Pictorial Representation of Illness and Self Measure Revised II (PRISM-RII): a novel method to assess perceived burden of illness in diabetes patients

The Pictorial Representation of Illness and Self Measure (PRISM) has been introduced as a visual measure of suffering. We explored the validity of a revised version, the PRISM-RII, in diabetes patients as part of the annual review. Participants were 308 adult outpatients with either type 1 or type 2 diabetes. (1) the PRISM-RII, yielding Self-Illness Separation (SIS) and Illness Perception Measure (IPM); (2) the Problem Areas in Diabetes (PAID) scale, a measure of diabetes-related distress; (3) the WHO-5 Well-Being Index; (4) and a validation question on suffering (SQ). In addition, patients' complication status, comorbidity and glycemic control values(HbA1c) were recorded. Patients with complications did have marginally significant higher scores on IPM, compared to patients without complications. Type 2 patients had higher IPM scores than Type 1 patients. SIS and IPM showed low intercorrelation (r = -.25; p <.01). Convergent validity of PRISM-RII was demonstrated by significant correlations between IPM and PAID (r = 0.50; p <0.01), WHO-5 (r = -.26; p <0.01) and SQ (r = 0.36; p <0.01). SIS showed only significant correlations with PAID (r = -0.28; p <0.01) and SQ (r = -0.22; p <0.01). Neither IPM nor SIS was significantly associated with HbA1c. The PRISM-RII appeared easy to use and facilitated discussion with care providers on coping with the burden of diabetes. PRISM-RII appears a promising additional tool to assess the psychological burden of diabetes