This page and associated links are designed to help to identify the emotional and psychological factors that play a role helping patients to manage diabetes. This is vital to consider as it allows for the patient to be seen as a whole person rather than just as a diabetic. In working with situational, cultural and lifespan issues with patients the key is to encourage empowerment and effective self-management of the whole of their lives.
People with diabetes experience disproportionately high rates of psychological disorders, with depression and anxiety being the most common diagnoses. Some studies have suggested that approximately 40% of patients will have significantly elevated symptoms of depression. As regards anxiety similar figures have been recorded.
|Key Points |
|Co-Morbidity and Psychological Disturbances|
|Impact of Diabetes across the Lifespan on patient & family|
|Adherence, Treatment, and Motivation|
|Psychological aspects of Symptoms|
Co-Morbidity and Psychological Disturbances
A diagnosis of diabetes and its subsequent management can potentially be associated with psychological problems. For example, one in three individuals with diabetes will suffer depression that impairs functioning, adherence to medical treatment and glycaemic control.
Most common conditions include:
Cultural origins will inform the decisions that most patients make about managing their condition
Problems may be caused by:
knowledge about diabetes and available services for treatment and support.
Fatalism - "It
is God's Will"
Barriers to diet and exercise interventions
Scepticism regarding the values of preventative health behaviours
Language and barriers to understanding
Issues of body weight, appearance, and what is considered culturally acceptable are also factors.
Remember - Information and treatment recommendations suggested may well be at odds with the patients cultural background, so cultural sensitivity and awareness will be more important than simply providing information about how to manage the condition
|Impact of Diabetes across the Lifespan on Patient & Family|
Diabetes may have a psychological impact on the outlook on life and lifespan that a patient may take. For example:
Parental concern about the possibility of their children developing the condition.
The need to manage the condition in addition to the psychological demands of meeting commonly experienced challenges faced throughout the life cycle, such as leaving home, marriage, and pregnancy.
The development of diabetic complications.
It is helpful for the health care professional to take time to find out what is going on
in the patient's life that may contribute to difficulties in managing the condition, and where appropriate, offer support and suggestions for how these 'life issues' might best be approached.
Adherence, Treatment, and Motivation
Sticking to treatment regimes for the condition is a challenge
This is determined by the extent to which a patient's behaviour coincides with health advice/recommendations
Remember that where diabetes is concerned effective recommendations are likely to be complex and vary from patient to patient (this is due to the need to balance the various components of treatment with each other and life issues outside of the condition)
As adherence to treatment and diabetic control is monitored it needs to be remembered that patients facing this challenge may well feel demoralised or depressed if outcomes are poor.
It is vital to ensure that the patient does not feel blamed for these as this could potentially undermine their motivation to comply with all aspects of treatment.
Remember it is not simply enough to educate and instruct the patient on how to manage their condition. Support and encouragement are vital if the patient is to feel empowered. In clinic the role of the professional should be one of facilitator rather than expert.
|Psychological Aspects of Symptoms|
Coming to terms with a diagnosis of chronic illness is a process of adjustment and coping on an emotional and practical
Where the individual encounters difficulties with
adjustment, they may also experience distress. Often, the meaning attached to
the illness (the illness representation) can influence the adjustment process.
There are five broad cognitive illness representation dimensions that are thought to be:
Identity (the label given to the illness and knowledge of its symptoms)
Cause (beliefs about the cause of the illness)
Timeline (the perceived duration and course of the illness)
Consequences (the perceived short and long term effects of the illness)
Control / cure (beliefs about the degree of controllability / curability of the illness)
Some symptoms (hypoglycaemic symptoms such as irritability, loss of concentration/poor memory, shaking and sweating) of diabetes may be misinterpreted as anxiety and contribute to the development of health anxiety and poor coping: the reverse may also occur.
|If the patient is reporting good diabetic control but still experiencing these symptoms it will be important to consider if they may not be coping well emotionally. |
If there are concerns
that the patient is suffering from some form of mood disorder it may well be worth suggesting that they
consider the possibility of commencing on a short course of anti-depressant medication. However, in the first instance simply talking to the patient and providing some support and reassurance may be of help.
'The Listening Report' produced by Diabetes UK in 2001/2002 noted that a third of diabetic patients felt that they needed someone to talk to.
Therapeutic interventions have also been shown to be of help, however at primary care level it is perhaps more helpful to adopt a preventative approach in treatment. Helpful strategies include:
Counselling patients about the need to express negative feelings about diabetes self-management
Helping the patient with conflict over normal developmental and life-span struggles
Encouraging participation/support from other family members
Diabetes specific coping skills training - focusing on specific sticking points/active problem solving
The Expert Patient Programme may be helpful for patients
Local services/organizations that may be able to provide further information and support include:
The Expert Patient Programme
The Diabetes Centres at the L&D and Bedford Hospitals
The Dunstable and Luton Counselling Service.|
For more severe and complex problems relating to
diabetes, the Clinical Health Psychology Service provides Clinical
Psychologist intervention for patients with diabetes under Bedford and L&D
Hospital Diabetes Centres, as described below.
If you are presented with a patient in the surgery and feel that they perhaps need more specialist input an onward referral may be appropriate. This could include the following:
A person experiencing psychological distress as a direct result of diabetes lifestyle
(for example diagnosis; development of diabetes-related complications; transitions impacting on diabetes and
identity e.g. pregnancy, adolescence).
A person or services experiencing substantial difficulties managing/living with diabetes - often broader life experience and psychosocial factors are a major influence here. Examples might include recurrent hyper/hypoglycaemia requiring medical attention; eating, weight and self-image issues; people who over or under use services.
People with longer term needs - e.g. rehabilitation or support issues for people living with multiple diabetes-related complications, or health problems; people with mental health needs.
To refer in the South
The patient's GP will need to refer the patient to the Diabetes Centre at the
Luton and Dunstable (L&D) Hospital. They will then be assessed by one of the Diabetes Specialist Consultants. If felt appropriate the patent will then be
referred for an assessment by the Clinical Psychologist at which stage a course of treatment will be decided upon and an intervention undertaken
if it is felt this will be beneficial.
PLEASE NOTE: AT PRESENT PSYCHOLOGICAL SERVICES AT THE LUTON AND. DUNSTABLE HOSPITAL ARE CURRENTLY ONLY AVAILABLE FOR THOSE PATIENTS LIVING IN THE SOUTH OF THE COUNTY.
To refer in the North
For patients that are attending the Diabetes Centre at Bedford Hospital, clinicians at the diabetes centre will liaise with the psychologist providing input to the diabetes centre. The psychologist will offer an assessment and this will guide further treatment and or referral to services best suitable to manage psychological aspects of care.
For those not attending the Diabetes Centre and presenting at GP surgeries, please see the referral criteria below for the following services that may be of help to those suffering from a psychological distress or a mental health disorder:
For referral guidance into appropriate services see - External Links & Resources