Brief report
Brazilian version of the Problem Areas in Diabetes Scale (B-PAID): Validation and identification of individuals at high risk for emotional distress

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Abstract

The purpose of this study was to validate the Brazilian version of the Problem Areas in Diabetes Scale (B-PAID) in a sample of outpatients with type 2 diabetes (DM2) and to identify the characteristics of individuals at high risk for emotional distress.

A cross-sectional study was conducted in a sample of 146 patients randomly selected among those attending outpatient clinics at a University Hospital in Porto Alegre, Brazil. Information was collected regarding age, gender, known duration of diabetes, type of treatment and level of schooling, and a blood sample was taken to measure HbA1c. B-PAID was compared with the already validated Brazilian versions of Satisfaction with Life (SWL) and WHO Quality of Life-Brief (WHOQOL) Scales.

One-hundred forty-six DM2 patients (48% males, 59.7 ± 9 years, BMI: 29.7 ± 5.2 kg/m2, mean duration: 8.63 ± 8 years, HbA1c: 7.2 ± 1.7%) were included. There were significant correlations between B-PAID and SWL (rp = 0.55, p < 0.001) and WHOQOL (rp = −0.33, p < 0.05) Scales. In a multiple regression analysis the B-PAID Scale was associated with younger age (p = 0.006) and lower education level (p = 0.05).

In conclusion, B-PAID is a reliable, valid outcome measure for Brazilian DM2 patients and identifies patients at increased risk for emotional distress who should be prioritized in psychosocial intervention.

Introduction

Diabetes mellitus (DM) is a chronic disease requiring a clinical and research approach including all biological, psychological and social individual needs. The measurement of psychological factors affecting an individual's compliance with treatment can be employed as a useful tool to identify emotional problems.

Psychological distress frequently occurs in people with DM and is related to the demanding treatment and concerns about developing complications [1]. Psychological distress may compromise self-care behavior and is often related to difficulties in coping with the daily regimen [2]. Several measures have been used to evaluate the quality of life of people with DM and they can provide objective information concerning the most common problems involved in coping with DM treatment. Various measures have been developed to quantify levels of emotional distress [3].

The Problem Areas in Diabetes Scale (PAID) is a brief self-reported measure of diabetes-related emotional distress and consists of 20 statements identified as common negative emotions involving the life with diabetes. In the U.S. it has been found to be valid and clinically useful for type 1 and type 2 diabetic patients [4], [5]. PAID has been translated into at least four languages, including Portuguese. Furthermore, it has been considered a good measure of diabetes-related emotional distress in several countries [4], [5], [6], [7].

The purpose of this study was to validate the Brazilian version of the Problem Areas in Diabetes Scale (B-PAID) in a sample of outpatients with type 2 diabetes (DM2) and to identify the characteristics of individuals with a high level of emotional distress.

Section snippets

Participants

A cross-sectional study was conducted in a sample of 146 type 2 diabetic patients randomly selected among those attending Endocrinology and Internal Medicine outpatient clinics at the Hospital de Clínicas de Porto Alegre, Brazil. The inclusion criteria were: patients with type 2 diabetes, literate, over 18 years old, without any serious ophthalmological problems affecting their reading ability or other incapacitating complications, such as unstable coronary artery disease, severe heart failure

Results

A total of 146 DM2 patients were interviewed. Their mean age was 59.7 ± 9 years, 48% were male, the known duration of diabetes was 8.63 ± 8 years and the mean BMI was 29.7 ± 5.2 kg/m2. Most subjects were treated with diet or oral agents 128 (87.7%) and only 18 (12.3%) were treated with insulin. The mean HbA1c was 7.2 ± 1.7%. In 83 (56.8%) patients the HbA1c was <7.0%, in 31 (21.2%) the HbA1c values were between 7 and 8.5%, and >8.5% in 32 (21.9%) patients. Regarding the level of schooling, 68.5% of the

Discussion

In this study it was observed that B-PAID is a valid tool to evaluate quality of life in patients with type 2 diabetes and it might identify individuals who were more susceptible to emotional distress and would benefit from psychological interventions.

A health-related quality of life measure is considered a valid measurement tool if it provides psychometric attributes such as high internal consistency, validity, sensitivity and scale and item interpretability [17]. The Cronbach's α coefficient

Acknowledgements

This study was partially supported by Projeto de Núcleos de Excelência do Ministério de Ciência e Tecnologia. CCG was recipient of a scholarship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

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