Psychological Outcomes of Patients With Screen-Detected Type 2 Diabetes

Abstract

OBJECTIVE -The objective of this study was to investigate how time since diagnosis and treatment intensity influence psychological outcomes in patients with screen-detected type 2 diabetes.RESEARCH DESIGN AND METHODS -A 2 ϫ 2 factorial cross-sectional design was used to examine psychological outcomes in 196 patients with screen-detected diabetes diagnosed 3-33 months previously who were receiving usual care or intensive multifactorial pharmacological treatment. Outcomes included anxiety, depression, diabetes-related distress, perceived seriousness and vulnerability, self-efficacy, and self-care. Multivariate analysis was used to examine variations in outcomes based on time since diagnosis (Ͻ1 vs. 2-3 years) and treatment intensity.RESULTS -Most patients reported little distress, low perceived seriousness and vulnerability, high self-efficacy, and low self-care, but outcomes varied considerably across conditions. Time effects were found for perceived vulnerability, which increases significantly with time since diagnosis. Time ϫ treatment interactions were found for anxiety, diabetes-related distress, and self-efficacy; notably, intensively treated patients showed more distress and less self-efficacy in the 1st year, and usual-care patients reported more distress and less self-efficacy 2-3 years after diagnosis.CONCLUSIONS -Screen-detected patients generally do not experience much difficulty with their condition in the first few years, but early and intensive treatment can influence patients' psychological outcomes, leading to relatively more anxiety and less self-efficacy in the 1st year after diagnosis but not necessarily improving self-care. This suggests that intensive treatments confront patients with their diabetes earlier on whereas milder treatments may delay confrontation. This finding should be taken into account in the development and timing of psychological interventions for patients with newly diagnosed diabetes.

No worries, no impact? A systematic review of emotional, cognitive, and behavioural responses to the diagnosis of type 2 diabetes

“…reported low anxiety, depression and diabetes related distress, regardless of the time since diagnosis (Thoolen, De Ridder, Bensing, Gorter, & Rutten, 2006). Overall, these studies confirm that screening has no long-term emotional effects for most patients, and only limited short-term effects.…”

“…More than half felt confident that they could do something about their diabetes themselves by adjusting their diet and taking medication (Adriaanse et al, 2002). A study assessing self-efficacy among 196 screen-detected patients found that three-quarters reported a high confidence that they could manage their disease but significantly less were actually engaged in self-care (Thoolen et al, 2006). Finally, in interviews with eight screen-detected patients, associates (2007a, 2007b) found that all patients talked confidently about their ability to control the disease.…”

“…Finally, three studies using interviews found that being diagnosed with diabetes can also diminish patients' feeling of control over their life, as they become increasingly dependent on health care providers and specific medical regimens (Dietrich, 1996;Everett & Kerr, 1998;Gillibrand & Flynn, 2001). In the one study examining this relationship (in screen-detected patients), lower self-efficacy was indeed associated with higher emotional distress (Thoolen et al, 2006).…”

Should we screen for emotional distress in type 2 diabetes mellitus?

“…[1][2][3][4] Controlled studies reported higher levels of anxiety in patients shortly after diagnosis with t2Dm compared with those of people not diagnosed as having the disease, but these raised anxiety levels were of short duration. [2][3][4] this minimal emotional response could be due to unawareness regarding the seriousness of the disease, which has a relatively mild, nonacute character in its early stages, but also to denial or indifference. 1 However, the exact causes for this lack of response are unclear.…”

The influence of social contextual conditions and basic psychological need fulfillment on self-management and emotional distress among urban African American adults with type-2 diabetes mellitus : a mixed methods study.

“…In a study by Delahanty et al (2007), participants who were treated with insulin reported significantly more distress than participants who reported being treated with oral medications or dietary restrictions. Closely related, Thoolen, de Ridder, Bensing, Gorter, & Rutten (2006) observed an interaction between participants' treatment intensity and length of diagnosis. Within this study, intensely treated patients, such as those treated with insulin, reported more distress in the first year of diagnosis, while moderately treated patients, such as those prescribed oral agents, reported more distress 2-3 years following diagnosis.…”