R. Jacob. Diabetes Psychology Presentation (M.C). 20.01.23.pptx

Considering the possible psychological aspects of living with diabetes Module 203: Living with diabetes symposium Friday 20th January 2023 Dr Russell Jacob Principle Clinical Psychologist Diabetes and Cardiology Service - RSCH and PRH, Sussex Diabetes Psychology Service – Royal Free Hospital, Londo...

Considering the possible psychological aspects of living with diabetes Module 203: Living with diabetes symposium Friday 20th January 2023 Dr Russell Jacob Principle Clinical Psychologist Diabetes and Cardiology Service - RSCH and PRH, Sussex Diabetes Psychology Service – Royal Free Hospital, London … moment to ‘check in’ • Consideration for todays session • Mindfully consider how we, and our peers, are now and throughout the session Exercise: Imagine you have just been given a diagnoses of either Type 1 or 2 Diabetes …. Imagine you go online and look at the Sunday papers and see the following front page ….. How might you experience this? 3 4 Biopsychosocial Model of Health (Engel, 1977) ‘Diabetes impacts on physical, emotional, social and financial aspects of life across cultures and countries, yet gaps in care exist around psychosocial and self-management education and support’ DAWN2 Study, Diabetic Medicine, 2013 – Diabetes UK 5 Age when diagnosed (where known ..) Lancet, 2018 https://www.thelancet.com/journals/landia/article/PIIS2213-85871730362-5 /fulltext Ethnicity Age and sex standardised prevalence rates (per 100) of Type 2 diabetes according to ethnic group: White 1.7 All ethnic minorities 5.7 African Caribbean 5.3 All South Asians 6.2 Indian or African Asian 4.7 Pakistani or Banagladeshi 8.9 Chinese 3.0 People of Black and South Asian ethnicity also develop Type 2 diabetes at an earlier age than people from the White population in the UK, 7 Deprivation • Deprivation is strongly associated with higher levels of obesity, physical inactivity, unhealthy diet, smoking and poor blood pressure control. All these factors are inextricably linked to the risk of diabetes or the risk of serious complications for those already diagnosed • Difficult to get clear evidence of absolute risk related to deprivation. • The Health Survey for England 2011 found that men in the lowest quintile of equivalised household income were 2.3 times more likely to have diabetes than those in the highest quintile, and for women the risk was 1.6 times higher. 8 Consider Physical Health Conditions and Mental Health Long-term conditions and mental health, The Kings Fund and Centre for Mental Health, 2012 9 Consider biopsychosocial factors following a diagnoses of diabetes (and impact of age) Short and long term complicatio ns Attending many appointments Monitoring BGL Insulin/ Injectable drugs Receiving diagnosis and informing others What a person may encounter in their life following diabetes diagnosis Sharing Blood Glucose Data e.g. CGM,Freestyle Libre Carbohydra te counting Medical information .... and maths! ‘Hypo’s’ Health care teams ‘Hyper’s’ Administeri ng medicatio n/ needles 10 Consider other biopsychosocial factors in the persons life not linked to diabetes, but impact Mental/ psychological health difficulties Education/ Employment Status Other physical health illnesses Caring for others with physical/ psychological problems Some potential general (non-diabetic) ‘life stressors’, that may impact diabetes control Cultural difference s Relationship problems (inc. Domestic abuse) Housing Financial problem s Demands of child care Poor sleep/ Noise pollution 11 A few examples of the possible psychological sequelae of living with diabetes 1. Not testing blood glucose levels • Fear of needles, inconvenience, poor organisation, little motivation, fear of seeing a ‘bad result’? • Shame? (Internal versus external) – NB modern devices allow others to see all your data [and hypothesise about the cause!]) 2. Running Blood glucose levels high or low (“chasing blood glucose levels”) Fear of hypos, fear of complications? Blood sugar level low  think “Oh no, I’ll pass out!”  run blood sugar level high  think “Oh no, I’ll end up in hospital with DKA/get complications !”  run blood sugar low … 12 3. Sporadic administration of medication • Don't want a regular reminder of the diagnosis? • Inconvenience, embarrassment? • Poor organisational skills? • May fear insulin e.g. weight gain? • Interpret as ‘end of life’? 4. Eating Disorder • e.g. Binging/overeating/ “Diabulimia” (fusion of the words Diabetes and Bulimia) 13 5. Diabetes ‘Burn-out’ (William Polonsky, 1999)  Feeling low in relation to your diabetes – includes … - Feeling overwhelmed and defeated by D.M Depressed/anxious/angry about self-care regimen Feeling alone/isolated with diabetes Feeling D.M is controlling your life • Burn-out  relates to experiences specifically related to your D.M. • Depression  elates more to your negative thoughts about yourself, the world, and hopelessness about the future 14 Signs and Symptoms associated with depressive disorders and Type 1 Diabetes-related distress in adults 15 (Pallayova and Taheri, 2014) Some of the psychological/mentalhealth factors that may negatively affect diabetes self-care 1. Depression E.g. can lead to loss of motivation to adhere to medication regimen or attend appointments. 2. Anxiety / anger / disgust / feeling ‘under-threat’ /trauma (diabetes related and non-diabetes related The ‘fight-or-flight’ response; ‘5-f’s (consider ‘faint’ and needle phobia) 3. ‘Locus of control’ Can you make a positive impact on your healthcare? (or consider this in the hands of the professionals?) 4. ‘Relationship to Help’ (Reder and Fredman, 1997) 16 Crucial to consider … The challenges of adherence to Medication /treatment plans “ Drugs don’t work in patients who don’t take them” Former U.S. Surgeon General C. Everett Koop) 17 Medication and Non-Adherence Adherence - ‘the degree to which the person’s behavior corresponds with the agreed recommendations from a health care provider’ World Health Organization 2009 Adherence is not simply doing ‘all or nothing’ PWD may adhere to some aspects of their medication regimen, but not all E.g. “ … take the tablets, miss the injections” Adherence – it is a behavior (not to be confused with an outcome) (DiMatteo et al, 2011) e.g. Healthy HbA1c; ‘Time in range’- depends on adhering to medication (and persisting) 18 Some of the factors affecting adherence 1) Cognitive and language barriers (Nash, 2013) Does the PWD understand their treatment regimen? three factors to consider: a. Health Literacy Does the person comprehend the HCP’s instructions? (e.g. PWD have a learning disability/ learning difficulty) b. Possibility of cognitive decline Particularly pertinent in older age PWD May be as a result of diabetes 19 Factors Affecting Adherence (and engagement) c. Language factors •Does the person require an interpreter? •Do they understand the nuances of medical-based language?  Ask yourself “… why does the PWD always bring another into the room for their consultation”?  If a family/friend helps translate, how do we know they themselves comprehend/relay correct information to PWD?  If PWD always attends with another, imagine being on your own with the PWD – how would the conversation go? 20 Factors Affecting Adherence (and engagement) 2) Psychological factors (a) Identity  Our sense of identity can be challenged by diabetes. Does the PWD feel “less than”? under surveillance from the ‘diabetespolice’? E.g family/friends saying “you know, you shouldn't eat that sort of food now!”? 21 Factors Affecting Adherence (and engagement) (b) Relationship with healthcare provider Relationship with HCP ideally warm, supportive and empathic. However, not always within control of HCP (e.g. PWD has interpersonal difficulties/EUPD etc) (c) Self-efficacy and perceived control Is the patient confident in their ability to implement and follow their self-management 22 Factors Affecting Adherence (and engagement) 3. Psychological distress/mental health problems  Diabetes distress/depression/anxiety/eating disorder/Bi-polar/Psychosis etc - all increase the challenge a PWD faces with diabetes selfmanagement  Important to complete comprehensive assessment and ensure PWD offered psychological/mental health support for nondiabetes related difficulties 23 and finally …. Remember … Diabetes is a treatable condition and most living with diabetes live well !!! 24 25