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Diabetes: A Psychological Perspective

Diabetes: A Psychological Perspective. Prof. Frank J. Snoek Medical Psychology Diabetes Psychology Research Group VU University Medical Centre Amsterdam - The Netherlands. Contents. Well-being and Self-management Coping issues Barriers to diabetes self-regulation Practice Implications.

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Diabetes: A Psychological Perspective

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  1. Diabetes: A Psychological Perspective Prof. Frank J. Snoek Medical Psychology Diabetes Psychology Research Group VU University Medical Centre Amsterdam - The Netherlands

  2. Contents • Well-being and Self-management • Coping issues • Barriers to diabetes self-regulation • Practice Implications

  3. Psychological Well-being in Diabetes? • Well-being is an important outcome in its self (SVD, 1995) • Poor Well-being impedes diabetes self-care

  4. Adaptational Tasks in Chronic Illness (Coping) • Maintain emotional balance after diagnosis (loss of health, self-esteem) • Cope with physical complaints and functional limitations • Maintain social roles, cope with negative labelling (stigma) • Cope with medical procedures and stresses/uncertainties • Communicate with and maintain relationships with HCP’s

  5. Behavioral Diabetes Model Well -Being Medical Outcomes Self-care

  6. What makes Self-care Difficult to Maintain • 365 days-a-year proposition • Pro-active coping required • Not pleasant, painful (injections, SMBG) • Interferes with daily life/flexibility • Often lack of direct positive feed-back • Adherence does not always ‘pay off’ • Long-term goals – immediate frustration Polonsky WH, 1999; Rubin,1992

  7. Diabetes treatment: A balancing act Prevent Hypos Prevent Hypers NOW MY FUTURE

  8. Barriers to Effective Coping with Diabetes • Intra-individual (cognitive, emotional, behavioral) • Inter-personal (family/martital conflict, lack of social support; miscarried helping/ ‘diabetes police’) • Environmental/contextual (access health services, care climate)

  9. Two levels of psychological problems • ‘Normal’ adaptation/coping problems • Psychological/psychiatric disorders (ICD-10, DSM-IV)

  10. Top 3 items diabetes-specific emotional distress(PAID-data: Polonsky et al., 1995; Welch et al, 1997; Snoek et al, 2000) • Worries about the future and complications • Feeling worried or guilty when ‘off track’ with the diabetes regimen • Not knowing if your mood or feelingsare related to your diabetes

  11. Adaptational Breakdown: ‘Diabetes Burn-out’ Negative experiences Negative attitudes Poor Self- care Poor control Hoover JW, 1988; Polonsky WH, 1999; Seligman, 1997; Snoek, 2000. Hoover JW, 1988;

  12. Psychological/Psychiatric Disorders in Diabetes • Depression • Anxiety • Eating Disorders

  13. Prevalence of Depression in DiabetesMeta-analysis of 39 Studies Depression prevalence is • Higher in women vs. men • Higher in clinic vs. community samples • Higher when assessed via self-report vs. diagnostic methods • Similar in patients with type 1 vs. type 2 diabetes Nondepressed 69% Significant Symptoms 31.0% 11% Major Depression Anderson et al., 2001

  14. Odds and Prevalence of Depression in 18 Controlled Studies 2.0 (1.8-2.2) OR (95% CI) The odds of depression were doubled in diabetics compared to controls. Depression prevalence(%) Nondiabetics Diabetics Anderson et al., 2001

  15. Adverse effects of Depression • Suffering, reduced QoL • Associated with hyperglycemia (Lustman et al., 2000) and complications (De Groot et., 2001) • Increased health care use and costs (Black, 1999; Ciechanowski et al., 2000)

  16. Anxiety • General Anxiety Disorder (GAD) and Phobias (prevalence? Popkin et al., 1988; Petrak et al., 2003) • Self-injecting/monitoring phobia (Snoek et al., 1994; Mollema et al., 2000). • Fear of Hypoglycaemia (Gonder-Frederick et al., 1997; Marrero et al., 1997). • Fear of Complications (Karlson,Agardh,1997; Zettler et al., 1995)

  17. Intra-personal BarriersEating Disorders: AN, BN, ED-NOS (bingeing) • Common among young diabetic girls (10-30%) (Jones et al., 2000) • Eating disorders (Binge Eating) in type 2 ? (Kenardy et al., 2000) • Associated with poor metabolic control (insulin omission) and • Earlier onset of complications (Rydall et al., 1997) • Increased mortality (Nielsen et al., 2002)

  18. Summary • Psychological and behavioral factors play key role in achieving and maintaining optimal control (Glasgow et al, 1999; Snoek, 2000) • Psychosocial problems are prevalent and deserve attention (Cox yet et al., 1992; Rubin,Peyrot, 1996; Snoek, 2000) • The patient’s emotional well-being needs to be monitored in diabetes care (St Vincent Declaration, 1995)

  19. How to address psychosocial issues? • Patient-centred care (communication, evaluation of patient-reported outcomes) • Team approach: Multidisciplinary, inlcuding behavioral scientist • Coping-oriented, self-management education and counseling

  20. A new paradigm… Self-management helps people with long-term medical condition to take responsibility for their own lives. It addresses the “whole person” and not just their illness or disability. It is about people with chronic disease becoming able to gain greater independence and live healthy, confident lives” Expert Patients Stakeholder Conference, 2000(http://www.doh.gov.uk/healthinequalities)

  21. More Information…. • Anderson & Rubin (eds). Practical Psychology for diabetes clinicians, ADA, 1996. • Snoek & Skinner (eds). Psychology in diabetes care, Wiley, 2000. • Psychosocial Aspects of Diabetes study group (EASD): www.emgo.nl/psad • fj.snoek@vumc.nl

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