Les déterminants biopsychosociaux de la qualité de vie subjective des patients diabétiques

Abstract

ObjectivesMany studies show that the subjective quality of life of diabetic patients may be determined by biological, social and psychological factors. However, a Bio-Psycho-Social (BPS) model suggests that all of these factors should be seen as a complex interaction instead of as independent factors. In hospital settings, a BPS model for care is often implemented in order to maximize patients’ physical and psychological quality of life. Because the patient's difficulties in psychosocial and medical domains are frequently intertwined, care management requires a close collaboration between different practitioners. However, very few studies have aimed to quantitatively demonstrate the importance of this model when conceptualizing subjective life quality. This study aims (1) to clinically describe a sample of hospitalized diabetic patients, (2) to demonstrate that additional psychosocial care is pertinent for hospitalized diabetic patients and (3) that the interaction of BPS components explains subjective quality of life better than any one individual component. Materials and methodsThirty-eight diabetic patients hospitalized in two units of the department of Endocrinology at the University Hospital of Nantes in France were recruited to participate in this study. Patients were asked to give their written consent before participation. Three investigators measured BPS complexity using a structured interview called the INTERMED scale. This scale takes into account biological, psychological, social and health care related factors over three time periods: past, present and future. This measure also yields a global score of the patient's biopsychosocial complexity. A score superior to 20 indicates high patient complexity and the need for interdisplinary health care. The SF-36 was administered in order to measure subjective life quality. ResultsOut of the 38 patients recruited, 28 gave written consent to participate in the study. Sixty-one percent were men, 82% were diagnosed with type 2 diabetes, 18% had comorbid obesity, and 86% needed daily insulin injections. Forty-three percent of included participants presented a high level of BPS complexity, which indicates that they would benefit from supplementary psychosocial care. On average, patients had a global complexity of 20.2 (S.D.=7.3). The highest average was observed on the biological subscale (M=7.9; S.D.=2.1) while the lowest was observed on the social subscale (M=3.1; S.D.=2.9). The average scores obtained on psychological (M=56.43; S.D.=22.45) and psychical (M=53.21; S.D.=21.38) indicators of quality of life were similar. Negative and significant correlations were established between biological (r=−.522, P<.01), psychological (r=−.387, P<.05), social (r=−.482, P<.01) and relational (r=−.466, P<.05) components of complexity and subjective quality of life. However, simply taking into account any individual component of complexity explained less variance (15–27%) in the quality of life than taking into account complexity as a whole (38%). ConclusionsThis study suggests that the interaction of biological and psychosocial factors contributing to case complexity is more important to subjective life quality among diabetic patients than any of the individual components of complexity examined. Furthermore, close to half of diabetic participants are highly complex meaning that they could greatly benefit from increased psychosocial care. The conception of patients supported by this study translates to a need for interdisciplinary collaboration, which entails the organisation of interventions from both medical and psychosocial practitioners in hospital settings. Specific services, such as liaison psychiatry, can help assure the holistic care for hospitalized patients.