The relationship between generic and diabetes specific psychological factors and glycaemic control in adults with type 1 diabetes.

259 adults with type 1 diabetes completed measure of anxiety, depression and diabetes specific distress, HbA1c from medical records. Anxiety not depression predicted HbA1c, this association was mediated by illness specific cognitions. Targeting illness specific cognitions may be more productive than treatment of general dysphoria in type 1 diabetes.

The prevalence of depression and anxiety in adults with Type 1 diabetes.

AIM: The aim of the present study was to determine the prevalence of anxiety and depression in a large UK group of people with Type 1 diabetes. METHODS: Patients aged 16-60 years were invited to complete self-report questionnaires when they attended outpatient clinic appointments. HbA(1c) was recorded from the clinic database. RESULTS: Analysis was based on 273 complete questionnaires. The mean scores for both anxiety (mean 6.4, sd 4.5) and depression (mean 3.4, sd 3.5) were consistent with normative data. Females reported significantly higher mean anxiety than males, although neither reached the criterion for 'caseness'. Significant differences to the norm were observed for the percentages reporting moderate to severe levels of depression in males (chi(2) = 6.44; d.f. = 2; P = 0.04) and moderate to severe levels of anxiety in females (chi(2) = 7.47; d.f. = 2; P = 0.02). HbA(1c) was positively correlated with HADS scores (anxiety r = 0.2, P = 0.001, depression r = 0.14, P = 0.02). CONCLUSIONS: While there is no significant difference in the mean anxiety or depression in this cohort compared with those reported for a non-diabetic, healthy population, the results suggest that there is an increased prevalence of clinically relevant anxiety in females and of depression in males with Type 1 diabetes when compared with the normative data.

A trial of cognitive analytic therapy in poorly controlled type I patients.

OBJECTIVE: This study compared the effect of cognitive analytic therapy (CAT), a focused time-limited psychotherapy, and diabetes specialist nurse education (DSNE) in a controlled trial of 26 chronically poorly controlled adult type I patients. RESEARCH DESIGN AND METHODS: Patients were randomized to either 16 sessions of CAT (treatment) or 14-18 sessions of DSNE (control). Pre- and post-treatment blood glucose control (HbA1), interpersonal difficulties, and diabetes knowledge were measured before and up to 9 months after treatment was completed. RESULTS: Although HbA1 levels improved in the DSNE group, at the end of treatment (mean fall 1.2%, P = 0.004) this was not maintained; so by the 9-month follow-up, the overall net fall was limited to 0.9% (P = 0.03 vs. entry value). There were no significant improvements in interpersonal difficulties in DSNE subjects at any retest point (P > 0.05). In contrast, glycemic control and interpersonal difficulties both improved after CAT. In contrast to DSNE, this improvement continued so that at the 9-month follow-up visit, the changes were significant (mean fall in HbA1 = 2%, P = 0.002 and P = 0.03 for the Inventory of Interpersonal Problems [IIP] scores). CONCLUSIONS: These results suggest that although there is no statistical difference between CAT and DSNE, the effects of CAT produce a more prolonged effect on glycemic control. If psychological difficulties underlying problems with self-care in a type I population are addressed, then improvements in diabetes control are likely to continue.

Assessing the impact of diabetes on female sexuality.

Sexual dysfunction in men is well recognised but the effects of diabetes on women's sexual health is less researched and understood. Few women seek help for sexual problems and yet effective treatments may be available. Some genito-urinary diseases are more common in diabetes and the community nurse should consider this as part of the patient's assessment. Women with diabetes should be given appropriate advice on pregnancy. Community nurses have a major role to play in helping women with diabetes to talk freely about their sexuality and sexual health problems.

The psychological factors associated with poor compliance with treatment in asthma.

Poor patient compliance with inhaled medication is known to cause morbidity and mortality in asthma. The reasons for nonadherence are not fully understood. We wondered whether psychological factors, such as patient attitudes to asthma and its treatment, anxiety, depression, and interpersonal problems, may be related to asthma self-care and compliance. In a prospective study, 102 patients with asthma, aged 18-70 yrs, requiring treatment with regular inhaled corticosteroids and beta-agonists were recruited from a hospital out-patient clinic and four general practices in South East London. They underwent psychological assessment using the Hospital Anxiety and Depression Scale (HADS), the Inventory of Interpersonal Problems (IIP), and a semi-structured interview focusing on patient attitudes, self-care, compliance, social support and treatment beliefs. Patients were given terbutaline and budesonide turbohalers to use twice daily over 12 weeks. Turbohaler Inhalation Computers (TICs) recorded each inhalation, providing a measurement of compliance. Seventy two patients completed the study. Thirty seven took less than 70% of the prescribed dose over the study period or omitted doses for 1 week and were defined as noncompliant. The noncompliant group had a higher mean (SD) score for depression (4.7 (3.3)) than the compliant group (3.2 (2.5)). The sample had a high mean (SD) score for anxiety (8.3 (4.4)), but there was no significant difference between the compliant and noncompliant groups. Patients' self-report and clinicians' impressions of compliance were not good predictors of actual compliance. Using discriminant analysis, a model was obtained from the questionnaires and interview items, which correctly classified 74% of the patients as compliant or non-compliant.(ABSTRACT TRUNCATED AT 250 WORDS)