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 301–400 of 663

The Arabic version of Diabetes-39: psychometric properties and validation
Khader, Y. S., Bataineh, S., & Batayha, W. (2008) · Chronic Illness · doi:10.1177/1742395308100647 · Cited by 23
A Novel Application of the Problem Areas in Diabetes (PAID) Instrument to Improve Glycemic Control and Patient Satisfaction
Chawla, A., Saha, C., & Marrero, D. G. (2009) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721709354607 · Cited by 22
“Since its development, the PAID has been used as a screening tool for depression, has been shown to be responsive to change, and has been shown to have high validity and reliability, even in varying patient populations.(6-9) Longitudinal PAID data have been obtained from several diabetes-related interventional studies.”
Method
Mediation by illness perceptions of the association between the doctor–patient relationship and diabetes-related distress
Bridges, H. A., & Smith, M. (2015) · Journal of Health Psychology · doi:10.1177/1359105315569094 · Cited by 22
“95) and validity of the questionnaire have been demonstrated (Welch et al., 1997).”
Background
Psychometric Evaluation of the Farsi Version of the Self-Care of Diabetes Inventory in Iranian Patients with Diabetes
Ebadi, A., Ausili, D., Albatineh, A., Salarvand, S., & Ghashlagh, R. G. (2019) · Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy · doi:10.2147/dmso.s235436 · Cited by 18
The psychological profile of youth and young adults with type 1 diabetes in New Zealand
McClintock, J. M., Blackmore, T., Chepulis, L. M., Fraser, S. K., & Paul, R. G. (2021) · Pediatric Diabetes · doi:10.1111/pedi.13289 · Cited by 27
“Scores ≥40 on the PAID are suggestive of distress related to diabetes.(25) Cronbach's alpha for the PAID in this sample was 0.”
An integrated psychosomatic treatment program for people with diabetes (psy-PAD)
Kampling, H., Köhler, B., Germerott, I., Haastert, B., Icks, A., Kulzer, B., Nowotny, B., Hermanns, N., & Kruse, J. (2022) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.m2022.0094 · Cited by 22
A prospective study of the effect of fasting during the month of Ramadan on depression and diabetes distress in people with type 2 diabetes
Al‐Ozairi, E., AlAwadhi, M. M., Al-Ozairi, A., Taghadom, E., & Ismail, K. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.05.006 · Cited by 22
The Relationship Between the Severity of Depressive Symptoms and Diabetes-Related Emotional Distress in Patients with Type 2 Diabetes
Hosoya, T., Matsushima, M., Nukariya, K., & Utsunomiya, K. (2012) · Internal Medicine · doi:10.2169/internalmedicine.51.5768 · Cited by 23
Response shift and glycemic control in children with diabetes
Wagner, J. A. (2005) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-3-38 · Cited by 22
Psychometric properties of the Iranian version of Diabetes Empowerment Scale (IR-DES-28)
Mahjouri, M. Y., Arzaghi, S. M., Heshmat, R., et al. (2012) · Journal of Diabetes & Metabolic Disorders · doi:10.1186/2251-6581-11-4 · Cited by 22
“The questionnaire assesses four domains of diabetes-related quality of life: emotional distress, treatment barriers, problems related to food and lack of social support [14,15].”
Background
Impact of Collaborative Shared Medical Appointments on Diabetes Outcomes in a Family Medicine Clinic
Hartzler, M. L., Grinalds, M. S., Williams, J., Schoen, J., Dunn, T., & Anderson, D. C. (2018) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721718776597 · Cited by 23
“Clinicians can use this tool to assess changes in a patient’s emotional adjustment to living with diabetes in general or can specifically evaluate the impact of self-care behaviors.(44) However, more research must be completed to identify a relationship between improved symptoms of emotional distress and diabetic outc…”
Method
Living with diabetes: a group-based self-management support programme for T2DM patients in the early phases of illness and their partners, study protocol of a randomised controlled trial
van Puffelen, A. L., Rijken, M., Heijmans, M., Nijpels, G., Rutten, G. E. H. M., & Schellevis, F. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-144 · Cited by 21
“The PAID has a strong concurrent and discriminant validity [37], has been proven to be responsive to change [38] and has been validated for Dutch T2DM patients [36,37].”
Background
Diabetes Distress in Adolescents and Young Adults Living With Type 1 Diabetes
Morrissey, E. C., Casey, B., Dinneen, S. F., Lowry, M., & Byrne, M. (2020) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2020.03.001 · Cited by 23
Nurses’ and physicians’ experiences with diabetes consultations and the use of dialogue tools in the DiaPROM pilot trial: A qualitative study
Haugstvedt, A., Hernar, I., Graue, M., Strandberg, R. B., Lie, S. S., Sigurðardóttir, Á. K., Richards, D. A., & Kolltveit, B. H. (2020) · Diabetic Medicine · doi:10.1111/dme.14419 · Cited by 21
Understanding the diversity and dynamics of living with diabetes: a feasibility study focusing on the case
Griffiths, F. E., Anto, N., Chow, E., et al. (2007) · Chronic Illness · doi:10.1177/1742395307079194 · Cited by 20
Quality of Life in People with Type 2 Diabetes in Relation to Deprivation, Gender, and Age in a New Community-Based Model of Care
Lindsay, G., Inverarity, K., & McDowell, J. R. S. (2011) · Nursing Research and Practice · doi:10.1155/2011/613589 · Cited by 20
“The problem areas in diabetes (PAID) questionnaire is a reliable and valid tool to determine diabetes specific emotional distress [12, 13, 18].”
Impact and Feasibility of Personalized Decision Support for Older Patients with Diabetes: A Pilot Randomized Trial
Huang, E. S., Nathan, A. G., Cooper, J. M., Lee, S. M., Shin, N. Y., John, P. M., Dale, W., Col, N. F., Meltzer, D. O., & Chin, M. H. (2016) · Medical Decision Making · doi:10.1177/0272989x16654142 · Cited by 20
Achieving patient priorities: an alternative to patient-reported outcome measures (PROMs) for promoting patient-centred care
Naik, A. D., & Catic, A. (2020) · BMJ Quality & Safety · doi:10.1136/bmjqs-2020-012244 · Cited by 21
The Effect of Self-Efficacy in Self-Management on Diabetes Distress in Young People with Type 2 Diabetes
Lin, P.-Y., Lee, T., Liu, C., & Lee, Y. (2021) · Healthcare · doi:10.3390/healthcare9121736 · Cited by 22
“Patients with scores of 40 or higher were considered to have “significant diabetes distress” that required special attention [17,29].”
Background
Relationship Between Psychosocial Factors and Glucose Control in Adults With Type 2 Diabetes
Roy, K., Iqbal, S., Gadag, V. G., & Bavington, B. (2020) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2020.01.005 · Cited by 23
Exploring correlates of diabetes-related stress among adults with Type 1 diabetes in the T1D exchange clinic registry
Boden, M. T., & Gala, S. (2017) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2017.10.012 · Cited by 19
Estimating a Preference-Based Single Index Measuring the Quality-of-Life Impact of Self-Management for Diabetes
Rowen, D., Labeit, A. M., Stevens, K. J., Elliott, D., Mulhern, B. J., Carlton, J., Basarir, H., & Brazier, J. E. (2018) · Medical Decision Making · doi:10.1177/0272989x18784291 · Cited by 19
“Likewise the measures that are diabetes-specific, such as Problem Areas in Diabetes (PAID) (4), are not preference-based and so cannot be used directly to generate QALYs.”
Background
The Impact of a Community Pharmacy Diabetes Self-Management Education Program on Diabetes Distress
Machen, M. L., Borden, H. C., & Hohmeier, K. C. (2018) · Journal of Pharmacy Technology · doi:10.1177/8755122518805429 · Cited by 20
Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: study protocol for the DiaPROM randomised controlled trial pilot study
Haugstvedt, A., Hernar, I., Strandberg, R. B., Richards, D. A., Nilsen, R. M., Tell, G. S., & Graue, M. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-024008 · Cited by 19
Young adults with type 1 diabetes and their experiences with diabetes follow‐up and participation in the DiaPROM pilot trial: A qualitative study
Hernar, I., Graue, M., Strandberg, R. B., Lie, S. S., Sigurðardóttir, Á. K., Richards, D. A., Kolltveit, B. H., & Haugstvedt, A. (2021) · Diabetic Medicine · doi:10.1111/dme.14535 · Cited by 19
Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: Study protocol for a randomised controlled trial
Amsberg, S., Wijk, I., Livheim, F., Toft, E., Johansson, U.-B., & Anderbro, T. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-022234 · Cited by 17
The Effect of a Patient Activation Tailored Intervention on Type 2 Diabetes Self-Management and Clinical Outcomes: A Study from Saudi Arabian Primary Care Settings
Almutairi, N., Gopaldasani, V., & Hosseinzadeh, H. (2023) · Journal of Diabetes Research · doi:10.1155/2023/2074560 · Cited by 17
Predictive Factors of the Adherence to Real-Time Continuous Glucose Monitoring Sensors: A Prospective Observational Study (PARCS STUDY)
Murata, T., Kuroda, A., Matsuhisa, M., Toyoda, M., Kimura, M., Hirota, Y., Kato, K., Sawaki, H., Tone, A., Kawashima, S., et al. (2020) · Journal of Diabetes Science and Technology · doi:10.1177/1932296820939204 · Cited by 19
“440 DBP, mmHg 72 (10) 71 (10) 73 (12) .”
Determinants of healthful eating and physical activity among adolescents and young adults with type 1 diabetes in Qatar: A qualitative study
AlBurno, H., Mercken, L. A. G., de Vries, H., Mohannadi, D. A., & Schneider, F. (2022) · PLoS ONE · doi:10.1371/journal.pone.0270984 · Cited by 24
Sexual dysfunction in women with type 1 diabetes in Norway: A cross‐sectional study on the prevalence and associations with physical and psychosocial complications
Haugstvedt, A., Jørgensen, J., Strandberg, R. B., Nilsen, R. M., Haugstvedt, J. F., Pop‐Busui, R., & Søfteland, E. W. (2021) · Diabetic Medicine · doi:10.1111/dme.14704 · Cited by 19
Educational attainment moderates the effect of a brief diabetes self-care intervention
Sacco, W. P., Bykowski, C. A., Mayhew, L. L., & White, K. E. (2011) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2011.08.027 · Cited by 17
Diabetes distress, happiness, and its associated factors among type 2 diabetes mellitus patients with different therapies
Liu, S.-Y., Huang, J., Dong, Q., Li, B., Zhao, X. Y., Xu, R. H., & Yin, H. (2020) · Medicine · doi:10.1097/md.0000000000018831 · Cited by 17
“The problem areas in diabetes scale (PAID) has been widely used in various countries and has good reliability and validity in measuring the emotional disorders of patients.([3,4,11,13,14]) In this study, a simplified version of the scale PAID-5 (consisting of items 3, 6, 12, 16, 19 of PAID) was used to conduct a quest…”
Method
Insulin mediated improvement in glycemic control in elderly with type 2 diabetes mellitus can improve depressive symptoms and does not seem to impair health-related quality of life
de Oliveira, R. A., de Almeida, M. Z. T., Queiroz, V. A., Rodacki, M., & Zajdenverg, L. (2015) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-015-0052-1 · Cited by 17
Can primary care team-based transition to insulin improve outcomes in adults with type 2 diabetes: the stepping up to insulin cluster randomized controlled trial protocol
Furler, J., Young, D. Y. L., Best, J. D., Patterson, E., O'Neal, D. N., Liew, D., Speight, J., Segal, L., May, C. R., Manski-Nankervis, J.-A. E., et al. (2014) · Implementation Science · doi:10.1186/1748-5908-9-20 · Cited by 16
“Diabetes-related distress: PAID [33] X X”
Psychosocial Outcomes with the Omnipod® 5 Automated Insulin Delivery System in Children and Adolescents with Type 1 Diabetes and Their Caregivers
Hood, K. K., Polonsky, W. H., MacLeish, S. A., Levy, C. J., Forlenza, G. P., Criego, A. B., Buckingham, B. A., Bode, B. W., Hansen, D. W., Sherr, J. L., et al. (2023) · Pediatric Diabetes · doi:10.1155/2023/8867625 · Cited by 16
“Similar to children and their caregivers, adolescents and their caregivers experienced reduced diabetes distress (PAID-T, P � 0 .”
InfluentialSelf-citation
Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT
Roddy, M. K., Spieker, A. J., Nelson, L. A., Greevy, R. A., LeStourgeon, L. M., Bergner, E. M., El-Rifai, M., Elasy, T. A., Aikens, J. E., Wolever, R. Q., et al. (2023) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2023.110921 · Cited by 17
The impact of type 1 diabetes and eating disorders: the perspective of individuals
Hillege, S. P., Beale, B., & McMaster, R. (2008) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2008.02283.x · Cited by 16
Short-Term Effects on Patient Satisfaction of Continuous Glucose Monitoring with the GlucoDay with Real-Time and Retrospective Access to Glucose Values: A Crossover Study
Hermanns, N., Kulzer, B., Gulde, C., Eberle, H., Pradler, E., Patzelt-Bath, A., & Haak, T. (2009) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2008.0078 · Cited by 16
“Patients also completed the Problem Areas in Diabetes Questionnaire (PAID), 12 which measures diabetes-related distress, and the state version of the State-Trait Anxiety Inventory (STAI-State), 13 which assesses anxiety symptoms.”
Psychometric evaluation of the Persian version of the diabetic foot self-care questionnaire in Iranian patients with diabetes
Mahmoodi, H., Abdi, K., Navarro‐Flores, E., et al. (2021) · BMC Endocrine Disorders · doi:10.1186/s12902-021-00734-5 · Cited by 16
Depression and Anxiety in Older and Middle‐aged Adults With Diabetes
Poulsen, K., & Pachana, N. A. (2011) · Australian Psychologist · doi:10.1111/j.1742-9544.2010.00020.x · Cited by 17
A randomised trial comparing low-fat diets differing in carbohydrate and protein ratio, combined with regular moderate intensity exercise, on glycaemic control, cardiometabolic risk factors, food cravings, cognitive function and psychological wellbeing in adults with type 2 diabetes: Study protocol
Watson, N. A., Dyer, K. A., Buckley, J. D., Brinkworth, G. D., Coates, A. M., Parfitt, G., Howe, P. R. C., Noakes, M., Dye, L., Chadwick, H. K., et al. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.11.001 · Cited by 15
Persistent Anxiety Is Associated with Higher Glycemia Post-Transition to Adult Services in Asian Young Adults with Diabetes
Zhu, L., CHANDRAN, S. R., Tan, W. B., Xin, X., Goh, S., & Gardner, D. S.-L. (2020) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2019.0226 · Cited by 15
“A total score of ≥40 was used as the threshold to indicate significant diabetes-related distress [23].”
Method
What characterises diabetes distress and its resolution? A documentary analysis
Sturt, J. A., McCarthy, K., Dennick, K., Narasimha, M., Sankar, S., & Kumar, S. (2015) · International Diabetes Nursing · doi:10.1179/2057332415y.0000000002 · Cited by 15
“Included in case note analysis (n= 63) Excluded from case note analysis (n= 7) Single attenders (n= 22) Attended 2+ appointments (n= 41) DD (n= 24) DD and established psychological morbidity (n= 13) General distress (n= 4) Type 1 diabetesa 23 4 9 8 5 1 Type 2 diabetesa 31 2 8 14 6 3 Single attenders 22 N/A 22 12 3 7 P…”
MethodInfluential
High Prevalence of Diabetes Distress in a University Population
Beverly, E. A., Rennie, R. G., Guseman, E. H., Rodgers, A., & Healy, A. M. (2019) · Journal of Osteopathic Medicine · doi:10.7556/jaoa.2019.099 · Cited by 16
Diabetes related distress is high in inpatients with diabetes
Kuniß, N., Kramer, G., Müller, U., Wolf, G., & Kloos, C. (2021) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-021-00659-y · Cited by 15
“Higher scores indicate more diabetesrelated distress (cut-off ≥ 40 indicates high distress) [6, 7, 9, 10].”
BackgroundMethod
Neuropsychological Assessment
Kessels, R. P. C., & Brands, A. M. A. (2009) · Humana Press eBooks · doi:10.1007/978-1-60327-850-8_4 · Cited by 15
Risk factors and quality of life of patients with high diabetes-related distress in primary care: a cross-sectional, multicenter study
Lim, S. M., Siaw, M. Y. L., Tsou, K. Y. K., Kng, K. K., & Lee, J. V. (2018) · Quality of Life Research · doi:10.1007/s11136-018-1994-1 · Cited by 17
How is neighborhood social disorganization associated with diabetes outcomes? A multilevel investigation of glycemic control and self-reported use of acute or emergency health care services
Kowitt, S. D., Donahue, K. E., Fisher, E. B., Mitchell, M., & Young, L. (2018) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-018-0069-0 · Cited by 15
Bodily Pain, Poor Physical Functioning, and Poor Glycemic Control in Adults With Diabetes
Sinnott, C., Rogers, M. A. M., Lehmann, D. F., & Weinstock, R. S. (2005) · Diabetes Care · doi:10.2337/diacare.28.6.1534 · Cited by 15
[Factors related to subjective evaluation of quality of life of diabetic patients].
Árcega-Domínguez, A., Lara-Muñoz, C., & Ponce‐de‐León‐Rosales, S. (2006) · PubMed · Cited by 15
Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: A randomised controlled trial
Wijk, I., Amsberg, S., Johansson, U.-B., Livheim, F., Toft, E., & Anderbro, T. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-072061 · Cited by 15
Impacto de las herramientas «Mapas de Conversaciones™» sobre el conocimiento de la diabetes en pacientes españoles con diabetes mellitus tipo 2: un estudio aleatorizado y comparativo
Martínez, M. P., Moreno, L., Cobo, A., Reviriego, J., Rodríguez, Á., Cleall, S., & Reaney, M. D. (2014) · Endocrinología y Nutrición · doi:10.1016/j.endonu.2014.06.001 · Cited by 14
Traducción al español, adaptación y validación del Cuestionario de miedo a la hipoglucemia en adultos con diabetes tipo 1 de la Comunidad de Madrid
Tasende, C., Rubio, J. A., & Álvarez, J. (2018) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2017.12.003 · Cited by 14
The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach
Griva, K., Rajeswari, M., Nandakumar, M., Khoo, E. Y. H., Lee, V. Y. W., Chua, C. G., Goh, Z. Z. S., Choong, Y., & Newman, S. P. (2019) · BMC Nephrology · doi:10.1186/s12882-018-1183-z · Cited by 15
Study protocol: Safety and efficacy of smart watch integrated do-it-yourself continuous glucose monitoring in adults with Type 1 diabetes, a randomised controlled trial
Sehgal, S., de Bock, M. I., Williman, J. A., Taylor, B. J., Elbalshy, M. M., Galland, B. C., Hall, R. M., Paul, R. G., Boucsein, A., Jones, S., et al. (2021) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-021-00923-y · Cited by 15
Defining patient-reported outcomes in diabetes, obesity, cardiovascular disease, and chronic kidney disease for clinical practice guidelines - perspectives of the taskforce of the Guideline Workshop
Barnard-Kelly, K. D., Battelino, T., Brosius, F. C., Ceriello, A., Cosentino, F., Gavin, J. R., Giorgino, F., Green, J., Ji, L., Kellerer, M., et al. (2025) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02550-2 · Cited by 15
Social Orientation and Diabetes-Related Distress in Japanese and American Patients with Type 2 Diabetes
Ikeda, K., Fujimoto, S., Morling, B., Takahara, S., Carroll, A. E., Harashima, S., Uchida, Y., & Inagaki, N. (2014) · PLoS ONE · doi:10.1371/journal.pone.0109323 · Cited by 14
Is Social Support Universally Adaptive in Diabetes? A Correlational Study in an Arabic-Speaking Population With Type 2 Diabetes
SUKKARIEH-HARATY, O. A., & Howard, E. (2014) · Holistic Nursing Practice · doi:10.1097/hnp.0000000000000060 · Cited by 14
Women with Type 1 Diabetes Mellitus: Effect of Disease and Psychosocial-Related Correlates on Health-Related Quality of Life
Gillani, S. W., Ansari, I. A., Zaghloul, H. A., et al. (2018) · Journal of Diabetes Research · doi:10.1155/2018/4079087 · Cited by 14
“N.B.: construction and psychometric validation of health beliefs, susceptibility, DLC, self-efficacy, and PAID scales were evaluated in the pilot study as mentioned earlier.”
BackgroundInfluential
Self-care of patients with type 2 diabetes mellitus over the course of illness: implications for tailoring support
on behalf of the Diacourse study group, van Puffelen, A. L., Kasteleyn, M. J., de Vries, L., Rijken, M., Heijmans, M., Nijpels, G., & Schellevis, F. (2020) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-019-00479-y · Cited by 12
Impact of insulin pump therapy on key parameters of diabetes management and diabetes related emotional distress in the first 12 months
Oldham, V., Mumford, B., Lee, D., Jones, J. P., & Das, G. C. (2020) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2020.108281 · Cited by 14
The joint association of diabetes distress and depressive symptoms with all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 20])
Hayashino, Y., Okamura, S., Tsujii, S., Ishii, H., & for the Diabetes Distress and Care Registry at Tenri Study Group (2020) · Diabetologia · doi:10.1007/s00125-020-05274-6 · Cited by 14
A cluster randomised pragmatic trial applying Self-determination theory to type 2 diabetes care in general practice
Juul, L., Maindal, H. T., Zoffmann, V., Frydenberg, M., & Sandbæk, A. (2011) · BMC Family Practice · doi:10.1186/1471-2296-12-130 · Cited by 17
“Construct validity of PAID had been investigated in American, Dutch and Swedish contexts [24-27].”
Background
Development and pilot of a low-literacy diabetes education book using social marketing techniques
Kavin, M., Añel‐Tiangco, R. M., Mauger, D. T., & Gabbay, R. A. (2010) · Diabetes Therapy · doi:10.1007/s13300-010-0009-1 · Cited by 14
Treatment satisfaction and quality-of-life between type 2 diabetes patients initiating long- vs. intermediate-acting basal insulin therapy in combination with oral hypoglycemic agents – a randomized, prospective, crossover, open clinical trial
Hermanns, N., Kulzer, B., Kohlmann, T., Jacob, S., Landgraf, W., Theobald, K., & Haak, T. (2015) · Health and Quality of Life Outcomes · doi:10.1186/s12955-015-0279-4 · Cited by 14
“86) [19, 20], and the mental health score of the SF-12® Health Survey [21].”
Background
The 5x1 DAFNE study protocol: a cluster randomised trial comparing a standard 5 day DAFNE course delivered over 1 week against DAFNE training delivered over 1 day a week for 5 consecutive weeks
Elliott, D., Lawton, J., Rankin, D., Emery, C., Campbell, M., Dixon, S., & Heller, S. R. (2012) · BMC Endocrine Disorders · doi:10.1186/1472-6823-12-28 · Cited by 14
“Emotional Well-being: is assessed using the Hospital Anxiety and Depression Scale (HADS; [15]), the diabetes-specific Problem Areas in Diabetes Scale (PAID [16]).”
Method
Evaluating the Psychometric Properties of the Arabic Version of the Diabetes Distress Scale
Darawad, M. W., Hammad, S., Samarkandi, O. A., Hamdan‐Mansour, A. M., & Khalil, A. A. (2017) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20170818-12 · Cited by 14
Transition Education for Young Adults With Type 1 Diabetes: Pilot Feasibility Study for a Group Telehealth Intervention
Albanese-O’Neill, A., Beauchamp, G., Thomas, N., WESTEN, S. C., Johnson, N., Schatz, D., & Haller, M. J. (2018) · JMIR Diabetes · doi:10.2196/10909 · Cited by 15
“Participants then completed the Problem Areas in Diabetes (PAID) Scale to assess baseline levels of diabetes-specific distress [13,14] and the Confidence in Diabetes Scale (CIDS) to assess baseline levels of diabetes-specific self-efficacy [15].”
Method
Reduction of Severe Hypoglycaemia in People with Type 2 Diabetes after a Structured Inpatient Intervention
Kloos, C., Burghardt, K., Müller, U., Kramer, G., Muller, N., Wolf, G., & Kuniß, N. (2019) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-0983-1559 · Cited by 14
“To screen for depression and evaluate diabetes-related stress the Well-Being 5 (5 questions, score 0–25, higher scores are associated with higher well-being) and PAID questionnaire (20 questions, score 0–100, higher scores are associated with higher distress) were used [12, 13].”
Method
Identifying health‐related quality of life (HRQL) domains for multiple chronic conditions (diabetes, hypertension and dyslipidemia): patient and provider perspectives
Bounthavong, M., & Law, A. V. (2008) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2007.00933.x · Cited by 14
Do diabetologists recognise self-management problems in their patients?
Keers, J. C., Links, T. P., Bouma, J., Gans, R. O. B., ter Maaten, J. C., Wolffenbuttel, B. H. R., Sluiter, W. J., & Sanderman, R. (2004) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2004.02.018 · Cited by 14
“Diabetes-related distress was measured using the Problem Areas in Diabetes scale (PAID) [13, 14 ].”
Method
Association between diabetes-related distress and glycemic control in primary care patients with Type 2 diabetes during the coronavirus disease 2019 (COVID-19) pandemic in Egypt
Elotla, S. F., Fouad, A., Mohamed, S. F., Joudeh, A. I., Mostafa, M., Hayek, S. E., Shah, J., & Ahmed, H. A. S. (2022) · Journal of Family and Community Medicine · doi:10.4103/jfcm.jfcm_238_22 · Cited by 13
Diabetes distress and diabetes burnout explored in various areas of life in patients with type 1 diabetes: effect of short-term psychological intervention
CYRANKA, K. M., Klupa, T., Pilecki, M. W., Sarna-Palacz, D., Juryk, A., Storman, D., Dudek, D., Malecki, M. T., & Matejko, B. (2024) · Endocrine · doi:10.1007/s12020-024-03760-0 · Cited by 13
“One of the mostly recommended tools is the Problem Areas in Diabetes (PAID) scale [9].”
Psychosocial outcomes with the Omnipod® 5 Automated Insulin Delivery System in caregivers of very young children with type 1 diabetes
MacLeish, S. A., Hood, K. K., Polonsky, W. H., Wood, J., Bode, B. W., Forlenza, G. P., Laffel, L. M., Buckingham, B. A., Criego, A. B., Schoelwer, M. J., et al. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15906 · Cited by 13
Self-citation
Diabetes distress instruments in adults with Type 1 diabetes: A systematic review using the COSMIN (COnsensus‐based Standards for the selection of health status Measurement INstruments) checklist
Kenny, E., O’Malley, R., Roche, K. F., Morrissey, E. C., Dinneen, S. F., Byrne, M., & Casey, B. (2020) · Diabetic Medicine · doi:10.1111/dme.14468 · Cited by 13
Developing a novel diabetes distress e-learning program for diabetes educators: an intervention mapping approach
Halliday, J. A., Speight, J., Russell‐Green, S., Eric, O., Hagger, V. L., Morris, A., Sturt, J. A., & Hendrieckx, C. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaa144 · Cited by 14
Two-year administration of sodium-glucose co-transporter 2 inhibitor brought about marked reduction of body fat independent of skeletal muscle amount or glycemic improvement in Japanese patients with type 2 diabetes
Sakamoto, M., Goto, Y., Nagayama, A., Yano, M., Sato, S., Tajiri, Y., & Nomura, M. (2021) · Diabetology International · doi:10.1007/s13340-021-00512-7 · Cited by 12
“However, in clinical practice, most patients with diabetes feel the current therapeutic strategy to be a burden or distress, especially continuing diet and exercise therapy for a long period [4].”
Background
Sitting less and moving more for improved metabolic and brain health in type 2 diabetes: ‘OPTIMISE your health’ trial protocol
Brakenridge, C. J., Gardiner, P. A., Grigg, R., WINKLER, E. A. H., Fjeldsoe, B. S., Schaumberg, M. A., Owen, N. G., Eakin, E., Biddle, S., Moodie, M., et al. (2022) · BMC Public Health · doi:10.1186/s12889-022-13123-x · Cited by 14
“Managing diabetes The Problem Areas in Diabetes (PAID) [84] scale assesses perceptions of the intervention and its influence on subjective diabetes management.”
Background
Cognitive Behavioral Therapy (CBT) Telehealth Augmented With a CBT Smartphone Application to Address Type 2 Diabetes Self-Management: A Randomized Pilot Trial
Callan, J. A., Sereika, S. M., Cui, R., Tamres, L. K., Tarneja, M., Greene, B., Slyke, A. V., Wu, M., Lukac, G. R., & Dunbar‐Jacob, J. M. (2022) · The Science of Diabetes Self-Management and Care · doi:10.1177/26350106221133027 · Cited by 13
Diabetes distress and fear of hypoglycaemia: what are the psychological benefits of insulin pump therapy?
Shaban, C., Knott, J., Jenkins, E., Weiß, M., Ryder, J., Charman, J., & Partridge, H. (2017) · Practical Diabetes · doi:10.1002/pdi.2135 · Cited by 13
A Conceptual Model for Quality of Life Among People with Type 2 Diabetes in the Philippines
Aoto, H., Tanimura, C., Majbauddin, A., Kobayashi, N., Morita, T., Inoue, K., Otani, S., Fukada, M., & Hanaki, K. (2019) · Yonago acta medica · doi:10.33160/yam.2019.03.008 · Cited by 12
Evaluating the effectiveness and utility of a novel culturally-adapted telemonitoring system in improving the glycaemic control of Asians with type-2 diabetes mellitus: a mixed method study protocol
Goh, K. L. S., Lee, C. S., Koh, C. H. G., Ling, N. L., Ang, S. B., Oh, C., Lin, Y., Yuan, W., Zheng, Q., & Tan, N. C. (2021) · Trials · doi:10.1186/s13063-021-05240-6 · Cited by 13
“betes mellitus and has been validated in a Singaporean population [25, 26].”
Background
Assessing Psychosocial Variables
Fisher, K. L. (2006) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721705285113 · Cited by 13
“Adjusting to diabetes has been associated with specific emotional distress that measures a wide range of feelings related to living with diabetes and its treatment, including guilt, anger, depressed mood, worry, and fear.(18) It is presumed that emotional distress, as represented by the presence of depression and/or p…”
Background
Reducing social diabetes distress with a conversational agent support system: a three-week technology feasibility evaluation
Bruijnes, M., Kesteloo, M., & Brinkman, W. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1149374 · Cited by 12
Improving Self-Monitoring of Blood Glucose among Adults with Type 1 Diabetes: Results of the Mobile™ Study
Overland, J., Abousleiman, J., Chronopoulos, A., Leader, N. J., Molyneaux, L. M., & Gilfillan, C. P. (2014) · Diabetes Therapy · doi:10.1007/s13300-014-0092-9 · Cited by 12
“These included the Diabetes Treatment Satisfaction Questionnaire (DTSQ), status and change measures (used under license) [4, 5], the Confidence in Diabetes Self-Care (CIDS) scale [8], and the Problem Areas in Diabetes Management (PAID) scale [9].”
Method
Effects of self-monitoring of glucose in non-insulin treated patients with type 2 diabetes: design of the IN CONTROL-trial
Malanda, U. L., Bot, S. D. M., Kostense, P. J., Snoek, F. J., Dekker, J. M., & Nijpels, G. (2009) · BMC Family Practice · doi:10.1186/1471-2296-10-26 · Cited by 11
Diabetes sleep treatment trial: Premise, design, and methodology
Chasens, E. R., Atwood, C. W., Burke, L. E., Korytkowski, M. T., Stansbury, R. C., Strollo, P. J., & Sereika, S. M. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.11.014 · Cited by 12
Association of Diabetes-related Emotional Distress with Diabetes Self-care and Glycemic Control among Adult Patients with Type 2 Diabetes at a Tertiary Hospital in Manila, Philippines
Totesora, D., Ramos-Rivera, M. I., Florencio, M. Q. V., & Reyes-Sia, P. N. (2019) · Journal of the ASEAN Federation of Endocrine Societies · doi:10.15605/jafes.034.02.10 · Cited by 13
“11 This an English self-report scale comprising of 16 items which focuses on four domain, namely (1) glucose management; (2) dietary control; (3) physical activity; and (4) health-care use.”
BackgroundMethodInfluential
The psychopathology of recurrent diabetic ketoacidosis: A case–control study
Garrett, C. J., Moulton, C. D., Choudhary, P., Amiel, S. A., Fonagy, P., & Ismail, K. (2020) · Diabetic Medicine · doi:10.1111/dme.14505 · Cited by 15
“Mean HbA1c IFCC mmol/mol (SD) 86 (27) 101 (23) 72 (22) <0.”
Reporting distress and quality of life of patients with diabetes mellitus in primary and secondary care in Greece.
Παπαθανασίου, Α., Shea, S., Koutsovasilis, A., Melidonis, A. J., Papavasiliou, E., & Lionis, C. D. (2008) · PubMed Central · Cited by 12
Psychological and Behavioral Predictors of Weight Loss in the Reach Ahead for Lifestyle and Health-Diabetes Lifestyle Intervention Cohort
Vakharia, J. D., Thaweethai, T., Licht, P., Wexler, D. J., & Delahanty, L. M. (2023) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2023.02.018 · Cited by 13
The effectiveness of a structured group education programme for people with established type 2 diabetes in a multi-ethnic population in primary care: a cluster randomised trial
Dallosso, H., Mandalia, P., Gray, L. J., Chudasama, Y. V., Choudhury, S., Taheri, S., Patel, N., Khunti, K., & Davies, M. J. (2022) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2022.03.017 · Cited by 11
Special Psychosocial Issues in Diabetes Management: Diabetes Distress, Disordered Eating, and Depression
Shapiro, M. S. (2022) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2021.11.007 · Cited by 12
Rationale, design, and recruitment outcomes for the Family/Friend Activation to Motivate Self-care (FAMS) 2.0 randomized controlled trial among adults with type 2 diabetes and their support persons
Mayberry, L. S., El-Rifai, M., Nelson, L. A., Parks, M., Greevy, R. A., LeStourgeon, L. M., Molli, S., Bergner, E. M., Spieker, A. J., Aikens, J. E., et al. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106956 · Cited by 11
Diabetes Distress Is Associated With Future Risk of Progression of Diabetic Nephropathy in Adults With Type 2 Diabetes: A Prospective Cohort Study (Diabetes Distress and Care Registry at Tenri [DDCRT23])
Hayashino, Y., Okamura, S., Tsujii, S., Ishii, H., Ishii, H., Kuwata, H., Tsujii, S., Okamura, S., Matsunaga, S., Sakuramachi, Y., et al. (2023) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2023.04.018 · Cited by 11
Association of Impaired Awareness of Hypoglycemia with Driving Safety and Hypoglycemia Problem-solving Abilities among Patients with Type 1 Diabetes in Japan: The PR-IAH Study
Sakane, N., Kato, K., Hata, S., Nishimura, E., Araki, R., Kouyama, K., Hatao, M., Matoba, Y., Matsushita, Y., Domichi, M., et al. (2023) · Internal Medicine · doi:10.2169/internalmedicine.0332-22 · Cited by 11
“Higher scores indicate greater diabetes-related distress, and a cut-off score of 40 indicates high distress (21, 22).”
Background
Low-Intensity mental health Support via a Telehealth Enabled Network for adults with diabetes (LISTEN): protocol for a hybrid type 1 effectiveness implementation trial
Holloway, E. E., Gray, S., Mihalopoulos, C., Versace, V. L., Gautier, R. L., Chatterton, M. L., Hagger, V. L., Halliday, J., Henshaw, K., Harrap, B., et al. (2023) · Trials · doi:10.1186/s13063-023-07338-5 · Cited by 11
“The PAID scale is valid, reliable and sensitive to change [32].”
Method
Healthcare Technician Delivered Screening of Adults with Diabetes to Improve Primary Care Provider Recognition of Depression
Scollan‐Koliopoulos, M., Herrera, I., Romano, K., Gregory, C., Rapp, K., & Bleich, D. (2012) · Journal of Family Medicine and Primary Care · doi:10.4103/2249-4863.104955 · Cited by 11
Internet-delivered cognitive behaviour therapy for depression in people with diabetes: study protocol for a randomised controlled trial
Robins, L., Newby, J. M., Wilhelm, K. A., Smith, J. S., Fletcher, T., Ma, T., Finch, A. W., Campbell, L. V., & Andrews, G. (2015) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2015-000144 · Cited by 11
Association between the Type of Diabetes Treatment and Depressive Symptoms among Patients with Diabetes: A Cross-Sectional Study of Korea Community Health Surveys Data, 2011–2016
Lee, H. J., Jang, J., Lee, S. A., Oh, S. S., & Park, E. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16224441 · Cited by 11
“In another study that used the PAID questionnaire, the scores of the IDDM (insulin dependent diabetes mellitus) and NIDDM (non-insulin-dependent diabetes mellitus) groups differed in terms of the type of diabetes treatment [21].”
Method

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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