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Questionnaire on Stress in Patients with Diabetes


G. Duran, P. Herschbach, S. Waadt, F. Strain, A. Zettler (1995)

Background and Development:

The original QSD was developed from a population of 617 patients with both insulin-dependent and non-insulin dependent diabetes. The 90 item inventory was designed to assess psychosocial stress associated with problems in daily living with diabetes and to identify factors hampering patient compliance with the necessary treatment regimen. Items cover areas such as problems with work, difficulties with treatment regimen, acute and long-term complications, and personal attitude. Each item is ranked on a 5-point scale measuring the extent to which the item causes daily stress for the individual. Principle components analysis resulted in the identification of 10 factors: three address social problems, three address emotional problems, two cover barriers to adherence, and two relate to physical limitations. Internal reliability for these 10 factors was good, with Cronbach’s alpha ranging from 0.63 to 0.88. Validity of the measure was assessed by comparison with two other measures: the Complaint List which provides an assessment of general health complaints, and the Satisfaction with Health questionnaire which measures general satisfaction with overall health. Correlation coefficients between the QSD and these two other measures were considerable (0.48 and –0.42 respectively) and were highly significant (p< 0.001). The QSD also can discriminate between medical subgroups in their rated stress. Patients on insulin treatment, with long-term complications, or with acute complications rated significantly higher stress than other patients.

The revised QSD (QSD-R) contains 45 questions that define eight stress scales for patients with diabetes: leisure time, depression/fear of future, hypoglycemia, treatment regimen/diet, physical complaints, work, partner, and doctor-patient relationship. The revised measure was assessed in 1930 patients with both type 1 and type 2 diabetes. Cronbach’s alpha ranged from 0.69 to 0.81 for the eight scales. Test-retest reliability for the eight scales ranged from 0.45 to 0.73. In a subset of 80 patients, correlations between QSD-R scales and two other measures of stress (the State-Trait Anxiety Inventory and the Beck Depression Inventory) show significant relationships with correlations between 0.36 and 0.71. The overall QSD-R score correlated very well with these scales (0.62 and 0.61, respectively). As with the QSD, patients with complications or poor HbA1c control scored higher than others.

Assessment in Elderly Populations:

Validity and reliability of the QSD-R has not been studied in elderly populations.

Assessment in Minority Populations:

No studies involving minority populations have been conducted.

Subsequent Studies:

No subsequent studies using the QSD-R have been found.

Design Strengths and Weaknesses:

In a review of several diabetes-related health assessment measures, Garratt et al. (2002) state that the QSD-R has borderline to good internal and poor test-retest reliability. However, they note that QSD-R scores were significantly related to long-term complications and HbA1c.. The QSD-R incorporated patient input in the development of the measure. The QSD-R takes 5 to 15 minutes to complete.

Contact Information:

There are no costs for interested researchers/physicians (industry-sponsored projects excluded), but they should contact the authors for permission.

Peter Herschbach
Institut und Poliklinik für Psychosomatische Medizin
Psychotherapie und Medizinische Psychologie der Technischen Universität München
Langerstrasse 3, D - 81675, Munich, Germany


Duran, G., P. Herschbach, S. Waadt, F. Strain, A. Zettler (1995) Assessing daily problems with diabetes: A subject-oriented approach to compliance. Psychol. Rep., 76, 515-521.

Garratt, A.M., L. Schmidt, and R. Fitzpatrick (2002) Patient-assessed health outcome measures for diabetes: a structured review. Diabetes Med., 19, 1-11.

Herschbach, P., G. Duran, S. Waadt, A. Zettler, C. Amm, and B. Marten-Mittag (1997) Psychomentric properties of the Questionnaire on Stress in Patients with Diabetes--Revised (QSD-R). Health Psychol., 16, 171-174.

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