Cited by 664Diabetes Management and EducationPsychometric Methodologies and TestingHealth Education and Validation

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The Problem Areas in Diabetes Scale: An evaluation of its clinical utility

Welch, Garry W, Jacobson, Alan M, Polonsky, William H·1997·Diabetes Care

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Abstract

OBJECTIVE: To evaluate the reliability and concurrent and discriminant validity of the Problem Areas in Diabetes (PAID) scale, a new measure of emotional functioning in diabetes. RESEARCH DESIGN AND METHODS: A battery of questionnaires, including the PAID, was completed by 256 volunteer diabetic outpatients. In our analyses, we examined the PAID's internal structure and compared mean IDDM and NIDDM treatment group scores in regression analyses to explore its discriminant validity. We also evaluated concurrent validity from the correlations between the PAID and diabetes-specific measures of coping and health attitudes and HbA1c. RESULTS: Principal component analyses identified a large emotional adjustment factor, supporting the use of the total score. Significant sizable correlations were found between the PAID and a range of selected health attitudinal measures. There were significant differences (with small-to-moderate effect sizes) in PAID scores between IDDM and NIDDM patients and between IDDM and NIDDM insulin- and tablet-treated subgroups; no differences were found between NIDDM insulin- and tablet-treated subgroups. CONCLUSIONS: The study findings provided support for the construct validity of the PAID, including evidence for discriminant validity from its ability to detect differences between IDDM and NIDDM treatment groups expected to differ in the emotional impact of life with diabetes. Future studies should explore the PAID's performance in nonspecialist treatment settings as well as its responsiveness to clinical change.

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Items 101–200 of 663

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High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy
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“01 Reason for completion TP, No (%) Positive pancreatic margin 42 (49) Technical issues 23 (27) Vascular resection/reconstruction 12 (14) Other 9 (10) Pancreatic anastomosis, no.”
Background
Impact of Improved Glycemic Control on Quality of Life in Patients with Diabetes
Jacobson, A. M. (2004) · Endocrine Practice · doi:10.4158/ep.10.6.502 · Cited by 78
Self-citation
Psychometric properties of the parent and child problem areas in diabetes measures
Evans, M. A., Weil, L. E. G., Shapiro, J. B., Anderson, L. M., Vesco, A. T., Rychlik, K., Hilliard, M. E., Antisdel, J., & Weissberg-Benchell, J. (2019) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsz018 · Cited by 75
Specific cognitive abilities are associated with diabetes self-management behavior among patients with type 2 diabetes
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Psychosoziales und Diabetes (Teil 1)
Kulzer, B., Albus, C., Herpertz, S., Kruse, J., Lange, K., Lederbogen, F., & Petrak, F. (2013) · Diabetologie und Stoffwechsel · doi:10.1055/s-0033-1335785 · Cited by 79
The association of depressive symptoms and diabetes distress with glycaemic control and diabetes complications over 2 years in newly diagnosed type 2 diabetes: a prospective cohort study
Ismail, K., Moulton, C. D., Winkley, K., Pickup, J. C., Thomas, S. M., Sherwood, R. A., Stahl, D. R., & Amiel, S. A. (2017) · Diabetologia · doi:10.1007/s00125-017-4367-3 · Cited by 82
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“For example, patients often feel high levels of diabetes-related emotional distress, resulting in diabetes care “burnout” (1).”
Background
Subjective sleep impairment in adults with type 1 or type 2 diabetes: Results from Diabetes MILES—The Netherlands
Nefs, G., Donga, E., Someren, E. J. W. V., Bot, M., Speight, J., & Pouwer, F. (2015) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2015.07.008 · Cited by 76
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Self-citation
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Lamers, F., Jonkers, C. C. M., Bosma, H., Knottnerus, J. A., & van Eijk, J. T. M. (2011) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2010.05540.x · Cited by 72
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“This 20-item questionnaire assesses a wide range of feelings related to living with diabetes and diabetes treatment [28, 29].”
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“The questionnaire is valuable as a clinical and an outcome measure to identify diabetes-related distress and to assess psychological adjustment to diabetes (Welch et al., 1997).”
BackgroundResult
Internet use among primary care patients with type 2 diabetes
Grant, R. W., Cagliero, E., Chueh, H. C., & Meigs, J. B. (2005) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.04239.x · Cited by 68
“2 Blood pressure, mm Hg (SD) 129 (15)/77 (9) 134 (17)/75 (10) o.”
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Stuckey, H. L., Dellasega, C. A., Graber, N. J., Mauger, D. T., Lendel, I., & Gabbay, R. A. (2009) · Contemporary Clinical Trials · doi:10.1016/j.cct.2009.03.002 · Cited by 69
“To evaluate patient outcomes, five surveys were used: (a) the Audit of Diabetes Dependent Quality of Life (ADDQoL) [47]; (b) the Problem Areas in Diabetes (PAID) scale [48,49]; (c) the Diabetes Treatment Satisfaction Questionnaire (DTSQ) [50,51]; (d) the Summary of Diabetes Self Care Activities (SDSCA) [52]; and (e) a…”
Method
A culturally competent intervention of education and care for black women with type 2 diabetes.
D'Eramo-Melkus, G., Spollett, G., Jefferson, V., Chyun, D., Tuohy, B., Robinson, T., & Kaisen, A. (2004) · Applied Nursing Research · doi:10.1016/j.apnr.2003.10.009 · Cited by 74
Impact of Endocrine and Exocrine Insufficiency on Quality of Life After Total Pancreatectomy
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“Assessment of diabetes-specific emotional distress Diabetesspecific emotional distress was assessed using the Dutch version of the PAID survey [ 34 , 35].”
Method
Understanding Physicians’ Challenges When Treating Type 2 Diabetic Patients’ Social and Emotional Difficulties
Beverly, E. A., Hultgren, B. A., Brooks, K. M., Ritholz, M. D., Abrahamson, M. J., & Weinger, K. (2011) · Diabetes Care · doi:10.2337/dc10-2298 · Cited by 65
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Browne, J. L., Scibilia, R., & Speight, J. (2012) · Diabetic Medicine · doi:10.1111/dme.12078 · Cited by 63
“Inconsistent with previous research, distress scores did not differ significantly between those using insulin and those not using insulin (24).”
BackgroundResult
Attributing discrimination to weight: associations with well-being, self-care, and disease status in patients with type 2 diabetes mellitus
Potter, L. N., Wallston, K. A., Trief, P. M., Ulbrecht, J. S., Juth, V., & Smyth, J. M. (2015) · Journal of Behavioral Medicine · doi:10.1007/s10865-015-9655-0 · Cited by 71
“…that this measure has high concurrent validity with scales assessing constructs related to PAID (e.g. diabetes coping, diabetes social support; Welch et al., 1997) Self-care—Participants' diabetes self-care behavior was measured using the Summary of Diabetes Self-Care Activities (SDSCA;…”
Effect of device-guided breathing exercises on blood pressure in hypertensive patients with type 2 diabetes mellitus: a randomized controlled trial
Logtenberg, S. J. J., Kleefstra, N., Houweling, S. T., Groenier, K. H., & Bilo, H. J. G. (2006) · Journal of Hypertension · doi:10.1097/hjh.0b013e32801040d5 · Cited by 63
“Reliability and validity are good for both the US and Dutch situations [ 16 ,17].”
Background
Precision medicine in type 1 diabetes
Carr, A. L. J., Evans‐Molina, C., & Oram, R. A. (2022) · Diabetologia · doi:10.1007/s00125-022-05778-3 · Cited by 69
“Although there are established measures of diabetes distress, including the Problem Areas in Diabetes scale [140] and the Diabetes Distress Scale [141], these emotional issues are frequently not integrated into care.”
Background
Coping styles among adults with Type 1 and Type 2 diabetes
Karlsen, B., & Bru, E. (2002) · Psychology Health & Medicine · doi:10.1080/13548500220139403 · Cited by 62
“Active coping skills may be developed or enhanced through training, leading people with diabetes to the opposite direction from those who cope passively, and thus reinforcing an active approach to coping (Welch et al., 1997).”
Background
What is the best measure for assessing diabetes distress? A comparison of the Problem Areas in Diabetes and Diabetes Distress Scale: results from Diabetes MILES–Australia
Fenwick, E., Rees, G., Holmes‐Truscott, E., Browne, J. L., Pouwer, F., & Speight, J. (2016) · Journal of Health Psychology · doi:10.1177/1359105316642006 · Cited by 62
“The PAID has been shown to have high internal and test– retest reliability and to correlate strongly with general emotional distress, depression, selfcare behaviours, coping, and health beliefs (Polonsky et al., 1995; Welch et al., 1997).”
Background
Unraveling the concepts of distress, burnout, and depression in type 1 diabetes: A scoping review
Kiriella, D. A., Islam, S., Oridota, O., Sohler, N., Dessenne, C., de Beaufort, C. E., Fagherazzi, G., & Aguayo, G. (2021) · EClinicalMedicine · doi:10.1016/j.eclinm.2021.101118 · Cited by 68
The association between quality of life, depressive symptoms and glycemic control in a group of type 2 diabetes patients
Papelbaum, M., Lemos, H. M., Duchesne, M., Kupfer, R., Moreira, R. O., & Coutinho, W. F. (2010) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2010.05.024 · Cited by 61
Factors that affect health outcomes in adults with type 2 diabetes: A cross-sectional study
Huang, M., Courtney, M., Edwards, H. E., & McDowell, J. (2009) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2009.10.012 · Cited by 60
“95 (Watkins and Connell, 2004; Welch et al., 1997).”
How severe is diabetes after total pancreatectomy? A case-matched analysis
Roberts, K. J., Blanco, G., Webber, J., Marudanayagam, R., Sutcliffe, R. P., Muiesan, P., Bramhall, S. R., Isaac, J., & Mirza, D. F. (2013) · HPB · doi:10.1111/hpb.12203 · Cited by 60
“A diabetes-specific questionnaire using the Problem Areas in Diabetes (PAID) scale was used to assess diabetes-specific outcomes.(22,23) HbA1c levels are reported in mmol/mol.”
Method
Instrumentos de avaliação de qualidade de vida relacionada à saúde no diabetes melito
Aguiar, C. C. T., Vieira, A. P. G. F., Carvalho, A. F., et al. (2008) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302008000600004 · Cited by 60
“Sua consistência interna (alfa de Cronbach) estudada foi de 0,95 (59).”
Measurement of diabetes-related emotional distress using the Problem Areas in Diabetes scale: psychometric evaluations show that the short form is better than the full form
Lee, E., Lee, Y. W., Lee, K. W., Kim, Y., & Nam, M. (2014) · Health and Quality of Life Outcomes · doi:10.1186/s12955-014-0142-z · Cited by 59
Perceptions of support, diabetes-related coping and psychological well-being in adults with type 1 and type 2 diabetes
Karlsen, B., Idsøe, T., Hanestad, B., et al. (2003) · Psychology Health & Medicine · doi:10.1080/13548500310001637751 · Cited by 59
“…cover different coping styles relevant for the management of diabetes, this scale combines subscales from the Diabetes Coping Measure (Welch, 1994; Welch et al., 1997), subscales from the COPE scale (Carver et al., 1989), one subscale from the Ways of Coping Questionnaire (Folkman & Lazarus,…”
Method
How to identify clinically significant diabetes distress using the Problem Areas in Diabetes (PAID) scale in adults with diabetes treated in primary or secondary care? Evidence for new cut points based on latent class analyses
de Wit, M., Pouwer, F., & Snoek, F. J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056304 · Cited by 60
Controlled Trial of Nursing Interventions to Improve Health Outcomes of Older African American Women With Type 2 Diabetes
Skelly, A. H., Carlson, J., Leeman, J., Soward, A. C. M., & Burns, D. (2009) · Nursing Research · doi:10.1097/nnr.0b013e3181bee597 · Cited by 58
Quality of Life, Wishes, and Needs in Women with Gestational Diabetes: Italian DAWN Pregnancy Study
Lapolla, A., Cianni, G. D., Benedetto, A. D., Franzetti, I. G., Napoli, A., Sciacca, L., Torlone, E., Tonutti, L., Vitacolonna, E., & Mannino, D. (2012) · International Journal of Endocrinology · doi:10.1155/2012/784726 · Cited by 57
“The diagnosis of a chronic disease, for example, diabetes mellitus, may generate anxiety [5]; this is especially true for women who received the diagnosis of diabetes during their pregnancy [6, 7].”
Background
Can sharing experiences in groups reduce the burden of living with diabetes, regardless of glycaemic control?
Due‐Christensen, M., Zoffmann, V., Hommel, E. E., & Lau, M. C. C. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03521.x · Cited by 54
Diabetes distress in males and females with type 1 diabetes in adolescence and emerging adulthood
Lašaitė, L., Dobrovolskienė, R., Danytė, E., Stankutė, I., Ražanskaitė-Virbickienė, D., Schwitzgebel, V., Marčiulionytė, D., & Verkauskienė, R. (2016) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2016.08.013 · Cited by 62
“…other authors have found conflicting results, with some confirming the original single-factor structure (Huang, Courtney, Edwards, & McDowell, 2010; Welch et al., 1997), and others identifying multiple subdimensions (Amsberg, Wredling, Lins, Adamson, & Johansson, 2008; Miller & Elasy, 2008; Snoek,…”
Result
A Team-Based Online Game Improves Blood Glucose Control in Veterans With Type 2 Diabetes: A Randomized Controlled Trial
Kerfoot, B. P., GAGNON, D. R., McMahon, G. T., Orlander, J. D., Kurgansky, K. E., & Conlin, P. R. (2017) · Diabetes Care · doi:10.2337/dc17-0310 · Cited by 60
“In addition, patients completed two online questionnaires: an 8-item Diabetes Empowerment Scale (DES) Short Form (23) and 20-item Problem Areas in Diabetes (PAID) questionnaire (24), at baseline, 6 months, and 12 months.”
Method
Using Mobile Health to Improve Social Support for Low-Income Latino Patients with Diabetes: A Mixed-Methods Analysis of the Feasibility Trial of TExT-MED + FANS
Burner, E., Lam, C. N., DeRoss, R., Kagawa‐Singer, M., Menchine, M. D., & Arora, S. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2017.0198 · Cited by 55
Long-term effectiveness of a type 2 diabetes comprehensive care program. The CAIPaDi model
Hernández-Jiménez, S. C., García-Ulloa, A. C., Bello‐Chavolla, O. Y., Aguilar-Salinas, C. A., & Kershenobich, D. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.04.009 · Cited by 57
Improving self‐management in insulin‐treated adults participating in diabetes education. The role of overprotection by the partner
Hagedoorn, M., Keers, J. C., Links, T., Bouma, J., ter Maaten, J. C., & Sanderman, R. (2006) · Diabetic Medicine · doi:10.1111/j.1464-5491.2006.01794.x · Cited by 55
Improved transition to adult care in youth with type 1 diabetes: a pragmatic clinical trial
Butalia, S., Crawford, S. G., McGuire, K. A., Dyjur, D., Mercer, J., & Pacaud, D. (2021) · Diabetologia · doi:10.1007/s00125-020-05368-1 · Cited by 59
Are spouses of chronically ill partners burdened by exerting health-related social control?
August, K. J., Rook, K. S., Stephens, M. A. P., & Franks, M. M. (2011) · Journal of Health Psychology · doi:10.1177/1359105311401670 · Cited by 55
“Six items from a spouse version of the Problem Areas in Diabetes (PAID) scale (Welch et al., 1997) were used to assess spouse burden.”
Method
Barriers towards insulin therapy in type 2 diabetic patients: results of an observational longitudinal study
Hermanns, N., Mahr, M., Kulzer, B., Skovlund, S. E., & Haak, T. (2010) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-8-113 · Cited by 56
“The original scale has proved its validity and reliability [13].”
Background
Telephone-delivered lifestyle support with action planning and motivational interviewing techniques to improve rehabilitation outcomes.
Döbler, A., Belnap, B. H., Pollmann, H., Farin‐Glattacker, E., Raspe, H. H., & Mittag, O. (2018) · Rehabilitation Psychology · doi:10.1037/rep0000224 · Cited by 58
Validation of the Polish version of WHO-5 as a screening instrument for depression in adults with diabetes
Cichoń, E., Kiejna, A., Kokoszka, A., Gondek, T. M., Rajba, B., Lloyd, C. E., & Sartorius, N. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.107970 · Cited by 64
“The PAID scale [19] consists of 20 statements regarding the existence of negative states commonly experienced by people with diabetes (e.g. “worrying about the future and the possibility of serious complications”).”
BackgroundMethodInfluential
Adults With Diabetes Distress Often Want to Talk With Their Health Professionals About It: Findings From an Audit of 4 Australian Specialist Diabetes Clinics
Hendrieckx, C., Halliday, J. A., Russell‐Green, S., Cohen, N. D., Colman, P. G., Jenkins, A. J., O'Neal, D. N., & Speight, J. (2020) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2020.02.004 · Cited by 54
Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial.
van Son, J., Nyklíček, I., Pop, V. J., & Pouwer, F. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-131 · Cited by 55
“PAID scores are transformed to a 0-100 scale, to facilitate interpretation [45].”
BackgroundInfluential
Effect of switching from intermittently scanned to real-time continuous glucose monitoring in adults with type 1 diabetes: 24-month results from the randomised ALERTT1 trial
Visser, M. M., Charleer, S., Fieuws, S., Block, C. E. M. D., Hilbrands, R., Huffel, L. V., Maes, T., Vanhaverbeke, G., Dirinck, E. L., Myngheer, N., et al. (2023) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(22)00352-7 · Cited by 53
Effects of an Aquatic‐Based Exercise Program to Improve Cardiometabolic Profile, Quality of Life, and Physical Activity Levels in Men With Type 2 Diabetes Mellitus
Cugusi, L., Dessalvi, C. C., Nocco, S., Fabio, O., Bandino, S., Deidda, M., Caria, A., Bassareo, P. P., Piras, A., Cabras, S., et al. (2014) · PM&R · doi:10.1016/j.pmrj.2014.09.004 · Cited by 60
Long‐term effects of very low‐carbohydrate and high‐carbohydrate weight‐loss diets on psychological health in obese adults with type 2 diabetes: randomized controlled trial
Brinkworth, G. D., Luscombe‐Marsh, N. D., Thompson, C. H., Noakes, M., Buckley, J. D., Wittert, G., & Wilson, C. J. (2016) · Journal of Internal Medicine · doi:10.1111/joim.12501 · Cited by 58
Psychosoziales und Diabetes (Teil 2)
Kulzer, B., Albus, C., Herpertz, S., Kruse, J., Lange, K., Lederbogen, F., & Petrak, F. (2013) · Diabetologie und Stoffwechsel · doi:10.1055/s-0033-1335889 · Cited by 55
The Epidemiology of Depression and Diabetes Distress in Type 2 Diabetes in Kuwait
Al‐Ozairi, E., Al-Ozairi, A., Blythe, C., Taghadom, E., & Ismail, K. (2020) · Journal of Diabetes Research · doi:10.1155/2020/7414050 · Cited by 54
“The PAID is a measure of a person ’ s emotional adjustment in response to living with diabetes [15].”
Factors associated with psychological distress, behavioral impact and health-related quality of life among patients with type 2 diabetes mellitus
Co, M. A., Tan, L. S. M., Tai, E. S., Griva, K., Mohamed, A., Chong, K. J., Lee, Y. S., Lee, J., Khoo, E. Y.-H., & Wee, H. L. (2015) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2015.01.009 · Cited by 54
“ThePAIDwaspositively correlatedwithHbA1c (Polonsky, 1995; Reddy, 2013; Tsujii, Hayashino, Ishii, &Diabetes, 2012) and has the ability to discriminate between those who were insulin treated from thosewho received oralmedications (Welch, 1997).”
Background
Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes
Heller, S. R., Lawton, J., Amiel, S. A., Cooke, D. D., Mansell, P., Brennan, A., Elliott, D., Boote, J. D., Emery, C., Baird, W. O., et al. (2014) · Programme Grants for Applied Research · doi:10.3310/pgfar02050 · Cited by 55
Effectiveness of psychoeducational interventions for the treatment of diabetes-specific emotional distress and glycaemic control in people with type 2 diabetes: A systematic review and meta-analysis
Perrin, N., Bodicoat, D. H., Davies, M. J., Robertson, N., Snoek, F. J., & Khunti, K. (2019) · Primary care diabetes · doi:10.1016/j.pcd.2019.04.001 · Cited by 58
The association between types of eating behaviour and dispositional mindfulness in adults with diabetes. Results from Diabetes MILES. The Netherlands
Tak, S. R., Hendrieckx, C., Nefs, G., Nyklíček, I., Speight, J., & Pouwer, F. (2015) · Appetite · doi:10.1016/j.appet.2015.01.006 · Cited by 51
COllaborative open platform E-cohorts for research acceleration in trials and epidemiology
Tran, V.-T., & Ravaud, P. (2020) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.04.021 · Cited by 51
Changes in Diabetes Distress Related to Participation in an Internet-Based Diabetes Care Management Program and Glycemic Control
Fonda, S. J., McMahon, G. T., Gomes, H. E., Hohne, S. H., & Conlin, P. R. (2009) · Journal of Diabetes Science and Technology · doi:10.1177/193229680900300113 · Cited by 54
Cost and benefits of a multidisciplinary intensive diabetes education programme
Keers, J. C., Groen, H., Sluiter, W. J., Bouma, J., & Links, T. P. (2005) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2005.00536.x · Cited by 52
“The Problem Areas in Diabetes questionnaire (PAID) ( Welch et al . 1997; Snoek et al . 2000) mea-”
The relationship between diabetes-related distress and clinical variables and perceived support among adults with type 2 diabetes: A prospective study
Karlsen, B., & Bru, E. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2013.06.016 · Cited by 53
“…demonstrated the PAID to display good psychometric properties and to correlate strongly with a wide range of theoretically related constructs such as for example general emotional distress, depression and diabetes self-care behavior (Polonsky et al., 1995; Snoek et al., 2000a; Welch et al., 1997).”
BackgroundMethodResultInfluential
Psychosocial Factors and Diabetes Mellitus: Evidence-Based Treatment Guidelines
Petrak, F., Herpertz, S., Albus, C., Hirsch, A., Kulzer, B., & Kruse, J. (2005) · Current Diabetes Reviews · doi:10.2174/157339905774574329 · Cited by 51
Empowerment in diabetes care: towards measuring empowerment
Sigurðardóttir, Á. K., & Jónsdóttir, H. (2008) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.2007.00506.x · Cited by 51
Neuropathy and presence of emotional distress and depression in longstanding diabetes: Results from the Canadian study of longevity in type 1 diabetes
Bai, J.-W., Lovblom, L. E., Cardinez, M., Weisman, A., Farooqi, M. A., Halpern, E. M., Boulet, G., Eldelekli, D., Lovshin, J. A., Lytvyn, Y., et al. (2017) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2017.05.002 · Cited by 54
Glycemic control, depression, diabetes distress among adolescents with type 1 diabetes: effects of sex, race, insurance, and obesity
Hong, K. M. C., Glick, B. A., Kamboj, M. K., & Hoffman, R. P. (2021) · Acta Diabetologica · doi:10.1007/s00592-021-01768-w · Cited by 54
ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes
Limbert, C., Tinti, D., Malik, F. S., Kosteria, I., Messer, L. H., Jalaludin, M. Y., Benitez‐Aguirre, P., Biester, S., Corathers, S. D., von Sengbusch, S., et al. (2022) · Pediatric Diabetes · doi:10.1111/pedi.13417 · Cited by 59
Patient-reported outcomes for people with diabetes: what and how to measure? A narrative review
Terwee, C. B., Elders, P. J. M., Blom, M. T., Beulens, J. W. J., Rolandsson, O., Rogge, A. A., Rose, M., Harman, N., Williamson, P. R., Pouwer, F., et al. (2023) · Diabetologia · doi:10.1007/s00125-023-05926-3 · Cited by 54
Individual mindfulness-based cognitive therapy for people with diabetes: a pilot randomized controlled trial
Schroevers, M. J., Tovote, K. A., Keers, J. C., Links, T. P., Sanderman, R., & Fleer, J. (2015) · Mindfulness · doi:10.1007/s12671-013-0235-5 · Cited by 50
“It has been reported that the PAID has high internal consistency, good construct validity, and is sensitive to changes over time (Welch et al. 1997; Welch et al. 2003).”
Background
Are benefits from diabetes self-management education sustained?
Sperl‐Hillen, J. M., Beaton, S. J., Fernandes, O. D., Worley, A. V., Vazquez‐Benitez, G., Hanson, A. M., Lavin-Tompkins, J. M., Parsons, W., Adams, K., & Spain, C. V. (2013) · PubMed · Cited by 51
Feasibility of yoga as a complementary therapy for patients with type 2 diabetes: The Healthy Active and in Control (HA1C) study
Bock, B. C., Thind, H. K., Fava, J. L., DUNSIGER, S. I., Guthrie, K. M., Stroud, L. R., Gopalakrishnan, G., Sillice, M. A., & Wu, W. (2018) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2018.09.019 · Cited by 53
Identification of Psychological Factors Associated with Adherence to Self-Care Behaviors amongst Patients with Type 1 Diabetes
Alvarado-Martel, D., Fernández, M. Á. R., Vigaray, M. C., Carrillo, A., Boronat, M., Expósito‐Montesdeoca, A. B., & Wägner, A. M. (2019) · Journal of Diabetes Research · doi:10.1155/2019/6271591 · Cited by 55
“We used the cutoff set by the author [24].”
Method
Supporting diabetes self-management in primary care: Pilot-study of a group-based programme focusing on diet and exercise
Bastiaens, H., Sunaert, P., Wens, J., Sabbe, B., Jenkins, L., Nobels, F. R. E., Snauwaert, B., & Royen, P. V. (2009) · Primary care diabetes · doi:10.1016/j.pcd.2009.02.001 · Cited by 52
The role of affective temperaments in metabolic control in patients with type 2 diabetes
Góis, C., Barbosa, A., Ferro, A., Santos, A. L., Sousa, F., Akiskal, H. S., Akiskal, K. K., & Figueira, M. L. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.05.021 · Cited by 49
Frequency and perceived burden of diabetes self-management activities in employees with insulin-treated diabetes: relationships with health outcomes
Weijman, I., Ros, W. J. G., Rutten, G. E. H. M., Schaufeli, W. B., Schabracq, M. J., & Winnubst, J. A. M. (2004) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2004.08.004 · Cited by 49
Comparison of illness representations dimensions and illness representation clusters in predicting outcomes in the first year following diagnosis of type 2 diabetes: results from the DESMOND trial
Skinner, T. C., Carey, M. E., Cradock, S., Dallosso, H. M., Daly, H., Davies, M. J., Doherty, Y., Heller, S., Khunti, K., Oliver, L., et al. (2011) · Psychology & Health · doi:10.1080/08870440903411039 · Cited by 47
“Psychological outcomes were assessed using the Problem Areas in Diabetes (PAID) scale (Welch, Jacobson, & Polonsky, 1997 ) to assess diabetes specific emotional distress and the Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983 ) for measured depression.”
Method
Dismissing Attachment and Outcome in Diabetes: The Mediating Role of Coping
Turan, B., Oşar, Z., Turan, J. M., ILKOVA, H. M., & Damcı, T. (2003) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.22.6.607.22933 · Cited by 48
The effect of an education programme (MEDIAS 2 ICT) involving intensive insulin treatment for people with type 2 diabetes
Hermanns, N., Kulzer, B., Maier, B., Mahr, M., & Haak, T. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.05.017 · Cited by 47
Impact of Reinforcement of Diabetes Self-Care on Poorly Controlled Diabetes
Beverly, E. A., Fitzgerald, S. M., Brooks, K. M., Hultgren, B. A., Ganda, O. P., Munshi, M. N., & Weinger, K. (2013) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721713486837 · Cited by 47
“95).(24,27) The PAID is sensitive to changes in glycemic control, and high PAID scores are associated with lower self-reported adherence to treatment recommendations.”
Background
A Randomized Comparison of Online- and Telephone-Based Care Management with Internet Training Alone in Adult Patients with Poorly Controlled Type 2 Diabetes
McMahon, G. T., Fonda, S. J., Gomes, H. E., Alexis, G., & Conlin, P. R. (2012) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2012.0137 · Cited by 48
Health promotion for patients with diabetes: health coaching or formal health education?
Cinar, A. B., & Schou, L. (2013) · International Dental Journal · doi:10.1111/idj.12058 · Cited by 46
Modular ICT-based patient empowerment framework for self-management of diabetes: Design perspectives and validation results
Lamprinos, I., Demski, H., Mantwill, S., Kabak, Y., Hildebrand, C., & Ploessnig, M. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.04.006 · Cited by 46
“Diabetes-related distress was measured using a slightly adapted version of the Problem Areas in Diabetes (PAID) scale [27][28].”
Method
Outcomes of an Intervention to Reduce Uncertainty Among African American Women with Diabetes
Amoako, E. P., Skelly, A., & Rossen, E. (2008) · Western Journal of Nursing Research · doi:10.1177/0193945908320465 · Cited by 48
Coping strategies and their association with diabetes specific distress, depression and diabetes self-care among people living with diabetes in Zambia
Hapunda, G. (2022) · BMC Endocrine Disorders · doi:10.1186/s12902-022-01131-2 · Cited by 48
Improvement and Emergence of Insulin Restriction in Women With Type 1 Diabetes
GOEBEL-FABBRI, A. E., Anderson, B. J., Fikkan, J. L., Franko, D. L., Pearson, K. R., & Weinger, K. (2011) · Diabetes Care · doi:10.2337/dc10-1547 · Cited by 44
“The Problem Areas in Diabetes (PAID) survey (11,12) is a 20-item Problem questionnaire that assesses a broad range of feelings related to living with diabetes.”
Background
Co-existing Non-communicable Diseases and Mental Illnesses Amongst the Elderly in Punjab, India
Verma, M., Grover, S., Tripathy, J. P., International Union Against Tuberculosis and Lung Disease, T. U. S. E. A. O., International Union Against Tuberculosis and Lung Disease, P., Singh, T., Nagaraja, S. B., Kathirvel, S., Singh, G., & Nehra, R. (2019) · touchREVIEWS in Endocrinology · doi:10.17925/ee.2019.15.2.106 · Cited by 46
“One such instrument is the Problem Areas In Diabetes questionnaire which covers a wide variety of emotional concerns that are associated with depressive symptoms and undesirable coping styles.(23) Female gender, residing in a nuclear family, being separated/widowed/divorced and the presence of other chronic diseases w…”
Background
Reliability and validity of the Icelandic version of the problem area in diabetes (PAID) scale
Sigurðardóttir, Á. K., & Benediktsson, R. (2006) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2006.10.008 · Cited by 44
“Floor or ceiling effects have not been reported (Polonsky et al., 1995; Welch et al., 1997).”
BackgroundMethodResultInfluential
Psychometric Properties of the Problem Areas in Diabetes (PAID) Instrument in Singapore
Venkataraman, K., Tan, L. S. M., Bautista, D. C., Griva, K., Zuniga, Y. L. M., Mohamed, A., Lee, Y. S., Lee, J., Tai, E. S., Khoo, E. Y. H., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0136759 · Cited by 43
“This is in line with existing literature, with weak to moderate correlations reported with HbA1c in cross-sectional studies[2, 5, 7], and small to moderate effect sizes in intervention studies[4].”
Result
Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review
Wee, P. J. L., Kwan, Y. H., Loh, D. H. F., Phang, J. K., Puar, T. H. K., Østbye, T., Thumboo, J., Yoon, S., & Low, L. L. (2021) · Journal of Medical Internet Research · doi:10.2196/25002 · Cited by 46
Impact of diabetes distress on glycemic control and diabetic complications in type 2 diabetes mellitus
Park, H., Cho, Y., Seo, D. H., Ahn, S. H., Hong, S., Suh, Y. J., Chon, S., Woo, J., Baik, S. H., Lee, K. W., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-55901-0 · Cited by 58
“For the PAID scale, a score of 40 or higher is indicative of high diabetes distress and demonstrates discriminative validity 24,25 .”
Background
Adherence to Insulin, Emotional Distress, and Trust in Physician Among Patients with Diabetes: A Cross-Sectional Study
Halepian, L., Saleh, M. B., Hallit, S. R., & Khabbaz, L. R. (2018) · Diabetes Therapy · doi:10.1007/s13300-018-0389-1 · Cited by 43
“The PAID measures diabetes-related emotional distress, which correlates with measures of related concepts such as depression, social support, health beliefs, and coping style, as well as predicts future blood glucose control of the patient [32].”
Background
New insights into diabetes burnout and its distinction from diabetes distress and depressive symptoms: A qualitative study
Abdoli, S., Hessler, D., Smither, B., Miller-Bains, K. L., Burr, E. M., & Stuckey, H. L. (2020) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2020.108446 · Cited by 41
Validation of the Turkish version of the Centre for Epidemiologic Studies Depression Scale (CES-D) in patients with Type 2 diabetes mellitus
Lehmann, V., Makine, C., Karşıdağ, Ç., Kadıoğlu, P., Karşıdağ, K., & Pouwer, F. (2011) · BMC Medical Research Methodology · doi:10.1186/1471-2288-11-109 · Cited by 42
“The Problem Areas in Diabetes scale (PAID) is a 20 item self-report measurement that can be used to assess diabetes-specific emotional distress, such as worries about complications or concerns about food [17,32,33].”
Background
High rates of elevated diabetes distress in research populations: A systematic review and meta-analysis
Dennick, K., Sturt, J. A., Hessler, D., Purssell, E., Hunter, B. M., Oliver, J., & Fisher, L. (2015) · International Diabetes Nursing · doi:10.1080/20573316.2016.1202497 · Cited by 41
Cut Points for Identifying Clinically Significant Diabetes Distress in Adolescents With Type 1 Diabetes Using the PAID-T: Results From Diabetes MILES Youth–Australia
Hagger, V. L., Hendrieckx, C., Cameron, F. J., Pouwer, F., Skinner, T. C., & Speight, J. (2017) · Diabetes Care · doi:10.2337/dc17-0441 · Cited by 43
Group Diabetes Education Administered Through Telemedicine: Tools Used and Lessons Learned
Kearns, J. W., Bowerman, D., Kemmis, K. L., Izquierdo, R. E., Wade, M. J., & Weinstock, R. S. (2012) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2011.0165 · Cited by 41
Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review
Langendoen‐Gort, M., Groeneveld, L., Prinsen, C. A. C., Beulens, J. W. J., Elders, P. J. M., Halperin, I. J., Mukerji, G., Terwee, C. B., & Rutters, F. (2022) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-022-09734-9 · Cited by 43
Relation between psychosocial variables and the glycemic control of patients with type 2 diabetes: a cross-sectional and prospective study
Nozaki, T., Morita, C., Matsubayashi, S., Ishiodo, K., Yokoyama, H., Kawai, K., Matsumoto, M., Takii, M., & Kubo, C. (2009) · BioPsychoSocial Medicine · doi:10.1186/1751-0759-3-4 · Cited by 41

Authors: Welch, G. W., Jacobson, A. M., & Polonsky, W. H.
Affiliations: Mental Health Unit, Balboa Medical Center San Diego, California
Joslin Diabetes Center (US)
ORCID: Polonsky, William H
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 1997-05-01
Volume: 20
Issue: 5
Pages: 760-766
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.20.5.760
OpenAlex: W2134365893
Cited by: 664
References: 0
Citations by year: 2026: 20 · 2025: 20 · 2024: 35 · 2023: 37 · 2022: 49 · 2021: 46 · 2020: 35 · 2019: 37 · 2018: 28 · 2017: 33 · 2016: 23 · 2015: 31 · 2014: 32 · 2013: 25 · 2012: 37
FWCI: 0.71
Type: journal article
Language: en
Open access: closed
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r01dk027845-14)
National Institute of Diabetes and Digestive and Kidney Diseases (DK27845, DK42315, R01DK042315)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Health Sciences › Nursing › Research and Theory › Health Education and Validation
Keywords: Problem Areas in Diabetes scale, emotional adjustment, type 1 diabetes, type 2 diabetes, discriminant validity, concurrent validity, psychometric properties, coping, health attitudes, insulin-treated diabetes, HbA1c
MeSH terms: Adaptation, Psychological, Adult, Attitude to Health, Demography, Diabetes Mellitus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diet, Diabetic, Education, Emotions, Female, Humans, Hypoglycemic Agents, Insulin, Male, Middle Aged, Surveys and Questionnaires, Socioeconomic Factors, Reproducibility of Results, Discriminant Analysis

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The Problem Areas in Diabetes Scale: An evaluation of its clinical utility

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