Distress and depression among patients with diabetes mellitus: prevalence and associated factors: a cross‐sectional study



This study aimed to validate the internal consistency of the Persian version of the diabetes distress scale-17 (DDS-17) and to investigate the prevalence of diabetes distress (DD), depression, and possible relevant factors.


This was a cross-sectional study on 820 diabetes patients (62.4 % females) in Tehran, Iran between January and June 2017. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the protocol. Patients filled out a demographic and health survey, DDS-17, the Beck Depression Inventory Second Edition (BDI-II) and the Summary of Diabetes Self–Care Activities Measure (SDSCA). DDS-17 consist of emotional burden, and physician, regimen, and interpersonal related distress. The correlation between DDS subscales and association between DDS and BDI-II or SDSCA scores were assessed using SPSS.


The mean age was 58.91 ± 12.35 years. Majority of patients had high DD (37.2 %) and severe depression (38.7 %). The general and specific diets got the highest score in six SDSCA subscales. The Persian version of DDS-17 had excellent internal consistency with Cronbach’s alpha coefficient of 0.924. The DDS score had significant relationship with socioeconomic level (p < .001), type of DM (p < .001), type of treatment (p < .001), glycemic control status (p < .001), complication (p < .001) and depression level (p < .001). The level of hemoglobin A1c was the most useful predictor of DDS score (p < .001).


High prevalence of depression and distress in patient with diabetes calls for greater emphasizes on the importance of enhanced physicians and patients’ knowledge in these areas.

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Data availability

Data sharing is available upon the author’s requests.


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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. We thank Mr. Tom Chadderdon for providing language help and proof reading of the article.

Author information




Mahtab Niroomand, Azadeh Mazaheri Meibodi and Abdorrahim Absalan contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ehsan Aliniagerdroudbari, Sepideh Babaniamansour and Ali Golshaian. The first draft of the manuscript was written by Mahtab Niroomand, Ehsan Aliniagerdroudbari and Sepideh Babaniamansour. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Mahtab Niroomand.

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The implementation of the project was approved by the ethics committee of Shahid Beheshti University of Medical Sciences. 

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Niroomand, M., Babaniamansour, S., Aliniagerdroudbari, E. et al. Distress and depression among patients with diabetes mellitus: prevalence and associated factors: a cross‐sectional study. J Diabetes Metab Disord (2021). https://doi.org/10.1007/s40200-020-00721-y

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  • Diabetes mellitus
  • Psychological distress
  • Depression
  • Self‐care
  • Glycated hemoglobin A