Cognitive and emotional pathways to diabetes distress: a structural equation and latent profile analysis

Diabetes distress is a common and clinically significant condition linked to the daily demands of diabetes management. It affects up to 36% of individuals with type 2 diabetes and is associated with poor outcomes. However, the cognitive and emotional mechanisms underlying this distress remain unclear, especially in high-burden settings such as Saudi Arabia. The study aims to quantify the cognitive and emotional pathways associated with diabetes distress and identify distinct profiles of psychological burden.

A cross-sectional study was conducted among 438 adults with diabetes in 4 primary healthcare centers in Saudi Arabia. Participants were recruited using convenience sampling, and data were collected through a structured questionnaire administered during healthcare visits. Pain catastrophizing, illness perceptions, and diabetes distress were assessed using validated scales. We used structural equation modeling (SEM) to estimate direct and indirect effects and latent profile analysis (LPA) to identify patient subgroups. Multinomial logistic regression was used to examine associated factors.

The findings showed that pain catastrophizing (β = 0.30; 95% CI: 0.19-0.44) and emotional representations of illness (β = 0.51; 95% CI: 0.17-0.83) were positively associated with diabetes distress. Conversely, perceived consequences did not show a significant association. Pain catastrophizing was strongly associated with both perceived consequences (β = 0.68; 95% CI: 0.57-0.76) and emotional representations (β = 0.66; 95% CI: 0.60-0.81). The indirect effect of pain catastrophizing on diabetes distress through emotional representations was significant (β = 0.34; 95% CI: 0.11-0.59), while through perceived consequences was not (β = 0.06; 95% CI: -0.17 to 0.30). The total effect of pain catastrophizing on distress was strong (β = 0.70; 95% CI: 0.63-0.83). The SEM explained 67% of the variance in diabetes distress. The study identified three profiles: low burden, moderate distress, and high burden. A higher burden was associated with a longer disease duration and complications, while higher education reduced risk.

Diabetes distress is driven by strong cognitive and emotional pathways, with emotional illness representations acting as the primary mediator. Distinct patient profiles highlight the need for targeted interventions.