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

Abstract

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