INTRODUCTION
Title : Indian journal of psychological medicine
Author : Dhanya Raveendranathan,
Jismy George
Nandhini Lakshmana Perumal ,
Dept.psychiatry and endocrinology
St John’s medical college
Place : Bangalore
Month of Publication : July/August 2019
Year/ Volume/ Issue : 2019 /41/issue 4
Pages : 412
Number of issues per year :6
Print frequency : Bimonthly
Indexed with : Pubmed, Pubmed central, Google Scholar, , MedInd,
Journal Website : http://www.ijpm.org
Publisher : Medknow publishers
DESCRIPTION OF ARTICLE
TITLE
“The Effectiveness of a Brief Psychological Intervention for Patients with Diabetes-Related
Distress
AUTHORS
Dhanya Raveendranathan, Jismy George, Nandhini Lakshmana Perumal1 , Ashok Mysore
Department Of endocrinology and psychiatry
St Johns Medical College,Bangalore
INTRODUCTION
Diabetes mellitus is a group of metabolic diseases in which the person has high blood
glucose (blood sugar) level either due to inadequate insulin production or because the
body's cells do not respond properly to insulin or both.
Diabetes is one of the most rapidly growing epidemic in India
India is the diabetic capital of the world as per a report by WHO
Every 6th individual in the world is a diabetic or is at risk of it.
BACKGROUND OF THE STUDY
DM treatment includes diabetes self-management practices along with
pharmacological management
It would result in the patient making major lifestyle modifications such as
regular blood glucose monitoring,
physical activity
dietary modifications
medication adherence
This has major effect on mental health of individual causing diabetes related
distress(DRD)
Studies have shown 47.6% of diabetic patients are affected by DRD rather than
depression causing poor outcome of the disease.
NEED OF THE STUDY
Most of the studies in this field focuses on depression rather than diabetis related
distress.
Research on intervention strategies for DRD has been limited
Research on the use and impact of these strategies to improve DRD in clinical
settings is sparse.
AIMS
The study aims at studying the effectiveness of a brief psychological intervention for
patients with DRD as part of an interdisciplinary liaison-service between
endocrinology and psychiatry departments.
OBJECTIVES
To determine the effectiveness of a Brief Psychological Intervention for Patients with
Diabetes-Related Distress
VARIABLES
Dependent: diabetic patients
Independent : psychological intervention
INCLUSION CRITERIA
Diabetic patients attending opd of the selected teaching hospital
and with mental health concerns
EXCLUSION CRITERIA
(not mentioned)
Those with no mental health concerns
RESEARCH SETTING
A Teaching hospital in bangalore
MATERIALS AND METHODOLOGY
• Research Approach : Quantitative
• Research Design : quasi experimental design
• Sampling frame : diabetic patients attending the opd
• Sample : 41 patients
• Sampling Technique : non probability purposive sampling
HYPOTHESIS
• No hypothesis or assumptions mentioned
Hypothesis
• H0: There is no significant relation between psychological intervention and distress
• H1: There is a significant relation between psychological intervention and distress
METHODOLOGY
institutional ethical clearance and according to latest amendment of
Helsinki declaration subjects were treated and handeled
1
DM patients attending endocrine OPD with mental health issues were
selected
2
these selected patients underwent detailed mental health assessment by a
team of experts including a psychiatric nurse
3
only those with DRD and no other mental disorder(41) were provided
brief psychological intervention
4
The details regarding the assessment and intervention were systematically
5 recorded in the patient’s clinical records.
only those with DRD and no other mental disorder(41) were provided
brief psychological intervention by a trained psychiatric nurse
6
it consisted of brief diabetes education focusing on physical activity and
medication adherence, relaxation techniques, and illness ‑specific
7 problem‑solving strategies.
8 All the components of the intervention were used in all the patients
2 months later follow up was done using Clinical global impression severity
scale to see the effectiveness of intervention(35)
9
Following tools were used to assess the patients:
mini mental to rule out other mental illness
status
diabetes 17 item self reported scale to
detect DRD
distress scale
physical 2 item scale to see the activity level
activity of patients
questionnaire
clinical global
impression
severity
ANALYSIS
Categorical variables were compared by using Wilcoxon signed rank test
With significance of p<0.001
RESULTS
The baseline and follow up scores of CGI-S was compared and found that
psychological intervention was effective in improving psychological distress of
patients with DRD.
The intervention also succeeded in improving DM self-management practices like
physical activity and medication adherence which were examined in a subset of the
sample.
comparison of pre and post intervention scores
9
0
CGI-S VAS physical activity Medication adherance
quesionnaire
baseline score Column1
Fig 2.1
DISCUSSION
In the present study:
The key components of the brief psychological intervention chosen for this study were
illness-specific problem-solving strategies and relaxation techniques
There is emerging evidence that problem-solving therapy can benefit patients having
DRD and impaired DM self-management practices
The intervention was also shown to significantly improve DM self-management practices
such as physical activity and medication adherence
There is sparse literature regarding interventions for DRD done in clinical settings.
IMPLICATION
Nursing practice
Diabetes related distress is now a known entity as a clinical nurse must consider
psychological aspects of diabetic clients while providing them holistic care
Nursing education
The nurse educator can modify the management protocol for care of patients with diabetes so
that budding nurse are aware of the need of psychological interventions for these patients
Nursing research
The study provides scope for future research or utilization of findings and dissemination of
knowledge in nursing practice as there are very limited study performed in this field.
CONCLUSION
There is a definite need to address DRD in routine clinical settings.
Systematically conducted controlled studies are required to test the efficacy of a brief
intervention for DRD.
The mental health needs of DM patients are often not addressed.
A systematic inter-disciplinary liaison service will further enable in early detection and
treatment of mental health comorbidities which can ultimately improve DM treatment
outcomes.
Furthermore, this will enable in providing more comprehensive treatment for DM
patients.
New learning
Wilcoxon signed-rank test
The Wilcoxon signed-rank test is a non-parametric statistical hypothesis test used to compare
two related samples, matched samples, or repeated measurements on a single sample to assess
whether their population mean ranks differ (i.e. it is a paired difference test).
The Wilcoxon signed rank test is the non-parametric of the dependent samples t-test. Because
the dependent samples t-test analyzes if the average difference of two repeated measures is zero,
it requires metric (interval or ratio) and normally distributed data; the Wilcoxon sign test uses
ranked or ordinal data; thus, it is a common alternative to the dependent samples t-test when its
assumptions are not met.
Eg :
A research team wants to test whether a new teaching method increases the literacy of children.
Therefore, the researchers take measure the literacy of 20 children before and after the teaching
method has been applied. The literacy is measured on a scale from 0 to 10, with 10 indicating
high literacy. The initial baseline shows an average literacy score of 5.9 and after the method
has been used the average increases to 7.6.
The first step of the Wilcoxon sign test is to calculate the differences of the repeated
measurements and to calculate the absolute differences.
The next step of the Wilcoxon sign test is to sign each rank. If the original difference < 0 then
the rank is multiplied by -1; if the difference is positive the rank stays positive.
The next step of the Wilcoxon sign test is to sign each rank. If the original difference < 0 then
the rank is multiplied by -1; if the difference is positive the rank stays positive
The next step is to calculate the W+ and W-.
Whenever a test is based the normal distribution the sample z value needs to be 1.96 or higher to
reject the null hypothesis
