Book Review: Diabetes and wellbeing: Managing psychological and emotional challenges of diabetes types 1 and 2

Book Review in peer revewed Journal of Diabetes Nursing about the psychological and emotional challenges associated with living with Diabetes. The book is recommended to both health professionals and people with Diabetes.

Comparing personality type profiles of primary teachers in the Catholic and state school systems

Intersections between disability, type of impairment, gender and socio-economic disadvantage in a nationally representative sample of 33,101 working aged Australians

Background:People with disabilities are socio-economically disadvantaged and have poorer health than people without disabilities; however, little is known about the way in which disadvantage is patterned by gender and type of impairment.Objectives:1. To describe whether socio-economic circumstances vary according to type of impairment (sensory and speech, intellectual, physical, psychological and acquired brain injury) 2. To compare levels of socio-economic disadvantage for women and men with the same impairment typeMethods:We used a large population-based disability-focused survey of Australians, analysing data from 33,101 participants aged 25 to 64. Indicators of socio-economic disadvantage included education, income, employment, housing vulnerability, and multiple disadvantage. Stratified by impairment type, we estimated: the population weighted prevalence of socio-economic disadvantage; the relative odds of disadvantage compared to people without disabilities; and the relative odds of disadvantage between women and men.Results:With few exceptions, people with disabilities fared worse for every indicator compared to people without disability; those with intellectual and psychological impairments and acquired brain injuries were most disadvantaged. While overall women with disabilities were more disadvantaged than men, the magnitude of the relative differences was lower than the same comparisons between women and men without disabilities, and there were few differences between women and men with the same impairment types.Conclusions:Crude comparisons between people with and without disabilities obscure how disadvantage is patterned according to impairment type and gender. The results emphasise the need to unpack how gender and disability intersect to shape socio-economic disadvantage.

Further investigation of the psychometric properties of the Insulin Treatment Appraisal Scale among insulin-using and non-insulin-using adults with type 2 diabetes : results from Diabetes MILES-Australia

Negative attitudes towards insulin are commonly reported by people with type 2 diabetes mellitus (T2DM) and can act as a barrier to timely insulin initiation. The Insulin Treatment Appraisal Scale (ITAS) is a widely used 20-item measure of attitudes towards insulin. While designed for completion by both insulin using and non-insulin using adults with T2DM, its psychometric properties have not been investigated separately for these groups. Furthermore, the total score is routinely reported in preference to the published two-factor structure (negative/positive appraisals). Further psychometric validation of the ITAS is required to examine its properties.

Rethinking the employer's summary dismissal power in the employment contract

 The principal subject of this thesis is the employer’s summary dismissal power under Australian contract law. Summary dismissal is by far the most brutal way that an employment relationship may end. Its suddenness can have long-lasting economic and psychological impacts upon the dismissed employee. However, the area has been neglected in legal scholarship. The result of this is that issues arising from the jurisprudence have not been the subject of critique and scrutiny, until now. This thesis addresses this gap in the scholarship. The thesis also proposes a new approach to resolving these disputes based on the proportionality concept. An employer's decision to dismiss its employees in this way should be commensurate to the detriment caused by the employee's actions. Therefore, one 'should not use a sledgehammer to crack a nut.'

Examining the prevalence of type-D personality in an Australian population

© 2015 The Australian Psychological Society. Objective: Type-D personality is a construct that describes a tendency to simultaneously experience negative emotions and inhibit self-expression for fear of negative social judgement. The link between type-D and poor health outcomes may be partly mediated by two prominent psychosocial mechanisms, poor-quality health-related behaviour and poor perceived-social support. Method: The present study replicated and extended a 2008 UK and Irish prevalence study, utilising a sample from the Australian general population. The study aimed to investigate the relationship between type-D personality and subjective levels of social support, health-related behaviours and neuroticism, as well as examining the estimated prevalence rate of type-D in the general Australian population. Nine hundred and fifty five Australian participants over the age of 18 (194 male and 761 female) completed four measures assessing levels of type-D personality, quality of health-related behaviours, perceived-social support and neuroticism. Results: As hypothesised, the estimated prevalence rate was not found to be significantly different from the rate obtained by Williams etal. (2008). In addition, type-D individuals reported significantly lower perceived-social support and poorer-quality health behaviours than non-type-D individuals. Conclusions: The results of this study provide further support for the association of type-D personality with poor health-related behaviours and poor perceived-social support, as well as demonstrating the applicability of the type-D construct to the Australian general population for the first time. General healthcare applications are discussed, as well as the potential for type-D personality research to influence public illness prevention in general.

Suicidal ideation reported by adults with type 1 or type 2 diabetes: results from Diabetes MILES-Australia

AIMS: To examine the prevalence and correlates of suicidal ideation in a community-based sample of adults with Type 1 or Type 2 diabetes.

METHODS: Participants were 3338 adults aged 18-70 years with Type 1 diabetes (n=1376) or Type 2 diabetes (non-insulin: n=1238; insulin: n=724) from a national survey administered to a random sample registered with the National Diabetes Services Scheme. Depression and suicidal ideation were assessed using the Patient Health Questionnaire, and diabetes-specific distress with the Problem Areas In Diabetes scale. Separate logistic regression analyses by diabetes type/treatment were used to determine relative contribution to suicidal ideation.

RESULTS: Overall, we observed a suicidal ideation rate of 14% in our sample. Participants with Type 2 diabetes using insulin reported more frequent depressive symptoms, and were more likely to report recent suicidal ideation (19%) compared with those with either Type 1 diabetes or Type 2 diabetes not using insulin (14 and 12%, respectively). After controlling for depression, there was little difference in the prevalence of suicidal ideation between diabetes types/treatments, but higher diabetes-specific distress significantly increased the odds of suicidal ideation.

CONCLUSIONS: As suicidal ideation is a significant risk factor for a suicide attempt, the findings have implications for healthcare professionals, pointing to the importance of adequate screening and action plans for appropriate follow-up of those reporting depression. Our findings are also indicative of the psychological toll of diabetes more generally, and the need to integrate physical and mental healthcare for people with diabetes. This article is protected by copyright. All rights reserved.

Subjective sleep impairment in adults with type 1 or type 2 diabetes: results from Diabetes MILES - the Netherlands

AIMS: Despite growing recognition of the impact of sleep on diabetes, a clear profile of people with diabetes regarding subjective sleep impairment has yet to be established. This study examines: (1) subjective sleep characteristics in adults with type 1 and type 2 diabetes; (2) the relationship of poor subjective sleep quality with glycaemic control, self-care and daytime functioning; (3) possible risk markers for poor sleep quality. METHODS: In a cross-sectional study, Dutch adults with type 1 (n=267) or type 2 diabetes (n=361) completed an online survey, including the Pittsburgh Sleep Quality Index (PSQI), socio-demographic, clinical, self-care and psychological measures. RESULTS: Poor sleep quality (PSQI-score >5) was reported by 31% of adults with type 1 and 42% of adults with type 2 diabetes. Participants with good and poor sleep quality did not differ in self-reported HbA1c or the frequency of meeting lifestyle recommendations. Poor sleep quality was related to a higher self-care burden and higher levels of daytime sleepiness, fatigue, depressive and anxiety symptoms, and diabetes-specific distress. In multivariable logistic regression analyses examining risk markers, poor sleep quality was associated with depressive symptoms in adults with type 1 (OR=1.39, 95% CI 1.25-1.54) and type 2 diabetes (OR=1.31, 1.16-1.47), and with being female in those with type 2 diabetes (OR=2.72, 1.42-5.20). CONCLUSIONS: Poor subjective sleep quality is prevalent both in adults with type 1 and type 2 diabetes, and is related to poor daytime functioning and higher self-care burden. The temporal relation with depression and merits of therapy should be explored.

Statistically modelling the relationships between Type D personality and social support, health behaviors and symptom severity in chronic illness groups

OBJECTIVE: The study aimed to develop a predictive model of how Type D personality influences health behaviours, social support and symptom severity and assess its generalisability to a range of chronic illnesses.

DESIGN: Participants were classified as either healthy (n = 182) or having a chronic illness (n = 207). Participants completed an online survey measuring Type D and a range of health-related variables. Chronic illness participants were classified as having either a functional somatic syndrome (i.e. chronic fatigue syndrome or fibromyalgia), where the underlying pathological processes were unclear, or illnesses such as type 2 diabetes, osteoarthritis or rheumatoid arthritis, where the causes are well understood.

MAIN OUTCOME MEASURES: Outcome measures were health behaviours, social support and both physical and psychological symptoms.

RESULTS: The rate of Type D was higher in chronic illness participants (53%) than in healthy controls (39%). Negative affectivity (NA) and social inhibition (SI) both correlated with outcome measures, although NA was generally the stronger predictor. Using NA and SI as independent subscales led to superior prediction of health outcomes than using categorical or continuous representations.

CONCLUSION: Findings suggest that the relationship between Type D and health outcomes may generalise across different chronic illnesses.

Comparison of two measures of work functioning in a population of claimants with physical and psychological injuries

Research has focused on advancing our understanding of strategies to improve return to work outcomes following a physical injury. There has been limited research on the different types of supports needed for workers returning to work following a psychological injury. Developing a better understanding of work limitations when people are back at work is a key step in the development of strategies in this area. Unfortunately, measurement tools have been established separately by injury type, limiting research opportunities to compare differences in work limitations. In this article, we compare two measures of work functioning in a population of claimants that have returned to work following a musculoskeletal or psychological injury: a modified version of the Work Limitations Questionnaire (WLQ) developed for workers with physical injuries and the Lam Employed Absence Productivity Scale (LEAPS) developed for workers with mental health claims. A telephone questionnaire was administered to 214 claimants who returned to work following a claim for a psychological injury or a musculoskeletal injury. While the modified WLQ detected differences in work limitations by injury type, there were no significant differences in levels of work functioning detected by the LEAPS. The comparison demonstrated the value of including questions about work limitations that go beyond mental and interpersonal demands for claimants with psychological injuries; however, there is also a need to limit questions about physical constraints. A modified version of the WLQ is recommended to further our understandings of the similarities and differences in the experiences of workers with psychological versus physical injuries.

The impact of insulin therapy and attitudes towards insulin intensification among adults with type 2 diabetes: A qualitative study

BACKGROUND: As type 2 diabetes (T2DM) is a progressive chronic condition, regular clinical review and treatment intensification are critical for prevention of long-term complications. Our aim was to explore the personal impact of insulin therapy, both positive and negative consequences, and attitudes towards future insulin intensification. METHODS: Twenty face-to-face interviews were conducted, and transcripts were analysed using thematic inductive analysis. Eligible participants were adults with T2DM, using insulin injections for <4years. Participants were mostly men (n=13, 65%), (median (range)) aged 65 (43-76) years, living with T2DM for 11.5 (2-27) years. RESULTS: Five themes emerged regarding the consequences (positive and negative) of insulin therapy, including: physical impact, personal control, emotional well-being, freedom/flexibility, (concerns about) others' reactions. Increased inconvenience and the perceived seriousness of using fast-acting insulin were both reported as barriers to future insulin intensification, despite most participants being receptive to the idea of administering additional injections. CONCLUSIONS: Positive and negative experiences of insulin therapy were reported by adults with T2DM and most were receptive to insulin intensification despite reported barriers. These findings may inform clinical interactions with people with T2DM and interventions to promote receptiveness to insulin initiation and intensification.

Diabetes distress among adolescents with type 1 diabetes: a systematic review

Diabetes distress (DD) refers to the negative emotions arising from living with diabetes and the burden of self-management. Among adults, the prevalence and significance of DD are well established, but this is not the case among adolescents. This systematic review investigated among adolescents with type 1 diabetes: the prevalence of DD; demographic, clinical, behavioral and psychosocial correlates of DD and interventions that reduce DD. Consistent with adult studies, around one third of adolescents experience elevated DD and this is frequently associated with suboptimal glycemic control, low self-efficacy and reduced self-care. Three measures of DD have been developed specifically for adolescents, as those designed for adults may not be sufficiently sensitive to adolescent concerns. Interventions reducing DD in the short term include strategies such as cognitive restructuring, goal setting and problem solving. Further work is needed to investigate sustainability of effect. Rigorous research is needed to progress this field among adolescents.