Living with diabetes: From psychological challenges to practical mental health support

This dissertation focuses on understanding the psychological challenges faced by adults with diabetes, including diabetes distress, fatigue, and disordered eating behaviour. It also examines ways to identify and manage these challenges, including the development of a diabetes-specific self-help intervention for adults with type 1 diabetes (T1D).Chapter 2 examined relationships between individual symptoms of diabetes distress, emotional well-being, and fatigue in adults with T1D. Results showed strong internal connectivity within each construct, with some symptoms, like food-related worries, appearing isolated. Few bridge symptoms were found between constructs, with emotional well-being as a primary bridge between distress and fatigue. No significant associations were found between diabetes distress and fatigue, suggesting that tailored, symptom-specific interventions may be needed. Chapter 3 investigated the relationships between diabetes distress, emotional self-awareness, and emotion regulation strategies (expressive suppression, cognitive reappraisal, mood repair). Clarity of feelings was associated with less diabetes distress. Increased clarity of feelings was also associated with increased mood repair, highlighting the importance of emotional awareness and regulation in interventions. Chapter 4 studied associations between disordered eating behaviour (DEB), diabetes distress, and emotion regulation strategies. DEB prevalence was 27.1% in adults with T1D. DEB was associated with more diabetes distress, cognitive reappraisal with less distress, and expressive suppression with more DEB. Chapter 5 examined the psychometric properties of the Dutch DEPS-R, a diabetes-specific screening tool for DEB. The DEPS-R showed acceptable to good internal consistency and construct validity. Both single-factor and three-factor structures were supported: “perspectives on weight,” “diabetes-related maladaptive behaviour,” and “binge eating and compensatory behaviours.” Chapter 6 examined coping strategies used by adults with T1D and T2D to manage diabetes distress. Problem-focused strategies (e.g., taking care of diabetes, eating healthy, having a routine) were used more frequently and considered more useful than emotion-focused strategies (e.g., attention exercises, writing, therapy). Differences in strategy use between individuals with low and high diabetes distress were limited, but more adaptive strategies were used by those with lower distress. Chapter 7 investigated uptake and usage of a self-help intervention (MyDiaMate) over nearly 2 years. Participation varied by module length, and most participants reported low emotional well-being and high distress and fatigue. 78.1% were not receiving psychological treatment, indicating unmet need. No evidence suggested that more severe profiles reduced participation. Together, the findings of the chapters underscore the relevance of assessing and addressing the emotional challenges of living with T1D. Furthermore, it emphasises the importance of integrating effective emotion regulation strategies into psychological interventions targeting diabetes distress and disordered eating behaviour. Finally, it highlights the relevance of diabetes-specific self-help interventions such as MyDiaMate, which offers tailored support for various aspects of the psychological burden of living with diabetes.