Structural equation modeling of the effects of psychological distress and a fear of coronavirus disease 2019 on diabetes care in Japan: a cross-sectional study.

This study aimed to examine the effects of psychological distress and a fear of coronavirus disease 2019 (COVID-19) on diabetes care in Japan. We used data from a 2020 nationwide Internet survey in Japan involving 28,000 respondents aged 15-79 years. The question items included psychological factors (Kessler psychological distress scale and fear of COVID-19), employment, trust in neighbors, informal caregiving, and history of diabetes care. After excluding respondents with comorbidities and those who had not visited the hospital, 625 patients with diabetes were analyzed. Statistical mediation was then examined through a path analysis using structural equation modeling (SEM). Discontinued diabetes care was independently associated with psychological distress (risk ratio = 1.44, 95% confidence interval [1.01-2.06]) and a fear of COVID-19 (1.41 [1.01-1.95]). The SEM results indicated that a fear of COVID-19, employment, trust in neighbors, and informal caregiving were indirectly associated with continued diabetes care via psychological distress. These findings suggest that a fear of COVID-19 may affect psychological distress and continued diabetes care among patients with diabetes in Japan, and that trust in neighbors and family caregiving may be related to the discontinuation of diabetes care. Therefore, because psychological factors and socioeconomic status may affect diabetes care, it is important to consider a fear of COVID-19 among patients with diabetes to maintain diabetes treatment.