Barriers to Addressing Psychological Problems in Diabetes: Perspectives of Diabetologists on Routine Diabetes Consultations in Denmark

Cleabruun Johansen

doi:10.4172/2161-0487.1000141

Abstract

Background: Diabetes is associated with an increased risk of diabetes distress, depression, anxiety and eating disorders. Still, health professionals working with diabetes often fail to identify patients with serious psychological problems and to address psychological issues in general. Our aim was to explore diabetologist’s perceived barriers to addressing psychological issues in diabetes consultations. Methods: We conducted qualitative semi-structured individual interviews with 12 diabetologists working in specialist diabetes clinics in four different Danish hospitals. All interviews were transcribed verbatim and analysed by systematic meaning condensation. Results: We identified three main categories of barriers: 1) the structural organisation of diabetes consultations, e.g. sparse consultation time, extensive screen work, and missing referral possibilities; 2) the relation between patients and physicians, e.g. the perception of patient attitudes or patient personality; and 3) the individual diabetologist, e.g. acquired and inherent skills, and the physicians perceived area of responsibility. Psychological aspects of diabetes were generally perceived as more important by younger diabetologists. More senior clinicians tended to regard psychological issues as of less importance and not within their core responsibility. Conclusion: The structural organisation of consultations, especially time constraints, and the perceived area of responsibility were the most prominent barriers to addressing mental health problems in diabetes consultations. Our study provides explanations for the gap between the widespread knowledge among diabetologists of the importance of psychological issues and the frequent failure to address such issues, and thus provides a basis for the development of strategies to facilitate a change of practice.

Highlights

Diabetes is associated with an increased risk of diabetes distress, depression, anxiety and eating disorders
The different types of barriers fell in three broad categories: I) the structural organisation of diabetes consultations, such as sparse consultation time, extensive screen work, and missing referral possibilities; II) the relation between patients and physicians, such as the perception of patient attitudes, patient personality, and levels of physician/patient intimacy; III) the individual diabetologist, such as acquired and inherent skills, personal feelings and energy level, and the physician’s perceived area of responsibility
Our study provides a range of explanations as to why psychological aspects of living with diabetes are frequently overlooked in diabetes consultations

Summary

Introduction

Diabetes is associated with an increased risk of diabetes distress, depression, anxiety and eating disorders. Health professionals working with diabetes often fail to identify patients with serious psychological problems and to address psychological issues in general. Health professionals working with diabetes patients often fail to identify psychological problems and disorders. Compared with the general population, clinical depression and anxiety occur about twice as often among persons with both type 1 and type 2 diabetes [3,4,5,6], and the risk of eating disorders is increased [7]. Diabetes distress is associated with patients’ diabetes management even more so than depression [10]

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