G. Psychosocial assessment and care - Diabetes Care

G. Psychosocial assessment and care

Recommendations

* Preliminary assessment of psychological and social status should be included as part of the medical management of diabetes. (E)
* Psychosocial screening should include but is not limited to attitudes about the illness, expectations for medical management and outcomes, affect/mood, general and diabetes-related quality of life, resources (financial, social, and emotional), and psychiatric history. (E)
* Screening for psychosocial problems such as depression, eating disorders, and cognitive impairment is needed when adherence to the medical regimen is poor. (E)
* It is preferable to incorporate psychological treatment into routine care rather than wait for identification of a specific problem or deterioration in psychological status. (E)

Psychological and social state can impact the patient??ôs ability to carry out diabetes care tasks. As a result, health status may be compromised. Family conflict around diabetes care tasks is also common and may interfere with treatment outcomes. There are opportunities for the clinician to assess psychosocial status in a timely and efficient manner so that referral for appropriate services can be accomplished. 

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Key opportunities for screening of psychosocial status occur at diagnosis, during regularly scheduled management visits, during hospitalizations, at discovery of complications, or at the discretion of the clinician when problems in glucose control, quality of life, or adherence are identified. Patients are likely to exhibit psychological vulnerability at diagnosis and when their medical status changes: the end of the honeymoon period, when the need for intensified treatment is evident and when complications are discovered.

Psychosocial screening should include but is not limited to attitudes about the illness, expectations for medical management and outcomes, affect/mood, general and diabetes-related quality of life, resources (financial, social, and emotional), and psychiatric history. Particular attention needs to be paid to gross noncompliance with medical regimen (due to self or others), depression with the possibility of self-harm, indications of an eating disorder or a problem that appears to be organic in origin, and cognitive functioning that significantly impairs judgment. In these cases, immediate referral for further evaluation by a mental health specialist familiar with diabetes management should occur. Behavioral assessment of management skills is also recommended.

It is preferable to incorporate psychological treatment into routine care rather than waiting for identification of a specific problem or deterioration in psychological status. Screening tools can facilitate this goal, and although the clinician may not feel qualified to treat psychological problems, utilizing the patient-provider relationship as a foundation for further treatment can increase the likelihood that the patient will accept referral for other services. It is important to establish that emotional well-being is part of diabetes management.

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AMERICAN DIABETES ASSOCIATION
DIABETES CARE, VOLUME 27, SUPPLEMENT 1, JANUARY 2004

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May 27, 10 • Diabetes mellitus