Cognições e coping cognitivo relacionados a qualidade de vida em diabéticos

Abstract

Diabetes Mellitus (DM) is a serious illness, of multiple etiology, caused by the deficiency of insulin secretion and/or its action. If not treated accurately, DM can bring several health complications. The course and prognostics of DM depend on the level of self-control of the patient, which can become difficult if the person has a condition such as depression. The present work aimed the investigation of the intensity of dysfunctional cognitions, quality of life (QL) and cognitive coping, in groups of diabetic patients with and without symptoms of depression. First, a literature review was conducted about studies that evaluated the relation between diabetes and depression and the impacts of this association in diabetic patients’ QL. This review also addressed dysfunctional cognitions and cognitive coping strategies. The results of the review show that the presence of depression amplifies the negative impacts on the diabetes control, which can make treatment more difficult and decrease the subject’s QL. As for the dysfunctional cognitions, studies suggest that negative cognitive styles and flawed information processing increase the risk of depression in these individuals, and that negative cognitions interfere on the vitality and adherence to treatment, which may lead to more complications. On the other hand, the search for studies that evaluate the types of cognitive coping most used by patients with DM was inconclusive, since such aspect has yet to be studied in this type of group. This may be due to the lack of appropriate evaluation instruments. Therefore, there was a need to adapt to Brazil an evaluation instrument of this construct, the Cognitive Emotional Regulation Questionnaire (CERQ). The results found in this process indicate that CERQ is appropriate to evaluate this aspect in the general population, since the factorial structure found was similar to the original structure and other versions of the instrument. This study was used as a base line for the construction of a specific version of CERQ – for people with diabetes – which was used in the investigation of their cognitive coping. Before the confirmations and hypothesis raised in the literature review, a comparative study was conducted with 43 participants, all diagnosed with DM, 13 of whom expressed clear symptoms of depression and 30 who did not show depression symptoms. The objective of this comparative study was to evaluate the cognitions, cognitive coping, QL and level of emotional suffering. Participants were evaluated individually with clinical interviews and standardized tests. The results showed that diabetics with depression symptoms have worse QL, more emotional suffering due to DM, as well as more dysfunctional cognitions, than others without depression symptoms. Moreover, it was showed that the less adaptive cognitive coping strategies used by diabetics to deal with the illness are the ones that are more associated with worse QL and more emotional suffering. At last, even considering DM as something negative and stressful, the strategies that were most used by this public to deal with the disease are the more adaptive approaches which can contribute to a better psycho-social adjustment and QL. Lastly, suggestions of new researches that would continue the matters raised are presented.