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Diabetes - Pyschological Factors

Diabetes - Psychological Effects & Emotional Support

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Introduction

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
Cultural Issues
Impact of Diabetes across the Lifespan on patient & family
Adherence, Treatment, and Motivation
Psychological aspects of Symptoms
Treatment
Referral pathways

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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:

Depression

Anxiety

Eating Disorders

Phobias

Adjustment disorders

Sexual Dysfunction

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Cultural Issues

Cultural origins will inform the decisions that most patients make about managing their condition

Problems may be caused by:

Ignorance about diabetes and available services for treatment and support.

Poverty

Fatalism - "Its God's Will"

Religious convictions

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

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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 the patients 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.

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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.

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 self-empowered. In clinic the role of the professional should be one of facilitator rather than expert.

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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 side.

When this adjustment is not achieved successfully it is common to experience psychological distress.  Some of the factors that influence the outcome relate to the meaning (illness representation) that an individual attaches to a diagnosis of chronic illness.

There are five broad cognitive illness representations dimensions that are thought to be:

1.

Identity (the label given to the illness and knowledge of its symptoms)

2.

Cause (beliefs about the cause of the illness)

3.

Timeline (the perceived duration and course of the illness)

4.

Consequences (the perceived short and long term effects of the illness)

5.

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.
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Treatment
 

If there are concerns about the patient suffering from some form of mood disorder it may well be worth suggesting that they discuss 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.

Diabetes UK Tools to measure quality of life, emotional and psychological needs of people with diabetes patient reported outcomes

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:

De-emphasising dieting

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.

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What Next?

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:

1.

Person experiencing psychological distress as a direct result of diabetes lifestyle For example diagnosis, development of diabetes-related complications, transitions impacting on diabetes and self e.g. pregnancy, adolescence.

2.

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.

3.

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.

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Referral Pathways
 

To refer in the South

 

The patient's GP will need to refer the patient to the Diabetes Centre at the L&D. Hospital. They will then be assessed by one of the Diabetes Specialist Consultants. If felt appropriate the patent will then be assessed by the Psychologist at which stage a course of treatment will be decided upon and an intervention undertaken.

 

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

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Useful External Links & Resources

PDF File

Psychology Services Guidance

View

Expert Patient Programme

Free self-management courses providing tools and techniques to help Diabetics take control of their health and manage their condition better on a daily basis.

View

Diabetes Attitudes, Wishes and Needs Study

The DAWN (Diabetes Attitudes Wishes and Needs) programme is a global Novo Nordisk initiative in collaboration with the International Diabetes Federation and an international expert advisory board. Its aim is to improve the health and quality of life of people with diabetes by facilitating concrete initiatives and best practice sharing worldwide to overcome the psychosocial barriers to effective self-management.

View

Diabetes UK Tools.

Tools to measure quality of life, emotional and psychological needs of people with diabetes patient reported outcomes

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