Nurses’ recognition and registration of depression, anxiety and diabetes-specific emotional problems in outpatients with diabetes mellitus

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Abstract

Objective

The aim of this study was to investigate how often emotional problems were recognized and registered by diabetes nurses.

Methods

We studied medical charts and questionnaire data of 112 diabetes patients. The hospital anxiety, depression scale and the problem areas in diabetes survey were used to measure anxiety, depression and diabetes-specific emotional distress.

Results

In patients with moderate to severe levels of anxiety or depression, the presence of an emotional problem was recorded in the medical chart in 20–25% of the cases. The registration-rate of diabetes-specific emotional distress was also found to be low, ranging from 0% (treatment-related problems) to 29% (diabetes-related emotional problems).

Conclusion

Registration-rates of emotional problems by diabetes nurses were found to be low, but quite similar to detection rates of physicians and nurses in studies with non-diabetic samples.

Practice implications

These findings suggest that recognition-rates of emotional problems in diabetes patients need to be increased. Future studies should investigate whether recognition and subsequent treatment of emotional problems in diabetes patients can be facilitated by utilizing validated, standardized self-report questionnaires.

Introduction

Co-morbid emotional problems such as depression and anxiety are associated with decreased quality of life in diabetes patients, impaired self-care behaviors and diminished glycaemic control [1], [2], [3], [4]. The management of diabetes can also be hindered by the presence of diabetes-specific emotional problems, such as fear of hypoglycaemia, worries regarding complications or not accepting diabetes [5], [6], [7]. Although effective behavioral or pharmacological treatments are available for most emotional problems in patients with diabetes [5], [8], [9], the detection-rates of emotional problems are generally found to be low. For example, primary care physicians fail to recognize and treat depression in about 35–70% of the cases [10]. It was found that diabetologists recognized psychiatric disorders and/or initiate anti-depressant therapy in only one-third of their patients who had clinical depression [11]. Diabetes nurses (DNs) often spend more time with patients then doctors do, and they also have different responsibilities in the diabetes team, and we believe that DNs may play, therefore a helpful role in the detection of emotional problems.

However, nurses also recognized only 29% of the depressed cases in nursing home residents [12], while practice nurses detected 16% of patients with increased levels of psychological distress [13]. Finally, only 38–56% of internal medical inpatients with a mental disorder were recognized by both medical doctors and nurses and only 20% received mental health treatment [14].

We did not find any studies regarding the recognition of depression, anxiety and/or diabetes-specific distress by diabetes nurses. Therefore, the aim of the present observational study was to investigate whether DNs recognize and record the presence of emotional problems in outpatients with diabetes with high levels of depression, anxiety and/or diabetes-specific distress. Furthermore, we have explored the associations between recognition and subsequent registration of emotional problems and patient characteristics such as age, sex and type of diabetes.

Section snippets

Setting

Between May 1997 and December 1999, a randomized controlled trial was conducted at the outpatient diabetes clinic of the VU University Medical Center, which serves about 1200 diabetes patients. The Medical Ethics Committee of the VUmc approved this study. Main aim of that trial was to investigate whether monitoring and discussing of psychological well-being in outpatients with diabetes improves the outcomes of diabetes outpatient care. Patients of the present study participated in control group

Participation rate

During randomization of the randomized controlled trial, 122 patients were assigned to control group that was asked to complete a set of questionnaires at baseline [15]. The baseline data of that control group are studied in the present paper. Of the group of 122 patients in the control group, 10 were not able to participate due to language and reading and/or vision problems. Of the 112 remaining patients, subscale scores could be calculated for only 90–94 patients (PAID) and 97/98 patients

Discussion

The aim of the present study was to investigate whether DNs recognize and record the presence of emotional problems in outpatients with diabetes that have high levels of depression, anxiety and/or diabetes-specific distress. We have found that the majority of the diabetes outpatients with high levels of emotional problems are not recognized and described as such in their medical charts. In fact, the presence of emotional problems was recorded in only 20–30% of the patients with high scores on

Acknowledgements

This study was funded by the Dutch Diabetes Research Foundation (Diabetes Fonds Netherland, DFN, project numbers 95.805 and 2000.00.018). The authors wish to express their gratitude to all the patients who enrolled the trial.

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