ABSTRACT
BACKGROUND: Type 1 diabetes (T1D) affects psychologically not only the persons with diabetes themselves but affects their family members. Few studies were conducted to investigate mental health in T1D partners. This study aims: (1) to investigate the frequency of depressive and anxiety symptoms in T1D partners and, (2) to investigate the associations among partners' depressive and anxiety symptoms and their sociodemographic and behavioral characteristics, and (3) to investigate the associations among partners' depressive and anxiety symptoms and clinical, laboratory and demographic characteristics of their T1D spouses in a Brazilian population. METHODS: In a transversal study 72 T1D partners were interviewed. Partners were invited to take part in the study during their T1D spouses' routine consultations. Those who consented to take part in the study signed the consent form. This study followed the principles of the Declaration of Helsinki and was approved by the University Ethics in Research Committee. Inclusion criteria were T1D partners age ≥ 18 and T1D diagnosis > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, and severe chronic and terminal diseases. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression scale (HADD) and anxiety symptoms were evaluated by the anxiety subscale of the same instrument (HADA). T1D partners were divided into subgroups according to score ≥ 8 and < 8 in both subscales. Demographic and clinical data were obtained from interview. Descriptive analyses were undertaken using means and percentages, as appropriate. Differences between groups were assessed by the Mann-Whitney test for numerical variables, by the Chi Square test or by Fisher's exact test for categorical variables, as appropriate. All analyses were undertaken using SAS version 9.2 for Windows. Statistical significance was set at 0.05. RESULTS: Of all 72 T1D partners, 72.2% were male, mean age was 42.7 ± 14.1 years old, years of school attendance were 11.8 ± 3.9 years, and 48.5% had income reaching until 3 Brazilian minimal wages. Forty-three percent reported high anxiety symptoms (HADA ≥ 8) and 18.1% reported high depressive symptoms (HADD ≥ 8). Comparing T1D partners group with HADA ≥ 8 and < 8, the first one was associated with CGM use (41.94% vs 19.51%; p = 0.03). Similarly, comparing T1D partners group with HADD ≥ 8 and < 8, the first one was associated with (1) longer duration of T1D of their spouses (28.6 ± 7.1 vs 22.4 ± 12.2; p = 0.02); (2) less years of school attendance of T1D partners (9.3 ± 3.2 vs 12.3 ± 3.8; p = 0.02), and (3) higher number of hypoglycemic episodes requiring other person's intervention (6.3 ± 8.9 vs 2.4 ± 4.7; p = 0.009). Seventy-six percent of partners who helped personally in their spouses' hypoglycemia recovery had HADD ≥ 8 vs 44.7% with HADD < 8 (p = 0.03). Likewise, 84.6% vs 54.2% of partners in which their spouses have T1D chronic complications had HADD ≥ 8 and < 8, respectively (p = 0.04). CONCLUSION: This study showed a high frequency of relevant anxiety and depressive symptoms in this T1D partner population. Several issues related to T1D of their spouses were associated with these symptoms. These results emphasize the need to incorporate the psychological and psychiatric aspects into T1D partners' education and care.
ABSTRACT
BACKGROUND: Adults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetes-related distress (DD). Low socioeconomic level is associated with increased risk of poor self-management, treatment difficulties and psychological distress. The goals of this study were to document the frequency of major depressive disorder (MDD), high depressive symptoms and high DD, to assess levels of empowerment and to determine the association with each of these measures and glycemic control in a low-income Brazilian sample of adults with T1D. METHODS: In a cross-sectional study, inclusion criteria were age > 18 years and diagnosis of T1D > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, severe diabetes-related complications and pregnancy. Diagnoses of MDD were made using interview-based DSM-5 criteria. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The Diabetes Distress Scale (DDS) assessed DD. Empowerment levels were evaluated by the Diabetes Empowerment Scale short form (DES-SF). Glycemic control was measured by HbA1c. The latest lipid panel results were recorded. Number of complications was obtained from medical records. RESULTS: Of the 63 T1D patients recruited, 36.5% were male, mean age was 31.5 (± 8.9), mean number of complications was 1 (± 1.1), and mean HbA1c was 10.0% (± 2). Frequency of MDD was 34.9% and 34.9% reported high depressive symptoms. Fifty-seven percent reported clinically meaningful DD. High diabetes regimen distress and low empowerment were associated to HbA1c (p = 0.003; p = 0.01, respectively). In multivariate analyses, lower empowerment levels were associated to higher HbA1c (beta - 1.11; r-partial 0.09; p value 0.0126). MDD and depressive symptoms were not significantly correlated with HbA1c in this expected direction (p = 0.72; p = 0.97, respectively). CONCLUSIONS: This study showed high rates of MDD, high depressive symptoms and high DD and low levels of empowerment in this low income population. Empowerment and diabetes regimen distress were linked to glycemic control. The results emphasize the need to incorporate the psychological and psychosocial side of diabetes into strategies of care and education for T1D patients.
ABSTRACT
BACKGROUND: Elevated rates of anxiety and depressive symptoms in Type 1 Diabetes patients (T1D) and high rates of diabetes-specific distress (DD) have been shown. Several factors may be responsible for increase the DD levels such as age, life changes, lack of familiar support, education, insulin regimens (IRs) and chronic complications. The goals of this study were: 1-to compare DD levels, anxiety and depressive symptoms according to age (< and ≥ 25 years old), 2-to evaluate the association between DD levels, anxiety and depressive symptoms and IRs, and 3-to evaluate the association between DD levels, anxiety and depressive symptoms and chronic complications. METHODS: In a cross-sectional study, T1D patients receiving outpatient care at Unicamp tertiary hospital were included. Inclusion criteria were age at least 18 years old and diagnosis of T1D for 6 months. Exclusion criteria were cognitive impairment, major psychiatric disorders, severe diabetes-related complications, and pregnancy. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D) and the anxiety symptoms by the anxiety subscale of the same instrument (HAD-A). DDS scale assessed DD. Glycemic control was evaluated by HbA1C. The latest lipid panel results were recorded and IRs and chronic complications were obtained through chart review. RESULTS: Of all 70 patients, 70% were younger than 25 years old. No differences were found between two groups according to gender, education, and income (p = 0.39, p = 0.87, and p = 0.52, respectively). HbA1c mean was 10% in both groups (p = 0.15). Older patients had higher levels of total DD and physician DD than younger (p = 0.0048 and p = 0.0413; respectively).Total DD and DD on subscales 1 and 2 were higher in patients using fixed doses of insulin compared to variable doses according to carbohydrates count (p = 0.0392, p = 0.0383 and p = 0.0043, respectively). No differences were found between anxiety and depressive symptoms and age and IRs. Similarly, no differences were found among DD levels, anxiety and depressive symptoms in patients with and without chronic complications. CONCLUSIONS: When providing education and care for T1D patients, health providers should consider age, patient's developmental stage, with its related demands and the burden of insulin regimen.
ABSTRACT
BACKGROUND: Diabetes related distress is common in type 1 diabetes patients (T1D). High levels of diabetes distress are related to poor metabolic control. An instrument to evaluate diabetes distress in T1D patients is "type 1 diabetes scale-T1DDS". The aim of this study was to translate and culturally adapt the T1DDS into Brazilian culture. METHODS: T1DDS scale was translated into Portuguese. Back translation was performed and evaluated by a specialists committee. Pre-test was performed with 40 T1D outpatients at State University of Campinas hospital. Internal consistency, external consistency and re-test were performed. RESULTS: 72% women, mean age: 32, 1 ± 9, 7 years, mean diabetes duration: 15, 8 ± 9, 1 years, mean scholarity: 11, 5 ± 3, 6, glycosylated hemoglobin mean: 9 ± 2%. Internal consistency: Cronbach alpha of T1DDS Brazilian version was 0.93. External consistency: Spearman's coefficient between T1DDS and PAID, Brazilian version, was 0.7781; (p < 0.0001). CONCLUSIONS: The T1DDS Brazilian version is a reliable tool to evaluate diabetes distress in T1D patients in the Brazilian Population. This tool can be useful in clinical care and to identify patiens at risk and in need for psychosocial intervention.
