Abstract
BackgroundThere is considerable evidence that repetitive negative thoughts are often associated with adverse health outcomes. The study aims are (i) to identify the frequency and valence of thoughts about health in people with diabetes mellitus using questions based on the day reconstruction method (DRM) and (ii) to analyse associations between thoughts about health and health-related quality of life (HRQoL), diabetes-related distress and depressive symptoms.MethodsCross-sectional study of a random sample of a German statutory health insurance population with diabetes aged between 18 and 80 linking questionnaire and claims data. Associations between frequency and valence of thoughts about health on a previous day and HRQoL assessed by a 12-Item Short-Form Health Survey, diabetes-related distress assessed using the Problem Areas in Diabetes scale and depressive symptoms assessed by Patient Health Questionnaire-9 were analysed using linear and logistic regression analysis, adjusting for sociodemographic and clinical characteristics.ResultsThoughts about health were analysed in 726 participants (86% type 2 diabetes, 62% male, mean age 67.6 ± 9.7 years). A total of 46% had not thought about their health the day before, 17.1% reported low frequency and negative thoughts, 21.4% low frequency and positive thoughts, 12.1% high frequency and negative thoughts and 3.4% high frequency and positive thoughts. The presence of thoughts about health irrespective of their frequency and valence is associated with a lower physical and mental component summary score of the 12-Item Short-Form Health Survey. Negative thoughts are associated with high diabetes-related distress. Frequent or negative thoughts are associated with depressive symptoms.ConclusionsThoughts about health are a part of everyday life for a substantial number of people with diabetes. Surprisingly, even positive thoughts are associated with poorer HRQoL in our study. Further research within the DRM paradigm is needed to understand how thoughts about health may affect people’s (assessment of) state of health. Thoughts about health should be considered in diabetes education and patient counselling with a view to preventing and treating emotional disorders. More attention should be paid to the outcomes of interventions that may themselves lead to an increase in the frequency of thoughts about health.
Highlights
There is considerable evidence that repetitive negative thoughts are often associated with adverse health outcomes
Thoughts about health are a part of everyday life for a substantial number of people with diabetes
Even positive thoughts are associated with poorer health-related quality of life (HRQoL) in our study
Summary
There is considerable evidence that repetitive negative thoughts are often associated with adverse health outcomes. Diabetes mellitus (DM) is a chronic condition and is associated with complex and time-consuming selfmanagement tasks in everyday life, increased morbidity, and reduced health-related quality of life (HRQoL) [1]. A systematic review found evidence that perseverative negative thinking (e.g., worries and rumination) was associated with depression, anxiety and emotional distress in people with long-term conditions [2]. Negative thoughts (referred to as worries) about weight amongst people with DM are significantly associated with higher perceived diabetes-related distress and poorer psychological well-being [6]. Another study showed that a higher frequency of negative thoughts was associated with higher levels of depressive symptoms in people with DM [7]. The authors used the validated Automatic Thoughts Questionnaire which measured depressionrelated cognitions by assessing negative self-statements (e.g., ‘I feel like I’m up against the world’) on a 5-Likert scale from ‘not at all’ to ‘all the time’ [7,8,9]
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