BACKGROUND Diabetes is a serious chronic illness that disproportionately affects prevalence and comorbidity rates among Hispanic populations. Little comparative research has been conducted on the emotional distress experienced by Hispanic patients living with type 2 diabetes. PURPOSE [corrected] To conduct a psychometric examination of an established measure of emotional distress specific to diabetes and to use this tool to examine levels and predictors of distress in a comparative study of Hispanic and non-Hispanic type 2 diabetes patients. METHOD Psychometric analyses were conducted (skewness, kurtosis, differential item function (DIF), confirmatory factor analysis (CFA), internal consistency reliability) to examine the equivalence of U.S. English and U.S. Spanish language versions of a measure of diabetes-related distress (Problem Areas in Diabetes (PAID). Regression modeling was used to evaluate differences in distress by ethnic group, after adjusting for blood glucose control, sex, age, education, physical functioning, mental health functioning, and spirituality. Psychometric results showed that PAID had high reliability (alpha = 0.96). Skewness, kurtosis, and DIF were not present. CFA identified a large general factor, supporting use of the total PAID score. Univariate analyses found a significantly higher mean PAID score for Hispanic patients compared to non-Hispanic (45.9 +/- 28.5 vs. 35.9 +/- 26.4). A final regression model based on age, physical functioning, and mental functioning accounted for approximately 50% of PAID variance. CONCLUSION Our findings supported the reliability and unidimensionality of the U.S. Spanish and U.S. English PAID versions for comparative research. Compared to non-Hispanic patients, Hispanic patients reported higher distress, which was substantially predicted from age and physical and mental functioning.