Managing type 2 diabetes and depression in primary care
Abstract:Aim: To examine the associations of diabetes with depression and stress, and to examine these factors in relation to self-care, using both quantitative and qualitative methods.
Method: Fourteen general practices in Wandsworth, South London were selected for having high rates of patients with type 2 diabetes. A total of 389 questionnaires were returned from patients from these practices identified with type 2 diabetes. Questionnaires covered depression (Hospital Anxiety and Depression scale, HAD), severe life event (List of Threatening Experiences, LTE) and self-care activities (Summary of Diabetes Self-Care Activities, SDSCA). In addition, a subgroup of 16 patients identified as depressed on the HAD scale were approached for interview.
Results: One-third of the sample had depression, and depression was associated with severe life events. In terms of self-care, poorer diet was associated with depression and the presence of a severe life event. Lack of exercise was similarly associated with depression and severe life event. Interviews highlighted the difficulty of keeping to good self-care regimes when depressed and/or under stress. Interviewees also described their experience of having diabetes as stigmatising and isolating because of problems with socialising, especially drinking and eating restrictions. Respondents noted that coping with diabetes can be very stressful, particularly immediately following diagnosis, and this can increase feelings of depression. Some respondents felt that primary care professionals failed to meet the emotional needs they experienced as a result of their diabetes.
Conclusions: Understanding the role of stress and depression in coping with diabetes is important in providing a full picture of prevention and treatment options.
Document Type: Research Article
Publication date: September 1, 2006