In recent years, the incidence of diabetes has increased and spread to younger people. However, the current inability to cure diabetes has forced patients and their families to face long-term treatment and condition monitoring. The psychological problems generated during this period have gradually attracted the attention of experts.
The psychological condition is affected by two factors, internal and external. Internal factors refer to the patient's own psychological characteristics, while external factors refer to the support of the patient from the people around him, family economic status, etc. The "Position Statement on Psychological Care for Patients with Diabetes" (hereinafter referred to as the statement) issued by the American Diabetes Association roughly divides patients according to age into adolescent patients, adult patients, and elderly patients. It proposes corresponding psychological assessment and evaluation based on the psychological characteristics of these three age groups. Nursing advice. The statement also provides recommendations for psychological evaluation and treatment of diabetics with diabetes complications.
adolescent patients
The similarity between children and adolescents is that their cognition, emotion, growth and development are all in a stage of dynamic change, and they may lack the concept of healthy behaviors. The difference is that children with diabetes are highly dependent on their parents and often follow their parents' wishes. Guidance or parents to complete diabetes management measures such as insulin injection, blood sugar testing, taking medicine, and dietary restrictions. Adolescents have their own distinctive characteristics - adolescence. During this period, patients' unique sense of independence and finding a sense of identity among their peers will have a negative impact on diabetes. Management poses greater challenges.
Depression is more common among parents of children with type 1 diabetes, especially in the early stages of diagnosis. If parents have psychological problems such as depression, the self-adaptation to the disease and diabetes management of children with diabetes, especially younger patients, will be affected. Therefore, in addition to providing diabetes education to parents of children and teaching them to inject insulin, measure blood sugar, and arrange appropriate meals for children, doctors must also pay attention to the psychological problems of parents.
Adolescence is a "transitional period" between childhood and adulthood. On the one hand, one relies on the support and care of parents and medical staff, and on the other hand, one must gradually learn to self-manage the disease. Adolescent "rebellion" is reflected in the desire to make decisions on one's own and turning to peer groups to find self-worth and self-concept. Patients' desire to fit in with their peers may lead them to arbitrarily reduce or secretly perform diabetes self-management behaviors (such as blood glucose testing, insulin injections), thereby affecting disease management during school. As the condition changes, some adolescent patients may need to change their treatment plan (such as using an insulin pump). However, if the adolescent refuses the doctor's treatment plan, it is still unclear whether the doctor can stop the treatment in accordance with legal and ethical principles. Regarding this issue, the statement believes that patients with diabetes who are generally older than 12 to 13 years old have the right to agree or disagree with most treatment plans, unless refusing the treatment plan will have a significant impact on their health.
However, we cannot blame poor blood sugar management entirely on the uncooperation and lack of health awareness of adolescent patients. After all, it involves three groups: patients, parents, and doctors. Good communication and collaboration among the three groups can help teenagers with diabetes transition to the stage of self-management of blood sugar faster and better. Therefore, doctors and parents of patients need to detect psychological problems in adolescent patients as early as possible, such as depression, anxiety, eating-related problems, and learning disabilities. When treatment is not up to standard or the treatment plan is adjusted, a complete psychological evaluation of the patient and a comprehensive review of the treatment plan are required. Patients who refuse help from health care professionals, family, and friends require a more detailed psychological evaluation.
If adolescent diabetic patients want to gradually learn and eventually fully master the method of managing blood sugar, they must communicate with medical staff. The statement recommends that patients should have the opportunity to communicate individually with medical staff starting from the age of 12. In the process of communicating with them, medical staff must respect their thoughts and privacy rights and not just treat them as children. In addition to face-to-face communication, teenagers with diabetes can also use smartphones to transmit blood sugar data to doctors, so that doctors can easily understand the patient's blood sugar control.
adult
Adults are the core strength of a family. They enter the workplace, get married and have children, and assume the important responsibilities of parenthood, all of which are completed at this stage. For people with diabetes, whether they are looking for a job, getting married, or getting pregnant and having children, they will face pressure. On the one hand, employers and people around you may put psychological pressure on people with diabetes. On the other hand, there are physical risks caused by diabetes. For example, pregnancy is a big test for women with diabetes during their childbearing years.
For adults with diabetes, strong support from their partners can help improve patients' diabetes management behaviors and outcomes and improve quality of life. Studies show that 50% of men with type 1 diabetes have erectile dysfunction. If a patient with diabetes develops complications that affect sexual function, it may affect the patient's role in the family. The statement recommends that doctors regularly assess patients' social support status (including family members, colleagues, medical staff, etc.). When facing problems such as pregnancy and sexual function, patients and medical staff should communicate and formulate solutions to related problems.
elderly
Elderly patients with diabetes may experience disease exacerbation, cognitive dysfunction, comorbid diseases, functional impairment, limited interpersonal communication, financial difficulties, and depression. Elderly patients with diabetes are at greater risk of developing mild cognitive impairment than older adults without diabetes. The guidelines recommend that patients over 65 years old undergo annual screening to detect mild cognitive impairment or dementia.
Psychological intervention goals include self-management support, self-care, financial and emotional support, and promotion of psychophysical health. The elderly’s children and caregivers should provide psychosocial support to the elderly and discuss and decide on diabetes management plans together.
