Why is emotional and psychological support important?
Emotional and psychological support are important firstly because people with diabetes tell us that it is important to them (as evidenced by some of the results of the initiatives below) and secondly because the literature tells us that supporting people emotionally and psychologically leads to better outcomes for them.
Knowledge of diabetes care is poor, people have difficulty accessing information and support specific to their own needs and those with poor health, from ethnic minority communities, older persons and from disadvantaged populations have less confidence in self-care. Individual priorities and concerns are often not addressed and many feel that professionals are too busy to talk. (1)(2)(3)(4)(5)
The management of diabetes is complex, challenging and mainly behavioural in nature. (6) Therefore the provision of information, education and psychological support that facilitates self-management is the cornerstone of diabetes care. (7)
Many people feel stigmatised by having diabetes, either for cultural reasons, because of the lack of understanding in society and the fact that many feel they are blamed for having diabetes.
This can lead to depression which is often associated with poor self care resulting in reduced quality of life, decreased physical activity, reduced adherence to treatments, greater likelihood of unhealthy behaviours such as smoking, and poor glycaemic control resulting in increased risk of complications. (8)
Formal psychological support from healthcare and psychological professionals will help people with diabetes identify any emotional and behavioural barriers that may be adversely affecting people from managing their diabetes effectively.
The attitudes, skills and knowledge of health professionals, including their communication skills, also influence behaviour and ability to self-care. (9) Other people with diabetes can also provide help, emotional and peer support . (10)(11) Informal interpersonal or social support provided by family, friends and pets is crucial to the ability of a person with diabetes to be able to live successfully with the condition. The quality of personal relationships can impact on an individual’s behaviour and wellbeing. (12)
Part of the benefit of providing emotional and psychological support is to help people with diabetes to make choices, actively self manage their condition on a day-to-day basis and minimise the risks of the long term damage that diabetes can cause.
However, adherence to self-care activities can be very demanding and many people living with diabetes find this very difficult.
Greater clarity is needed about what people with diabetes need and how services should be accessed to influence the care and delivery of local services to recognise the importance of emotional and psychological support needs– in whatever form this takes.
Examples of quality of life scales to assess psychological state, the impact of diabetes on quality of life and patient satisfaction of diabetes services
The new General Medical Services contract 2006 encourages practices to identify those who have diabetes and may be depressed. It requires practices to actively case find for depression and identify the percentage of patients on the diabetes register and/or the CHD register for whom case finding for depression has been undertaken on one occasion during the previous 15 months.
The Quality and outcomes framework (QOF) suggests three severity measures be used to inform treatment and interventions:
Hospital Anxiety and Depression Scale (HADS)
Depression may occur in patients living with a medical condition for a variety of reasons. Psychological distress as manifest in depression may affect an individual's quality of life. It is therefore important to identify patients with depression and provide appropriate treatment.
The Hospital Anxiety and Depression Scale was developed to detect anxiety and depression in hospital, primary care and community settings. The scale originated in the work of Zigmond and Snaith(Zigmond and Snaith, 1983).
Problem Areas in Diabetes (PAID)
The PAID is a measure of diabetes-specific emotional distress that was developed by the Joslin Diabetes Center, Boston. This self-administered questionnaire consists of 20 items that cover a range of emotional problems frequently reported in Type 1 and Type 2 diabetes. More information is available from www.joslinresearch.org.
Diabetes Treatment Satisfaction Questionnaire
The DTSQ consists of two separate surveys. The original DTSQs (status version) was designed to make the initial assessment of total diabetes treatment satisfaction, treatment satisfaction in specific areas, and perceived frequencies of hyperglycemia and hypoglycemia.
The change version (DTSQc) has the same eight items as the status version, but reworded slightly to measure the change in satisfaction rather than absolute satisfaction. The author emphasizes the importance of obtaining a license/permission to use the instruments and ensuring that the authorised version is used. Further information is available from Dr Clare Bradley (c.bradley@rhul.ac.uk)
Audit of Diabetes-Dependent Quality of Life (ADDQoL)
The ADDQoL contains 13 items which were designed to measure individuals’ perceptions of the impact of diabetes on their quality of life. The ADDQoL questionnaire and scoring methodology (including weighting) are available in Bradley et al. (1999). More information is available from the author c.bradley@rhul.ac.uk.
Diabetes Health Profile (DHP)
The DHP consists of two separate self-administered questionnaires developed to assess diabetes-specific psychological and behavioural problems including psychological distress, barriers to activity and eating behaviour. The DHP-1 was developed for use with Type 1 diabetes and comprises 32 items. The DHP-18 which has been derived from the DHP-1 contains 18 of the original 32 items and is suitable for use with adults with either Type 1 or Type 2 diabetes.
Both the DHP-1 and DHP-18 have been used in a wide range of clinical trials, community surveys and clinical settings and are available in different languages. For further information and permission to use the DHP, please contact Dr Keith Meadows keith.meadows@thpct.nhs.uk
2008
References
- (National Centre for Social Research 2000, Health Foundation and Picker Institute Research (2005)
- Listening Project 2006. Nick Breeze, Suzanne Lucas and Carol Williams (pre publication
- Raleigh VS, Clifford GM, Diabetes National Service Framework, Analysis of Audit Commission Survey data on people with diabetes. Audit Commission, Commissioned by Department of Health. (2000),
- Review of dietary information and advice needed by people with diabetes. Diabetes UK Emma Bartlett 2006,
- Assessment of Information and communication needs to reach black and minority ethnic communities in the UK. Jenne Dixit. 2004)
- (Anderson RM, Funnell MM, Barr Pa et al. 1991)
- NSF for diabetes - England: Standards. DH 2001)
- NDST FActsheet No. 18 The Psychological Impact of diabetes. July 2006
- (Bradley C & Marteau TM 1987
- ( NSF for diabetes: England - Delivery Strategy. DH. 2002)
- (Anderson B, Wolf F, Burhurt M et al. effects of peer group intervention on metabolic control of adolescents with IDDM. Diabetes Care 1989; 12(3): 179-83)
- (Peyrot M & McMurrey JF. 1985, Kaplan et al. 1987, Hanson CL et al. 1987, Bailey BJ et al. 1993).