1
|
Franc S, Bensaid S, Schaepelynck P, Orlando L, Lopes P, Charpentier G. Impact of chronic emotions and psychosocial stress on glycemic control in patients with type 1 diabetes. Heterogeneity of glycemic responses, biological mechanisms, and personalized medical treatment. DIABETES & METABOLISM 2023; 49:101486. [PMID: 37858921 DOI: 10.1016/j.diabet.2023.101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
Many studies have clearly established that chronic psychosocial stress may sustainably worsen glycemic control in patients with type 1 diabetes mellitus (T1DMM), thus promoting diabetes complications. Chronic psychosocial stress may be due to: i) the long-term accumulation of stressful life events that require readjustment on the part of the individual (loosing friends, changing schools), and/or ii) exposure to severe chronic stressors (persistent difficulties and adversities of life). Whatever the reason, many studies have clearly established a positive correlation between chronic psychosocial stress and HbA1c levels. However, a small fraction of patients is minimally affected or not affected at all by chronic psychosocial stress. Conversely, positive life events can substantially improve glycemic control. Recent evidence suggests the existence of subpopulations that differ in personality traits, neurohormonal regulatory responses, and food intake behavior (increased or decreased). Better characterization of the clinical and neurohormonal differences between these subpopulations may help develop personalized treatment strategies in the future. In the near future, psychotherapeutic support and automated insulin delivery (AID) could alleviate chronic stress, prevent worsening glycemic control, and ease the burden of diabetes.
Collapse
Affiliation(s)
- Sylvia Franc
- French Center for Studies and Research on the Intensification of Diabetes Treatment, CERITD, Evry, France; Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France.
| | - Samir Bensaid
- French Center for Studies and Research on the Intensification of Diabetes Treatment, CERITD, Evry, France
| | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Diseases, Pôle ENDO, APHM-Hôpital la Conception, Marseille, France
| | - Laurent Orlando
- French Center for Studies and Research on the Intensification of Diabetes Treatment, CERITD, Evry, France
| | - Philippe Lopes
- LBEPS, Laboratory of Exercise Biology for Performance and Health, Evry University, Evry-Courcouronnes, France
| | - Guillaume Charpentier
- French Center for Studies and Research on the Intensification of Diabetes Treatment, CERITD, Evry, France; Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
| |
Collapse
|
2
|
Mbamognoua N, Osseni RA, Ongoth FEM, Ohouna RLM, Bouenizabila E, Moko AO, Monabeka HG. Psychosocial Experience of Parents of Children, Adolescents and Young Adults with Type 1 Diabetes in Brazzaville. Health (London) 2022. [DOI: 10.4236/health.2022.146045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
3
|
Siddharthan GM, Reddy MM, Sunil BN. "Perceived stress" and its associated factors among diabetic patients receiving care from a rural tertiary health care center in South India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:11. [PMID: 33688520 PMCID: PMC7933676 DOI: 10.4103/jehp.jehp_388_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/04/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND "Stress" acts as both etiological link and also as an outcome in the case of diabetes mellitus. There is a paucity of literature regarding stress levels and also factors associated with it among diabetic patients in India. OBJECTIVE To assess the perceived stress levels and their associated factors among diabetic inpatients in a rural tertiary health care center, South India. MATERIALS AND METHODS A facility-based cross-sectional analytical study was conducted among inpatient diabetics seeking care at a rural tertiary care center in Kolar district of Karnataka. A pre-tested semi-structured questionnaire was used to capture the sociodemographic, disease-related, treatment-related and behavior-related characteristics of the inpatients. The outcome of "perceived stress" was captured using a standard questionnaire of Cohen Perceived Stress Scale-10. Poisson regression was used for multivariable analysis, and the association was expressed as prevalence ratio with 95% confidence intervals (CI). RESULTS Out of the 247 study participants analysed, "perceived stress" was seen among 97 (39.3%) of the participants (95% CI: 33.3%-45.5%). Multivariable analysis showed that factors like younger age, lesser duration of diabetes, presence of any comorbidity, being underweight, having conflicts at work place/home in the last 1 month, and not having enough money for treatment had shown higher levels of "perceived stress." CONCLUSION About two out of five inpatient diabetics seeking care from rural tertiary health centres had shown to have "perceived stress." There is a need for the inclusion of stress management techniques in the diabetes education program at all levels of health-care systems.
Collapse
Affiliation(s)
- Gowshik M. Siddharthan
- Undergraduate Student, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Mahendra M. Reddy
- Department of Community Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Bagepally N. Sunil
- Department of Community Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| |
Collapse
|
4
|
Nini Shuhaida MH, Siti Suhaila MY, Azidah KA, Norhayati NM, Nani D, Juliawati M. Depression, anxiety, stress and socio-demographic factors for poor glycaemic control in patients with type II diabetes. J Taibah Univ Med Sci 2019; 14:268-276. [PMID: 31435416 PMCID: PMC6695081 DOI: 10.1016/j.jtumed.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This study aims to identify risks induced by depression, anxiety, stress, and socio-demographic factors associated with poor glycaemic control among type II diabetes mellitus patients in Kuala Terengganu, Malaysia. METHODS This cross-sectional study was performed in two Malaysian health clinics by using the Malay version of a self-administered questionnaire. This instrument contains a diabetes care profile, a 21-item version of the Depression Anxiety Stress Scales (DASS21), and a Malaysian Medication Adherence Score (MalMAS). Simple and multiple logistic regression analyses were performed. RESULTS A total of 338 type II diabetes mellitus patients responded (response rate 93.1%). The proportion of patients with poor glycaemic control was 76.0%. Multiple logistic regression analysis showed that 1) social support scores [Adj. OR (95% CI): 1.06 (1.03,1.10); p = 0.001]; 2) unemployment [Adj. OR (95% CI): 0.46 (0.22,0.95); p = 0.035]; 3) pensioner status [Adj. OR (95% CI): 0.28 (0.13,0.61); p = 0.001]; and 4) perception of diabetes as interfering with daily living activities [Adj. OR (95% CI): 3.18 (1.17,8.70); p = 0.024] were significant factors for poor glycaemic control. CONCLUSIONS Unemployment, perception of diabetes' interference with daily living activities, and social support are significantly correlated with poor glycaemic control. Further studies assessing other important clinical and psychosocial factors that may influence glycaemic control are suggested. A younger age range of participants is recommended for better outcomes and interventional implementation of findings.
Collapse
Affiliation(s)
| | - Mohd Y. Siti Suhaila
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Kadir A. Azidah
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Noor M. Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Draman Nani
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Muhammad Juliawati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| |
Collapse
|
5
|
Ferrito L, Predieri B, Pjetraj D, Alessandrelli MC, Pagnini M, Iannilli A, Marino M, Tombolini S, Pintaudi B, Lucisano G, Zani F, Iughetti L, Nicolucci A, Cherubini V. Weekend-Based Parent-Group Intervention to Reduce Stress in Parents of Children and Adolescents with Type 1 Diabetes: A Pilot Study. J Diabetes Res 2019; 2019:7935945. [PMID: 31871949 PMCID: PMC6906866 DOI: 10.1155/2019/7935945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/28/2019] [Accepted: 09/12/2019] [Indexed: 02/07/2023] Open
Abstract
Diagnosis of type 1 diabetes (T1D) in a child is often associated with anger, denial, fear, and depression from the parents. The aim of the study was to improve parents' adaptation to the diagnosis of diabetes of their child. Sixty-two parents (29 mothers, 33 fathers) of 36 children with type 1 diabetes (mean age = 11.3-3.3 years; diabetes duration > 1 year; HbA1c = 57 ± 11 mmol/mol) participated in a three-day educational working group pilot intervention study. Intervention was based on the reexamination of the traumatic event of diagnosis of T1D through spatial and time-line anchorage, retracing of the future, emotional awareness, and interactive discussion. Relaxing technique, diaphragmatic breathing, and guided visualization were used by 2 psychologists and 1 pediatric endocrinologist. The study was approved by EC and participants filled a consent form. At baseline and after intervention, parents filled in a questionnaire including Diabetes-Related Distress (DRD), Parent Health Locus of Control Scale (PHLOC), Parent Stress Index Short Form (PSI-SF), Hypoglycemia Fear Survey-Parents (HFS-P) and Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC), and Health Survey Short Form-36 (SF-36). Three months after the intervention, both parents reported a reduction in the "difficult child" subscale of the PSI-SF (p < 0.05) and increased scores of social functioning of the SF-36 (p < 0.05). DRD score was significantly reduced in mothers (p = 0.03), while the "parental distress" subscale of the PSI-SF was significantly improved in fathers (p = 0.03). This weekend-based parent group intervention seems to reduce stress and improve social functioning of parents of children and adolescents with type 1 diabetes.
Collapse
MESH Headings
- Adaptation, Psychological
- Adolescent
- Adolescent Behavior
- Adult
- Age Factors
- Breathing Exercises
- Child
- Child Behavior
- Child, Preschool
- Cost of Illness
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Emotions
- Feasibility Studies
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Imagery, Psychotherapy
- Male
- Middle Aged
- Parents/education
- Parents/psychology
- Pilot Projects
- Psychotherapy, Group
- Relaxation Therapy
- Social Behavior
- Stress, Psychological/diagnosis
- Stress, Psychological/prevention & control
- Stress, Psychological/psychology
- Time Factors
- Treatment Outcome
Collapse
Affiliation(s)
- Lucia Ferrito
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Dorina Pjetraj
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | | | - Manuela Pagnini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Antonio Iannilli
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Monica Marino
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Stefano Tombolini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | | | - Giuseppe Lucisano
- CORESEARCH SRL-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Fabiana Zani
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Nicolucci
- CORESEARCH SRL-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Valentino Cherubini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| |
Collapse
|
6
|
Pathways of the relationships among eating behavior, stress, and coping in adults with type 2 diabetes: A cross-sectional study. Appetite 2018; 131:84-93. [DOI: 10.1016/j.appet.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/19/2018] [Accepted: 09/06/2018] [Indexed: 11/20/2022]
|
7
|
Weigensberg MJ, Vigen C, Sequeira P, Spruijt-Metz D, Juarez M, Florindez D, Provisor J, Peters A, Pyatak EA. Diabetes Empowerment Council: Integrative Pilot Intervention for Transitioning Young Adults With Type 1 Diabetes. Glob Adv Health Med 2018; 7:2164956118761808. [PMID: 29552422 PMCID: PMC5846920 DOI: 10.1177/2164956118761808] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/30/2017] [Accepted: 12/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background The transition of young adults with type 1 diabetes (T1D) from pediatric to adult care is challenging and frequently accompanied by worsening of diabetes-related health. To date, there are no reports which prospectively assess the effects of theory-based psycho-behavioral interventions during the transition period neither on glycemic control nor on psychosocial factors that contribute to poor glycemic control. Therefore, the overall aim of this study was to develop and pilot test an integrative group intervention based on the underlying principles of self-determination theory (SDT), in young adults with T1D. Methods Fifty-one young adults with T1D participated in an education and case management-based transition program, of which 9 took part in the Diabetes Empowerment Council (DEC), a 12-week holistic, multimodality facilitated group intervention consisting of "council" process based on indigenous community practices, stress-reduction guided imagery, narrative medicine modalities, simple ritual, and other integrative modalities. Feasibility, acceptability, potential mechanism of effects, and bio-behavioral outcomes were determined using mixed qualitative and quantitative methods. Results The intervention was highly acceptable to participants, though presented significant feasibility challenges. Participants in DEC showed significant reductions in perceived stress and depression, and increases in general well-being relative to other control participants. Reduction in perceived stress, independent of intervention group, was associated with reductions in hemoglobin A1C. A theoretical model explaining the effects of the intervention included the promotion of relatedness and autonomy support, 2 important aspects of SDT. Conclusions The DEC is a promising group intervention for young adults with T1D going through transition to adult care. Future investigations will be necessary to resolve feasibility issues, optimize the multimodality intervention, determine full intervention effects, and fully test the role of the underlying theoretical model of action.ClinicalTrials.gov Registration Number NCT02807155; Registration date: June 15, 2016 (retrospectively registered).
Collapse
Affiliation(s)
- Marc J Weigensberg
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cheryl Vigen
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, California
| | - Paola Sequeira
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Donna Spruijt-Metz
- Department of Psychology, Dornsife School of Arts and Sciences, University of Southern California, Los Angeles, California
| | - Magaly Juarez
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Daniella Florindez
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Anne Peters
- Department of Internal Medicine, Keck School of Medicine, University of Southern California, Beverly Hills, California
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, California
| |
Collapse
|
8
|
James J, Harris YT, Kronish IM, Wisnivesky JP, Lin JJ. Exploratory study of impact of cancer-related posttraumatic stress symptoms on diabetes self-management among cancer survivors. Psychooncology 2017; 27:648-653. [DOI: 10.1002/pon.4568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 07/24/2017] [Accepted: 10/05/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Janey James
- School of Public Health; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Yael T. Harris
- Division of Endocrinology; Diabetes and Metabolism, Hofstra Northwell School of Medicine; Hempstead NY USA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health; Columbia University Medical Center; New York NY USA
| | - Juan P. Wisnivesky
- Division of General Internal Medicine; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Jenny J. Lin
- Division of General Internal Medicine; Icahn School of Medicine at Mount Sinai; New York NY USA
| |
Collapse
|
9
|
Novak JR, Anderson JR, Johnson MD, Walker A, Wilcox A, Lewis VL, Robbins DC. Associations Between Economic Pressure and Diabetes Efficacy in Couples With Type 2 Diabetes. FAMILY RELATIONS 2017; 66:273-286. [PMID: 29151662 PMCID: PMC5685529 DOI: 10.1111/fare.12246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
Objective The purpose of this study was to explore dyadic associations between economic pressure and diabetes self-efficacy via emotional distress in patients with type 2 diabetes and their partners. Background Understanding how economic pressure is associated with successful diabetes management is an important area for research, as couples with type 2 diabetes can incur heavy economic pressures that could likely influence diabetes outcomes. Method Data from 117 married couples were used to test actor-partner associations using moderated mediation analyses in a structural equation modeling framework. Problem-solving communication was tested as a possible moderator of the economic pressure-emotional distress pathway. Results Results revealed that greater patient economic pressure was associated with lower patient and spouse confidence in the patient's diabetes management ability through higher levels of patient emotional distress. The deleterious association between economic pressure and emotional distress was less pronounced when spouses reported more effective problem-solving communication. Conclusion These results provide evidence that the economic pressure couples with type 2 diabetes face may reduce the patient and spouse's confidence in the patient's diabetes management ability. Implications This study demonstrates the importance of couple's relationship processes in buffering the impact of economic pressure on diabetes management, providing a clear target for intervention and education efforts.
Collapse
|
10
|
Zilioli S, Ellis DA, Carré J, Slatcher RB. Biopsychosocial pathways linking subjective socioeconomic disadvantage to glycemic control in youths with type I diabetes. Psychoneuroendocrinology 2017; 78:222-228. [PMID: 28219814 PMCID: PMC5362289 DOI: 10.1016/j.psyneuen.2017.01.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 11/25/2022]
Abstract
Older adolescent and young adults (OAYA) with type 1 diabetes (T1D) living in contexts of socio-economic disadvantage (SED) suffer disproportionately from poor glycemic control and related health complications. Although SED may convey a variety of risks, it may exacerbate diabetes-related stress levels, which in turn may account for observed disparities in health outcomes. The primary goal of the present study was to investigate the relationship between subjective SED, diabetes-related perceived stress, and diurnal cortisol secretion in urban OAYA with T1D. A secondary goal was to determine if cortisol was related to measures of blood glucose (HbA1c and mean blood glucose). Analyses were conducted among OAYA ages 17-20 years (n=61) affected by T1D, who provided daily saliva samples for four days, measures of glycemic control (i.e., HbA1c and mean blood glucose assessed via Continuous Glucose Monitor), and completed psychosocial questionnaires. We found that subjective SED was associated with a flatter diurnal cortisol rhythm via diabetes-related stress. Flattened cortisol rhythm was, in turn, associated with higher levels of HbA1c, but not with mean blood glucose assessed via Continuous Glucose Monitor. These results represent some of the first empirical evidence on how distal social factors (i.e., subjective SED) and proximal psychological processes (diabetes-related perceived stress) are connected to condition-relevant biological mechanisms (i.e., elevated HbA1c), via broad biological pathways implicated in health (i.e., flatter cortisol slope).
Collapse
Affiliation(s)
- Samuele Zilioli
- Department of Psychology, Wayne State University, Detroit, MI, 48202, USA; Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, 48202, USA.
| | - Deborah A. Ellis
- Family Medicine and Public Health Science, Wayne State University, Detroit, Michigan, 48202, USA
| | - Justin Carré
- Department of Psychology, Nipissing University, North Bay, Ontario, P1B 8L7, Canada
| | - Richard B. Slatcher
- Department of Psychology, Wayne State University, Detroit, Michigan, 48202, USA
| |
Collapse
|
11
|
Yafi M. ‘My diabetes precipitated psychosis in my mum’. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Michael Yafi
- Department of Pediatrics, Division of Pediatric Endocrinology; The University of Texas; Houston Texas United States
| |
Collapse
|
12
|
Ramkisson S, Pillay BJ, Sartorius B. Psychosocial stress in South African patients with type 2 diabetes. JOURNAL OF INSULIN RESISTANCE 2016. [DOI: 10.4102/jir.v1i1.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective: Diabetes mellitus is considered an emotionally and behaviourally demanding condition which adds to the stress of a patient’s daily living. There is a paucity of literature in South Africa regarding stress and diabetes. This study therefore aims to identify the areas and contributory factors of psychosocial stress in South African patients with diabetes.Method: A cross-sectional study was conducted at two public facilities and five private medical practices on the north coast of KwaZulu-Natal, South Africa. The Questionnaire on Stress in Diabetes – Revised was administered to 401 participants.Results: Eighteen percent of the sample reported having extreme psychosocial stress. Depression, physical complaints and self-medication/diet were the main areas which contributed to high psychosocial stress. Factors that also contributed to high levels of psychosocial stress were low educational level, unemployment, female gender, attending the public sector and high HbA1c levels.Conclusion: Psychosocial stress affects metabolic control in patients with diabetes, thereby increasing the risks of long-term complications.
Collapse
|
13
|
Hilliard ME, Yi-Frazier JP, Hessler D, Butler AM, Anderson BJ, Jaser S. Stress and A1c Among People with Diabetes Across the Lifespan. Curr Diab Rep 2016; 16:67. [PMID: 27287017 PMCID: PMC4936828 DOI: 10.1007/s11892-016-0761-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Stress is known to negatively affect health and is a potentially serious barrier to diabetes-related health outcomes. This paper synthesizes what is known about stress and glycemic control among people with type 1 and type 2 diabetes across the lifespan. Chronic stress-especially in relation to living with diabetes-was most strongly associated with A1c, particularly among subgroups that face disproportionate stress, such as minority groups or adolescents/young adults. Mechanisms of the stress-A1c association include physiological, psychological, behavioral, and environmental links. Understanding the dimensions of stress as they relate to health in diabetes can be of significant clinical importance, and interventions targeting mechanisms that either exacerbate or buffer stress have reported modest improvements in A1c.
Collapse
Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave, Suite 940, Houston, TX, 77004, USA.
| | | | - Danielle Hessler
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Ashley M Butler
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave, Suite 940, Houston, TX, 77004, USA
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave, Suite 940, Houston, TX, 77004, USA
| | - Sarah Jaser
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| |
Collapse
|
14
|
Price AM, Maayan T, Wake MA, Hiscock H. Is glycosylated haemoglobin associated with psychosocial stress in non-diabetic 6-year-olds? J Paediatr Child Health 2014; 50:153-7. [PMID: 24168703 DOI: 10.1111/jpc.12415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 11/29/2022]
Abstract
AIM Glycosylated haemoglobin (HbA1c), a marker of diabetic glycemic control, is associated with chronic psychosocial stress in non-diabetic adults. This study aimed to determine whether HbA1c also acts as a biomarker of psychosocial stress in healthy 6-year-olds. DESIGN AND PARTICIPANTS Eligible participants were 326 children recruited from 6 socio-economically diverse areas in Melbourne, Australia, who took part in an earlier randomised trial for sleep problems at age 7 months. At 6 years, they participated in a follow-up assessment. OUTCOME HbA1c collected by finger-prick. Exposures (collected simultaneously): proxy measures of child stress including: (i) child mental health; (ii) maternal mental health (depression, anxiety, stress), negative life events in the preceding year, life stresses and coping; and (iii) family socioeconomic status and financial stress. ANALYSES linear regressions, adjusted for original randomisation status and clustering. RESULTS Sixty percent (134/225) of children retained at 6 years provided HbA1c data, which ranged from 3.9%-5.8% (SD 0.3%). No child or family variable was associated with HbA1c. Of the maternal variables, only anxiety predicted HbA1c (adjusted difference per point increase: -0.01, 95% CI: -0.003 to 0.02, P = 0.01); this association was in the opposite direction to that hypothesised and clinically insignificant. CONCLUSION HbA1c was not associated with psychosocial stress in healthy 6-year-olds. This suggests that any link between HbA1c and psychosocial stress emerges after this age, and that HbA1c is unlikely to be a reliable biomarker for stress in early childhood or over the transition to school.
Collapse
Affiliation(s)
- Anna Mh Price
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
15
|
Kalra S, Sridhar GR, Balhara YPS, Sahay RK, Bantwal G, Baruah MP, John M, Unnikrishnan AG, Madhu K, Verma K, Sreedevi A, Shukla R, Prasanna Kumar KM. National recommendations: Psychosocial management of diabetes in India. Indian J Endocrinol Metab 2013; 17:376-95. [PMID: 23869293 PMCID: PMC3712367 DOI: 10.4103/2230-8210.111608] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges.
Collapse
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - G. R. Sridhar
- Department of Endocrine and Diabetes Centre, Visakhapatnam, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), AIIMS, New Delhi, India
| | | | - Ganapathy Bantwal
- Department of Endocrinology, St. John's Medical College, Bengaluru, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Centre Hospitals, Guwahati, India
| | - Mathew John
- Department of Endocrinology, Providence Endocrine and Diabetes Specialty Centre, Trivandrum, India
| | | | - K. Madhu
- Department of Psychology, Andhra University, Vishakhapatnam, India
| | - Komal Verma
- Department of Psychology, Consultant Psychologist, Noida, India
| | - Aswathy Sreedevi
- Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Rishi Shukla
- Department of Endocrinology, Center For Diabetes, Kanpur, Uttar Pradesh, India
| | - K. M. Prasanna Kumar
- Department of Endocrinology, CDEC and Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
16
|
Tsiouli E, Alexopoulos EC, Stefanaki C, Darviri C, Chrousos GP. Effects of diabetes-related family stress on glycemic control in young patients with type 1 diabetes: Systematic review. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:143-149. [PMID: 23418238 PMCID: PMC3576940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the way that family stress influences glycemic control among patients with diabetes who are younger than 18 years of age. DATA SOURCES PubMed and Scopus were searched for relevant studies published since 1990 using the following key words: diabetes type 1, glycemic control, family stress, family conflict, and family function. STUDY SELECTION In total, 1478 papers were identified in the initial search. The final review included 6 cohort studies, 3 cross-sectional studies, and 1 qualitative review in which family stress was assessed using specific diabetes-related conflict measurement instruments, and glycemic control was evaluated by glycosylated hemoglobin measurement. SYNTHESIS In most studies family stress was negatively correlated with patients' glycemic control. Family function was strongly related to patients' glycemic control, while family conflict was adversely associated with glycemic control. Families of low socioeconomic status, those of adolescents with diabetes, and those of single parents were more prone to diabetes-related stress and thus more susceptible to worse glycemic control. CONCLUSION Therapeutic psychological interventions and educational programs can help alleviate family diabetes-related stress and will likely improve glycemic control.
Collapse
Affiliation(s)
- Elina Tsiouli
- Biomedical Research Foundation, Academy of Athens, Soranou Ephessiou Str, 4, GR-115-27, Athens, Greece
| | | | | | | | | |
Collapse
|
17
|
Abstract
Stress is an important contributor to pathological conditions in humans. Hormonal changes that occur during acute and chronic stress situations can affect glucose homeostasis in both healthy people and in those with diabetes. Several studies have reported a negative effect of acute stress on maintenance of blood glucose concentrations in patients with type 1 and type 2 diabetes. The effect of stress on glycemic control in people with diabetes may be related to a direct effect of stress hormones on blood glucose levels and an indirect effect of stress on patient behaviors related to diabetes treatment and monitoring and meal and exercise plans. In contrast, there is no clear evidence that stressful life events promote the development of diabetes in children or in adults. Stress hyperglycemia, the development of hyperglycemia during acute illness, represents another interesting connection between the stress system and glucose homeostasis. A large body of evidence supports an association between stress hyperglycemia and increased morbidity and mortality in critically ill patients. Interestingly, there is some evidence supporting a beneficial effect of insulin in reducing morbidity and mortality in patients admitted to intensive care units. Finally, stress can influence the development of type 2 diabetes indirectly by promoting obesity and metabolic syndrome.
Collapse
|
18
|
Berlin KS, Rabideau EM, Hains AA. Empirically Derived Patterns of Perceived Stress Among Youth With Type 1 Diabetes and Relationships to Metabolic Control. J Pediatr Psychol 2012; 37:990-8. [DOI: 10.1093/jpepsy/jss080] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Whittemore R, Jaser S, Chao A, Jang M, Grey M. Psychological experience of parents of children with type 1 diabetes: a systematic mixed-studies review. DIABETES EDUCATOR 2012; 38:562-79. [PMID: 22581804 DOI: 10.1177/0145721712445216] [Citation(s) in RCA: 248] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this review is to describe the prevalence of psychological distress in parents of children with type 1 diabetes (T1DM), the relationship between parental psychological distress and health outcomes, and parents' psychological experience of having a child with T1DM. Clinical and research implications are presented. METHOD A systematic mixed-studies review was undertaken to review the quantitative and qualitative research on the parental experience of having a child with T1DM. A total of 34 articles met the inclusion criteria and were included in the review. RESULTS The prevalence of parental psychological distress across all studies ranged from 10% to 74%, with an average of 33.5% of parents reporting distress at diagnosis and 19% of parents reporting distress 1 to 4 years after diagnosis. Parental psychological distress in parents of children with T1DM, regardless of how it was defined, was associated with higher child self-report of stress and depressive symptoms, more problematic child behavior, and lower child self-report of quality of life. Parental psychological distress also had negative effects on diabetes management. Themes of the qualitative synthesis indicated that parents perceived T1DM as a difficult diagnosis that contributed to significant family disruption. Adjustment occurred over time; however, ongoing stress was experienced. CONCLUSIONS Screening for psychological distress in parents of children with T1DM is indicated, and preventive interventions are needed.
Collapse
Affiliation(s)
| | - Sarah Jaser
- Yale School of Nursing, New Haven, Connecticut
| | - Ariana Chao
- Yale School of Nursing, New Haven, Connecticut
| | | | | |
Collapse
|
20
|
Nunez MA, Yarandi H, Nunez-Smith M. Self-management among patients living with diabetes in the United States Virgin Islands. J Health Care Poor Underserved 2011; 22:271-83. [PMID: 21317521 DOI: 10.1353/hpu.2011.0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The United States Virgin Islands (USVI) is facing a diabetes epidemic similar to the one on the U.S. mainland, yet little is known regarding the cultural context relevant to self-management in this U.S. territory. We conducted in-home interviews (n=53) supplemented by self-administered questionnaire and A1c testing with U.S. Virgin Islanders to characterize self-management knowledge, attitudes, and behaviors among patients living with diabetes. The mean glycosylated hemoglobin (A1c) was 7.63 (Range=5-13); a composite score of traditional self-management behaviors was not associated with A1c. Several recurrent themes emerged from qualitative analysis including: 1) cultural nuances shaped perspectives on self-management, 2) culturally-specific challenges were barriers to effective self-management, 3) medical homes were rarely viewed as the primary source of education and support, and 4) fear largely motivated or stalled self-management practices. This study highlights the need for culturally-tailored measures and interventions to address the specific needs within this population.
Collapse
Affiliation(s)
- Maxine A Nunez
- University of the Virgin Islands, St. Thomas, United States Virgin Islands.
| | | | | |
Collapse
|
21
|
Abstract
In the modern environment one is exposed to various stressful conditions. Stress can lead to changes in the serum level of many hormones including glucocorticoids, catecholamines, growth hormone and prolactin. Some of these changes are necessary for the fight or flight response to protect oneself. Some of these stressful responses can lead to endocrine disorders like Graves' disease, gonadal dysfunction, psychosexual dwarfism and obesity. Stress can also alter the clinical status of many preexisting endocrine disorders such as precipitation of adrenal crisis and thyroid storm.
Collapse
Affiliation(s)
- Salam Ranabir
- Department of Medicine, Regional Institute of Medical Sciences, Imphal, India
| | - K. Reetu
- Department of Physiology, Jawaharlal Nehru Institute of Medical Sciences, Imphal, India
| |
Collapse
|
22
|
Frey MA, Ellis D, Templin T, Naar-King S, Gutai JP. Diabetes Management and Metabolic Control in School-Age Children With Type 1 Diabetes. CHILDRENS HEALTH CARE 2010. [DOI: 10.1207/s15326888chc3504_4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
23
|
Cammarata C, Meyer KJ, Geffken G, Felipe D, Franz D, Vargas A, Kamps JL. Psychosocial Issues That Affect Youth with Diabetes. AMERICAN JOURNAL OF HEALTH EDUCATION 2009. [DOI: 10.1080/19325037.2009.10599102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christina Cammarata
- Christina Cammarata is a post doctoral associate in the Department of Psychiatry/Department of Pediatrics, PO Box 100234, University of Florida, Gainesville Florida 32610
| | - Kara J. Meyer
- Kara J. Meyer is a postdoctoral associate in the Department of Psychiatry, PO Box 100234, University of Florida, Gainesville Florida 32610
| | - Gary Geffken
- Gary Geffken is an associate professor in the Department of Pediatrics, PO Box 100234, University of Florida, Gainesville Florida 32610
| | - Dania Felipe
- Dania Felipe is a senior fellow in the Department of Pediatrics - Division of Endocrinology, Louisiana State University Health Sciences Center Children’s Hospital, New Orleans, LA 70118
| | - Diane Franz
- Diane Franz is a licensed clinical psychologist, Children’s Hosptial of New Orleans, Department of Psychology
| | - Alfonso Vargas
- Alfonso Vargas is a professor and vice-chairman for Education and International Affairs Department of Pediatrics/Division of Endocrinology Louisiana State University Health Sciences Center Children’s Hospital, Louisiana State University, New Orleans, LA 70118
| | - Jodi L. Kamps
- Jodi L. Kamps is a licensed clinical psychologist, Children’s Hosptial of New Orleans, Department of Psychology
| |
Collapse
|
24
|
McBroom LA, Enriquez M. Review of family-centered interventions to enhance the health outcomes of children with type 1 diabetes. DIABETES EDUCATOR 2009; 35:428-38. [PMID: 19299519 DOI: 10.1177/0145721709332814] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this systematic literature review was to examine family-centered interventions that enhance the health outcomes of children with type 1 diabetes. The review summarizes the interventions and outcome measures that consisted of A1Cs, family relationships, and family conflict. METHODS Multiple electronic databases were searched from their start date to September 2008 for reports of studies that examined family-centered interventions among children with type 1 diabetes. RESULTS Nine publications, all randomized controlled trials, were located that investigated the effectiveness of family-centered interventions. Findings indicated that family-centered interventions significantly improved A1Cs, enhanced family dynamics, and decreased family conflict. CONCLUSIONS Family-centered interventions targeting children diagnosed with type 1 diabetes appear to be effective in enhancing health outcomes. These interventions focused on traditional 2-parent families, and many did not report race or ethnicity. Given the increasing number of single-parent households and divorced parents, a need exists to explore and develop family-centered interventions that target nontraditional family structures as well as addressing cultural differences.
Collapse
Affiliation(s)
- Leesa A McBroom
- The University of Missouri Sinclair School of Nursing, William Jewell College of Nursing, Liberty, Missouri (Ms McBroom)
| | - Maithe Enriquez
- University of Missouri–Kansas City School of Nursing (Dr Enriquez)
| |
Collapse
|
25
|
Cameron FJ, Northam EA, Ambler GR, Daneman D. Routine psychological screening in youth with type 1 diabetes and their parents: a notion whose time has come? Diabetes Care 2007; 30:2716-24. [PMID: 17644619 DOI: 10.2337/dc07-0603] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Fergus J Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Melbourne, Victoria 3052, Australia.
| | | | | | | |
Collapse
|
26
|
Northam EA, Todd S, Cameron FJ. Interventions to promote optimal health outcomes in children with Type 1 diabetes--are they effective? Diabet Med 2006; 23:113-21. [PMID: 16433707 DOI: 10.1111/j.1464-5491.2005.01678.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The incidence of Type 1 diabetes is increasing worldwide, imposing enormous public health costs, as well as profoundly affecting individual quality of life. There is evidence that psychological problems are increased in children with diabetes and this morbidity is often associated with poor metabolic control. Specific risk factors for this dual morbidity are emerging from empirical studies. The next challenge is to identify effective interventions for use with children at risk for adverse mental and physical health outcomes. The intervention literature is reviewed. It is noted that most studies have used diabetes-specific, unstandardized interventions in groups of adolescents, with few interventions trialled with younger children. No study has targeted a specific psychological disorder such as behaviour problems or depression, both of which are known to be increased in children with diabetes and for which effective standardized interventions are available. Attention is drawn to methodological limitations in many of the studies conducted to date and suggestions made to reduce these in future interventions attempting to reduce the burden of illness in children with diabetes.
Collapse
Affiliation(s)
- E A Northam
- Department of Psychology, University of Melbourne, Melbourne, Vic., Australia.
| | | | | |
Collapse
|
27
|
Stallwood L. Influence of caregiver stress and coping on glycemic control of young children with diabetes. J Pediatr Health Care 2005; 19:293-300. [PMID: 16202837 DOI: 10.1016/j.pedhc.2005.04.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2005] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The purpose of this research was to examine the influence of caregiver stress, perceived stress and coping on home management and glycemic control of young children with type 1 diabetes. METHOD A correlational design of 73 conveniently sampled caregivers of children younger than 9 years of age receiving routine care in an urban hospital diabetes clinic completed the Problem Areas in Diabetes Survey, the Appraisal of Diabetes Scale, the Coping Health Inventory for Parents, and the Diabetes Self-Management Profile. Data were analyzed using Pearson product-moment correlation. RESULTS Higher caregiver stress was associated with lower Hgb A(1c) levels. Higher levels of home management were associated with lower Hgb A(1c). No significant relationship was noted between caregiver coping and home management. DISCUSSION Caregivers managing their child's type 1 diabetes rated themselves as having stress, and those able to maintain their child's glycemic control indicated higher levels of perceived stress. It is essential that practitioners assess caregiver stress regardless of the child's apparent glycemic control.
Collapse
Affiliation(s)
- Lynda Stallwood
- University of colorado-Health Sciences Center, Denver, CO 80123, USA.
| |
Collapse
|
28
|
Boman KK, Viksten J, Kogner P, Samuelsson U. Serious illness in childhood: the different threats of cancer and diabetes from a parent perspective. J Pediatr 2004; 145:373-9. [PMID: 15343194 DOI: 10.1016/j.jpeds.2004.05.043] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare the incidence of disease-related distress symptoms in parents of children with cancer and diabetes. STUDY DESIGN A total of 675 parents of patients with cancer, patients with diabetes, and control subjects were assessed for 11 distress symptom clusters. Patient and control parent mean differences were tested by 2-tailed t tests; illness groups were compared by means of analysis of variance. Distress variations as a function of time since diagnosis were examined by regression analysis. RESULTS The distress levels of patient parents exceeded those of control parents for global distress ( P <.0001) and for most symptom subcategories. Distress levels of parents of patients with cancer (CP) significantly exceeded those of parents of patients with diabetes (DP) in anxiety ( P <.0001), physical and psychologic distress ( P <.0001), depression ( P <.005), and loneliness ( P <.05). Levels in DP matched those of CP in uncertainty, loss of control/the patient, self-esteem, disease-related fear, and sleep disturbances. Distress levels were lower in CP most distant in time from diagnosis, whereas DP showed a reversed trend. CONCLUSIONS Parental distress patterns in childhood illness depend on illness type and time passed since diagnosis. Symptom profiles verify the need for psychosocial attention at the initial shock after the cancer diagnosis and indicate long-term consequences for many parents. In pediatric diabetes, the persistence or intensification of distress over time is of specific clinical relevance.
Collapse
Affiliation(s)
- Krister K Boman
- Department of Woman and Child Health, Childhood Cancer Research Unit, Karolinska Institutet, S-171 76 Stockholm, Sweden.
| | | | | | | |
Collapse
|
29
|
Sudhir PM, Kumaraiah V, Munichoodappa C. Role of family in the management of Type-I diabetes: an Indian experience. J Clin Psychol 2003; 59:715-22. [PMID: 12754699 DOI: 10.1002/jclp.10151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of the family in the management of Type-I diabetes is gaining recognition. In countries where the adolescent is dependent on the family for medical needs, the family's role is all the more important. At times, when the family is uncooperative, the care of the adolescent is hampered, making psychosocial intervention even more difficult. The following case study illustrates the difficulty encountered while working with a young diabetic belonging to an Indian family. The issues related to parental role and management of diabetes-related problems are discussed.
Collapse
Affiliation(s)
- Paulomi Matam Sudhir
- National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore, India.
| | | | | |
Collapse
|
30
|
Hoes M. Clinical models of stress. Acta Neuropsychiatr 2002; 14:196-201. [PMID: 26984333 DOI: 10.1034/j.1601-5215.2002.140407.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Here we propose a stress model with disease-specific aspects and aspecific factors. The latter are subdivided into load (perception, psychic defence mechanisms), strain (psychophysiological responses) and stress sensu strictu (biological and behavioural compensation). Insufficiently compensated strain will result in being sick and precipitation of a specific disease according to one's predisposition. In the clinical practice, multiconditionality requires a multidimensional analysis, the the five-axial DSM-system being designed especially for this purpose. Multidisciplinary treatment is then organized accordingly, i.e. Axis I: case management, medication; Axis II, (focal) psychotherapy; Axis III, somatic specialists; Axis IV, social worker; Axis V, psychotherapy for coping deficits. OBJECTIVE To test the efficacy of this multimethodical approach. METHOD In a 1-year prospective study of 257 admissions in a department of psychiatry in a general hospital, the General Health Questionnaire (30 items) was filled out at admission, discharge and first polyclinical visit post-discharge. RESULTS The 213 evaluable questionnaires at admission did not show differences (17-18.9) between the four groups, mood disorders (62%), alcoholism (17%), psychoses (15%) and anxiety disorders (6%). At discharge all four groups had reached the cut-off value for 'not-sick' (< 6), this remaining so at follow-up; the three measurements differed significantly throughout the patient groups. Hospitalization was definitely 28.2 days shorter than the Dutch mean of 42 days. CONCLUSIONS Working to the proposed clinical model for multiconditionalty is effective on intensity and duration of disorders, sustained improvement is attained.
Collapse
Affiliation(s)
- Mjajm Hoes
- 1Department of Psychiatry, Ziekenhuis Rivierenland, Tiel, the Netherlands
| |
Collapse
|
31
|
Abstract
BACKGROUND In past decades clinicians have increasingly recognized the importance of psychological support for people with diabetes and their families, and many have recommended integrating psychological counselling into routine diabetes care. It is therefore important to consider whether psychological interventions in diabetes are effective in improving clinical outcomes. METHODS This review was limited to the literature reporting on the treatment of five common psychological problems known to complicate diabetes management: depression, eating disorders, anxiety/stress, self-destructive behaviour and interpersonal/family conflicts. A literature search was undertaken using MedLine and PsychInfo, including studies published in English peer-reviewed journals between 1990 and 2001, reporting on the effects of psychological interventions in the areas mentioned. Case studies were excluded from the review. RESULTS In line with earlier reviews, relatively little empirical research was found to substantiate the effect of psychological counselling in complicated diabetes. Most studies are uncontrolled, and involve small samples. In total only 11 randomized controlled trials were identified. Results indicate that cognitive behaviour therapy (CBT) is effective in the treatment of depression in Type 2 diabetes patients, both in reducing depressive symptoms and HbA1c. Favourable effects have been observed in pilot studies applying CBT in the field of stress management, eating disorders and self-destructive behaviour, but future research should substantiate these preliminary findings. Behaviour family therapy proved beneficial in terms of resolving family conflicts, but did not impact glycaemic control. CONCLUSIONS Evidence to support the effect of psychological treatment in problematic diabetes is still scarce, due to limited research in this area. Suggestions are made to further develop psychotherapeutic research in diabetes care. We conclude that future research should gain from a behavioural medicine approach to diabetes, with close collaboration between diabetologists and psychologists.
Collapse
Affiliation(s)
- F J Snoek
- Department of Medical Psychology, Diabetes Research Group, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.
| | | |
Collapse
|
32
|
Surwit RS, van Tilburg MAL, Zucker N, McCaskill CC, Parekh P, Feinglos MN, Edwards CL, Williams P, Lane JD. Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care 2002; 25:30-4. [PMID: 11772897 DOI: 10.2337/diacare.25.1.30] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is conflicting evidence regarding the utility of stress management training in the treatment of diabetes. The few studies that have shown a therapeutic effect of stress management have used time-intensive individual therapy. Unfortunately, widespread use of such interventions is not practical. The aim of the present investigation is to determine whether a cost-effective, group-based stress management training program can improve glucose metabolism in patients with type 2 diabetes and to determine whether a particular subset of patients is more likely to get positive results. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes were randomized to undergo a five-session group diabetes education program with or without stress management training. Participants (n = 108) were followed for 1 year, during which HbA(1c) tests and questionnaires assessing perceived stress, anxiety, and psychological health were administered at regular intervals to evaluate treatment effects. RESULTS Stress management training was associated with a small (0.5%) but significant reduction in HbA(1c). Compliance with the treatment regimen decreased over time but was similar to that seen in patients receiving stress management for other reasons in the clinic. Trait anxiety (a measure of stable individual differences in anxiety proneness) did not predict response to treatment, showing that highly anxious patients did not derive more benefit from training. CONCLUSIONS The current results indicate that a cost-effective, group stress management program in a "real-world" setting can result in clinically significant benefits for patients with type 2 diabetes.
Collapse
Affiliation(s)
- Richard S Surwit
- Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Anderson BJ. Children with diabetes mellitus and family functioning: translating research into practice. J Pediatr Endocrinol Metab 2001; 14 Suppl 1:645-52. [PMID: 11393558 DOI: 10.1515/jpem.2001.14.s1.645] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The specific challenges of living with diabetes mellitus (DM) which the child and parent must confront at each developmental stage are identified from infancy through adolescence. This discussion is divided into four developmental stages: 1) DM in infancy (0-2 years of age); 2) DM in toddlers and preschoolers (2-5 years); 3) DM in the school-age child (6-11 years); and 4) DM during early- to mid-adolescence (12-16 years). The central milestones of normal psychosocial development are reviewed and a summary is provided of recent research at each developmental stage with an emphasis on clinical implications for pediatric diabetes care teams.
Collapse
Affiliation(s)
- B J Anderson
- Joslin Diabetes Center/Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
34
|
Wearden AJ, Tarrier N, Davies R. Partners' expressed emotion and the control and management of type 1 diabetes in adults. J Psychosom Res 2000; 49:125-30. [PMID: 11068056 DOI: 10.1016/s0022-3999(00)00141-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE "Expressed emotion" (EE) refers to a set of valid and reliable measures of family emotional attitudes, which are robust predictors of illness course in several psychiatric conditions and which have recently been studied in some medical conditions. We hypothesised that high EE in partners of diabetes patients would be associated with poorer glucose control, management of and adaptation to diabetes. METHODS Sixty adult Type 1 diabetes patients, who were attending routine clinics at a specialist diabetes centre, and their partners were interviewed separately and completed various questionnaire measures. Partners' EE was rated from a modified Camberwell Family Interview; patients were interviewed to assess self-management practices. Glycated hemoglobin (HbA(1c)) was the measure of glucose control. RESULTS Only 10/60 (17%) partners were classified as high EE. Patients with high-EE partners had significantly worse self-management scores, more negative appraisal of diabetes, and higher depression scores than those with low-EE partners, but there was no association between EE measures and HbA(1c). CONCLUSIONS In contrast to findings from previous research on the families of patients with psychiatric illnesses, only a minority of partners of adult patients with Type 1 diabetes are classified as high-EE. We found no evidence that partners' EE was related to patients' blood glucose control.
Collapse
Affiliation(s)
- A J Wearden
- Department of Clinical Psychology, University of Manchester, Oxford Road, M13 9PL, Manchester, UK.
| | | | | |
Collapse
|
35
|
Baumer JH, Hunt LP, Shield JP. Social disadvantage, family composition, and diabetes mellitus: prevalence and outcome. Arch Dis Child 1998; 79:427-30. [PMID: 10193257 PMCID: PMC1717742 DOI: 10.1136/adc.79.5.427] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the relation between social disadvantage and family composition on diabetes prevalence and diabetes care outcome. DESIGN Retrospective audit in the south west of England of 801 children with diabetes mellitus. MAIN OUTCOME MEASURES Prevalence of diabetes in relation to the Townsend index. Admissions to hospital with diabetes related problems, glycated haemoglobin, time spent in hospital, outpatient attendance rates. RESULTS There was no association between social status and diabetes prevalence. Social deprivation increased the likelihood of admission for hypoglycaemia. Children living with a single parent were more likely to be admitted to hospital with a diabetes related problem and stay in hospital longer. Having either a parent with diabetes or a single parent increased the rates of clinic non-attendance. No association was identified between medium term diabetes control and either social disadvantage or single parent status. CONCLUSIONS Social disadvantage has no effect on diabetes prevalence and little on diabetes outcome in childhood. Family structure and parental diabetes have adverse effects on some aspects of diabetes outcome.
Collapse
Affiliation(s)
- J H Baumer
- Department of Child Health, Derriford Hospital, Plymouth, UK
| | | | | |
Collapse
|