Programa Psicoeducativo sobre Depressão e Ansiedade para Pessoas com Diabetes Mellitus (PROPSID)

Abstract

Diabetes mellitus (DM) is a chronic disease, requiring continued medical treatment. Studies have indicated the presence of cognitive impairment, depression, and anxiety, the latter two having a 2 to 3 times stronger relationship than in the general population. It is known that mental health has a strong influence on treatment adherence and disease course. This study aimed to evaluate and intervene in aspects of anxiety, depression, stress and quality of life (QoL) in adults with DM. To this end, three exploratory and quantitative studies were conducted in which participants completed questionnaires and self-report instruments. The first cross-sectional study was about assessing the presence of TM in people with DM compared to those without the disease. The sample was composed of two groups. Group I, had 61 individuals with diabetes, aged between 20 and 48 years, of which 53 were women (86.9%). Group II, of people without the disease, had 115 participants, aged between 20 and 50 years (M=34.82; SD=8.57), 101 of whom were women (87.8%). The groups were matched for sex and age. The results indicated statistically significant differences in the intensity of stress, anxiety and depression. Group I had higher scores for all symptoms [(stress: t=2.45; p<0.05) (anxiety: t=4.34; p<0.001) (depression: t=2.85; p<0.01) and (total: t=3.53; p<0.01)]. The second study describes the process of construction and initial content validation of the Psychoeducational Program on Anxiety and Depression for People with Diabetes Mellitus - PROPSID. The program was developed from evidence found in the national and international literature on the treatment of diabetes and psychoeducational interventions in the health context. For the validation, we counted with the participation of five expert judges who answered questionnaires about several aspects of the material. The Content Validity Coefficient (CVC), which evaluates inter-rater agreement, was applied. The overall coefficient was 0.93. Finally, we developed a clinical, quasi-experimental study of repeated measures, using the pre- and post-test design, to evaluate the impacts of psychoeducation on people with DM. The sample was 11 patients, 9 women (81.8%) and 2 men, aged between 26 and 65 years (M=42.81; SD=12.24). The intervention consisted of 8 weekly group and online meetings, addressing topics on anxiety, depression, medication, supported self-care, and coping strategies. Post-test results indicated significant reduction in anxiety (Z=-2.38; p<0.05), stress (Z=-2.00; p<0.05), and depression (Z=-2.20; p<0.05, with magnitude of intervention effect considered strong. There was also clinically perceived improvement in patients' self-care and QoL. We conclude that strategies to manage psychic aspects help to improve emotional symptoms and care with DM. For future studies, it is suggested that longitudinal studies be carried out, with larger and more representative samples and comparison groups, in order to verify possible changes in coping strategies and maintenance of gains with the intervention.