Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1)
Abstract
:1. Introduction
2. Materials and Methods
2.1. The Depression Inventory for Type 1 Diabetes (DID-1): Scale Development
2.1.1. Conceptual Framework and Composition of Preliminary Items
2.1.2. Expert Opinion
2.1.3. Pretesting
2.2. Scale Validation
2.2.1. Participants and Ethics
2.2.2. Informed Consent
2.2.3. Measures
2.2.4. Data Analyses
3. Results
3.1. Sample Characteristics
3.2. Evaluation of Scale
3.2.1. Reliability
3.2.2. Construct Validity Test
3.2.3. Test-Retest Stability
3.2.4. Convergent Validity
3.2.5. Discriminant Validity
3.2.6. Cut-Off Scores
3.2.7. Criterion-Related Validity
3.2.8. Validity Parameters of Other Depression Scales
3.3. Prevalence of Depressive Symptoms
3.4. Differences in DID-1 and 7-Factor Scores as a Function of Subject Characteristics
4. Discussion
5. Conclusions
- -
- The DID-1 has excellent psychometric properties, with high internal consistency and test-retest reliability.
- -
- The DID-1 is a depression assessment instrument designed specifically for people with T1D.
- -
- The DID-1 is a good instrument for screening or initial assessment to determine the presence of depressive symptoms in patients with T1D.
- -
- The DID-1 offers advantages compared with the scales used in the general population: The scores on these scales are usually distributed according to the severity of the symptoms (mild, moderate…). With this instrument we are providing healthcare professionals with a tool to detect whether or not the patient has depressive symptoms.
- -
- The DDI-1 is also a useful tool for research in T1D, as it is specific to this population, has good psychometric properties and its use would standardize studies using the same assessment tool.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Depression (SCID-I) (N = 207) | Depression (DID-1) (N = 207) | |||
---|---|---|---|---|
Variable | Yes (n = 32) | No (n = 175) | Yes (n = 45) | No (n = 162) |
Sex | ||||
Men | 6 (18.8) | 93 (53.1) | 12 (26.7) | 87 (53.7) |
Women | 26 (81.3) | 82 (46.9) | 33 (73.3) | 75 (46.3) |
Physical illness | ||||
Yes | 20 (62.5) | 56 (32) | 26 (57.8) | 50 (30.9) |
No | 12 (37.5) | 119 (68) | 19 (42.2) | 112 (69.1) |
Age of the participants * | 40.41 ± 10.84 (18–57) | 32.60 ± 10.74 (15–65) | 36.24 ± 11.68 (16–57) | 33.12 ± 10.86 (15–65) |
Diabetes duration * | 16.82 ± 9.85 (0.07–35) | 15.08 ± 9.65 (0.04–50) | 15.57 ± 9.77 (0.07–36) | 15.28 ± 9.64 (0.04–50) |
HbA1c (%) * | 7.8 ± 1.8 (5.70–14) | 7.6 ± 1.3 (5.10–14) | 7.76 ± 1.67 (5.10–14) | 7.57 ± 1.32 (5.20–14) |
HbA1c (mmol/mol) * | 62 ± −3.82 (39–130) | 60 ± −9.3 (32–130) | 61 ± −5.24 (32–130) | 59 ± −9.07 (33–130) |
Items | Factor 1 | Factor 2 | Factor 3 | Factor 4 | Factor 5 | Factor 6 | Factor 7 |
---|---|---|---|---|---|---|---|
FACTOR 1: Symptoms of depression | |||||||
2. People around me have noticed sudden changes in my mood | 0.877 | −0.114 | −0.292 | 0.124 | −0.007 | 0.072 | 0.101 |
3. I often have feelings of emptiness or sadness | 0.870 | −0.063 | 0.051 | −0.039 | 0.113 | −0.065 | −0.050 |
1. My general mood isn’t good | 0.869 | −0.095 | 0.020 | −0.051 | 0.048 | −0.085 | 0.075 |
4. I frequently feel like crying | 0.765 | −0.036 | 0.107 | 0.055 | 0.016 | −0.089 | 0.031 |
25. I feel unhappy | 0.722 | 0.085 | 0.061 | 0.172 | −0.109 | −0.060 | 0.104 |
24. I don’t feel as happy as before | 0.709 | −0.081 | 0.131 | −0.082 | 0.005 | 0.112 | 0.069 |
5. I frequently feel like screaming, hitting or breaking something | 0.708 | −0.005 | −0.224 | 0.124 | −0.001 | 0.025 | 0.170 |
13. I don’t take care of my appearance | 0.685 | 0.005 | −0.125 | −0.140 | 0.152 | 0.153 | −0.116 |
26. My current situation drives me to despair | 0.662 | 0.025 | 0.225 | 0.123 | −0.007 | −0.146 | 0.012 |
20. I obsess over things | 0.661 | 0.038 | −0.054 | −0.199 | 0.318 | −0.057 | −0.142 |
7. I often feel like being alone | 0.660 | 0.247 | 0.138 | −0.171 | −0.228 | −0.149 | 0.035 |
29. Time seems to pass more slowly | 0.660 | −0.072 | −0.199 | 0.111 | −0.207 | 0.303 | 0.185 |
27. It terrorizes me to think about my future | 0.653 | −0.057 | −0.131 | 0.063 | 0.352 | 0.076 | −0.050 |
22. It is hard for me to fall asleep when I go to bed | 0.621 | −0.001 | 0.021 | 0.064 | −0.057 | −0.230 | 0.357 |
18. I often feel useless | 0.610 | 0.040 | 0.390 | 0.112 | −0.153 | −0.032 | −0.119 |
21. I am restless and it is difficult for me to stay still | 0.573 | 0.039 | −0.149 | 0.044 | 0.164 | −0.099 | 0.284 |
6. I am more tired than usual | 0.568 | −0.023 | 0.060 | −0.108 | 0.145 | −0.249 | 0.341 |
28. It is difficult for me to do the things I used to do | 0.542 | 0.053 | 0.136 | −0.067 | 0.032 | 0.017 | 0.276 |
8. I think my life is going to be a failure | 0.507 | −0.004 | 0.400 | 0.054 | −0.074 | 0.139 | −0.029 |
11. I feel inferior to everyone else | 0.465 | 0.001 | 0.339 | −0.001 | 0.161 | 0.026 | −0.205 |
12. Things don’t satisfy me as much as they used to | 0.459 | 0.089 | 0.305 | −0.135 | 0.043 | 0.223 | 0.148 |
19. I feel like the people who loved me have abandoned me | 0.458 | −0.042 | 0.174 | 0.382 | −0.165 | 0.180 | −0.163 |
10. I don’t trust people | 0.416 | 0.177 | 0.150 | −0.220 | −0.179 | 0.189 | 0.100 |
FACTOR 2: Diminished interest | |||||||
31. I don’t want to take my glucose test results to my doctor | −0.129 | 0.804 | 0.031 | 0.088 | −0.010 | −0.093 | 0.194 |
40. I don’t feel like going to my medical checkups | −0.024 | 0.779 | −0.061 | 0.090 | −0.060 | 0.163 | 0.142 |
45. I am not interested in learning anything else about diabetes | −0.136 | 0.683 | −0.193 | 0.080 | −0.042 | 0.335 | 0.048 |
42. I’ve stopped taking care of my diabetes | 0.157 | 0.651 | −0.275 | 0.177 | 0.155 | 0.085 | −0.294 |
16. I don’t take care of my health like before | 0.398 | 0.595 | −0.007 | −0.024 | 0.022 | −0.103 | −0.221 |
FACTOR 3: Hopelessness and dissatisfaction | |||||||
17. I’ve thought about taking my life | −0.094 | −0.130 | 0.834 | 0.141 | 0.017 | −0.165 | 0.037 |
15. I think my life serves no purpose anymore | 0.180 | −0.182 | 0.662 | 0.134 | 0.032 | 0.111 | 0.102 |
32. I feel like I can’t cope with my diabetes | −0.093 | 0.415 | 0.467 | 0.069 | 0.271 | −0.080 | 0.088 |
14. Sexual relations don’t satisfy me | 0.303 | −0.031 | 0.316 | −0.254 | 0.078 | 0.166 | 0.179 |
FACTOR 4: Guilt | |||||||
38. I think my diabetes is a punishment | 0.009 | 0.083 | 0.087 | 0.712 | −0.018 | 0.113 | −0.035 |
36. I am ashamed of my diabetes | −0.167 | 0.255 | 0.025 | 0.664 | −0.080 | 0.130 | 0.183 |
33. I feel guilty about my diabetes | −0.107 | 0.207 | 0.196 | 0.613 | 0.126 | −0.236 | 0.089 |
23. I feel like everyone would be better off if I died | 0.104 | −0.111 | 0.487 | 0.532 | −0.106 | −0.024 | −0.127 |
34. I feel like I can’t take care of myself and that I need help from others | 0.207 | −0.048 | −0.101 | 0.385 | 0.326 | −0.145 | 0.247 |
FACTOR 5: Fear, frustration and irritability | |||||||
41. I dread thinking about the possible complications that diabetes might cause me | 0.052 | 0.032 | −0.076 | −0.025 | 0.787 | 0.078 | 0.014 |
30. I feel angry about my diabetes | 0.038 | −0.014 | 0.323 | −0.030 | 0.565 | 0.111 | 0.132 |
44. I feel like I can’t live a normal life like everyone else | 0.070 | 0.009 | 0.120 | 0.039 | 0.550 | 0.328 | 0.044 |
FACTOR 6: Defenselessness | |||||||
43. I don’t believe any treatment can improve my diabetes | −0.128 | 0.104 | −0.052 | 0.042 | 0.149 | 0.815 | −0.076 |
37. I feel like I can’t do anything to improve my diabetes | 0.122 | 0.288 | −0.069 | 0.005 | 0.151 | 0.486 | 0.118 |
FACTOR 7: Interference in daily life | |||||||
9. My sleep schedule has changed (I sleep more hours or less hours than before) | 0.575 | 0.136 | −0.129 | −0.052 | −0.131 | −0.105 | 0.577 |
35. It is hard for me to concentrate because of my diabetes | −0.042 | 0.071 | 0.204 | 0.147 | 0.178 | 0.113 | 0.515 |
39. I worry about my diabetes so much that I can’t think about anything else | 0.106 | −0.224 | 0.077 | 0.321 | 0.189 | 0.150 | 0.371 |
Factor | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
---|---|---|---|---|---|---|---|
1 | 1.000 | 0.338 | 0.568 | 0.299 | 0.421 | 0.309 | 0.268 |
2 | 1.000 | 0.308 | 0.125 | 0.370 | 0.238 | 0.115 | |
3 | 1.000 | 0.182 | 0.295 | 0.258 | 0.187 | ||
4 | 1.000 | 0.300 | 0.166 | 0.143 | |||
5 | 1.000 | 0.113 | 0.242 | ||||
6 | 1.000 | 0.163 | |||||
7 | 1.000 |
N = 207 | DID-1 Scale | Factor 1 | Factor 2 | Factor 3 | Factor 4 | Factor 5 | Factor 6 | Factor 7 | |
---|---|---|---|---|---|---|---|---|---|
Variable | N (%) | M ± SD t/p | M ± SD t/p | M ± SD t/p | M ± SD t/p | M ± SD t/p | M ± SD t/p | M ± SD t/p | M ± SD t/p |
Sex | |||||||||
Men | 108 (47.8) | 97.79 ± 44.51 | 59.53 ± 31.08 | 11.37 ± 6.93 | 2.50 ± 1.51 | 9.44 ± 5.74 | 8.72 ± 4.51 | 4.27 ± 2.96 | 1.93 ± 1.55 |
Women | 99 (52.2) | 122.22 ± 51.01 −3.679/≥ 0.001 | 77.87 ± 36.62 −3.866/≥ 0.001 | 12.58 ± 6.67 −1.279/0.202 | 3.29 ± 2.46 −2.813/0.005 | 10.80 ± 5.73 −1.704/0.090 | 10.92 ± 5.34 −3.193/0.002 | 4.34 ± 2.79 −0.175/0.861 | 2.41 ± 1.82 −2.039/0.043 |
Physical illness | |||||||||
Yes | 76 (36.7) | 125.30 ± 54.52 | 80.14 ± 38.86 | 12.46 ± 6.26 | 3.76 ± 2.99 | 10.85 ± 6.48 | 10.92 ± 5.47 | 4.66 ± 3.03 | 2.50 ± 1.87 |
No | 131 (63.3) | 101.97 ± 44.22 3.174/0.002 | 62.70 ± 31.33 3.336/0.001 | 11.74 ± 7.12 0.733/0.465 | 2.42 ± 1.06 3.757/≥0.001 | 9.75 ± 5.29 1.334/0.184 | 9.26 ± 4.74 2.209/0.029 | 4.10 ± 2.75 1.337/0.183 | 1.99 ± 1.58 1.986/0.049 |
Age of the participants | |||||||||
<30 years old ≥30 years old | 78 (37.7) 129 (62.3) | 108.55 ± 46.68 111.73 ± 51.16 −0.448/0.654 | 65.65 ± 31.19 71.18 ± 37.41 −1.146/0.253 | 12.86 ± 8.07 11.49 ± 5.89 1.304/0.195 | 2.48 ± 1.18 3.18 ± 2.45 −2.717/0.007 | 10.70±5.95 9.82 ± 5.65 1.068/0.287 | 10.24 ± 5.23 9.64 ± 4.97 0.824/0.411 | 4.51 ± 3.14 4.18 ± 2.69 0.795/0.428 | 2.09 ± 1.77 2.23 ± 1.67 −0.581/0.562 |
Diabetes duration | |||||||||
<15 years with diabetes ≥15 years with diabetes | 101 (48.8) 106 (51.2) | 111.81 ± 48.28 109.32 ± 50.70 0.362/0.718 | 69.93 ± 34.90 68.31 ± 35.67 0.330/0.742 | 12.17 ± 7.04 11.85 ± 6.61 0.336/0.737 | 2.86 ± 1.91 2.97 ± 2.26 −0.378/0.706 | 10.39 ± 5.81 9.92 ± 5.74 0.587/0.558 | 9.93 ± 5.16 9.81 ± 5.00 0.169/0.866 | 4.36 ± 2.98 4.25 ± 2.76 0.280/0.780 | 2.16 ± 1.65 2.19 ± 1.77 −0.167/0.868 |
HbA1c (%) | |||||||||
<7.0% ≥7.0% | 71 (34.6) 134 (65.4) | 104.29 ± 47.96 113.26 ± 49.70 −1.244/0.215 | 65.56 ± 34.05 70.57 ± 35.54 −0.974/0.331 | 9.80 ± 4.05 13.23 ± 7.66 −4.189/≥0.001 | 2.80 ± 1.95 2.99 ± 2.18 −0.614/0.540 | 10.09 ± 5.70 10.06 ± 5.60 0.038/0.970 | 9.66 ± 4.80 9.88 ± 5.19 −0.294/0.769 | 4.01 ± 2.78 4.45 ± 2.90 −1.050/0.295 | 2.35 ± 1.68 2.06 ± 1.68 1.185/0.237 |
Depression (SCID-I) | |||||||||
Yes | 32 (15.5) | 188.47 ± 33.60 | 126.78 ± 17.84 | 16.50 ± 8.17 | 5.87 ± 3.56 | 14.78 ± 8.79 | 14.75 ± 5.41 | 6.09 ± 3.56 | 3.68 ± 2.20 |
No | 175 (84.5) | 96.29 ± 37.02 13.126/≥ 0.001 | 58.55 ± 26.23 18.309/≥ 0.001 | 11.18 ± 6.21 3.499/0.001 | 2.37 ± 1.01 5.513/≥ 0.001 | 9.31 ± 4.57 3.436/0.002 | 8.97 ± 4.47 6.483/≥ 0.001 | 3.98 ± 2.60 3.202/0.003 | 1.90 ± 1.44 4.406/≥ 0.001 |
DID-1 | BDI-II | SDS | |
---|---|---|---|
Sensitivity (Se) | 0.906 | 0.969 | 0.719 |
Specificity (Sp) | 0.909 | 0.843 | 0.937 |
False Positives (FP) | 9.14% | 15.70% | 6.29% |
False Negatives (FN) | 9.38% | 3.12% | 28.13% |
Youden’s Index | 0.815 | 0.812 | 0.622 |
Prevalence | 21.74% | 28.43% | 16.43% |
PPV a | 0.644 | 0.534 | 0.676 |
NPV b | 0.981 | 0.993 | 0.948 |
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Carreira, M.; Ruiz de Adana, M.S.; Domínguez, M.; Valdés, S.; Almaraz, M.C.; Olveira, G.; Anarte, M.T. Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1). Int. J. Environ. Res. Public Health 2021, 18, 12529. https://doi.org/10.3390/ijerph182312529
Carreira M, Ruiz de Adana MS, Domínguez M, Valdés S, Almaraz MC, Olveira G, Anarte MT. Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1). International Journal of Environmental Research and Public Health. 2021; 18(23):12529. https://doi.org/10.3390/ijerph182312529
Chicago/Turabian StyleCarreira, Mónica, María Soledad Ruiz de Adana, Marta Domínguez, Sergio Valdés, Maria Cruz Almaraz, Gabriel Olveira, and María Teresa Anarte. 2021. "Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1)" International Journal of Environmental Research and Public Health 18, no. 23: 12529. https://doi.org/10.3390/ijerph182312529