Burnout, distress, and depressive symptoms in adults with type 1 diabetes

Abstract

Introduction: We identified established scales and subscales related to the hypostatized dimensions of diabetes burnout (exhaustion, detachment, powerlessness) emerging from our preliminary qualitative studies, and examined the relationship of diabetes burnout with diabetes distress, depressive symptoms, and diabetes outcomes.

Methods: In this cross-sectional study, adults with type 1 diabetes (n = 111) completed an online survey including measures of diabetes distress, depressive symptoms, and proposed measures of diabetes burnout. Participants also answered questions related to diabetes outcomes (i.e., last reported HbA1c, missed appointments) as well as other clinical and sociodemographic characteristics. Items related to diabetes burnout were identified and analyzed in an exploratory factor analysis (EFA). The items retained through the EFA were then used in a series of regression analyses to estimate the relationships of the diabetes burnout measure with participants' background characteristics, diabetes distress, depressive symptoms, and diabetes outcomes.

Results: The EFA provided mixed results. The proposed measures of powerlessness were consistent with the original hypothesis. However, the identified measures of exhaustion and detachment did not load onto the anticipated factors. After revising the subscales based on the results of the factor analysis, the measures of diabetes burnout demonstrated strong internal consistency with Cronbach alphas (all subscales and total scale ≥0.85). Diabetes burnout was significantly associated with both depression (es = 0.70; p < .01) and diabetes distress (es = 0.80; p < .01). While measures of diabetes burnout, distress, and depressive symptoms were significant predictors of multiple diabetes outcomes, overall diabetes burnout was no longer significantly related to these outcomes after controlling for diabetes distress and depressive symptoms.

Conclusion: The results of the study provide a first step toward identifying a reliable, valid measure of diabetes burnout. Further research is needed to identify additional items to supplement/replace existing measures and to further differentiate diabetes burnout from diabetes distress and depressive symptoms.

Keywords: Depressive symptoms; Diabetes burnout; Diabetes distress; Diabetes outcomes; Diabetes self-management.