Department of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster LA1 4AT, UK.
J Diabetes Res. 2024 Nov 14;2024:3946553. doi: 10.1155/2024/3946553. eCollection 2024.
Diabetes distress is a common emotional issue for those living with diabetes, which has the potential to negatively impact well-being, management behaviors, and HbA1c levels. These implications have led to diabetes distress becoming an important consideration in diabetes healthcare and management. Nonetheless, discussions remain ongoing on how to best conceptualize this experience. Recent research has attempted to enhance conceptualization by considering the underlying emotional mechanisms that may underpin the highly contextualized experience of diabetes distress. Qualitative insights can further add to these understandings; however, the research in this remit is yet to be systematically reviewed. This review therefore sought to add to the growing body of literature attempting to better conceptualize diabetes distress and the underlying mechanisms that may contribute to this experience. A secondary aim was to leverage this understanding to consider ways to improve patient-healthcare interactions. A qualitative systematic review and thematic synthesis was undertaken. Eligible studies were identified through PsycINFO, MEDLINE, CINAHL, and EMBASE databases from November 2020 to May 2021. Study quality was assessed using the McMaster Critical Review Form. Nineteen papers were included in the review. The analysis resulted in seven descriptive themes which contributed to three analytical themes: (1) threatened autonomy, (2) sense of helplessness, and (3) negative sense of self. These results highlight that a major area underpinning experiences of diabetes distress is not feeling in control. Consideration should be given to how psychological factors, such as locus of control and learned helplessness, may constitute underlying mechanisms impacting emotional regulation in those experiencing diabetes distress. Clinicians should consider including and leading discussions around distress during appointments, as well as using approaches that promote patient autonomy and empowerment.
糖尿病困扰是糖尿病患者常见的情绪问题，可能对幸福感、管理行为和 HbA1c 水平产生负面影响。这些影响导致糖尿病困扰成为糖尿病医疗保健和管理的一个重要考虑因素。尽管如此，关于如何最好地概念化这种体验的讨论仍在继续。最近的研究试图通过考虑潜在的情绪机制来增强概念化，这些机制可能是糖尿病困扰这种高度情境化体验的基础。定性见解可以进一步增加对这些理解的认识；然而，这一领域的研究尚未得到系统审查。因此，本综述旨在为不断增长的文献提供补充，试图更好地概念化糖尿病困扰以及可能导致这种体验的潜在机制。次要目的是利用这种理解来考虑如何改善患者与医疗保健提供者的互动。本研究采用定性系统评价和主题综合方法进行。从 2020 年 11 月至 2021 年 5 月，通过 PsycINFO、MEDLINE、CINAHL 和 EMBASE 数据库，确定了符合条件的研究。使用麦克马斯特批判性评论表格评估研究质量。综述共纳入 19 篇论文。分析结果产生了七个描述性主题，这些主题对三个分析性主题做出了贡献：（1）自主权受到威胁；（2）无助感；（3）消极的自我感。这些结果表明，糖尿病困扰体验的一个主要支撑领域是感觉无法控制。应该考虑心理因素（如控制源和习得性无助）如何构成影响经历糖尿病困扰者情绪调节的潜在机制。临床医生应考虑在预约期间包括并引导围绕困扰的讨论，并采用促进患者自主性和赋权的方法。
