Thesis Title: Psychological Correlates of Distress, Self-Care and Quality of Life in Type I and Type II Diabetes

Author: Mahnaz Yousaf

Supervisor: Rukhsana Kausar

Degree: PhD

Year: 2017

University: Institute of Applied Psychology, Punjab University, Lahore, Pakistan

Corresponding Address: Department of Applied Psychology, University of the Punjab, Lahore, Pakistan. Email:, Phone: 92-42-9231245


Diabetes has been considered as one of the most challenging and burdensome disease of 21st century and is posing a serious threat to the world’s public health and economy. The present study was conducted to explore psychological correlates of diabetes distress, self-care and quality of life in individuals with type I and type II diabetes. This study aimed to: examine whether individuals with type I and type II diabetes differ in stress, personality dispositions, coping strategies, readiness to change, glycemic level, distress, self-care and quality of life; to examine predictive relationship between predictors (stressors and personality) and outcome variables (diabetes distress, self-care, and quality of life); to examine mediating role of coping, readiness to change and glycemic level in the relationship between predictors and outcome variables. Sample comprised of 250 individuals with diabetes with equal number of diabetes type I and type II and they were recruited from diabetes clinics. Readiness to change questionnaire was developed for the present study and brief version of coping strategies questionnaire was prepared from indigenously developed Coping Strategies Questionnaire (Kausar, 1997), Holmes and Rahe Stress Inventory (Holmes & Rahe, 1967), Urdu translated versions of Big Five Personality Inventory (Rammstedt & John, 2007), The Diabetes Distress Scale (Polonsky et al., 2005), A Summary of Diabetes Self Care Activities Scale (Toobert, et al., 1985) and Quality of Life Scale (Burckhardt, Woods, Schultz, & Ziebarth, 1989) were used for assessment. Factor analysis, Pearson correlation analysis, SEM, Hierarchical regression analysis and independent sample t-test were used to analyze the data. No significant differences were found in individuals with type I and type II diabetes, on distress, self-care and quality of life. For type I diabetes, personality trait neuroticism had positive relationship (r = .17) while extraversion (r = .19), and conscientiousness (r = .20) and negative relationship with diabetes distress. Coping strategies had significant positive relationship (r = .20) while readiness to change action had significant negative relationship with distress(r = .18). For type II diabetes, personality trait extraversion had a significant positive relationship with self-care activity diet (r = .18). Coping strategies have positive relationship with self-care (r = .28, r =.18). Readiness to change has a significant positive relationship with self-care activity diet (r = .21), while stress had a positive relationship with self-care activity foot care (r = .21). Active practical coping and religious focused coping had a significant positive relationship (r = .24), while avoidance focused coping had significant negative relationship with quality of life (r = -.25). Moreover, all types of distress have negative relationship with quality of life (r = – .25, r = .-26). Mediations analysis showed that active practical coping mediated the relationship between conscientiousness and diabetes distress. Action and maintenance stages of readiness to change, glycemic level, all types of distress, and self-care activates of diet and foot care mediated the relationship between neuroticism and quality of life. Conscientiousness, active practical coping and readiness to change maintenance (β = .16*, β = .20**) are negative whereas neuroticism, and religious focused coping are positive (β = .17*, β = .16*) predictors of diabetes distress. Extraversion and readiness to change action and maintenance are positive predictors (β = .18*, β = .18**) and neuroticism (β = .19**) and glycemic level (HbAlc) are negative predictors of selfcare diet (β = .14**). Religious focused coping and glucemic level (HbA1c) are predictors of foot care (β = .19*, β =-.16**) and medication (β = .16*, β = -.14*). Stressors (ΔR2= .14**), agreeableness, (β = -.18**) and active distractive coping negatively predict (β = -.16*) quality of life while extraversion (β = .16*), active practical coping (β = .15*), religious focused coping (β = .18*), maintenance (β = .18*), and glycemic level (β = .15*) positively predict quality of life. All types of distress negatively predicted Qol (β = -.17*) whereas all self-care activities positively predicted Qol (β = .27**). The findings are discussed in the light of earlier research and in culture context of Pakistan. The findings have important implications for individuals with diabetes, their families, medical and mental health professionals and researchers.

Keywords: Diabetes, distress, self-care, quality of life.


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