Assessing Psychosocial Distress in Diabetes

Development of the Diabetes Distress Scale

  1. William H. Polonsky, PHD, CDE1,
  2. Lawrence Fisher, PHD2,
  3. Jay Earles, PSYD3,
  4. R. James Dudl, MD4,
  5. Joel Lees, MD5,
  6. Joseph Mullan, PHD2 and
  7. Richard A. Jackson, MD6
  1. 1Department of Psychiatry, University of California, San Diego, California
  2. 2Department of Family and Community Medicine, University of California, San Francisco, California
  3. 3Tripler Army Medical Center, Honolulu, Hawaii
  4. 4Kaiser Permanente, San Diego, California
  5. 5Naval Medical Center, San Diego, California
  6. 6Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
  1. Address correspondence and reprint requests to William H. Polonsky, PhD, CDE, P.O. Box 2148, Del Mar, CA 92014. E-mail: whpolonsky{at}


OBJECTIVE—The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples.

RESEARCH DESIGN AND METHODS—In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158).

RESULTS—Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (α > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001).

CONCLUSIONS—The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted November 23, 2004.
    • Received September 21, 2004.
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