How do perceptions of illness affect quality of life in people with diabetes?

Exploring the relationships between illness perceptions, self-efficacy, coping strategies, psychological distress and diabetes-specific quality of life

By Ralph Geerling


It’s been said that perception is reality. But to think that there is a straight line between them may be oversimplifying the complex role that our psychological processes play. This is certainly true for people living with diabetes who, based on those perceptions, make numerous decisions each day about what they eat and what they do, all of which can have a big impact on their quality of life (QoL). But what makes the way one person thinks about their condition have a different effect on their QoL then another person? This may be linked to the individual differences in self-confidence (self-efficacy), coping strategies and the experience of emotional distress.

Dr Simon Knowles and colleagues report on a study (2020) in which they examined the relationship between a person’s perception of their illness and how diabetes impacts on their QoL; and specifically whether a person’s self-efficacy, coping strategies and emotional distress can explain any observed differences in the relationship. Their survey was completed by 115 Australian adults (average age 53±16 years) with diabetes (56 with type 1; 59 with type 2); 51% were women. 

Whilst adjusting for any effects that age or gender may have on the relationship, they found it is anything but a straight line from perception to reality (QoL). Sub-optimal illness perceptions had both a direct and indirect relationship with diabetes-specific QoL; and self-efficacy and maladaptive coping mediated the relationship between illness perceptions and distress. The distress components, anxiety and depressive symptoms, acted separately as key mediators between self-efficacy, coping and diabetes-specific QoL.

The researchers identified mindfulness interventions as a means to address the psychological processes affecting the relationship between illness perceptions and QoL. Mindfulness exercises have been shown to increase awareness and attention, which can be useful for moderating perceptions, e.g. of an illness, and this has previously proved useful among people with diabetes. They also note the importance of addressing self-efficacy and coping patterns as a means to reduce the negative impact of diabetes on QoL, pointing to the important associations these constructs had in the overall outcome.

This is a useful study, providing further evidence of the complex structures that exist governing the quality of a person’s experiences with health and illness. It is also a powerful reminder of how interconnected these structures are and that, with the right tools and support, a change in one can tip the balance and become the difference between sub-optimal and optimal QoL.

Knowles SR, Apputhurai P, O’Brien CL, Ski CF, Thompson DR & Castle DJ. Exploring the relationships between illness perceptions, self-efficacy, coping strategies, psychological distress and quality of life in a cohort of adults with diabetes mellitus. Psychology, Health & Medicine, 2020; 25:2, 214-228.