背景:糖尿病的足部并发症是常见且具有破坏性的,导致大量的医疗费用和高发病率。沿海地区的疾病负担要高得多。糖尿病患者的心理健康问题发生率过高,包括焦虑,抑郁症和糖尿病困扰。这些会影响足部并发症的自我管理和预防措施和治疗的一致性,对结果产生负面影响。在整个英国,获得心理健康服务的情况各不相同,并且缺乏高质量的证据来证明糖尿病困扰治疗的有效性。本研究旨在探讨心理社会负担的经验以及对心理社会支持的看法和经验。生活在沿海地区的糖尿病和足部并发症患者中。
方法:如果患者经历过糖尿病相关的足部并发症(截肢,溃疡和/或Charcot神经关节病)在过去5年内,并在经过验证的筛查工具(DDS2)上对糖尿病困扰评分为阳性。符合条件的患者填写了描述糖尿病困扰症状的横断面问卷(DDS17),焦虑(GAD-7)和抑郁(PHQ-9),半结构化面试。使用频率对问卷进行分析,并使用反身主题分析对访谈进行分析。
结果:共有183名患者完成了DDS2筛查问卷。其中,56(30.6%)糖尿病困扰筛查阳性。27名患者完成了DDS17、GAD-7和PHQ-9问卷。11名(40.7%)参与者表示高度糖尿病困扰,4名(14.8%)表示中度困扰。17名参与者(年龄范围52-81岁;12名男性)参加了采访。确定了四个关键主题:足部问题的影响;足部问题的情感后果;心理支持的经验和看法;以及应对足部问题的情感影响的策略。
结论:糖尿病困扰在糖尿病相关足部并发症患者中普遍存在。脚部问题影响参与者的日常活动,社交生活和工作能力。尽管表达了持续的恐惧,与脚部问题有关的担忧和抑郁,只有一名参与者获得了正式的心理支持.许多参与者依靠例行预约与足病医生交谈,并描述了制定各种应对策略。健康专业人员绝不能忽视糖尿病患者足部并发症的社会心理负担。这项研究的结果可以为未来服务和干预措施的设计提供信息。
BACKGROUND: Foot complications in diabetes are common and destructive, resulting in substantial healthcare costs and high rates of morbidity. Coastal areas have a significantly higher burden of disease. People with diabetes experience disproportionately high rates of psychological health issues, including anxiety, depression and diabetes distress. These can affect self-management and concordance with preventive measures and treatments of foot complications, negatively impacting on outcomes. Access to psychological health services is variable across the United Kingdom and there is a paucity of high-quality evidence for the effectiveness of treatments for diabetes distress. This study aimed to explore experiences of psychosocial burden and perceptions and experiences of psychosocial support, among patients with diabetes and foot complications living in a coastal area.
METHODS: Patients were eligible to participate if they had experienced diabetes-related foot complications (amputation, ulceration and/or Charcot neuroarthropathy) within the last 5 years and scored positive for diabetes distress on a validated screening tool (DDS2). Eligible patients completed cross-sectional questionnaires describing symptoms of diabetes distress (DDS17), anxiety (GAD-7) and depression (PHQ-9) and to take part in a face-to-face, semi-structured interview. Questionnaires were analysed using frequencies and interviews were analysed using reflexive thematic analysis.
RESULTS: A total of 183 patients completed the DDS2 screening questionnaire. Of these, 56 (30.6%) screened positive for diabetes distress. Twenty-seven patients completed DDS17, GAD-7 and PHQ-9 questionnaires. Eleven (40.7%) participants indicated high levels of diabetes distress and four (14.8%) indicated moderate distress. Seventeen participants (age range 52-81 years; 12 men) took part in an interview. Four key themes were identified: impact of living with foot problems; emotional consequences of foot problems; experiences and perceptions of psychological support; and strategies to cope with the emotional impact of foot problems.
CONCLUSIONS: Diabetes distress was prevalent among patients with diabetes-related foot complications. Foot problems impacted on participants\' daily activities, social lives and ability to work. Despite expressing feelings of ongoing fear, worry and depression relating to their foot problems, only one participant had accessed formal psychological support. Many participants relied on talking to podiatrists at routine appointments and described developing various strategies to cope. The psychosocial burden of living with foot complications in diabetes must not be overlooked by health professionals. Findings from this study can inform the design of future services and interventions.