{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T08:08:59Z","timestamp":1779178139626,"version":"3.51.4"},"reference-count":68,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100015777","name":"Division of Research Capacity Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100015777","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006312","name":"South African Agency for Science and Technology Advancement","doi-asserted-by":"publisher","award":["137992"],"award-info":[{"award-number":["137992"]}],"id":[{"id":"10.13039\/501100006312","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Psychol"],"abstract":"<jats:p>People living with diabetes (PLWD) faced heightened biomedical and psychosocial risk during the COVID-19 pandemic, yet little is known about their mental health in South Africa. This study examined whether COVID-19 threat appraisals (fear of COVID-19, perceived vulnerability to disease, and COVID-19-related worry) predicted depression, anxiety, posttraumatic stress, and alcohol use among PLWD, and described the prevalence of these outcomes in a post-peak phase of the pandemic. Participants (n\u2009=\u2009266) were recruited from public hospitals in the Western Cape and completed sociodemographic and standardised measures. Grounded in Lazarus and Folkman\u2019s Stress and Coping theory, hierarchical regression analysis showed that fear of COVID-19 was the most consistent predictor of psychological distress, explaining between 9 and 20% of the variance across outcomes. Study participants reported on average elevated levels of psychological distress, suggesting the need to integrate routine mental health assessment and referral into diabetes care.<\/jats:p>","DOI":"10.1177\/13591053261450005","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:54:14Z","timestamp":1778734454000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Examining the mental health impact of the COVID-19 pandemic on people living with diabetes in the Western Cape, South Africa"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1545-418X","authenticated-orcid":false,"given":"Bronwyne","family":"Coetzee","sequence":"first","affiliation":[{"name":"Stellenbosch University, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6292-8862","authenticated-orcid":false,"given":"Phillipa","family":"Haine","sequence":"additional","affiliation":[{"name":"Stellenbosch University, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1241-2566","authenticated-orcid":false,"given":"Ashraf","family":"Kagee","sequence":"additional","affiliation":[{"name":"Stellenbosch University, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Abdelghani M Hamed MG Said A et al. (2022) Evaluation of perceived fears of COVID-19 virus infection and its relationship to health-related quality of life among patients with diabetes mellitus in Egypt during pandemic: A developing country single-center study. Diabetology International 13(1): 108\u2013116. https:\/\/doi.org\/10.1007\/s13340-021-00511-8","DOI":"10.1007\/s13340-021-00511-8"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Ahmed AT Karter AJ Warton EM et al. (2008) The relationship between alcohol consumption and glycemic control among patients with diabetes: The Kaiser Permanente Northern California Diabetes Registry. Journal of General Internal Medicine 23: 275\u2013282. https:\/\/doi.org\/10.1007\/s11606-007-0502-z","DOI":"10.1007\/s11606-007-0502-z"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"Ahorsu DK Lin CY Imani V et al. (2022) The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction 20(3): 1537\u20131545. https:\/\/doi.org\/10.1007\/s11469-020-00270-8","DOI":"10.1007\/s11469-020-00270-8"},{"key":"e_1_3_3_5_1","doi-asserted-by":"crossref","unstructured":"Alessi J de Oliveira GB Franco DW et al. (2020) Mental health in the era of COVID-19: Prevalence of psychiatric disorders in a cohort of patients with type 1 and type 2 diabetes during the social distancing. Diabetology & Metabolic Syndrome 12(1): 0. https:\/\/doi.org\/10.1186\/s13098-020-00584-6","DOI":"10.1186\/s13098-020-00584-6"},{"key":"e_1_3_3_6_1","doi-asserted-by":"crossref","unstructured":"Al-Sofiani ME Albunyan S Alguwaihes AM et al. (2021) Determinants of mental health outcomes among people with and without diabetes during the COVID-19 outbreak in the Arab Gulf region. Journal of Diabetes 13(4): 339\u2013352. https:\/\/doi.org\/10.1111\/1753-0407.13149","DOI":"10.1111\/1753-0407.13149"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdaa106"},{"key":"e_1_3_3_8_1","doi-asserted-by":"crossref","unstructured":"Beck AT Epstein N Brown G et al. (1988) An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology 56(6): 893\u2013897. https:\/\/doi.org\/10.1037\/0022-006X.56.6.893","DOI":"10.1037\/0022-006X.56.6.893"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Beran D Aebischer Perone S Castellsague Perolini M et al. (2021) Beyond the virus: Ensuring continuity of care for people with diabetes during COVID-19. Primary Care Diabetes 15(1): 16\u201317. https:\/\/doi.org\/10.1016\/j.pcd.2020.05.014","DOI":"10.1016\/j.pcd.2020.05.014"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"Blevins CA Weathers FW Davis MT et al. (2015) The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial Psychometric Evaluation. Journal of Traumatic Stress 28(6): 489\u2013498. https:\/\/doi.org\/10.1002\/jts.22059","DOI":"10.1002\/jts.22059"},{"key":"e_1_3_3_11_1","doi-asserted-by":"crossref","unstructured":"Boake M Mash R (2022) Diabetes in the Western Cape South Africa: A secondary analysis of the diabetes cascade database 2015 \u2013 2020. Primary Care Diabetes 16(4): 555\u2013561. https:\/\/doi.org\/10.1016\/j.pcd.2022.05.011","DOI":"10.1016\/j.pcd.2022.05.011"},{"key":"e_1_3_3_12_1","doi-asserted-by":"crossref","unstructured":"Bovin MJ Marx BP Weathers FW et al. (2016) Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-fifth edition (PCL-5) in veterans. Psychological Assessment 28(11): 1379\u20131391. https:\/\/doi.org\/10.1037\/pas0000254","DOI":"10.1037\/pas0000254"},{"key":"e_1_3_3_13_1","doi-asserted-by":"crossref","unstructured":"Buchberger B Huppertz H Krabbe L et al. (2016) Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis. Psychoneuroendocrinology 70: 70\u201384. https:\/\/doi.org\/10.1016\/j.psyneuen.2016.04.019","DOI":"10.1016\/j.psyneuen.2016.04.019"},{"key":"e_1_3_3_14_1","doi-asserted-by":"crossref","unstructured":"Carducci C Rapini N Deodati A et al. (2021) Post-traumatic stress disorder (PTSD) in parents of children with type 1 diabetes during covid-19 pandemic. Italian Journal of Pediatrics 47(1): 176. https:\/\/doi.org\/10.1186\/s13052-021-01126-0","DOI":"10.1186\/s13052-021-01126-0"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Chen Y Wills L Wise H et al. (2024) Psychometric synthesis of the alcohol Use Disorders Identification Test (AUDIT). Journal of Counseling & Development 102(4): 406\u2013414. https:\/\/doi.org\/10.1002\/jcad.12531","DOI":"10.1002\/jcad.12531"},{"key":"e_1_3_3_16_1","doi-asserted-by":"crossref","unstructured":"Chlapecka A Kagstrom A Cermakova P (2022) Educational attainment inequalities in depressive symptoms in more than 100 000 individuals in Europe. European Psychiatry 65(Suppl 1): S269. https:\/\/doi.org\/10.1192\/j.eurpsy.2022.689","DOI":"10.1192\/j.eurpsy.2022.689"},{"key":"e_1_3_3_17_1","doi-asserted-by":"crossref","unstructured":"Coetzee B Haine P Kidd M et al. (2025) Coping in crisis: The role of sense of coherence life satisfaction and resilience in the relationship between depression social support fear of COVID-19 and perceived vulnerability to disease among nurses in South Africa. Journal of Health Psychology 30: 2542\u20132556. https:\/\/doi.org\/10.1177\/13591053241279000","DOI":"10.1177\/13591053241279000"},{"key":"e_1_3_3_18_1","doi-asserted-by":"crossref","unstructured":"Dartora WJ Schmidt MI Griep RH et al. (2023) Changes in lifestyle habits in individuals with diabetes during the COVID-19 pandemic: The ELSA-Brasil Cohort Study. COVID 3(10): 1601\u20131611. https:\/\/doi.org\/10.3390\/covid3100109","DOI":"10.3390\/covid3100109"},{"key":"e_1_3_3_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/13548506.2021.1954671"},{"key":"e_1_3_3_20_1","doi-asserted-by":"crossref","unstructured":"Duncan LA Schaller M Park JH (2009) Perceived vulnerability to disease: Development and validation of a 15-item self-report instrument. Personality and Individual Differences 47(6): 541\u2013546. https:\/\/doi.org\/10.1016\/j.paid.2009.05.001","DOI":"10.1016\/j.paid.2009.05.001"},{"key":"e_1_3_3_21_1","first-page":"363","article-title":"Center for epidemiologic studies depression scale: Review and revision","author":"Eaton WW","year":"2004","unstructured":"Eaton WW, Muntaner C, Smith C, et al. (2004) Center for epidemiologic studies depression scale: Review and revision. In: Maruish ME(ed.) The Use of Psychological Testing for Treatment Planning and Outcomes Assessment. Mahwah, NJ: Lawrence Erlbaum Associates Publishers, pp.363\u2013377.","journal-title":"The Use of Psychological Testing for Treatment Planning and Outcomes Assessment"},{"key":"e_1_3_3_22_1","doi-asserted-by":"crossref","unstructured":"Forkus SR Raudales AM Rafiuddin HS et al. (2023) The Posttraumatic Stress Disorder (PTSD) Checklist for DSM\u20135: A systematic review of existing psychometric evidence. Clinical Psychology Science and Practice 30(1): 110. https:\/\/doi.org\/10.1037\/cps0000111","DOI":"10.1037\/cps0000111"},{"key":"e_1_3_3_23_1","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Lara RA G\u00f3mez-Urquiza JL Membrive-Jim\u00e9nez MJ et al. (2022a) Anxiety distress and stress among patients with diabetes during COVID-19 pandemic: A systematic review and meta-analysis. Journal of Personalized Medicine 12(9): 1412. https:\/\/doi.org\/10.3390\/jpm12091412","DOI":"10.3390\/jpm12091412"},{"key":"e_1_3_3_24_1","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Lara RA Suleiman-Martos N Membrive-Jim\u00e9nez MJ et al. (2022b) Prevalence of depression and related factors among patients with chronic disease during the COVID-19 pandemic: A systematic review and meta-analysis. Diagnostics 12(12): 3094. https:\/\/doi.org\/10.3390\/diagnostics12123094","DOI":"10.3390\/diagnostics12123094"},{"key":"e_1_3_3_25_1","doi-asserted-by":"crossref","unstructured":"Gonzalez JS Peyrot M McCarl LA et al. (2008) Depression and diabetes treatment nonadherence: A meta-analysis. Diabetes Care 31(12): 2398\u20132403. https:\/\/doi.org\/10.2337\/dc08-1341","DOI":"10.2337\/dc08-1341"},{"key":"e_1_3_3_26_1","doi-asserted-by":"crossref","unstructured":"Haine P Kagee A Coetzee B et al. (2025) Unmasking distress: An Analysis of COVID-19\u2019s mental health impact on nurses in South Africa. Western Journal of Nursing Research 47: 241\u2013251. https:\/\/doi.org\/10.1177\/01939459251316049","DOI":"10.1177\/01939459251316049"},{"key":"e_1_3_3_27_1","unstructured":"International Diabetes Federation (IDF) (2026) South Africa. https:\/\/idf.org\/our-network\/regions-and-members\/africa\/members\/south-africa\/ (accessed 6 May 2026)."},{"key":"e_1_3_3_28_1","doi-asserted-by":"crossref","unstructured":"Joensen LE Madsen KP Holm L et al. (2020) Diabetes and COVID-19: Psychosocial consequences of the COVID-19 pandemic in people with diabetes in Denmark-what characterizes people with high levels of COVID-19-related worries? Diabetic Medicine 37(7): 1146\u20131154. https:\/\/doi.org\/10.1111\/dme.14319","DOI":"10.1111\/dme.14319"},{"key":"e_1_3_3_29_1","doi-asserted-by":"crossref","unstructured":"Kagee A Bantjes J Saal W et al. (2022) Predicting posttraumatic stress disorder caseness using the PTSD Checklist for DSM-5 among patients receiving care for hiv. Journal of Traumatic Stress 35(1): 13\u201321. https:\/\/doi.org\/10.1002\/jts.22654","DOI":"10.1002\/jts.22654"},{"key":"e_1_3_3_30_1","doi-asserted-by":"crossref","unstructured":"Kagee A Coetzee B Saal W et al. (2015) Using the Beck Anxiety Inventory among South Africans living with HIV. Measurement and Evaluation in Counseling and Development 48(3): 204\u2013213. https:\/\/doi.org\/10.1177\/0748175615578734","DOI":"10.1177\/0748175615578734"},{"key":"e_1_3_3_31_1","doi-asserted-by":"crossref","unstructured":"Kagee A Padmabhanunni A Coetzee B et al. (2024) Sense of coherence social support satisfaction with life and resilience as mediators between fear of COVID-19 perceived vulnerability to disease and depression. South African Journal of Psychology 54(3): 300\u2013313. https:\/\/doi.org\/10.1177\/00812463241259123","DOI":"10.1177\/00812463241259123"},{"key":"e_1_3_3_32_1","doi-asserted-by":"crossref","unstructured":"Lazaridou A Paschali M Vilsmark ES et al. (2022) The impact of COVID-19 pandemic on mental and physical wellbeing in women with fibromyalgia: A longitudinal mixed-methods study. BMC Women\u2019s Health 22(1): 267. https:\/\/doi.org\/10.1186\/s12905-022-01840-9","DOI":"10.1186\/s12905-022-01840-9"},{"key":"e_1_3_3_33_1","volume-title":"Stress, Appraisal, and Coping","author":"Lazarus RS","year":"1984","unstructured":"Lazarus RS, Folkman S (1984) Stress, Appraisal, and Coping. New York: Springer Publishing Company."},{"key":"e_1_3_3_34_1","doi-asserted-by":"crossref","unstructured":"Malakoane B Heunis JC Chikobvu P et al. (2020) Public health system challenges in the Free State South Africa: A situation appraisal to inform health system strengthening. BMC Health Services Research 20: 58. https:\/\/doi.org\/10.1186\/s12913-019-4862-y","DOI":"10.1186\/s12913-019-4862-y"},{"key":"e_1_3_3_35_1","doi-asserted-by":"crossref","unstructured":"Mapanga W Craig A Mtintsilana A et al. (2023) The effects of COVID-19 pandemic lockdowns on alcohol consumption and tobacco smoking behaviour in South Africa: A national survey. European Addiction Research 29(2): 127\u2013140. https:\/\/doi.org\/10.1159\/000528484","DOI":"10.1159\/000528484"},{"key":"e_1_3_3_36_1","doi-asserted-by":"publisher","DOI":"10.2174\/18749445-v15-e2206140"},{"key":"e_1_3_3_37_1","doi-asserted-by":"crossref","unstructured":"Moradian S Teufel M Jahre L et al. (2021) Mental health burden of patients with diabetes before and after the initial outbreak of COVID-19: Predictors of mental health impairment. BMC Public Health 21(1): 2068. https:\/\/doi.org\/10.1186\/s12889-021-12101-z","DOI":"10.1186\/s12889-021-12101-z"},{"issue":"1","key":"e_1_3_3_38_1","first-page":"23","article-title":"Reliability and factor structure of the AUDIT among male and female bar patrons in a rural area of South Africa","volume":"14","author":"Morojele NK","year":"2015","unstructured":"Morojele NK, Kekwaletswe CT, Nkosi S, et al. (2015) Reliability and factor structure of the AUDIT among male and female bar patrons in a rural area of South Africa. African Journal of Drug and Alcohol Studies 14(1): 23\u201335.","journal-title":"African Journal of Drug and Alcohol Studies"},{"key":"e_1_3_3_39_1","doi-asserted-by":"crossref","unstructured":"Musche V Kohler H B\u00e4uerle A et al. (2021) COVID-19-related fear risk perception and safety behavior in individuals with diabetes. Healthcare 9(4): 480. https:\/\/doi.org\/10.3390\/healthcare9040480","DOI":"10.3390\/healthcare9040480"},{"key":"e_1_3_3_40_1","doi-asserted-by":"crossref","unstructured":"Myers BA Klingensmith R de Groot M (2022) Emotional correlates of the COVID-19 pandemic in individuals with and without diabetes. Diabetes Care 45(1): 42\u201358. https:\/\/doi.org\/10.2337\/dc21-0769","DOI":"10.2337\/dc21-0769"},{"key":"e_1_3_3_41_1","doi-asserted-by":"crossref","unstructured":"Padmanabhanunni A Pretorius TB Stiegler N et al. (2022) A serial model of the interrelationship between perceived vulnerability to disease fear of COVID-19 and psychological distress among teachers in South Africa. Annales M\u00e9dico-psychologiques Revue Psychiatrique 180(1): 23\u201328. https:\/\/doi.org\/10.1016\/j.amp.2021.11.007","DOI":"10.1016\/j.amp.2021.11.007"},{"key":"e_1_3_3_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12144-024-06113-2"},{"key":"e_1_3_3_43_1","doi-asserted-by":"crossref","unstructured":"Pettinicchio D Maroto M Chai L et al. (2021) Findings from an online survey on the mental health effects of COVID-19 on Canadians with disabilities and chronic health conditions. Disability and Health Journal 14(3): 101085. https:\/\/doi.org\/10.1016\/j.dhjo.2021.101085","DOI":"10.1016\/j.dhjo.2021.101085"},{"key":"e_1_3_3_44_1","doi-asserted-by":"crossref","unstructured":"Qubekile Y Paruk S Paruk F (2022) Prevalence of depressive symptoms and quality of life among patients with diabetes mellitus with and without HIV infection: A South African study. South African Journal of Psychiatry 28: 1762. https:\/\/doi.org\/10.4102\/sajpsychiatry.v28i0.1762","DOI":"10.4102\/sajpsychiatry.v28i0.1762"},{"key":"e_1_3_3_45_1","doi-asserted-by":"crossref","unstructured":"Roncon L Zuin M Rigatelli G et al. (2020) Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. Journal of Clinical Virology 127: 104354. https:\/\/doi.org\/10.1016\/j.jcv.2020.104354","DOI":"10.1016\/j.jcv.2020.104354"},{"key":"e_1_3_3_46_1","doi-asserted-by":"crossref","unstructured":"Sacre JW Holmes-Truscott E Salim A et al. (2021) Impact of the COVID-19 pandemic and lockdown restrictions on psychosocial and behavioural outcomes among Australian adults with type 2 diabetes: Findings from the PREDICT cohort study. Diabetic Medicine 38(9): e14611. https:\/\/doi.org\/10.1111\/dme.14611","DOI":"10.1111\/dme.14611"},{"key":"e_1_3_3_47_1","doi-asserted-by":"crossref","unstructured":"Sahadew N Singaram VS Brown S (2016) Distribution incidence prevalence and default of patients with diabetes mellitus accessing public healthcare in the 11 districts of KwaZulu-Natal South Africa. South African Medical Journal 106(4): 389\u2013393. https:\/\/doi.org\/10.7196\/samj.2016.v106i4.10143","DOI":"10.7196\/SAMJ.2016.v106i4.10143"},{"key":"e_1_3_3_48_1","doi-asserted-by":"crossref","unstructured":"Saha S Al-Rifai RH Saha S (2021) Diabetes prevalence and mortality in COVID-19 patients: A systematic review meta-analysis and meta-regression. Journal of Diabetes & Metabolic Disorders 20: 939\u2013950. https:\/\/doi.org\/10.1007\/s40200-021-00779-2","DOI":"10.1007\/s40200-021-00779-2"},{"key":"e_1_3_3_49_1","doi-asserted-by":"crossref","unstructured":"Saal W Kagee A Bantjes J (2020) Gender differences in the utility of the alcohol use disorder identification test in screening for alcohol use disorder among HIV test seekers in South Africa. AIDS and Behavior 24(7): 2073\u20132081. https:\/\/doi.org\/10.1007\/s10461-019-02772-6","DOI":"10.1007\/s10461-019-02772-6"},{"key":"e_1_3_3_50_1","doi-asserted-by":"crossref","unstructured":"Saunders JB Aasland OG Babor TF et al. (1993) Development of the alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on early detection of persons with harmful alcohol consumption\u2013ii. Addiction 88(6): 791\u2013804. https:\/\/doi.org\/10.1111\/j.1360-0443.1993.tb02093.x","DOI":"10.1111\/j.1360-0443.1993.tb02093.x"},{"key":"e_1_3_3_51_1","doi-asserted-by":"crossref","unstructured":"Semenkovich K Brown ME Svrakic DM et al. (2015) Depression in type 2 diabetes mellitus: Prevalence impact and treatment. Drugs 75: 577\u2013587. https:\/\/doi.org\/10.1007\/s40265-015-0347-4","DOI":"10.1007\/s40265-015-0347-4"},{"key":"e_1_3_3_52_1","doi-asserted-by":"crossref","unstructured":"Sibiya N Mzimela N Mbatha B et al. (2023) The insights on why diabetes prevalence may increase amid or post COVID-19 pandemic. Current Diabetes Reviews 19(4): e110422203401. https:\/\/doi.org\/10.2174\/1573399818666220411122345","DOI":"10.2174\/1573399818666220411122345"},{"key":"e_1_3_3_53_1","doi-asserted-by":"crossref","unstructured":"Singhai K Swami MK Nebhinani N et al. (2020) Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus. Diabetes & Metabolic Syndrome Clinical Research & Reviews 14(6): 1603\u20131605. https:\/\/doi.org\/10.1016\/j.dsx.2020.08.025","DOI":"10.1016\/j.dsx.2020.08.025"},{"key":"e_1_3_3_54_1","doi-asserted-by":"crossref","unstructured":"Snoek FJ Bremmer MA Hermanns N (2015) Constructs of depression and distress in diabetes: Time for an appraisal. Lancet Diabetes & Endocrinology 3(6): 450\u2013460. https:\/\/doi.org\/10.1016\/s2213-8587(15)00135-7","DOI":"10.1016\/S2213-8587(15)00135-7"},{"key":"e_1_3_3_55_1","doi-asserted-by":"crossref","unstructured":"Solymosi R Jackson J P\u00f3sch K et al. (2021) Functional and dysfunctional fear of COVID-19: A classification scheme. Crime Science 10(1): 4. https:\/\/doi.org\/10.1186\/s40163-020-00137-2","DOI":"10.1186\/s40163-020-00137-2"},{"key":"e_1_3_3_56_1","doi-asserted-by":"crossref","unstructured":"Sorsdahl K Petersen I Myers B et al. (2023) A reflection of the current status of the mental healthcare system in South Africa. SSM-Mental Health 4: 100247. https:\/\/doi.org\/10.1016\/j.ssmmh.2023.100247","DOI":"10.1016\/j.ssmmh.2023.100247"},{"key":"e_1_3_3_57_1","unstructured":"Stats SA (2017) Mortality and causes of death in South Africa 2016: Findings from death notification. Available at: http:\/\/www.statssa.gov.za\/publications\/P03093\/P030932017.pdf (accessed 6 May 2026)."},{"key":"e_1_3_3_58_1","doi-asserted-by":"crossref","unstructured":"Sun H Saeedi P Karuranga S et al. (2022) IDF Diabetes Atlas: Global regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Research and Clinical Practice 183: 109119. https:\/\/doi.org\/10.1016\/j.diabres.2021.109119","DOI":"10.1016\/j.diabres.2021.109119"},{"key":"e_1_3_3_59_1","doi-asserted-by":"crossref","unstructured":"Sifunda S Mbewu AD Mabaso M et al. (2023) Prevalence and psychosocial correlates of diabetes mellitus in South Africa: results from the South African National Health and Nutrition Examination Survey (SANHANES-1). International Journal of Environmental Research and Public Health 20(10): 5798. https:\/\/doi.org\/10.3390\/ijerph20105798","DOI":"10.3390\/ijerph20105798"},{"key":"e_1_3_3_60_1","volume-title":"Using Multivariate Statistics","author":"Tabachnick BG","year":"2019","unstructured":"Tabachnick BG, Fidell LS (2019) Using Multivariate Statistics, 7th edn. Pearson.","edition":"7"},{"key":"e_1_3_3_61_1","doi-asserted-by":"crossref","unstructured":"Taber KS (2018) The use of Cronbach\u2019s alpha when developing and reporting research instruments in science education. Research in Science Education 48(6): 1273\u20131296. https:\/\/doi.org\/10.1007\/s11165-016-9602-2","DOI":"10.1007\/s11165-016-9602-2"},{"key":"e_1_3_3_62_1","doi-asserted-by":"crossref","unstructured":"Tele\u015f M (2024) The effect of fear on health information searching behavior during the pandemic: The case of COVID-19. International Journal of Medical Informatics 184: 105368. https:\/\/doi.org\/10.1016\/j.ijmedinf.2024.105368","DOI":"10.1016\/j.ijmedinf.2024.105368"},{"key":"e_1_3_3_63_1","doi-asserted-by":"crossref","unstructured":"Umberson D Montez JK (2010) Social relationships and health: A flashpoint for health policy. Journal of Health and Social Behavior 51 Suppl(Suppl): S54\u2013S66. https:\/\/doi.org\/10.1177\/0022146510383501","DOI":"10.1177\/0022146510383501"},{"key":"e_1_3_3_64_1","doi-asserted-by":"crossref","unstructured":"Van Dam NT Earleywine M (2011) Validation of the Center for Epidemiologic Studies Depression Scale\u2014revised (CESD-R): Pragmatic depression assessment in the general population. Psychiatry Research 186(1): 128\u2013132. https:\/\/doi.org\/10.1016\/j.psychres.2010.08.018","DOI":"10.1016\/j.psychres.2010.08.018"},{"key":"e_1_3_3_65_1","doi-asserted-by":"crossref","unstructured":"Weerakoon SM Jetelina KK Knell G et al. (2021) COVID-19 related employment change is associated with increased alcohol consumption during the pandemic. American Journal of Drug and Alcohol Abuse 47(6): 730\u2013736. https:\/\/doi.org\/10.1080\/00952990.2021.1912063","DOI":"10.1080\/00952990.2021.1912063"},{"key":"e_1_3_3_66_1","doi-asserted-by":"crossref","unstructured":"Weism\u00fcller B Schweda A D\u00f6rrie N et al. (2021) Different correlates of COVID-19-related adherent and dysfunctional safety behavior. Frontiers in Public Health 8: 625664. https:\/\/doi.org\/10.3389\/fpubh.2020.625664","DOI":"10.3389\/fpubh.2020.625664"},{"key":"e_1_3_3_67_1","unstructured":"World Health Organisation (WHO) (2024) Diabetes. Available at:\u2009https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diabetes (accessed 6 May 2026)."},{"key":"e_1_3_3_68_1","doi-asserted-by":"crossref","unstructured":"Yan AF Sun X Zheng J et al. (2020) Perceived risk behavior changes and health-related outcomes during COVID-19 pandemic: Findings among adults with and without diabetes in China. Diabetes Research and Clinical Practice 167: 108350. https:\/\/doi.org\/10.1016\/j.diabres.2020.108350","DOI":"10.1016\/j.diabres.2020.108350"},{"key":"e_1_3_3_69_1","doi-asserted-by":"crossref","unstructured":"Yuan K Gong YM Liu L et al. (2021) Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century including COVID-19: A meta-analysis and systematic review. Molecular Psychiatry 26(9): 4982\u20134998. https:\/\/doi.org\/10.1038\/s41380-021-01036-x","DOI":"10.1038\/s41380-021-01036-x"}],"container-title":["Journal of Health Psychology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13591053261450005","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13591053261450005","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13591053261450005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T07:47:33Z","timestamp":1779176853000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13591053261450005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":68,"alternative-id":["10.1177\/13591053261450005"],"URL":"https:\/\/doi.org\/10.1177\/13591053261450005","relation":{},"ISSN":["1359-1053","1461-7277"],"issn-type":[{"value":"1359-1053","type":"print"},{"value":"1461-7277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"article-number":"13591053261450005"}}