PSYCHOSOCIAL

Psychosocial

Psychosocial

Introduction

Psychosocial stress and the use of various kinds of psychosocial support were evaluated. Using the Questionnaire on Stress in Patients with Diabetes (QSD-R), stress in different facets of daily life was assessed in a sample of 410 patients with type 1 and type 2 diabetes. Sixty-eight diabetics (16.6%) suffered from extreme psychosocial stress, which was defined as a mean global stress score above standard deviation. The use of insulin within the type 2 diabetic sample was especially associated with psychosocial stress. An association of diabetic control and the extent of psychosocial stress was found. With regard to the psychosocial stress profile, depression was predominant in both types of diabetes followed by fear of hypoglycemia in the type 1 subsample and physical complaints in the type 2 subsample. Primary care physicians and diabetologists were the main sources of psychosocial support. Psychosocial stress in diabetic patients is quite frequent and is associated with metabolic control; it should be considered more frequently in diabetes care.

Literature review

In the last decade, there has been a growing interest in psychosocial aspects of diabetes with an increasing number of epidemiologic studies on the comorbidity of psychiatric disorders or psychiatric symptoms [1 and 2]. Anxiety is one of the main problems of diabetic patients especially with regard to hypoglycemia or late diabetic lesions [3]. There is evidence that compared to diabetics with good metabolic control, diabetics with poor metabolic control and high risk of early diabetic lesions often suffer from psychiatric symptoms and disorders.

The aim of this multicenter study was to evaluate the association of psychosocial stress and the use of psychosocial support in patients with both types of diabetes. Besides evaluating the need of psychosocial support, another aim of the study was to find out associations between sociodemographic variables, type of diabetes, duration of the illness, metabolic control, diabetic lesions, and the extent of psychosocial burden. Furthermore, both the target group of potential support and the time when the psychosocial intervention was required were of interest.

Comparatively more research has been undertaken on psychosocial risk factors for than on psychosocial adjustment to coronary heart disease in women. Low social class, low educational attainment, the double loads of work and family, chronic troubling emotions and lack of social support emerge as documented risk factors in women. Regarding psychosocial adjustment to coronary heart disease in women, there is a paucity of data, and studies including large samples of women and adjusting for gender are warranted. Psychosocial adjustment in women after a myocardial infarction seems to be worse than in men, whereas results on adjustment after coronary artery bypass grafting are inconclusive. Return to work rates after myocardial infarction or coronary artery bypass grafting are significantly lower in women than in men. Data on sexual activity of women after myocardial infarction or coronary artery bypass grafting are scarce, and there seems to be a complete lack of physician counseling on this topic. Studies on rehabilitation outcome report poorer programme uptake, poorer adherence and significantly higher drop-out rates for women ...