Depression, Anxiety, and Diabetes in Older Adults

Kellee Poulsen (2010). Depression, Anxiety, and Diabetes in Older Adults PhD Thesis, School of Psychology, The University of Queensland.

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Author Kellee Poulsen
Thesis Title Depression, Anxiety, and Diabetes in Older Adults
School, Centre or Institute School of Psychology
Institution The University of Queensland
Publication date 2010-08-01
Thesis type PhD Thesis
Supervisor Prof Nancy Pachana
Prof Christina Lee
Total pages 472
Total colour pages 1
Total black and white pages 471
Subjects 17 Psychology and Cognitive Sciences
Abstract/Summary Diabetes mellitus is one of the largest health problems in Australia. Research consistently shows that diabetes is psychologically and behaviourally challenging, with people with diabetes two to three times more likely to experience depression and anxiety than people without diabetes. In people with diabetes, depression and anxiety are associated with poorer diabetes self-management; poorer glycaemic control; higher hospitalisation rates; increased likelihood of diabetes-related complications; higher mortality; poorer health-related quality of life (HRQOL); and greater health care utilisation. Although it is well-established that people with diabetes experience disproportionately higher rates of depression and anxiety than people without diabetes, majority of the literature has excluded adults aged 60 years and older; those most likely to develop type 2 diabetes mellitus (T2DM) and diabetes-related complications. Furthermore, it remains unclear whether diabetes affects people of different ages uniformly. The current thesis presents a review of the literature on the associations between diabetes, depression, and anxiety, and the impact such psychological conditions have on physical health, diabetes-related outcomes, and HRQOL. This is followed by a literature review examining factors unique to older adults with diabetes. Three empirical investigations were conducted to examine the associations between depression, anxiety, and HRQOL among older adults with and without diabetes, with a focus also on age differences across middle-aged and older adults with diabetes. In Study 1, rates of depressive and anxious symptoms were compared among older adults with and without diabetes. The study also examined differences in depression, anxiety and diabetes-related emotional distress between middle-aged and older adults with diabetes. A total of 224 participants completed a range of questionnaires measuring depression, anxiety, and diabetes-related emotional distress (if applicable). Results showed that older adults with diabetes have significantly higher levels of depression and comparable levels of anxiety to older adults without diabetes. Examination of age differences indicates older adults with diabetes have significantly lower levels of depression, anxiety and diabetes-related distress than middle-aged adults with diabetes. These results suggest that older adults with diabetes experience disproportionately higher levels of depression than older adults without diabetes. However, among people with diabetes, middle-aged adults appear to experience poorer psychological functioning than older adults. Although high rates of depression and anxiety have been found among people with diabetes, in clinical practice the recognition and subsequent treatment of psychological problems is limited. The purpose of Study 2 was to investigate how often depression and anxiety are detected by diabetes health professionals, and whether identification of psychological symptoms is influenced by age, glycaemic control, duration of diabetes, and levels of depression and anxiety. Results indicate that despite high prevalence rates of clinically significant depression and anxiety, only 43.5% and 36% of such cases were identified as depressed or anxious, respectively. Diabetes health professionals were more likely to identify emotional problems if participants experienced more severe levels of depression and anxiety, or comorbid depression and anxiety. The final empirical study was designed to compare HRQOL of middle-aged and older adults with diabetes, with similarly aged adults without diabetes; and to examine the influence of depressive and anxious symptoms on HRQOL among people with diabetes. A diabetes-specific measure of HRQOL was utilised in combination with a generic measure of HRQOL in order to provide a more accurate assessment. Results showed middle-aged and older adults with diabetes experience poorer HRQOL than similarly aged adults without diabetes. Among people with diabetes, depression was associated with decrements in all domains of HRQOL, whereas the relationship between anxiety and HRQOL was less pervasive. The three empirical chapters of the thesis clearly emphasise that depression is highly prevalent among older adults with diabetes, and is associated with poor HRQOL across all domains of physical functioning and diabetes-specific HRQOL. Despite the high prevalence of depression among people with diabetes, and the resultant detrimental health outcomes, identification of depression by health professionals is poor, especially among older adults. Identification and treatment of psychological problems are of central importance to providing high-quality clinical care of people with diabetes. A review of the literature regarding psychological interventions for people with diabetes is presented in the thesis. Given limited research has examined the treatment of depression in older adults with diabetes a cognitive-behavioural treatment was developed for older adults with diabetes and depression as part of the thesis. The findings of the present investigations emphasise the importance of identifying and treating psychological symptoms in people with diabetes. Older adults with diabetes experience unique challenges due to the physical, cognitive, and social changes which accompany the ageing process. Furthermore, older adults with diabetes experience higher rates of depression and worse HRQOL than older adults without diabetes, and are at a high risk of being misdiagnosed and untreated. Improvements in the identification and treatment of depression are clearly needed, especially for older adults with diabetes.
Keyword Diabetes
Older Adults
Cognitive-behavioural Therapy
Additional Notes Colour: 261 Landscape: 86-87, 120-123, 253-254, 385-399, 417-420, 430-431, 436, 439, 441, 444, 452-453, 464

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Created: Fri, 17 Jun 2011, 02:04:52 EST by Miss Kellee Poulsen on behalf of Library - Information Access Service