Examining Factors Associated with Mental and Physical Wellbeing in American Indian People with Diabetes

American Indian people with Type 2 diabetes (T2D) are more likely to have a lower health-related quality of life (HRQoL) than those without T2D. A new study in Cherokee Nation citizens from Oklahoma finds that this increased risk may be due to things that influence psychological or social wellbeing, collectively called psychosocial factors. Some psychosocial factors that may lower HRQoL include post-traumatic stress disorder (PTSD), lack of social support, or low levels of resilience. Addressing these factors could improve HRQoL for American Indian people with diabetes.

HRQoL is a multi-dimensional measure of physical, psychological, and social health and wellbeing. Previous research has shown that living with diabetes can lower HRQoL. For instance, people with diabetes may have to make difficult dietary changes, and some may worry about their blood glucose levels throughout the day. However, few studies have looked at HRQoL in American Indians with T2D or the myriad psychosocial factors that may contribute to lower HRQoL in this population.

The researchers used data collected between August 2017 and April 2019 from telephone surveys with over 4,000 Cherokee Nation users of the tribally operated healthcare system. The surveys collected information on a range of health behaviors and health issues. Of the people surveyed, 953 (23%) had diabetes. Participants with diabetes were more likely to be older, have a lower household income, have a higher BMI, and not be college educated. People with diabetes were also less likely to be very satisfied with life compared to those without diabetes.

Members of American Indian communities face unique challenges that can affect their psychosocial wellbeing. Researchers examined how these factors related to the physical and mental aspects of HRQoL in the participants with diabetes. They found that experiencing PTSD and feeling dissatisfied with life were both associated with poor physical and mental health. Interestingly, researchers found that being more resilient lowered the odds of experiencing poor physical and mental health. Resilience is the ability to adapt when faced with adversity.

Studies have shown that American Indian communities continue to thrive despite historical and contemporary trauma, oppression, and loss. Results from this study indicate that this resilience may be a protective factor that can help mitigate the risk of stress and trauma associated with having T2D within the American Indian community. This study suggests that resilience-based interventions may improve HRQoL in this population. Long-term studies are needed to show whether addressing the effects of PTSD and life dissatisfaction can improve mental and physical wellbeing in American Indians with T2D.

Though the findings in this study are specific to the Cherokee Nation, the authors underscore the importance of including American Indian communities in studies related to HRQoL. Results from this study may be used to inform future preventative strategies and treatment options for people living with T2D within the Cherokee Nation and beyond.


Scarton, L., Hebert, L. E., Goins, R. T., Umans, J. G., Jiang, L., Comiford, A., Chen, S., White, A., Ritter, T., & Manson, S. M. (2021). Diabetes and health-related quality of life among American Indians: the role of psychosocial factors. Quality of Life Research, 30(9), 2497–2507. DOI: https://doi.org/10.1007/s11136-021-02830-4

Page updated June 17, 2022