Coping and psychosocial adjustment of women with diabetes

Treatment adherence in patients with type 2 diabetes mellitus correlates with different coping styles, low perception of self-influence on disease, and depressive symptoms

BACKGROUND

Insulin analogs are regarded as more convenient to use than human insulin; however, they require a different administration scheme due to their unique pharmacokinetic and pharmacodynamic properties. This study aimed to assess difficulties with adherence to treatment with insulin analogs in patients with type 2 diabetes mellitus (T2DM), who had previously been treated with human insulin. The associations between difficulties with adherence and clinical, demographic, and psychological characteristics were also evaluated.

PATIENTS AND METHODS

The study was conducted on 3,467 consecutively enrolled patients with T2DM (54.4% women), mean age 63.9 years (SD =9.57), who had recently undergone a physician-directed change in treatment from human insulin to insulin analogs. The questionnaires addressed difficulties with switching the therapy, coping styles, well-being, and perception of self-influence on the disease.

RESULTS

No adherence problems in switching therapy were reported in 56.6% of patients. Specific moderate difficulties were reported in 10.4%-22.1% of patients, major difficulties in 0.7%-6.9% of patients, and very significant difficulties in 0.03%-1.3% of patients. Overall, remembering to modify the insulin dose in the case of additional meals was the most frequently reported difficulty, and problems with identifying hypoglycemic symptoms were the least frequently reported. The increased risk of difficulties was moderately related to low perception of self-influence on diabetes and poor well-being. The intensity of problems was higher among those who were less-educated, lived in rural areas, had complications, and/or reported maladaptive coping styles.

CONCLUSION

Switching from human insulin to an insulin analog did not cause adherence problems in more than half of the patients. In the remaining patients, difficulties in adherence correlated with maladaptive coping styles, low perception of self-influence on disease course, and depressive symptoms.

Quality of life for patients with exacerbation in inflammatory bowel disease and how they cope with disease activity

OBJECTIVE

Health-related quality of life (HRQoL) for patients with ulcerative colitis (UC) or Crohn's disease (CD) is influenced by symptoms and treatments. Periods with increased disease activity are specifically trying, but the knowledge of how patients manage this is sparse. The aim of this cross-sectional study was to examine (1) HRQoL for patients with UC or CD, (2) how patients cope with increased disease activity, and (3) if coping is associated with HRQoL.

METHODS

A postal questionnaire was sent to patients with UC and CD who attended the gastroenterology and surgery department at a Swedish university hospital. Coping, HRQoL, and emotional well-being were assessed by Jalowiec Coping Scale, Short Form-36 Health survey, Short Health Scale, and the Hospital Anxiety and Depression Scale.

RESULTS

Patients with increased disease activity reported impaired HRQoL and emotional distress. This was more prevalent among patients with CD, as compared to patients with UC. Optimistic, self-reliant and confrontive coping strategies were most frequently used to manage stressors, with no differences found between patients in exacerbation or remission or between patients with UC or CD.

CONCLUSION

Impaired HRQoL and emotional distress is prevalent among patients with exacerbation in UC and CD. Thus, a complete evaluation of psychosocial status and management of psychosocial distress should be included in the clinical treatment of the patient. Patients use a variety of coping strategies in an effort to manage increased disease activity. However, these results did not support any associations between coping and HRQoL.

Coping and psychosocial adaptation to Type 2 diabetes in older Blacks born in the Southern US and the Caribbean

Older Black men and women (n = 212) with Type 2 diabetes completed questionnaires. Spearman's rho correlation indicated that confrontive coping strategies supported effective psychosocial adaptation for persons originally from Haiti and Jamaica, while emotive coping strategies were related to ineffective psychosocial adaptation for persons originally from Barbados and to increased psychological distress for all participants. Women used more palliative coping; no gender differences were observed for psychosocial adaptation. Health care orientation, extended family relationships, and psychological distress domains distinguished Blacks born in Haiti from Blacks born in Barbados and Jamaica, the Southern US and Jamaica, and the Southern US, Barbados, and Jamaica. Findings from this study may aid in the development of interventions focused on improving diabetes self-management for older Blacks.

Scale of therapeutic behavior of type 2 diabetic patients. Hierarchical analysis of a questionnaire

OBJECTIVES

Patient's therapeutic behavior determines the quality of self care in diabetes. The sociological approach can contribute to a better understanding of the internal logic of patient's behavior. The objective of our work is to study patients representations of their illness and its treatment in Moroccan type 2 diabetic patients. Our study concerns 307 type 2 diabetic patients.

METHOD

The collection of data has been achieved by means of a questionnaire by investigators with sociological training. The study consists of hierarchical analysis of a questionnaire on representations, attitudes and behavior of patients with the help of Loevinger's coefficient.

RESULTS

Test of several groups of hierarchized-answer questions allows to identify a 5 questions scale (scale whose coefficient value is 0.47). Otherwise, different social, psychological and therapeutic variables influence the integration of patients in the scale of therapeutic behavior.

CONCLUSION

It is possible to recognize a scale of therapeutic behavior in type 2 diabetes. The use of several other sociological qualitative or quantitative methods, by different authors and in different contexts enables to approach the logic of the therapeutic behavior. Its understanding can allows us to adapt the education, the treatment and the follow-up to every patient.

Experiencing chronic illness: cocreating new understandings

This study was conducted as part of a research course in which new partnerships with area citizens and community-driven programs of research were developed. Working together, the teachers, students, and citizens were able to document their practical knowledge through conducting a study of the lived experiences of chronic illness using Heideggerian hermeneutical phenomenology. The pattern, Experiencing Chronic Illness: Cocreating New Understanding, and three themes emerged during the analysis of the data (a) focusing on functional status doesn't adequately account for the experience of chronic illness, (b) decentering the focus on the treatment of symptoms makes way for equally important discussions of meaning making in the context of chronic illness, and (c) the objectified language of healthcare covers over how chronic illness is experienced.

Psychosocial maturity among people with diabetes mellitus

There is a relationship between coping with chronic illness and a person's psychosocial development. The aim of this study was to describe dimensions of psychosocial development based on results of a previous factor analysis of the Modified Erikson Psychosocial Stage Inventory among people with type 2 diabetes. Interviews were carried out with 10 people with diabetes. The transcribed interviews were analysed by qualitative content analysis into main categories, categories and themes. The categories were trust, lack of trust, positive identity, identity confusion, integrity and lack of integrity. Themes that permeated the categories in a positive way were 'activity' and 'involvement', while themes that permeated the categories in a negative way were 'passivity' and 'alienation'. Our interpretation is that the category 'trust' is the basis for 'identity', and together 'trust' and 'identity' are the basis for maturity and 'integrity'. A conclusion is that positive psychosocial maturity has to do with attaining trust, identity and integrity through activity and involvement. Qualities important for maturation through trust, identity and integrity are understanding, capacity, purposefulness and fortitude. Our interpretation of maturity is considered as being an important and interesting focus in nursing, while the above related qualities are closely connected to coping with diabetes.

Gender differences in the psychological adjustment to type 1 diabetes mellitus: an explorative study

This study examined gender differences in (1) the psychological adjustment to diabetes and (2) the relation between psychological adjustment and metabolic control in patients with type 1 diabetes. The 280 adult patients attending the outpatient diabetes clinic completed psychological self-rating questionnaires evaluating coping, depression, marital satisfaction, cognitive and emotional adjustment to diabetes. Glycaemic control was measured with HbA(1c)-values. This study revealed that men used significantly more active coping, less avoiding, less social support seeking and less depressive coping. Despite these differences, glycaemic control was not significantly better in men than in women. Women reported more depressive symptomatology than men did and more women were depressed. Significant gender differences were also found in psychological adjustment to diabetes. The psychological factors negatively related with the psychological adjustment to diabetes in men and women are depressive coping and depressive symptomatology.