526-P: Prevalence and Predictors of Spiritual/Existential Distress among Adults with Uncontrolled Diabetes

Abstract

Purpose: Spiritual and/or existential (S/E) distress is the experience of strain or conflict within a person’s religious, spiritual, or existential framework and is associated with worse psychological and health outcomes among individuals with acute illness. Little is known about S/E distress among individuals with a chronic condition, such as diabetes mellitus (DM). We explored the prevalence of S/E distress among adults with DM and examined patient factors associated with S/E distress. Methods: Data came from the 2019-2020 baseline assessment of participants in an ongoing trial of an intervention addressing social determinants of health among people with DM (n=286). Participants had HbA1cs ≥ 7.5 (18-70 years) or ≥ 8.0 for (71-75 years). We measured S/E distress in two ways: 1) with an abbreviated version of the Religious and Spiritual Struggle Scale (RSSS-14); and 2) with three screening questions adapted from the Rush Religious Struggle Screening Protocol (3Q). Bivariate analyses examined the association between patient factors, including health behaviors, DM distress, social support, and S/E distress. Results: Mean age of the sample was 53 years (SD:13.3). Prevalence of S/E distress was 20% (3Q) and 22% (RSSS-14). Both screeners found that compared to those without S/E distress, those with S/E distress reported a poorer general diet, lower social support, higher levels of DM distress, and higher psychological distress (all p <0.05). The RSSS-14 also identified elevated levels of HbA1c, more chronic conditions, and greater unmet social needs among those with potential S/E distress (all p <0.05). The 3Q identified poorer medication adherence (p=0.03) in those with S/E distress. Conclusions: One-fifth of adults with poor glycemic control have potential S/E distress, and such distress is associated with worse mental health and functional status. Future interventions should seek to address S/E distress as part of efforts to improve DM patient-centered and clinical outcomes. Disclosure G. Rajaee: Consultant; Self; UnitedHealth Group. M. Heisler: None. J. Piette: None. K. Resnicow: None. X. Shi: None. A. N. Smith: None. P. X. Song: None. M. R. Patel: None. Funding National Institutes of Health (R01DK116715)