ABSTRACT
High rates of type 2 diabetes (T2DM) and depression exist in rural Appalachia with limited access to psychotherapeutic treatment. No manualized cognitive behavioral therapy (CBT) treatment materials exist that are culturally tailored for individuals in this region with T2DM. We describe the development of the Program ACTIVE CBT intervention for use with adults with T2DM and depression by mental health providers in rural Appalachia. Qualitative and quantitative methods were used to test the feasibility and acceptability of Program ACTIVE. Intervention materials were rated at the 6th-7th grade reading level. Key informant interviews evaluated materials as culturally sensitive and accessible. Participants indicated high levels of satisfaction with therapy (94%), support from their therapist (86%), and usefulness of therapy and depression improvement (80.3%). Program ACTIVE was found to be a feasible and acceptable culturally tailored manualized CBT treatment for adults with T2DM and depression living in rural Appalachia. Implementation of these materials on a regional scale needs to be assessed.
ABSTRACT
OBJECTIVE: Despite high rates of diabetes and depression in rural areas, limited data exists to document patterns and predictors of depressive symptoms in rural patients with type 2 diabetes (T2DM). The purpose of this study was to assess the rates and predictors of co-morbid depressive symptoms over an 18-month period in a cohort of rural Appalachian adults with T2DM. METHODS: N = 100 adult T2DM patients were recruited from family medicine and endocrinology practices located in the rural Appalachian counties of southeastern Ohio and West Virginia. Data were collected using a longitudinal observational survey design. RESULTS: The sample consisted of predominantly White (93%) females (62%) who were married (71%), completed high school or less (48%), and had a mean age of 60 years (SD 11). Mean BDI score was 14.0 (SD 12) with 27% scoring in the moderate/severe range for depressive symptoms. A majority of patients (77%) reported depressive symptoms, at both time points, with 88% of these reporting consistent depressive symptoms in the year prior to study follow-up. Patients with depressive symptoms at Time 1 and Time 2 did not differ from other groups in the number of treatment strategies or medications used. Predictors of depressive symptoms in this group were increased diabetes treatment complexity (OR = 2.3), lack of home ownership (OR = 11.4), and decreased satisfaction with antidepressant medications (OR = 2.0; χ(2) = 28.9, p < .0001). CONCLUSIONS: Rural T2DM patients reported high rates of repeated depressive symptoms without corresponding rates of depression treatment. These patients may benefit from close monitoring and ongoing adjustment of their treatment for depression and diabetes by primary care providers.
Subject(s)
Depressive Disorder/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Poverty Areas , Psychophysiologic Disorders/epidemiology , Rural Population/statistics & numerical data , Adult , Aged , Appalachian Region , Cohort Studies , Comorbidity , Cross-Sectional Studies , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/psychology , Female , Humans , Male , Middle Aged , Personality Inventory , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychologyABSTRACT
Despite the high prevalence of sexual dysfunction in survivors of colorectal cancer, studies have shown that patients and providers rarely discuss how these symptoms may be influencing overall quality of life. The type and severity of symptoms of sexual dysfunction can vary greatly depending on the type of colorectal cancer and treatment, and assessment of sexual dysfunction is key to understanding how patients may be affected by these symptoms. Although patients would like to discuss these issues with their provider, they are often reluctant to ask questions about sexual functioning during appointments. Likewise, health care providers may hesitate to address sexual dysfunction due to time limitations or lack of knowledge regarding treatment of sexual problems. Health care providers can facilitate discussion of sexual dysfunction by (I) assessing sexual functioning throughout treatment; (II) initiating discussions about symptoms of sexual dysfunction at each appointment; and (III) maintaining adequate referral resources for treatment of sexual dysfunction.
ABSTRACT
Advances in colorectal cancer screening and treatment have increased survivorship significantly in recent years. This has led to an increased emphasis on the need for continuing patient care long after cancer treatment is completed. Colorectal cancer survivors may face a number of psychosocial issues following treatment, including cancer-related distress, adjustment to physical changes following treatment, and challenges related to returning to work. Although there are many resources available to assist with these challenges, many patients may not seek this information from their providers during follow-up care visits. This article highlights some of the most common patient concerns related to survivorship in colorectal cancer and serves as a reminder to ask about these concerns throughout the course of treatment and follow-up care.
