Download files
Access & Terms of Use
open access
Copyright: Bhakti Reddy, Jaya Prakash Reddy
Copyright: Bhakti Reddy, Jaya Prakash Reddy
Altmetric
Abstract
Diabetes Mellitus (DM) is commonly associated with psychological distress and psychiatric comorbidity including depressive and anxiety disorders. DM consensus guidelines recommend psychosocial interventions as part of routine care. There is evidence that individually tailored interventions improve psychological outcomes and glycaemic control in DM. This thesis was part of a larger project focusing on a brief minimal contact psychosocial intervention in patients with Type 1 and 2 DM (T1DM and T2DM) attending two general hospital-based specialist clinics in Sydney.
The objective of this thesis is to establish whether individual differences (personality styles, coping patterns, and the serotonin transporter genotype), and illness factors (DM type, diabetes-related distress) could determine psychologically vulnerable subpopulations of DM patients who would benefit from brief psychosocial interventions.
A total of 274 T1DM and T2DM patients were recruited into the study. Baseline data (clinical interview, self-administered questionnaires: PHQ, K10, PAID, COPE, NEO and SF-12, and glycosylated haemoglobin levels) were collected upon recruitment. Cheek swabs were taken for serotonin transporter gene (5HTTLPR 6CLA4) genotyping.
The rates of common psychological disorders (including depression, anxiety and specific diabetes-related distress) varied according to demographic profiles such as age and gender; disease factors such as medical comorbidity; and coping styles. Participants who predominantly used avoidance coping styles had higher PHQ-9 depression (p < 0.01) and PAID DM-specific distress (p < 0.01) scores. DM-specific distress predicted significantly higher levels of PHQ-9 depression (p < 0.01) and glycosylated haemoglobin (HbA1c) (p < 0.01). Females, with the 5HTTLPR s/s genotype, had significantly higher levels of anxiety (p < 0.01) as measured by the K-10 anxiety subscale. The intervention study experienced a high attrition rate, and factors determining attrition are discussed in this thesis.
The Problem Areas in Diabetes (PAID) questionnaire in this study demonstrated the ability to detect a significantly distressed population that could potentially benefit from psychological interventions and is therefore an effective screening tool for psychological morbidity in DM.
The implications of these findings for the design of future consultation liaison psychiatry services and brief intervention programs for people with T1DM and T2 DM are discussed in this thesis.