Validation and Cross-Cultural Adaptation of the Diabetes Distress Scale in a Spanish Population

Purpose: The purpose of the study was to translate, culturally adapt, and validate the Diabetes Distress Scale (DDS) in Spain. Methods: A cross-sectional validation study was conducted among adults with diabetes attending public health centers in Spain. Participants completed the Spanish DDS and Problem Areas in Diabetes (PAID) questionnaire. Exploratory and confirmatory factor analyses used polychoric correlations and diagonally weighted least squares estimation. Reliability was examined with Cronbach’s α and McDonald’s ω. Concurrent, convergent, discriminant, and incremental validity were tested through correlation and regression analyses. Gender invariance was assessed using multigroup confirmatory factor analysis. Results: The 4-factor model was supported. Internal consistency was excellent. DDS total scores strongly correlated with PAID scores, explaining 84.5% of variance ( R 2 = 0.845). Original DDS cutoffs (<2.0, 2.0–2.9, ≥3.0) were confirmed, showing PAID differences. Gender invariance was achieved. Conclusions: The Spanish DDS showed strong psychometric properties, replicating the original 4-factor structure with high reliability and validity, offering a culturally appropriate tool for diabetes-related distress in Spain.