Catharina Gåfvels

High prevalence of diabetes among immigrants from non-European countries in Sweden

Patients with diabetes aged 35-64 years from four primary health care centres in Stockholm County were identified from electronic patient records (EPRs): diabetes prevalence occurred 414 of 15,317 men, and 250 of 15,388 women. The age- and sex-standardized prevalence of diabetes was as follows: Non-European immigrants, 5.82% (95% CI 5.06-6.58), European immigrants 1.96% (95% CI 1.53-2.39), and Swedish-born subjects 1.80% (95% CI 1.63-1.97). In conclusion, non-European immigrants showed a three-fold higher prevalence of diabetes compared to Swedish-born subjects.

Psychosocial problems in patients with newly diagnosed diabetes: Number and characteristics

Early in the course of diabetes, it is important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care. We aimed to identify (a) the number and characteristics of patients, 18-65 years, newly diagnosed with diabetes, who needed psychosocial interventions and (b) the type of psychosocial problems they had. A total of 106 patients (72 men) were included in the study. Interviews showed that 41.5% had psychosocial problems. Fifteen dropped out early in the study; 38% of those remaining had psychosocial problems (PSP). More than half had problems with their life situation; most commonly in relationships. About a third had problems related to diabetes, most commonly, work-related. Compared to other participants, PSP patients lived in more strained social situations, especially regarding personal finances and social support. More of the PSP patients were anxious and depressed. They used negative coping strategies more often and more frequently expected that diabetes would negatively affect their future. In conclusion, early in the course of diabetes, screening instruments should be used to identify PSP patients. Treatment by medical social workers skilled in diabetes care should be offered.

Coping strategies among patients newly diagnosed with diabetes or rheumatoid arthritis at baseline and after 24 months

Patients aged 18–65 years with newly diagnosed diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) were studied by the General Coping Questionnaire at baseline and after 24 months. In total, 34 diabetes mellitus and 46 rheumatoid arthritis patients were diagnosed with psychosocial problems. The use of negative coping strategies, such as protest, isolation, and intrusion, was associated mostly with being classified as having psychosocial problems. With the risk of experiencing a strong impact of the disease at 2 years of follow-up as outcome, intrusion was a significant and independent risk factor, while minimization was a significant and independent protective factor.

Follow-Up Two Years After Diagnosis of Diabetes in Patients With Psychosocial Problems Receiving an Intervention by a Medical Social Worker

We followed up the psychosocial situation two years after diabetes diagnosis in patients (n = 82) aged 18–65 years, with psychosocial problems (PSP; n = 27) or not (NPSP; n = 55). We used a social questionnaire, the Hospital Anxiety and Depression scale (HAD), the Sense of Coherence scale (SOC), and the General Coping Questionnaire (GCQ). The PSP group had a more difficult situation with more strained economy, lower social support, more anxiety and depression, and lower SOC on both occasions. Being in the PSP group predicted experiencing a strong negative influence of the disease at follow-up. Regarding coping strategies, “problem focusing” decreased in both PSP and NPSP over time. “Social trust” and “intrusion” decreased only in NPSP. Otherwise the coping pattern was unchanged, with PSP showing lower scores on “self-trust” and “minimization” and higher scores on “protest,” “isolation,” and “intrusion.” The most influenced areas at follow-up in the PSP group were work, relationship to partner and economy, and in the NPSP leisure-time activities, sexual life and work. Our findings underline the need to identify patients with psychosocial problems early.

Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or rheumatoid arthritis:

We studied emotional health in patients with diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) aged 18–65 years, at the time of diagnosis and after 24 months. Predictors for depression or anxiety according to the Hospital Anxiety and Depression scale after 2 years were assessed by logistic regression, with psychosocial factors and coping as dependent factors. There were many similarities between patients with diabetes mellitus or rheumatoid arthritis. Having children at home, low score on the Sense of Coherence scale, and high score on the coping strategy “protest” were important risk factors for depression and anxiety after 2 years.

Social work interventions in Sweden for patients newly diagnosed with type 1 or type 2 diabetes

ABSTRACT We evaluated psychosocial work with patients in ordinary clinical practice who were newly diagnosed with type 1 or type 2 diabetes and experienced psychosocial problems at disease onset. We examined types of psychosocial problems, causes of these problems, psychosocial interventions, extent of achievement of psychosocial treatment goals, and whether the patients felt they benefited from the treatment. Eighty-nine working-age (18–65-year-old) Swedish adults newly diagnosed with diabetes were included. Each was interviewed and responded to questionnaires at the beginning and end of the study period. Thirty-four (38%) received psychosocial treatment as needed over 2 years. A psychosocial treatment plan with a defined goal was developed for each. Interventions included counseling, problem-focused support, social information, and advice. The treatment process was documented. Eighteen patients had type 1, and 16 had type 2 diabetes. One-third had emotional problems directly caused by receiving a diagnosis. Several of them had crisis reactions. The rest had problems primarily caused by their life situations. Those with psychosocial problems caused by receiving a diagnosis achieved treatment goals more frequently than the others. Distinguishing the cause of the psychosocial problems of newly diagnosed patients may help ensure that social work resources in health care are used as effectively as possible.