Perceptions and correlates of distress due to the COVID-19 pandemic and stress management strategies among people with diabetes: a mixed methods study

Im, James; Escudero, Carlos; Zhang, Kendra; Choi, Dorothy; Sivakumar, Arani; Booth, Gillian L.; Sale, Joanna; Pritlove, Cheryl; Advani, Andrew; Yu, Catherine H.

Introduction Greater risk of adverse health outcomes and public health measures have increased distress among people with diabetes during the COVID-19 pandemic. The objectives of this study were to explore how the experiences of people with diabetes during the COVID-19 pandemic differ according to sociodemographic characteristics and identify diabetes-related psychosocial correlates of COVID distress. Methods Patients with type 1 or 2 diabetes were recruited from clinics and community health centres in Toronto, Ontario as well as patient networks. Participants were interviewed to explore the experiences of people with diabetes with varied sociodemographic and clinical identities, with respect to wellness (physical, emotional, social, financial, occupational), level of stress, and management strategies. Multiple linear regression was used to assess the relationships between diabetes distress, diabetes self-efficacy, and resilient coping with COVID distress. Results Interviews revealed that specific aspects of psychosocial wellness affected by the pandemic, and stress and illness management strategies utilized by people with diabetes differed based on socioeconomic status, sex, type of diabetes, and race. Resilient coping (β = -0.0517; 95% CI: -0.0918,-0.0116; P-value = 0.012), diabetes distress (β = 0.0260; 95% CI: 0.0149,0.0371; P-value < 0.0001), and diabetes self-efficacy (β = -0.0184; 95% CI: -0.0316,-0.0052; P-value = 0.007) were significantly associated with COVID distress. Conclusions Certain subgroups of people with diabetes have experienced a disproportionate amount of COVID distress. Assessing correlates of COVID distress among people with diabetes will help inform interventions such as diabetes self-management education to address the psychosocial distress caused by the pandemic.