Diabetes mellitus is a grouping of metabolic diseases whereby, the levels of blood sugar in the body are relatively high over an extended period. As of 2015, approximately 415 million individuals had diabetes globally with T2D accounting for around ninety percent of the cases; this represents roughly 8.3 percent of the adult populace with equivalent rates in both men and women (Varni et al ., 2018). By 2014, trends in diabetes prevalence indicated the probability of the world experiencing significant increases in the incidence of diabetes within the population. Amid the year 2012 to 2015, around 1.5 to 5.0 million annual deaths ensued from diabetes (Varni et al., 2018). T2D and T1D represent a challenging group of biopsychosocial complications for people with diabetes and their respective families, irrespective of the age of the onset of the disease, for instance, adulthood, adolescence, and childhood. Regardless of whether diabetes’ etiology indicates that diabetes mellitus is a disease that deprives the pancreas of beta cells (T1D) or enhances the growth of cells that are insulin-resistant, as well as glucotoxicity and lipo- (T2D), the patients' behavioral implications, are similar.
Psychological issues due to Diabetes
Depression
Depression refers to a general condition of low mood and the deprivation of pleasure in activities that were initially enjoyed (Lloyd, Pouwer, & Hermanns, 2013). Life often seems grey and flat, and nothing seems enjoyable, exciting, or fun anymore. Some of the common symptoms of depression identified among veterans include thoughts of death or suicide, poor decision-making, concentration, and memory, lack of enthusiasm, weight loss and lack of appetite, and the feeling of worthlessness, hopelessness, and helplessness. In a cross-sectional research’ meta-analysis aimed at diagnosing depressive and depression symptoms, Boon, Mohd, Sharif, & Chew, (2015) revealed that patients diagnosed with T1D demonstrated a 21.3 percent prevalence rate for significant depressive symptoms. Individuals with T2D, on the other hand, exhibited a twenty-seven percent prevalence rate. Another meta-analysis study of longitudinal research revealed a twenty-four to thirty-eight percent increased risk for developing T2D among family members with depressive symptoms. The rates of depressive disorder among individuals with T2D and T1D as evaluated by Lloyd, Pouwer, and Hermanns (2013) range from around eight percent to fifteen percent.
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Anxiety
Anxiety is also a common psychological issue identified among patients diagnosed with diabetes; additionally, their family members may also exhibit significant levels of anxiety due to the patients’ conditions and the strain inflicted upon them. Anxiety relates to the state of worry and apprehension that something unpleasant is likely to take place (Weaver, 2015). Individuals suffering from anxiety may exhibit a variety of symptoms, for instance, fear of complications, tightness in the chest and shortness of breath, increases in heart rate and palpitations, sweating, dizziness, or trembling. Other symptoms associated with anxiety include the fear of losing control, muscle tension, restlessness and feeling on edge, excessive worries, and physical disorders such as stomach upsets. Anxiety symptoms unique to diabetic patients include invasive self-care behaviors, hypoglycemia, and fear of complications (Weaver, 2015). Fear regarding the probability of the manifestation of chronic, long-term complications is usually identified as one of the most distressing elements of disorder amid patients with T2D and T1D. The anticipatory hypoglycemia fear is also a regular issue. Hypoglycemia refers to the levels of blood glucose which are significantly lower than the normal range. Hypoglycemia brings about an unpleasant physical attribute since it brings about temporary cognitive impairments and it involves a counter or adverse regulatory hormonal response (Weaver, 2015). The episodes of hypoglycemia are usually unpredictable, and patients may experience changes in short-term functioning and lack of social appraisal towards others. Invasive self-care behaviors include fears associated with the continuous monitoring of glucose, inserting subcutaneous infusion devices (insulin), self-monitoring of the levels of glucose in the blood, and the fear of injections.
Eating Disorders and Disordered Eating Behaviors
Eating disorders and DEBs (Disordered eating behaviors) constitute a range of symptoms, for instance, constrained caloric intake, purging behaviors, for example, the consumption of laxatives to cut weight, vomiting and excessive eating, binge eating, and distorted body image (Boon et al., 2015). The diagnostic categories of eating disorders are as follows: Binge Eating Disorder, Bulimia Nervosa, and Anorexia Nervosa. DEBs refer to eating behaviors and cognitions which take place at significantly low frequencies than eating disorders, and they bring about challenging vis a vis recommendation concerning the medical diagnoses’ behavioral management (Boon et al., 2015). The management of T2D and T1D entails various components that increase the risk of eating disorders and DEBs among patients. These components include the limitations of the choice of diet to enhance aspects such as weight loss or control the levels of blood glucose, close monitoring approaches, prescribed physical activities, and the capacity to manipulate one’s weight through activities such as insulin omission or under-administration. A study aimed at comparing the incidence of DEBs amid adolescents diagnosed with diabetes and non-diabetic adolescents using diabetes-adapted standards revealed that DEBs prevalence is significantly high among adolescents with diabetes (51.8 percent) compared to non-diabetic adolescents (48.1 percent) (Boon et al., 2015).
The Application of Psychological Theory
Health Belief Model (HBM)
The HBM refers to a psychological health behavior change theory developed to delineate and forecast health-associated behaviors, especially concerning health service uptake (Hayden, 2013). The theory suggests that a person’s belief concerning health issues, self-efficacy, and perceived benefits and barriers to an action elucidate one’s lack of engagement or one’s involvement in health-promoting behaviors. The theory emphasizes the availability of a cue to action or stimulus to enhance the health-promoting behavior (Hayden, 2013). The application of the theory will be based primarily on the evaluation and implementation of its constructs: perceived susceptibility, perceived severity, perceived barriers, and perceived benefits, self-efficacy, action cues, and modifying variables.
Perceived severity relates to the subjective analysis of the chronic nature of the health issue and its possible impacts (Hayden, 2013). The model propounds that patients who view a particular health issue as severe are more likely to participate in activities aimed at preventing the prevalence of the problem. Under this construct, a psychologist may enlighten the patient concerning the severity of the disorder, for instance, depression, and outline the effects of the disorder on one’s capacity to function at work and perform social roles. The psychologist thus uses this strategy to increase a patient’s urge to seek medical help or implement strategies that seek to reduce the severity or occurrence of the condition.
Perceived susceptibility relates to the subjective evaluation of the risks associated with developing a health issue (Hayden, 2013). The model argues that people who perceive their vulnerability to a specific health issue are likely to engage in activities or behaviors aimed at minimizing the risks associated with developing the disorder and vice versa. Psychologists ought to inform diabetic patients concerning their susceptibility to various psychological conditions to foster their capacity to engage in healthy and less risky behaviors because the high perception of probable health threats enhances a patient’s potential to participate in health-promoting behaviors.
The perceived benefits for executing an action impacts one health-related behavior significantly. Perceived benefits relate to one’s analysis of the efficacy or value of involving oneself in a health-promoting behavior to minimize the risks of a specific disease (Hayden, 2013). If one believes that a specific activity may decrease his susceptibility to a health issue or reduce its severity, then one is likely to involve oneself in that behavior irrespective of the objective aspects concerning the behavior’s effectiveness. Psychologists, therefore, ought to inform diabetic patients about behaviors that may reduce their vulnerability to various psychological issues such as anxiety and eating disorders. Perceived barriers relate to one’s evaluation of the hindrances to behavior change (Hayden, 2013). Psychologists ought to ensure that the benefits of preventing or managing a particular health condition in a diabetic patient outweigh the barriers, for instance, discomfort to facilitate the implementation of behavioral change by a patient.
The Role of Health Psychology in helping Individuals Cope with a Chronic Medical Issue
Health psychology emphasizes the need for diabetic patients to implement significant life change approaches to manage the disorder effectively. Health psychology underscores the need to eat a healthy diet, engage in frequent physical activities, and weight loss to enhance the capacity of the patient’ bodies to maintain the required levels of glycemia and mitigate the long-term impacts of the disorder (Huffman et al ., 2015). Secondly, the discipline underscores the significance of self-management behaviors in reducing the prevalence and effects of the disorder. Health psychologists often emphasize the concept of adherence to the guidelines involving clinical practice and self-efficacy behaviors in fostering the management of diabetes (Varni et al., 2018). Thirdly, health psychology interventions, for instance, psychosocial interventions may play a critical role in enhancing the ability of a patient’s body to control the levels of glucose and other behavioral and health outcomes (Varni et al., 2018). Fourthly, health psychologists play a crucial role in effectively identifying and treating various mental health issues and psychological challenges experienced by many diabetic patients and their subsequent family members.
Current Research on the Disorder
One current primary research revolves around the effectiveness of positive psychology interventions as a therapeutic approach to improving the psychological well-being of diabetic patients. Positive psychology interventions incorporate the use of exercises, for instance, gratitude letters and personal strengths, developed systematically, to enhance aspects such as resilience, positive affect, and optimism (Huffman et al., 2015). In non-diabetic research participants, PP interventions have demonstrated significant increases in an individual’s well-being, and considerable decreases in depression. Random trials involving patients with HIV, hypertension, and coronary heart disorders have also indicated the significant beneficial effects of this form of intervention on the patient’s depressive state, well-being, and health behaviors (Huffman et al., 2015). Various researchers have delineated the potential benefits of the PP intervention approaches in promoting the well-being, improving self-care, and reducing distress among patients with T2D (Huffman et al., 2015). However, limited studies have been conducted to support the arguments posed by different researchers.
References
Boon-How Chew, Mohd-Sidik, S., Shariff-Ghazali, S., & Chew, B.-H. (2015). Negative effects of diabetes-related distress on health-related quality of life: an evaluation among adult patients with type 2 diabetes mellitus in three primary healthcare clinics in Malaysia. Health & Quality of Life Outcomes , 13, 1–16.
Hayden, J. A. (2013). Introduction to Health Behavior Theory . Sudbury: Jones & Bartlett Learning, LLC.
Huffman, J. C., DuBois, C. M., Millstein, R. A., Celano, C. M., & Wexler, D. (2015). Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development. Journal of Diabetes Research , 2015, 1–18.
Lloyd, C. E., Pouwer, F., & Hermanns, N. (2013 ). Screening for depression and other psychological problems in diabetes: A practical guide . London: Springer
Varni, J. W., Delamater, A. M., Hood, K. K., Driscoll, K. A., Wong, J. C., Adi, S., Wilson, D. P. (2018). Diabetes management mediating effects between diabetes symptoms and health‐related quality of life in adolescents and young adults with type 1 diabetes . Pediatric Diabetes , 19(7), 1322–1330.
Weaver, L. J., & Madhu, S. V. (2015). Type 2 Diabetes and Anxiety Symptoms among Women in New Delhi, India. American Journal of Public Health , 105(11), 2335–2340.
