Perceived health status and perceived diabetes control: psychological indicators and accuracy

Abstract 

Objective

The aim of this study is to assess the association of psychological, as well as physical and sociodemographic, indicators with patients' ratings of personal health status and diabetes control and to investigate the association of mental health and depression with errors in the perception of diabetes control.

Method

A sociodemographically diverse sample of 623 diabetes patients was recruited from the general medicine clinics of a county health care system and a Veterans Affairs health care system. We examined three types of determinants of patients' health perceptions: physical health indicators (symptoms, comorbid diagnoses, and glycosylated hemoglobin or HbA_1c levels), psychological health indicators (general mental health and diabetes-related worry), and sociodemographic factors (age, race, gender, income, and education).

Results

After controlling for patient' sociodemographic characteristics, perceived general health was associated with patients' symptom burden and emotional distress (but not with patients' HbA_1c levels). Perceived diabetes control additionally was associated with HbA_1c and diabetes-related worries. Further analyses showed that both mental health and diagnosed depression were associated with errors in personal appraisals of diabetes control, with depressed patients more often inaccurately assessing their glycemic control as poor (false-positive error) and nondepressed patients more often missing poor HbA_1c levels (false-negative error).

Conclusions

Findings indicate that patients use a comprehensive model for assessing their general health and that depression may lead to more accurate assessments of poor glucose control.

Keywords: Diabetes mellitus, Perceived health status, Mental health, Depression, Accuracy, Diabetes control