Written emotional disclosure for improving depression for adults with long-term physical conditions : the case of type 2 diabetes

Depression is twice as prevalent among people with long-term physical conditions (LTPCs), and it confers an increased risk of additional morbidity and early mortality. Psychological interventions such as those based on cognitive behavioural therapy (CBT), can improve outcomes but widespread provision is problematic. Written emotional disclosure (WED) is a brief, inexpensive intervention that may offer a pragmatic solution. Its effects, however, are unclear, since reviews have drawn different conclusions and used inadequate methodology. A methodologically robust systematic review of RCTs, evaluating WEDs effects on psychological health and quality of life (QoL) in adults with LTPCs, concluded that WED may be effective for reducing negative affect including depression, and some associated outcomes. However, future endeavours must improve methodological rigor and explore WED for LTPCs impacted by negative affect. Type 2 diabetes is consistent with this specification yet understudied in WED. An exploratory RCT investigating WED for improving depressive symptom severity, and some secondary outcomes, in adults with Type 2 diabetes was undertaken. A test of WEDs anticipated effect, further exploration of this and an investigation of feasibility was initially intended. However, ethical and recruitment issues necessitated that the objectives be narrowed down to a focus on feasibility and a very much exploratory analysis of the effectiveness of WED. Recruitment was via primary care supplemented with online support groups, albeit secondary care was also attempted. The study identified that WED may be acceptably and feasibly implemented as part of general practice in the UK and for use with LTPCs in this context, specifically Type 2 diabetes. However, ethical and recruitment also issues necessitated delivery of WED to patients with none or very low-level depressive symptoms, for whom it may cause iatrogenic harm. However, a number of methodological issues substantially undermined these findings. Further research addressing the pitfalls associated with previous endeavours is required before consideration of WED in primary care for LTPCs including Type 2 diabetes

Written emotional disclosure for improving depression for adults with long-term physical conditions : the case of type 2 diabetes

Depression is twice as prevalent among people with long-term physical conditions (LTPCs), and it confers an increased risk of additional morbidity and early mortality. Psychological interventions such as those based on cognitive behavioural therapy (CBT), can improve outcomes but widespread provision is problematic. Written emotional disclosure (WED) is a brief, inexpensive intervention that may offer a pragmatic solution. Its effects, however, are unclear, since reviews have drawn different conclusions and used inadequate methodology. A methodologically robust systematic review of RCTs, evaluating WEDs effects on psychological health and quality of life (QoL) in adults with LTPCs, concluded that WED may be effective for reducing negative affect including depression, and some associated outcomes. However, future endeavours must improve methodological rigor and explore WED for LTPCs impacted by negative affect. Type 2 diabetes is consistent with this specification yet understudied in WED. An exploratory RCT investigating WED for improving depressive symptom severity, and some secondary outcomes, in adults with Type 2 diabetes was undertaken. A test of WEDs anticipated effect, further exploration of this and an investigation of feasibility was initially intended. However, ethical and recruitment issues necessitated that the objectives be narrowed down to a focus on feasibility and a very much exploratory analysis of the effectiveness of WED. Recruitment was via primary care supplemented with online support groups, albeit secondary care was also attempted. The study identified that WED may be acceptably and feasibly implemented as part of general practice in the UK and for use with LTPCs in this context, specifically Type 2 diabetes. However, ethical and recruitment also issues necessitated delivery of WED to patients with none or very low-level depressive symptoms, for whom it may cause iatrogenic harm. However, a number of methodological issues substantially undermined these findings. Further research addressing the pitfalls associated with previous endeavours is required before consideration of WED in primary care for LTPCs including Type 2 diabetes.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Improving health outcome for young people with long term conditions: The role of digital communication in current and future patient-clinician communication for NHS providers of specialist clinical services for young people receiving specialist clinical services:LYNC study protocol.

Background: Young people living with long term conditions are vulnerable to health service disengagement. This endangers their long term health. Studies report requests for digital forms of communication - email, text, social media - with their health care team. Digital clinical communication is troublesome for the UK NHS. Aim: To present the research protocol for evaluating the impacts and outcomes of digital clinical communications for young people living with long term conditions and provide critical analysis of their use, monitoring and evaluation by NHS providers. Methods: The research involves: 1) Patient and Public Involvement activities with 16-24 year olds with and without long term health conditions; 2) six literature reviews; 3) case studies – the main empirical part of the study – and 4) synthesis and a consensus meeting. Case studies use a mixed methods design. Interviews and non-participant observation of practitioners and patients communicating in up to 20 specialist clinical settings will be combined with data, aggregated at the case level (non-identifiable patient data), on a range of clinical outcomes meaningful within the case and across cases. We will describe the use of digital clinical communication from the perspective of patients, clinical staff, support staff and managers, interviewing up to 15 young people and 15 staff per case study. Outcome data includes emergency admissions, A&E attendance and DNA rates. Case studies will be analysed to understand impacts of digital clinical communication on patient health outcomes, health care costs and consumption, ethics and patient safety

What is diabetes distress and how can we measure it?:A narrative review and conceptual model

BACKGROUND: Diabetes distress is the negative emotional impact of living with diabetes. It has tangible clinical importance, being associated with sub-optimal self-care and glycemic control. Diabetes distress has been operationalized in various ways and several measures exist. Measurement clarity is needed for both scientific and clinical reasons. OBJECTIVES: To clarify the conceptualization and operationalization of diabetes distress, identify and distinguish relevant measures, and evaluate their appropriateness for this purpose. RESULTS: Six measures were identified: Problem Areas in Diabetes (PAID) scale, Diabetes Distress Scale (DDS); Type I Diabetes Distress Scale (T1-DDS), Diabetes-specific Quality of Life Scale—Revised (DSQoLs-R) ‘Burden and Restrictions—Daily Hassles’ sub-scale, Well-being Questionnaire 28 (W-BQ 28) ‘Diabetes Well-being’ sub-scale, and Illness Perceptions Questionnaire—Revised (IPQ-R) ‘Emotional Representations’ sub-scale. Across these measures a broad spectrum of diabetes distress is captured, including distress associated with treatment regimen, food/eating, future/complications, hypoglycemia, social/interpersonal relationships, and healthcare professionals. No single measure appears fully comprehensive. Limited detail of the qualitative work informing scale design is reported, raising concerns about content validity. CONCLUSIONS: Across the available measures diabetes distress is seemingly comprehensively assessed and measures should be considered in terms of their focus and scope to ensure the foci of interventions are appropriately targeted

Retrospective review of the drop in observer detection performance over time in lesion-enriched experimental studies.

The vigilance decrement describes a decrease in sensitivity or increase in specificity with time on task. It has been observed in a variety of repetitive visual tasks, but little is known about these patterns in radiologists. We investigated whether there is systematic variation in performance over the course of a radiology reading session. We re-analyzed data from six previous lesion-enriched radiology studies. Studies featured 8-22 participants assessing 27-100 cases (including mammograms, chest CT, chest x-ray, and bone x-ray) in a reading session. Changes in performance and speed as the reading session progressed were analyzed using mixed effects models. Time taken per case decreased 9-23% as the reading session progressed (p < 0.005 for every study). There was a sensitivity decrease or specificity increase over the course of reading 100 chest x-rays (p = 0.005), 60 bone fracture x-rays (p = 0.03), and 100 chest CT scans (p < 0.0001). This effect was not found in the shorter mammography sessions with 27 or 50 cases. We found evidence supporting the hypothesis that behavior and performance may change over the course of reading an enriched test set. Further research is required to ascertain whether this effect is present in radiological practice

Effective interventions for reducing Diabetes Distress:systematic review and meta-analysis

AIMS: To identify randomised controlled trials (RCTs) in which diabetes distress (DD) was assessed in adults under experimental conditions and to undertake meta-analysis of intervention components to determine effective interventions for reducing DD. METHODS: Systematic review searching Medline, Psychinfo and Embase to March 2013 for studies measuring DD. Two reviewers assessed citations and full papers for eligibility based on RCT design and Problem Areas in Diabetes Scale or Diabetes Distress Scale outcome measure. Interventions were categorised by content and medium of delivery. Meta-analyses were undertaken by intervention category where ≥7 studies were available. Standardised mean differences and 95% confidence intervals were computed and combined in a random effects meta-analysis. RESULTS: Of 16 627 citations reviewed, 41 RCTs involving 6650 participants were included. Twenty-one a priori meta-analyses were undertaken. Effective interventions were psycho-education (−0.21 [−0.33, −0.09]), generalist interventionist (−0.19 [−0.31, −0.08]), ≥6 sessions (−0.14 [−0.26, −0.03]) and ≥3 months duration (−0.14 [−0.24, −0.03]). Motivational interviewing reduced DD (−0.09 [−0.18, −0.00]) and improved baseline elevated glycaemia (−0.16 [−0.28, −0.04]). Although statistical significance was observed most effect sizes were below 0.2. CONCLUSION: The review signposts interventions likely to reduce elevated DD in Type 1 and Type 2 and across the age profile. Interventional research is needed and warranted targeting elevated distress