Emotional Dysregulation: The Effect of Fear and Anxiety on Self-Management Behaviors in Adults with T1DM

ABSTRACT Background: People with T1DM experience high levels of fear of hypoglycemia, fear of complications as well as other types of anxiety. These high levels of fear and anxiety adversely affect self-management behaviors and long-term mental health. This study asked two main questions; to what extent do negative emotions such as fear, and anxiety impact the self-management behaviors of people with T1DM. And, more generally, whether the physiological effects of T1DM and the chronic stress of managing the disease cause unique negative emotions. Methods: A descriptive cross-sectional study was completed on 25 adults between the ages of 18 and 55 years who had been diagnosed with T1DM at least a year prior and who had no previous diagnosis of Major Depression, anxiety disorders, or any other mental disorder. Information for the study was obtained through semi-structured interviews, completion of six psychological questionnaires and finger-stick blood draw for glucose control. The six psychological questionnaires included the Hypoglycemia Fear Survey II (HFS-II), the Spielberger State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), the Fear of Complications Questionnaire (FCQ), Diabetes Self-Management Questionnaire (DSMQ), and the Intolerance of Uncertainty Scale 12 short version (IUS-12). Results: Participants had a high level of fear of hypoglycemia (HFS -II, worry subscale =42.46), normal levels of fear of complications (RFCQ=20.560, normal levels of anxiety (STAI trait=38.96, state=36.4, HADS anxiety=6.96, IUS12 prospective= 17.84 and Inhibitory= 8.52). Regression analysis indicates that here is negative relationship between anxiety measured by the IUS12 and self-management behaviors (DSMQ physical activity t=-0.093 p<.005, healthcare t=-2.396 p<.025). Results from semi-structured interviews identified three main content themes; 1. Fear of hypoglycemia, 2. Fear of complications, 3. Burden of diabetes. Conclusions: Fear of hypoglycemia as well as fear of complications are the main threats that elicit fear and anxiety in people with T1DM more than any other stress they experience in their life. This study indicates that the main focus of their self-management behaviors is glucose control while self-management behaviors related to physical activity and healthcare behaviors are sub-optimal.