patients, even those whose emotional distress rises to the level of MDD or anxiety disorders, can benefit from consideration of the content of distress to direct care effectively, and we suggest strategies for integrating the emotional side of diabetes into regular diabetes care. This approach can reduce confusion between depression and distress so that appropriate and targeted patient‐centred interventions can occur.

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Self-citation

Authors: Fisher, L., Gonzalez, J. S., & Polonsky, W. H.
Affiliations: University of California, San Francisco (US)
Albert Einstein College of Medicine (US)
University of California San Diego (US)
Corresponding author: Fisher, L.
ORCID: Fisher, L.
Gonzalez, J. S.
Polonsky, W. H.
Venue: Diabetic Medicine
Publisher: Wiley
Published: 2014-06-18
Volume: 31
Issue: 7
Pages: 764-772
ISSN: 0742-3071 (ISSN-L)
1464-5491
DOI: 10.1111/dme.12428
PMC: PMC4065190
OpenAlex: W2036323100
Cited by: 470
References: 49
Citations by year: 2026: 47 · 2025: 30 · 2024: 34 · 2023: 36 · 2022: 32 · 2021: 40 · 2020: 43 · 2019: 45 · 2018: 45 · 2017: 44 · 2016: 27 · 2015: 32 · 2014: 14
FWCI: 6.19
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Diabetic Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (DK094863)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: diabetes distress, depression, emotional distress, major depressive disorder, subthreshold depression, diabetes self-management, anxiety disorders, patient-centered care
MeSH terms: Affect, Anxiety, Depression, Diabetes Mellitus, Emotions, Humans, Self Care, Severity of Illness Index, Medication Adherence

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The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision

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