Psychosocial issues for the diabetic patient

2010 Diabetes Area WorkshopFiona Little-CNC Mental Health

Overview

Prevalence of anxiety and depression Review of the symptoms Management of anxiety and depression-

screening, medication and therapeutic approaches

Referral pathways

Prevalence of depression and anxiety

Diagnosis of depression and anxiety is increasing in all areas of health especially in the area of chronic disease.

Incidence in the general population is reported to be between 10-30% (Lane et.al.)

Depression is reported by WHO to be the second most diagnosable illness by 2020.

Prevalence in relation to diabetes

Pts with diabetes are twice as likely to suffer from depression and anxiety as the general population

Higher rates in women (28%) than men (18%) (Anderson et.al.2001) but has been reported to be as high as 45% ( Grigsby et.al.2002)

Greater number of studies on the prevalence of depression than anxiety.

Impact of depression and anxiety for diabetes

Less likely to comply with the lifestyle recommendations for the management of diabetes- avoidance and decreased motivation

Increased risk of hyperglycemia Poorer compliancy with diet, medication and

exercise

Definition of depression

Major Depression is characterised by sadness that is out of proportion to the situation at hand, and is of sufficient persistence, duration and severity that it interferes with everyday functioning.

(Treatment Protocol Project,2007)

Low mood

Poor sleep

Change in appetite

Decreased motivation and interest-anhedonia

Feeling tired

Social, cognitive and behavioural symptoms of depression and anxiety

Decreased social interaction- withdrawal from activities previously enjoyed

Difficulty finding perspective- pessimistic outlook and negative thinking, problem solving impaired

Avoidance and procrastination-health issues become compounded

Definition of anxiety

6 month history of excessive anxiety or worry- “excessive” meaning more that would be expected for an event or situation

Significant difficulty controlling anxiety Over the past 6 months- 3 or more of the

following symptoms-restlessness, fatigue, decreased concentration, muscle tension and sleep disturbance.

Fear

Worrying thoughts

Indecision and difficulty problem solving

Confused thinking

Feeling restless and fidgety

Concern for the future

Practical strategies for management

Know the key symptoms-remember severity, duration and impact

Use of screening tools Basic psycho education Engagement and rapport are key principles in a

therapeutic relationship Know your referral pathways and how your role

can help

The role of screening tools

Used as a guide only to identify possible symptoms

Can be used as an educational tool for patients Useful as a benchmark to monitor changes in

progress HADS, Life Inventory, Worrying thought

questionnaire

The Hospital Anxiety Depression Scale

Screening tool that focuses on the cognitive aspects of depression and anxiety

Reduces the overlapping symptoms associated to both physical and mental health

Evidenced based Series of 14 questions-7 anxiety, 7 depression Scoring:0-3 for each question-cut off points for

both is 8-10 on each scale

The role of medication

The role of medication

There are 6 types of antidepressants SSRI-(Selective Serotonin Reuptake Inhibitors) MAOI-(Monoamine Oxidase Inhibitors) Tricyclic antidepressants Reversible MAOIS Tetracyclic antidepressants SNRI (Serotonin-noradrenaline reuptake inhibitors)

Therapeutic applications

CBT-depression-relationship between thoughts, feelings and behaviours

ACT-anxiety- based on mindfulness principles-teaching a person to accept their thoughts as part of a process-encouraging action based on values

Motivational interviewing-stages of change-precontemplation, contemplation,preparation,action and maintenance

Skills development-sleep, exercise, stress management

Referral Pathways

Need to tailor the care required to the most suitable service

GP/Physicians- available for psychological interventions under variety of mental health programs

Private Psychologist NGO’s- Centrecare, Life Solutions, Anglicare Public health- CMHT