Psychosocial Impact of the COVID-19 Pandemic on People With Type 1 Diabetes: Results of an Ecological Momentary Assessment Study

Fabienne Schmid; Andreas Schmitt; Norbert Hermanns; Bernhard Kulzer; Dominic Ehrmann

doi:10.3389/fcdhc.2022.834643

Psychosocial Impact of the COVID-19 Pandemic on People With Type 1 Diabetes: Results of an Ecological Momentary Assessment Study

Front Clin Diabetes Healthc. 2022 Jun 20:3:834643. doi: 10.3389/fcdhc.2022.834643. eCollection 2022.

Authors

Fabienne Schmid^{1

2}, Andreas Schmitt^{1

2

3}, Norbert Hermanns^{1

2

3

4}, Bernhard Kulzer^{1

2

3

4}, Dominic Ehrmann^{1

2

3

4}

Affiliations

¹ Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
² Diabetes Center Mergentheim (DCM), Bad Mergentheim, Germany.
³ German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.
⁴ Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.

Abstract

Aims: Psychological distress due to living with diabetes, demanding self-management tasks, impacts on life, and risks of complications is common among people living with diabetes. COVID-19 could pose a new additional risk factor for psychological distress in this group. This study aimed to analyze levels of COVID-19-related burdens and fears, variables explaining these levels, and associations with the concurrent 7-day COVID-19 incidence in people with type 1 diabetes (T1D).

Methods: A total of 113 people with T1D (58% women; age: 42.3 ± 9.9 years) participated in an ecological momentary assessment (EMA) study between December 2020 and March 2021. The participants reported daily levels of COVID-19-related burdens and fears over 10 consecutive days. Global ratings of COVID-19-related burdens and fears were assessed using questionnaires, as were current and previous levels of diabetes distress (PAID), acceptance (DAS), fear of complications (FCQ), depressive symptoms (CES-D), and diabetes self-management (DSMQ). Current levels of diabetes distress and depressive symptoms were compared with pre-pandemic ratings gained during an earlier study phase. Associations between burdens and fears, psychosocial and somatic aspects, and the concurrent 7-day incidence rate were analyzed using multilevel regression.

Results: Diabetes distress and depressive symptoms reported during the pandemic were comparable to pre-pandemic levels (PAID: p = .89; CES-D: p = .38). Daily EMA ratings reflected relatively low mean COVID-19-related burdens and fears in everyday life. However, there was substantial day-to-day variation per person indicating higher burdens on specific days. Multilevel analyses showed that daily COVID-19-related burdens and fears were significantly predicted by pre-pandemic levels of diabetes distress and diabetes acceptance but were not associated with the concurrent 7-day incidence rate nor with demographic and medical variables.

Conclusions: This study observed no increase in diabetes distress and depressive symptoms during the pandemic in people with T1D. The participants reported low to moderate levels of COVID-19-related burdens. COVID-19-related burdens and fears could be explained by pre-pandemic levels of diabetes distress and acceptance but not by demographic and clinical risk variables. The findings suggest that mental factors may constitute stronger predictors of COVID-19-related burdens and fears than objective somatic conditions and risks in middle-aged adults with T1D.

Keywords: COVID-19 incidence rate; COVID-19-related burden; depression; diabetes distress; ecological momentary assessment.