Evaluation of selected psychological parameters: Perception of happiness and hope of success in patients with type 1 diabetes mellitus

Happiness and hope are essential elements of mental wellbeing. One of the main objectives in healthcare, including diabetes care, is to help patients achieve and maintain their mental health, including their happiness and goals in life [1]. Happiness can be seen as a motivating agent to overcome challenges, which encourages cooperation and ensures better compliance with therapy [1]. Hope and success are interlinked. In order to drive one, the other needs to be redefined. Being hopeful about the future keeps people engaged, more productive, and ultimately allows people to envision a reality different than the one they’re currently in. Hope for success is about setting goals and working to create a plan to make a goal a reality [2]. In the literature on the subject, there are only a few studies concerning the level of happiness and hope for success in a group of patients with T2DM [3,4,5], and even fewer studies concerning patients with T1DM [6].

Research on quality of life indicates that patients with diabetes have a quality of life that is poorer than people in the general population, but better than those who are suffering from other chronic diseases [7,8]. Depression among patients with diabetes can be considered a factor that may indicate a level of happiness and hope for success that is likely lower in this group of patients. The metabolic parameters measured with the percentage of HbA1c were worse in patients with depressive-anxiety disorders and with a high level of B-PaidBM [7]. In recently published papers, we have shown that the combination of specific personality traits, social skills, family support, sports traditions, inheritance factors and access to new technologies in the treatment of T1DM under the supervision of a highly qualified specialist diabetologist may result in a unique and inspiring successful success in life, sport and treatment of diabetes [10,11].

One way to increase patients’ sense of control over diabetes, and thus open the door to success in various areas of life, is a continuous education process on T1DM [12]. The aim of our study was to assess the levels of happiness and hope for success in the group of T1DM patients that gathered during an online workshop on continuous glucose monitoring (CGM).

On April 28, 2021, 297 patients suffering from various types of diabetes took part in an educational workshop devoted to CGM systems. 120 patients agreed to anonymously participate in this study and completed the survey. Taking into account the small number of patients with T2DM and other types of diabetes in the studied group, we selected the patients with T1DM and performed analyses within this subgroup (n = 96, 80%). Our statistical analyses were carried out using R software ver. 4.0.5. Data was presented as numbers with percentages, mean with standard deviation, or median with interquartile range. To assess whether the variables had a normal distribution, a Shapiro-Wolf test was performed, and the homogeneity of the variance was checked by the Leven test. Differences between the two groups were analyzed accordingly with the T-student test (in the absence of homogeneity of the Welcha test) or non-parametric tests (Wilcoxon test). To compare three age groups, ANOVA test was used (homogeneity of variance were tested using the Bartlett test). To calculate comparisons with pairs between group levels with patches for multiple testing, we used the Post Hoc (TUKEY-HSD) test. To compare psychological test results (KNS scale, for SHS scale - no population data) with a general population, a z-test for means to calculate the test statistic was used, and the p-value was calculated using the approximation of the normal distribution curve.

To understand and interpret the connection between two categorical variables, the chi-square test was used. The threshold α = 0.05 was considered to be the level of significance. The data was interpreted by a clinical psychologist.

The study included 96 patients with type 1 diabetes. 28% were male. Most (61%) were 27–50 years of age (Table 1).

4.1. In our first analysis, we evaluated happiness levels with the use of the Subjective Happiness Scale (SHS).

The level of happiness did not differ depending on the sex of the examined patients (Males: 4.25 [3.06–5.44], Females: 5.00 [4.00–5.38]; Wilcoxon statistic W=526.5; p=0.1418).

Then we checked if there were any differences between age groups. Older patients, specifically those over 50 years of age, showed a significantly higher level of happiness than patients from the group aged 18–26 (p = 0.004). Other differences between the groups were not significant (p > 0.05) (Tab. 2).

4.2. For the second analysis, we checked the level of general level of hope for success and its two components: the belief in having a strong will and the belief in the ability to find solutions with the use of Hope for Success Questionnaire (KNS).

At first, we analyzed the sten score distribution for the global test result and compared it to that of the whole population, and we found no differences between the distributions (Table 3).

We then compared the results of the studied group with the validation data for the general population, also including subscale results. There were no differences between the studied population and general population in results for the overall KNS test (46.80 ± 9.53; 47.67 ± 7.86; p = 0.447) or in the subscales: belief in having a strong will (22.38 ± 5.58; 22.33 ± 4.62; p = 0.941 (Tables 5, 6, 8) and belief in the ability to find solutions (24.42 ± 4.71; 25.32 ± 4.19, p = 0.113).

For the next step, we wanted to know if there were gender differences within the studied population in terms of the hope for success. We found that men were characterized by higher conviction about the ability to find solutions than women (Table 4).

Finally, we wanted to check if there were differences in the hope for success in the studied group between age subgroups.

A significant post-hoc difference was observed between the age groups of 18–26 and 27–50 (p = 0.004), as well as 18–26 and >50 (p=0.005) for the global KNS result. A significant post-hoc difference was also observed between the age groups of 18–26 and 27–50 (p = 0.004), as well as 18–26 and >50 (p=0.005) for the belief in having strong will. A significant post-hoc difference was also observed between the groups aged <18 and 18–26 (p = 0.0170), between 18–26 and 27–50 (p = 0.009), and between 18–26 and >50 (p = 0.0002). In the KNS subscale “belief in the ability to find solutions,” the group in early adulthood was characterized by a significantly lower sten value than other age groups. No differences between the age groups were observed on the KNS subscale “belief in a strong will” (Table 5).

The purpose of our study was to test the subjective sense of happiness and the hope for success in a group of patients with type 1 diabetes, taking into account age and gender differences. We have shown that people over 50 had a higher level of happiness than patients aged 18 to 26 years. Men were characterized by a higher belief in the ability to find solutions than women. Patients aged 18 to 26 years were characterized by a significantly lower overall result in the KNS test than the older age groups. This age group also significantly had the lowest belief in the ability to find solutions in relation to other age groups.

Studies using the Subjective Happiness Scale that have been carried out in large populations have indicated that the mean sten score ranges from about 4.5 to 5.5 points, depending on the analyzed group. Students tended to achieve lower results (averaging slightly below 5) than working adults and the elderly and retired (averaging 5.6) [15,16]. In our study, both women and men achieved results in the 4 sten range (mean score 4.29), and these groups did not differ from each other. Analyzing the results according to age categories (<18, 18–26, 27–50 years, >50), the mean subjective happiness sten score was significantly higher in patients with T1DM aged over 50, compared to patients aged 18 to 26 years.

Living with a chronic disease is a complex, dynamic, cyclical, and multidimensional process related to the development of special attributes: acceptance, coping, self-care, integration, and adaptation [17]. If these aspects of those functioning with chronic disease are not fully developed, the level of subjective happiness may be lower, overvalued by frustration or anxiety. Appropriate education and T1DM treatment with access to highly qualified specialists and new technologies, as well as psychological support or psychotherapy, may be helpful in this respect [10].

However, the high level of happiness in the group of T1DM patients over the age of 50 is an optimistic indicator that disease acceptance and a sense of fulfillment can come with age. As patients confront their life expectations, possibilities, and fears with real-life challenges, including what they achieved, they may gain the ability to overcome obstacles regardless of chronic disease, or even be motivated by the disease [18].

The general level of hope for success and the subjective feeling that a solution to difficult problems can be found, and that one has a strong will to pursue goals, does not differentiate the T1DM group from the general population. Men were characterized by a higher belief in the ability to find solutions.

Comparing the results for several age groups, we observed that in younger adulthood (18–26 years of age), the hope for success in life and the feeling that one can deal with own problems is significantly lower in relation to older age groups. This may suggest that young adults with T1DM may be confronted with fears and obstacles related to diabetes while making important life decisions, undertaking challenges related to studies, choosing a job, and developing families [19]. This group of T1DM patients requires special attention from diabetologists, health care professionals, and educators as positive motivation, appropriate education, and psychological support can be beneficial for young adults. These interventions can help them change attitudes and overcome fears, and thus create a solid basis for a happy and a successful life with diabetes.

The outcome of older patients may be related to the fact that these patients have already achieved many of their life goals and managed to cope with many life challenges, even though they had T1DM. They found out that T1DM does not prevent them from fulfilling their dreams and even motivates them to do so. Their future plans were based on previous positive experiences.

This study had several limitations. It was an anonymous questionnaire and we had no access to clinical data, so we were unable to correlate the parameters assessed during the study with disease-related variables such as duration of diabetes, treatment of diabetes (multiple daily injections versus pump), use of continuous monitoring system, BMI, and the presence of complications related to diabetes. There was also no information on the mental state and possible psychiatric treatment of these patients. In addition, 4 patients did not provide information about their gender and age. Another limitation may be the unequal and small size of the analyzed subgroups. More importantly, the statistical analyses performed were rather simple and we did not apply multivariate analyses due to the limited number of participants in subgroups. On the other hand, the division of age into subgroups was necessary to use the data for norm groups prepared by the Polish Test Laboratory.

However, the fact that we analyzed a random sample of patients treated in various medical centers can be considered an advantage of the study. It is also worth emphasizing that the approach presented in our article to obtaining a group of diabetic patients who were specifically seeking patient resources is not often brought up in the literature. Positive psychology can be applied when describing the functioning of patients living with a chronic disease.

Our study may have clinical implications due to the fact that it indicates resources for patients with T1DM. It would be advisable to conduct a similar study in patients with T1DM who are not participating in similar workshops, as well as in a group of patients with T2DM, and in a control group of healthy people.

Young adults aged 18 to 26 years are a group particularly vulnerable to lower feelings of happiness, lower hope for success, and lower belief in the ability to find solutions than older age groups. In this group of patients, psychoeducation about life possibilities and improvement of the quality of life can be helpful, stimulating the idea that a patient with T1DM can lead a fully happy and successful life. Elderly patients over 50 years have good coping mechanisms and believe that their actions can bring good results.