ANN ARBOR—The emotional stress of dealing with diabetes tends to be more severe for Hispanics than African Americans, a new study shows, though psychological aspects are too often ignored for both groups.

“Treatment strategies, such as taking daily medications, pricking your finger to test your blood sugar levels, or injecting yourself with insulin can be very distressing for people, not to mention being confronted with your own mortality or at least as someone who has a chronic illness,” said Michael Spencer, associate professor at the University of Michigan School of Social Work and lead author on the study.

“The emotional response, especially for people who are deeply connected to their culture through food, can be quite difficult to deal with,” Spencer said.

Researchers examined diabetes-related emotional distress among 180 inner-city African American and Hispanic adults with Type 2 diabetes. The respondents participated in the REACH (Racial and Ethnic Approaches to Community Health) Detroit Family Intervention. Questions from the Problem Areas in Diabetes Scale (PAID) were asked in the chosen language of the participant (Spanish or English) between February 2002 and October 2003.

Overall, Hispanic respondents had a mean score more than twice those reported by African American (36.75 compared to 15.59). In other words, Hispanics had higher diabetes-related emotional distress.

“Emotional distress among Hispanics is a highly understudied area, so the significance of the study is that we were able to begin to explore the psychological aspects of diabetes among this population,” Spencer said.

Hispanics were affected by the demographic factors. Younger respondents (less than 55 years old) or those not graduating from high school meant more emotional stress for this segment. African Americans had higher distress levels when living with others, the study showed.

The emotional distress related to diabetes is often considered the ” elephant in the living room” among the diabetes community, Spencer said. The focus, he said, is on the biological aspects of diabetes or the behavior changes that must occur to control blood sugar, but the psychological aspects of living with and managing this chronic disease are often neglected.

African Americans reported significant emotional distress when dealing with daily hassles and perceived seriousness of their diabetes. The distress was less when these individuals had a better understanding of diabetes self-management, the researchers said. Also, less provider support and more health care dissatisfaction were significantly higher for African Americans, but not for Hispanics.

One issue addressed in the study involved physician support, which is an important factor in health disparities. Many respondents reported that they receive very little information about their illness from physicians and that the health care system does not promote relationship building with their patients.

“Compounding matters for minority clients,” Spencer said, ” are cultural and language barriers that may lead physicians to not communicate as well or provide as much information about diabetes to these patients.”

The potential lack of communication between physicians and patients will affect their ability to form relationships, and ultimately, affect diagnosis and the course of treatment patients might receive, he said.

The researchers said policymakers and providers must continue to find solutions to problems that exacerbate diabetes-related stress among minorities. For example, information should be available in languages other than English to reach immigrant and non-English speaking minorities.

Other authors include Edith Kieffer, research associate professor of social work at U-M, Brandy Sinco, research associate and statistician at U-M, Jacqueline Two Feathers, a U-M graduate in the School of Public Health, Gloria Palmisano, of REACH, J. Ricardo Guzman, of Community Health & Social Services Center, Inc., Sherman James, of Duke University, Gwendolyn Graddy-Dansby, of the Henry Ford Health System, and Michele Heisler, of the Veterans Affairs Center for Practice Management & Outcomes Research and U-M.

The research appears in the recent issue of the Journal of Health Care for the Poor and Underserved.

Related Link:

• School of Social Work