Anxiety Symptoms in Diabetes Scale in Adolescents (ASDS-A)

Abstract

The Anxiety Symptoms in Diabetes Scale in Adolescents (ASDS-A; Rechenberg, Szalacha, & Bugajski, 2023) is a rating scale designed to measure diabetes-specific sources of anxiety in adolescents with Type 1 diabetes (T1D). The development of the ASDS-A was initiated through a qualitative study involving adolescents aged 12 to 16 years with T1D, aiming to thoroughly describe the phenomenon of diabetes-specific anxiety and identify relevant item content. An initial draft of 50 items was generated, which underwent face and content validation through an expert review, leading to a reduction to 15 items. Subsequent psychometric evaluation was conducted using a sample of adolescents with T1D, aged 12 to 16 years. A principal component analysis identified a single dominant component, resulting in a final 14-item scale, with one item (Item 14) removed due to a low factor loading. The scale demonstrates strong internal consistency and concurrent validity. The ASDS-A can typically be completed within 15 minutes or less.

Keywords

Adolescents, Anxiety Symptoms, Face Validity, Hypoglycemia, Self-Management, Type 1 Diabetes

Authors

Kaitlyn Rechenberg, Laura Szalacha, Andrew Bugajski

Purpose

The ASDS-A is a dedicated measure designed to assess diabetes-specific anxiety symptoms in adolescents diagnosed with Type 1 diabetes. Its primary purpose is to provide a reliable and valid self-report instrument for identifying and quantifying the unique anxiety experiences related to managing Type 1 diabetes in this specific age group.

Validity

Concurrent Validity: The construct validity and concurrent validity of the ASDS-A were rigorously established by examining its correlations with nine closely related constructs. These constructs included general anxiety symptoms, depressive symptoms, self-management, and various subscales of diabetes-specific quality of life (QOL). The ASDS-A scores showed strong and appropriate correlations with the following measures:

• Generalized Anxiety Disorder-7 Scale (GAD-7; Spitzer et al., 2006): A significant positive correlation was observed (r = .493, p < .001), indicating that higher diabetes-specific anxiety is associated with higher general anxiety.

• Patient Health Questionnaire-2 Scale (PHQ-2; Richardson et al., 2010): A strong positive correlation was found (r = .51, p < .001), suggesting a relationship between diabetes-specific anxiety and depressive symptoms.

• Diabetes-Specific Pediatric Quality of Life Scale (PedsQOL 3.0; Varni et al., 2003) Subscales:

  • Diabetes symptoms: A significant negative correlation (r = −.581, p < .001) suggests that higher diabetes-specific anxiety is associated with more perceived diabetes symptoms.

  • Treatment barriers: A strong negative correlation (r = −.595, p < .001) indicates that increased anxiety is linked to greater perceived barriers to treatment.

  • Treatment adherence: A significant negative correlation (r = −.536, p < .001) suggests that higher anxiety is associated with lower treatment adherence.

  • Worry: A very strong negative correlation (r = −.694, p < .001) highlights a close relationship between diabetes-specific anxiety and general worry related to diabetes.

  • Communication: A strong negative correlation (r = −.660, p < .001) indicates that higher anxiety is associated with poorer communication regarding diabetes.

• Total Diabetes-Specific Pediatric Quality of Life Scale (PedsQOL 3.0; Varni et al., 2003): A significant positive correlation with the total score (r = .655, p < .001) further supports the concurrent validity of the ASDS-A, indicating that higher diabetes-specific anxiety is associated with lower overall quality of life in adolescents with T1D.

Reliability

Internal Consistency: The internal consistency of the ASDS-A was evaluated using Cronbach’s alpha, which was reported as .896. This value indicates excellent internal consistency, suggesting that the items within the scale are highly intercorrelated and measure a consistent underlying construct of diabetes-specific anxiety.

Factor Analysis

Principal Component Analysis: A principal component analysis was conducted during the development of the ASDS-A. Initially, two components were extracted with eigenvalues greater than 1. However, the eigenvalue of the first component, which was 6.106, was more than four times greater than that of the second component (1.41). A Scree plot also supported the conclusion that a single component was sufficient to explain the data. This single component accounted for 43.61% of the total variation in the data. Following this analysis, item 14 was removed from the scale due to a low factor loading of .287, resulting in a final 14-item measure.

Instrument: Anxiety Symptoms in Diabetes Scale in Adolescents (ASDS-A)

Test Type: Original
Format: The ASDS-A is a 14-item rating scale. Respondents answer questions on a 5-point Likert-type scale, ranging from “strongly disagree” to “strongly agree,” to indicate their agreement with each statement. ASDS-A scores can range from a minimum of 14 to a maximum of 52. The administration method is electronic, and the test items are available.
Language Available: English
Population Group: Human; Male; Female.
Age Group: Childhood (birth-12 yrs); School Age (6-12 yrs); Adolescence (13-17 yrs). The psychometric evaluation specifically focused on adolescents with Type 1 Diabetes aged 12 to 16 years.
Population Details: The respondents for the psychometric evaluation were adolescents with Type 1 Diabetes located in the United States.
Test Methodology: The development and evaluation of the ASDS-A employed various test methodologies, including Test Validity (encompassing Concurrent Validity, Construct Validity, and Content Validity), Test Reliability (specifically Internal Consistency), and Factor Analysis (specifically Principal Component Analysis).

Keywords

Adolescents; Anxiety Symptoms; Face Validity; Hypoglycemia; Self-Management; Type 1 Diabetes

Authors

Rechenberg, Kaitlyn
Affiliation: University of South Florida College of Nursing
Email: [email protected]
Correspondence Address: University of South Florida, 12901 Bruce B. Downs Blvd, MDC 22, Tampa, Florida, United States, 33612, [email protected]

Szalacha, Laura
Author ORCID Identifier: orcid.org/0000-0002-4504-6980
Affiliation: University of South Florida College of Nursing
Email: No data is Available

Bugajski, Andrew
Affiliation: Lakeland Regional Health Department of Research and Sponsored Studies
Email: No data is Available

Permissions & Fee and Test Year

Permissions: Contact Publisher
Fee: No
Commercial: No
Test Year: 2023

References

Rechenberg, K., Szalacha, L., & Bugajski, A. (2023). A self-report measure of diabetes-specific anxiety symptoms for adolescents. Children’s Health Care, 52(2), 123–137. doi.org/10.1080/02739615.2022.2047970

Items of the Anxiety Symptoms in Diabetes Scale in Adolescents (ASDS-A)

The ASDS-A is a 14-item measure. The specific items can be found in:

Test Location: 2022-45415-001, Table 2, Page 129 of the source reference.

Anxiety Symptoms in Diabetes Scale in Adolescents (ASDS-A)

1. When I am afraid, I feel like I might throw up.

2. I am embarrassed when I have to leave class to manage my diabetes.

3. I am embarrassed by my insulin pump.

4. People judge me because I have diabetes.

5. When I am afraid it is difficult to breathe.

6. I keep my blood sugar high on purpose when I’m out with my friends.

7. I worry about my mom because it’s stressful to have a teenager with diabetes.

8. I worry about my dad because it’s stressful to have a teenager with diabetes.

9. I worry a lot about my blood sugar getting too low.

10. I worry a lot about my blood sugar getting too low while I’m sleeping.

11. *I feel embarrassed when I have to interrupt an activity to manage my diabetes.

12. *I do not worry about my A1C.

13. *When I’m at school, I forget to manage my diabetes.

14. *I don’t worry about my diabetes too much.

15. *I like telling people about my diabetes.

Note: *Item reversed. As the loading for item 14 was only .287, it was dropped from the analysis. Items are rated on a 5-point Likert-type scale evaluating the degree to which respondents agree with each statement (strongly disagree to strongly agree).