Psychological effects of prevention: Do participants of a type 2 diabetes prevention program experience increased mental distress?
Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Germany. Diabetes/Metabolism Research and Reviews
(Impact Factor: 3.55).
01/2009; 25(1):83-8. DOI: 10.1002/dmrr.917
To evaluate the mental health outcome of a lifestyle intervention for the prevention of type 2 diabetes and to exclude possible harmful psychological effects.
There is little empirical data on potential harmful effects of prevention programs. However, information, education, diagnostic procedures, phenotyping and risk assessment may cause or intensify psychological distress such as anxiety, depression or somatization in vulnerable individuals.
The Tuebingen Lifestyle Intervention Program (TULIP) for the prevention of type 2 diabetes has assessed mental health outcome in the participants after 9 months of program participation using the Symptom Checklist-90-R (SCL-90-R). The 24-months lifestyle intervention TULIP comprises regular exercise and changes in nutrition and assesses both, a broad range of somatic parameters as well as psychometric variables. For an interim analysis of psychological outcome, complete data sets of the SCL-90-R assessed at baseline and after 9 months of intervention were available for 195 participants (125 females, 70 males; age: 46.1 +/- 10.6 years). Data on somatization, anxiety, depression and overall psychological distress were compared to baseline levels.
SCL-90-R scores of the TULIP-participants did not significantly differ from the German healthy reference population. Compared to baseline, a significant decrease in SCL-90-R scores was found for anxiety, depression and overall psychological distress at re-assessment after 9 months.
The interim analysis on mental health outcome of a type 2 diabetes prevention program comprising extensive phenotyping and risk assessment rules out adverse psychological effects, suggesting rather beneficial changes concerning symptoms of anxiety, depression and overall psychological distress.
Available from: Susanne Andersson
- "Individuals with worsening glucose metabolism, such as in diabetes, report higher levels of symptom distress (Symptom Checklist DSC-R 10) than those with IGT or normal glucose metabolism . Giel et al.  evaluated the mental health outcome of a lifestyle intervention by Symptom Checklist-90-R. After 9 months, the result suggests rather beneficial changes concerning symptoms of anxiety, depression, and overall psychological distress in people attending the prevention program. "
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ABSTRACT: The aim of the study was to identify symptoms in people with impaired glucose tolerance (IGT) and describe their experiences of living with the symptoms which they related to their condition. Twenty-one participants, from a cross-sectional population-based study, diagnosed as having IGT, were invited for an interview. The interviews were analyzed in two phases by means of a manifest and latent content analysis. The narratives included seven categories of symptoms (and more than 25 different symptoms) presented by the respondents. This study shows that symptoms such as the patient's own interpretation of different perceptions in the body must be considered, as well as signs and/or objective observations. Symptoms ought to be seen as complementary components in the health encounter and health conversation. The results of this study indicate that health professionals should increase their awareness of the balance between the implicit and the explicit bodily sensations that individuals communicate. Further studies are needed.
Available from: Amy Windover
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ABSTRACT: Preoperative bariatric psychological evaluations often use both a clinical interview and psychometric testing. Given concerns regarding the psychometric properties of some measures, the present study explored the internal consistency reliability and validity of the Symptom Checklist 90 Revised (SCL-90-R) and has provided a preliminary set of norms for the instrument within a bariatric population. Although the American Society for Metabolic and Bariatric Surgery has included the SCL-90-R as a suggested measure for the assessment of personality and psychopathology, no known studies have reported on the reliability or validity of the SCL-90-R within bariatric samples.
The present study was completed at a large Midwestern medical center in the United States. SCL-90-R inventories were completed by 322 preoperative bariatric patients as a part of their psychological evaluation. Most patients were women (75.5%), with a mean age of 46.7 ± 10.8 years and a mean body mass index of 50.4 ± 10.9 kg/m(2).
The internal consistency coefficients for the 9 subscales were .76-.90. Convergent validity was demonstrated by scale correlations with the data gathered in the clinical interview.
Compared with other recently studied measures, including the Millon Behavioral Medicine Diagnostic, the SCL-90-R demonstrated good internal consistency and preliminary validity data for bariatric patients. Providers might want to consider the SCL-90-R as a screening measure for bariatric surgery patients.
Available from: Justin B Echouffo-Tcheugui
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ABSTRACT: Type 2 diabetes mellitus (T2DM) and dysglycemia (impaired glucose tolerance and/or impaired fasting glucose) are increasingly contributing to the global burden of diseases. The authors reviewed the published literature to critically evaluate the evidence on screening for both conditions and to identify the gaps in current understanding. Acceptable, relatively simple, and accurate tools can be used to screen for both T2DM and dysglycemia. Lifestyle modification and/or medication (e.g., metformin) are cost-effective in reducing the incidence of T2DM. However, their application is not yet routine practice. It is unclear whether diabetes-prevention strategies, which influence cardiovascular risk favorably, will also prevent diabetic vascular complications. Cardioprotective therapies, which are cost-effective in preventing complications in conventionally diagnosed T2DM, can be used in screen-detected diabetes, but the magnitude of their effects is unknown. Economic modeling suggests that screening for both T2DM and dysglycemia may be cost-effective, although empirical data on tangible benefits in preventing complications or death are lacking. Screening for T2DM is psychologically unharmful, but the specific impact of attributing the label of dysglycemia remains uncertain. Addressing these gaps will inform the development of a screening policy for T2DM and dysglycemia within a holistic diabetes prevention and control framework combining secondary and high-risk primary prevention strategies.
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