Psychological factors affecting physical condition. Endocrine disease literature review

A Cross-Cultural Ranking of Stressful Life Events in Germany, India, South Africa, and the United States

Five groups of college and university students (N= 555) from four countries ranked 32 life events according to the amount of stress each was perceived to cause. The analyses of the rankings revealed substantial agreement on the relative stressfulness of life events among Americans, Germans, Indians, non-White South Africans, and White South Africans. The results suggest that standard measures of life stress can be used cross-culturally with some degree of confidence.

Cognitive functions and glycemic control in children and adolescents with type 1 diabetes

BACKGROUND

The relationship between metabolic control and cognitive function in adolescents with type 1 diabetes (DM type 1) is not clear. We compared the quality of glycemic control (GC) and cognitive measures in adolescents with DM type 1 to find out if the quality of diabetes management is related to cognitive impairment.

METHOD

We assessed executive functions (EFs) and other neuropsychological and psychosocial variables in 70 adolescent patients with DM type 1 and 20 age-matched controls. Patients were divided into two groups according to their last hemoglobin A1c (HbA1c): acceptable (HbA1c 5.9-8.0%, mean 6.9%, 36 patients, mean age 14 years) and non-optimal (HbA1c 8.2-11.6%, mean 9.3%, 34 patients, mean age 15.6 years).

RESULTS

We found impaired EFs, mainly problems of concept formation (p=0.038), cognitive flexibility (p=0.011) and anticipation (p=0.000), in the patients with DM type 1. Both groups did not differ in intelligence, most assessed EFs and adjustment to chronic illness (Youth Self-Report; YSR). Younger patients (<15 years) were cognitively less flexible. GC was worse in older patients and in patients with longer duration of the disease. We also found significant differences between patients with diabetes and controls concerning somatic complaints, internalizing problems (Child Behavior Checklist; CBCL) and social activity (CBCL and YSR).

CONCLUSIONS

DM type 1 is associated with cognitive deficits in adolescents independent of the quality of metabolic control and the duration of the disease. These deficits are probably related to the disease, especially in patients with early-onset diabetes.

A qualitative review of the role of qigong in the management of diabetes

OBJECTIVE

To review the evidence relating to the effectiveness of qigong in the management of diabetes.

METHODS

We performed a systematic literature review of qigong intervention studies published in English or Chinese since 1980, retrieved from English-language databases and Chinese journals. Qigong intervention studies conducted with adults with diabetes, which reported both preintervention and postintervention measures of fasting blood glucose and/or hemoglobin A(1c)(HbA(1c)) were included. Sample characteristics, intervention frequency/duration, and metabolic outcomes were reviewed.

RESULTS

Sixty-nine intervention studies were located. Of these, only 11 met the criteria for inclusion. There were consistent and statistically significant positive associations between participation in qigong and fasting and 2-hour oral glucose tolerance test results, blood glucose, and triglycerides and total cholesterol. Effects on insulin and HbA(1c) were inconsistent. There was no evidence of any effect of qigong on weight. Most of the studies were of short duration, involved small samples, and did not include a control group.

CONCLUSIONS

Although qigong has beneficial effects on some of the metabolic risk factors for type 2 diabetes, methodologic limitations make it difficult to draw firm conclusions about the benefits reported. Randomized controlled trials are required to confirm the potential beneficial effects of qigong on the management of type 2 diabetes.

Burnout and risk of type 2 diabetes: a prospective study of apparently healthy employed persons

OBJECTIVE

This prospective study was designed to test the extent to which the onset of type 2 diabetes in apparently healthy individuals was predicted by burnout, a unique affective response to combined exposure to chronic stressors.

METHODS

The study participants were 677 employed men and women who were followed up for 3 to 5 years (mean = 3.6 years) for the onset of diagnosed type 2 diabetes. Burnout was assessed by the Shirom-Melamed Burnout Measure with its three subscales: emotional exhaustion, physical fatigue, and cognitive weariness.

RESULTS

The burnout symptoms were remarkably consistent over the follow-up period irrespective of changes in place of work and in employment status. During the follow-up period, 17 workers developed type 2 diabetes. Logistic regression results indicated that burnout was associated with a 1.84-fold increased risk of diabetes (95% confidence interval [CI] = 1.19-2.85) even after adjusting for age, sex, body mass index, smoking, alcohol use, leisure time physical activity, initial job category, and follow-up duration. In a subsample of 507 workers, the relative risk of diabetes was found to be much higher after additional control for blood pressure levels (odds ratio = 4.32, 95% CI = 1.75-10.67), available only for this subsample.

CONCLUSIONS

These findings suggest that chronic burnout might be a risk factor for the onset of type 2 diabetes in apparently healthy individuals.

Psychological stress and the risk of diabetes-related autoimmunity: a review article

The beta cell stress hypothesis suggests that any phenomenon that induces insulin resistance, and thereby extra pressure on the beta cells, should be regarded as a risk factor for type 1 diabetes (T1D). Psychological stress decreases insulin sensitivity and increases insulin resistance and may hence be important in the development/onset of T1D. The aim of the current review article was to evaluate existing empirical evidence concerning an association between psychological stress and development/onset of T1D as well as diabetes-related autoimmunity. Ten retrospective case-control studies were found. Nine studies showed a positive association between stress and development/onset of T1D in children, adolescents or adults. One study did not find an association between stress and development/onset of T1D. An association between stress and diabetes-related autoimmunity was found at 1 and 2-3 years of age in a large epidemiological study of the general population. The hypothesis that psychological stress (via beta cell stress or direct influence on the immune system) may contribute to the induction or progression of diabetes-related autoimmunity has gained some strong initial support, but is in need of further empirical verification. It seems much clearer that stress can precipitate manifest T1D, although the biological mechanisms are still not known.

Anxiety and depression in juvenile diabetes: a critical review

A critical examination of the recent literature on anxiety and depression in juvenile diabetes is presented. The objectives of this review are: (1) to determine the general association of psychological factors, especially anxiety and depression, with diabetes, (2) to examine the specific association of anxiety and depression with metabolic control, and (3) to propose methodological changes that are needed to advance future research in this field. The major conclusions of this review support the notion of a general association of psychological disorders with juvenile diabetes. However, while anxiety and depression appear to play an important and complex role in determining adaptation to the disease, their relationship to metabolic control does not yet appear clear. Additional prospective and controlled studies as well as multivariate models of chronic disease are now necessary to more fully understand the etiology and impact of these disorders in the adolescent population.

Intractable vomiting in diabetic patients

Intractable nausea and vomiting have been described in individuals without any underlying physical etiology explaining these complaints. Physical or emotional abuse has been described in individuals suffering from these symptoms and associated with somatoform disorders manifesting primarily as gastrointestinal complaints. We present five patients with long-standing Type 1 diabetes who suffered from intractable vomiting. Personality disorders, profound depression and emotional abuse dramatically influenced the course of these patients' illness. In most of the patients, physical symptoms remarkably improved after identification and removal of the triggering factors. Therefore, psychogenic vomiting must be considered among the differential diagnoses of intractable nausea and vomiting, especially in individuals with chronic illnesses. A careful search for a physical etiology and medical treatment that does not cause relief of symptoms should suggest that there is almost certainly a psychological issue at the root of the problem.

Companion animals and adaptation in chronically ill children

Almost 20 million children in the U.S. have a chronic illness. Chronic illness requires ongoing management in the home, often with complex, stressful regimens. The increased lifespan of chronically ill children may lead to increased long term psychosocial and physical sequelae. Enhancing the quality of life for these children could promote optimal long-term adaptation. Health benefits of companion animals have been described across psychosocial, physiological. and behavioral spheres for healthy children and children with disabilities. These benefits have not been empirically examined for chronically ill children. This paper uses a stress-coping model to examine the role animals may play in adaptation for children with chronic illnesses. The contribution of companion animals to the constructs within the model and the adaptation process is discussed. This model provides a potential theoretical framework for synthesizing literature and pursuing empirical work on the role of companion animals in chronic childhood illness.

Joint liaison psychiatry-diabetes clinic: a new specialist service

AIMS

Specialist diabetes clinics have an established role in prevention and management of complications. As psychological problems are usually treated separately from diabetes centres, the role of a specialist psychiatrist within a teaching hospital was assessed. The aims of the study were to describe referral patterns, specific psychiatric conditions and treatments offered.

RESULTS

During weekly outpatient sessions over a 12-month period, 31 patients were referred with a wide range of psychiatric diagnoses. One-third of patients were seen on the day and two-thirds within 2 weeks of referral. Treatments included anti-depressant medication, counselling and cognitive behaviour therapy. Successful discharge was obtained in 10 subjects and eight were undergoing continued treatment.

CONCLUSIONS

The range of specific diagnoses requiring psychiatric supervision supported the role of specifically trained personnel as seen in a joint liaison psychiatry-diabetes service.

Prevalence of somatic indicators of distress in diabetes patients: comparison to psychiatric patients and community nonpatients

OBJECTIVE

Because psychiatric screening methods are usually developed using psychiatric samples but not medical samples, they often include distress indicators that overlap with medical illness. This potentially inflates psychopathology estimates for medically ill patient groups. The objective of this study was to determine whether somatic distress indicator base rates are elevated in diabetes patients.

METHOD

The occurrence of Symptom Checklist 90-R (SLC-90-R) somatic symptoms was studied in fifty-six diabetes mellitus patients (27 insulin dependent, 29 non-insulin dependent) with non-elevated SLC-90-R profiles, as compared to both community nonpatient and psychiatric patient norms.

RESULTS

Of the fifteen SCL-90-R items rated by endocrinologists as most likely to be diabetes-related, nine were endorsed more frequently by diabetes patients than by nonpatients: faintness/dizziness (endorsed by 36% of diabetics), reduced libido (endorsed by 41%), anenergia (68%), memory problems (66%), trembling (18%), numbness (55%), weakness (39%), overeating (59%), and somatic concerns (41%). Anergia and faintness/dizziness were endorsed more frequently by psychiatric patients than diabetes patients, whereas numbness was endorsed more often by diabetes patients.

CONCLUSIONS

Conservatism is warranted when applying these somatic indicators of distress to diabetes patients. Further studies are needed to determine whether such illness overlap biases case classification.

Psychosocial factors influencing the short-term outcome of antithyroid drug therapy in Graves' disease

OBJECTIVE

Although psychological stress and smoking have been proposed as factors contributing to Graves' disease, their independent roles in the course of this disease have not been determined. We assessed the association between the course of Graves' disease and psychosocial factors by using multivariate analysis.

METHODS

We investigated the association between the short-term outcome of Graves' disease (assessed 12 months after the beginning of antithyroid drug therapy) and stressful life events, daily hassles, smoking, drinking habits, coping skills, and social support (before and 6 months after beginning therapy) in 230 patients (182 women and 48 men) with newly diagnosed Graves' disease, using a logistic regression model.

RESULTS

After adjustment for smoking, coping skills, and thyroid function, daily hassles scores in women at 6 months after beginning therapy were significantly associated with a hyperthyroid state 12 months after beginning therapy. The relative risk was 3.9 for women with higher daily hassles scores compared with women with lower daily hassles scores (95% confidence interval, 1.1 to 13.2; p < .05). Smoking was not significantly associated with a hyperthyroid state 12 months after beginning therapy in either women or men.

CONCLUSIONS

Chronic psychological stress is associated with the course of Graves' disease in women.

The family and type 2 diabetes: a framework for intervention

Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.