Psychosocial problems among newly diagnosed rheumatoid arthritis patients.

We identified patients with newly diagnosed rheumatoid arthritis (RA) in the ages 18-65 years who needed psychosocial interventions. A total of 123 patients (90 women) were asked to participate, but 19 declined and 4 dropped out early in the study, leaving a total of 100 patients (75 women) in the sample. Questionnaires used were the Epidemiological Investigation on Rheumatoid Arthritis study questionnaire, the Hospital Anxiety and Depression Scale, the Sense of Coherence (SOC) scale, and the General Coping Questionnaire. Interviews showed that 46% of the included 100 patients had psychosocial problems (PSP). One third of them had problems directly related to RA. The rest had problems with their life situation in general, without or reinforced by RA. Compared to patients without psychosocial problems, PSP patients lived in more strained social situations, especially regarding personal finances and social support. More of the PSP patients were anxious, showed lower SOC scores, and also used more emotion-based coping strategies (resignation, protest, isolation and intrusion) and less problem-oriented (minimization). They also had higher scores on depression and more frequently expected that RA would negatively affect their future. PSP patients also experienced a more negative impact of the disease, a finding not confirmed by the sickness activity score judged by the rheumatologist. Thus, early in the course of RA, screening instruments should be used to identify PSP patients. Psychosocial treatment and support by medical social workers skilled in RA care should be offered.

Psychosocial problems in patients with newly diagnosed diabetes: number and characteristics.

Early in the course of diabetes, it is important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care. We aimed to identify (a) the number and characteristics of patients, 18-65 years, newly diagnosed with diabetes, who needed psychosocial interventions and (b) the type of psychosocial problems they had. A total of 106 patients (72 men) were included in the study. Interviews showed that 41.5% had psychosocial problems. Fifteen dropped out early in the study; 38% of those remaining had psychosocial problems (PSP). More than half had problems with their life situation; most commonly in relationships. About a third had problems related to diabetes, most commonly, work-related. Compared to other participants, PSP patients lived in more strained social situations, especially regarding personal finances and social support. More of the PSP patients were anxious and depressed. They used negative coping strategies more often and more frequently expected that diabetes would negatively affect their future. In conclusion, early in the course of diabetes, screening instruments should be used to identify PSP patients. Treatment by medical social workers skilled in diabetes care should be offered.

Estimation of diabetes prevalence among immigrants from the Middle East in Sweden by using three different data sources.

AIMS: To estimate diabetes prevalence in immigrants from the Middle East in Sweden compared with Swedish-born subjects. This group accounts for around 15% of Sweden's non-European immigrants. METHODS: Three samples were used: self-reported diabetes in a random sample (SALLS sample) of subjects aged 35-64 years in Sweden (n=22,032); known diabetes among patients aged 35-64 years in primary care (PC) at four primary healthcare centers in Stockholm County (n=30,679); and known and newly diagnosed diabetes in a random population sample of subjects aged 60 years in Stockholm County (n=4106). RESULTS: The odds ratio (OR) for subjects from the Middle East was: 1.69 (95% confidence interval [CI] 0.96-2.99) in the SALLS sample; 4.43 (95% CI 3.38-5.56) in the PC sample; and 3.96 (95% CI 1.98-7.92) in the age-60 sample, compared with native Swedes. Subjects from European and other Organization for Economic Cooperation and Development (OECD) countries showed an excess risk only in the SALLS sample (1.43, 95% CI 1.11-1.83). CONCLUSIONS: Immigrants from the Middle East showed a four-fold higher risk of diabetes compared with Swedish-born subjects in two of the three data sources. More studies are needed to confirm these results, but the findings call for targeted preventative strategies in this population group.

Coping strategies in men and women with type 2 diabetes in Swedish primary care.

Based on findings regarding gender differences in the experience and complications of diabetes, we studied coping strategies in men and women with type 2 diabetes in relation to their demographic, medical, socio-economic and psychosocial situation. Altogether 232 Swedish-born type 2 diabetes patients aged 35-64 years at four primary health care centres in Stockholm County were studied, 121 men and 111 women. Coping strategies were assessed by the General Coping Questionnaire (GCG), which describes five orientations dichotomised into positive and negative opposites: self-trust/fatalism; problem focusing/resignation; cognitive revaluation/protest; social trust/isolation; and minimisation/intrusion. Socio-economic and medical data were taken both from a questionnaire and from medical records. Gender differences for the coping strategies resignation, protest and isolation were found (p<0.05), with higher scores for women. The most important medical factor associated with coping strategies was HbA1c. Other significant factors detected in the multivariate analyses were psychiatric disorder, cohabitation and daily smoking. Thus, coping strategies and gender are important factors that should be addressed more in diabetes health care.

Gender equity in health care: the case of Swedish diabetes care.

To explore the issue of gender equity in diabetes care in Sweden and to develop strategies for monitoring gender equity in health care, population-based studies and statistics published since 1990 were reviewed that contained gender-specific data on health care utilization, glycemic control, patient satisfaction, health-related quality of life, and mortality from diabetes. The review shows that diabetic women in Sweden report more frequent outpatient contacts, less patient satisfaction, and a lower health-related quality of life than diabetic men. No gender differences were found in the level of glycemic control. Young and middle-aged men with diabetes have a high excess all-cause mortality as compared with nondiabetic men. A trend toward stronger social gradient in mortality among women than men with diabetes was observed in a large nationwide study.

[A study of experience and consequences of diabetes. Increased psychosocial support in the care of diabetes is needed]. / Studie av upplevelse och konsekvenser av diabetes. Okat psykosocialt stöd behövs i diabetesvården.

Having diabetes affects life in many ways. The achievement of well-functioning self-care is highly dependent on the patient's ability to come to terms with the disease as an integral part of life, an integration which in turn is crucially dependent on the patient's emotional experience of the disease and trustful relationships with the health care professionals involved. Thus, the caregiver's professional expertise must include knowledge of the medical, psychological and social aspects of the disease. The article consists in a review of the results and conclusions of a population study designed to examine insulin-dependent diabetics' experience of living with their disease, their use of, and attitudes to, diabetes care, and the social and psychosocial impact of the disease on their lifestyle. The principal determinants of the patients' relationship both to the disease itself and to diabetes care appeared to be gender and the presence or absence of chronic complications. Another finding was the need of increased psychosocial support expressed by many patients, which suggests medical social workers to be important members of the diabetes care team.

Lifestyle as regards physical exercise, smoking and drinking, of adult insulin-treated diabetic people compared with non-diabetic controls.

Chronic complications in diabetes are sometimes associated with living habits. To investigate whether diabetic people's habits of smoking, drinking alcohol and taking physical exercise differed from those of the general population, a questionnaire was sent to 561 insulin-treated diabetic people and to 1,125 controls, matched for age, sex and domicile. Diabetic people were current smokers as often as controls (21% vs 23%; ns), but they drank less alcohol and more of them were non-drinkers (22% vs 13%; p < 0.001). Diabetic people more often took physical exercise than did controls (40% vs 28%; p < 0.001). Diabetic women were more seldom smokers (18% vs 26%; p < 0.05), more often non-drinkers (26% vs 14%; p < 0.001) and exercised regularly more (44% vs 28%; p < 0.001) than female controls. Diabetic men were more similar to male controls in their habits. Young diabetic people drank less alcohol and were more often non-drinkers (22% vs 9%; p < 0.001) compared with their controls. Comparison within the diabetic group showed that men drank alcohol more frequently and in greater amounts, and that more women were non-drinkers (26% vs 18%; p < 0.05). People with chronic complications drank less frequently and exercised less regularly (34% vs 44%; p < 0.05) than those without complications. These findings suggest that diabetic people's smoking, drinking and exercise habits are rather similar to general people's. However, diabetic women seem to take risk factors for developing complications into consideration more than men, which could reflect a true gender pattern and/or be an effect of worrying more about diabetes.

Living with diabetes: relationship to gender, duration and complications. A survey in northern Sweden.

A questionnaire was sent to 561 insulin-treated diabetic patients aged 20-50 years living in the province of Västerbotten in Northern Sweden to assess their experience of living with diabetes. The response rate was 87% (n = 488). Differences in the experience of living with diabetes related to gender, age, duration of diabetes, and chronic diabetic complications were reported. Men seemed to underestimate problems related to diabetes more than women. They worried less about long-term complications and hypoglycaemia, but were more troubled by the limitation of personal freedom caused by their diabetes. In spite of their worries, women more often than men found positive aspects in having diabetes. Younger patients also had a more positive attitude towards their disease, even though they more often thought that diabetes had negatively affected their relationships with friends. Patients with a shorter diabetes duration were more concerned about the management of their diabetes than were patients with a long duration. The fear of chronic complications increased with diabetes duration. Chronic complications most affected patients' views of diabetes, their self-perception, and social life. Patients with childhood onset of diabetes knew less about the implications of the disease, and this reduced the intensity of their psychological response to the diagnosis. In conclusion, social and medical factors affected how diabetic patients perceived their disease. These findings suggest that the outcome of diabetes health care might improve if it was more individually adapted to each patient's personal experience of the disease and the psychological needs related to it.

The social consequences of insulin-treated diabetes mellitus in patients 20-50 years of age. An epidemiological case-control study.

In order to investigate the social consequences of diabetes we sent a questionnaire to all diabetic patients aged 20-50 years and 1.125 matched non-diabetic controls living in the county of Västerbotten in Northern Sweden. The response rate was 87% and 72%, respectively. Patients more often lived alone (18 vs 13% p less than 0.05) and had no children (39 vs 31% p less than 0.01). They were more often the only child of their parents (14 vs 8%, p less than 0.01). Thirty-seven percent of the patients and 22% of the controls (p less than 0.001) had been absent from work because of illness more than one month continuously during the last 3 years and had more often than controls prematurely retired from work (8 vs 2% p less than 0.001). Patients more often had hobbies (86 vs 76%, p less than 0.001) and were participating in social activities (52 vs 41%, p less than 0.001), but were less satisfied with their leisure time (71 vs 80%, p less than 0.001). Forty percent of the patients vs 31% of the controls (p less than 0.01) did not visit neighbours. Fifty-one percent of the patients vs 44% of the controls (p less than 0.05) never spent leisure time with their work mates. No significant differences were found in education, socioeconomic class, dwelling or household economy. The study shows that there are social differences between diabetic patients and non-diabetic people even though they are not overwhelming.