Smoking, drinking alcohol heavily and being overweight are associated with a large range of health problems. Diabetes is a common long-term health condition where a person's blood sugar level is too high. It is associated with smoking, drinking alcohol heavily and being overweight.
One potential factor that may affect patients' mental health and well being is potential for “blame” when a disease is caused by something people may be seen as responsible for themselves through their behaviour. When people smoke, drink alcohol heavily or are overweight and become ill it may lead others to blame them for their disease. They may also blame themselves. Feelings of shame or guilt about being responsible for their illness may lead to worsening mental health and may also affect how they use health services or manage their disease. For example, they may be reluctant to visit their GP if they think they will be blamed for smoking/drinking alcohol heavily/ being overweight. It is also possible that people may also be treated or feel they are treated with less empathy by healthcare professionals.
The aim of this project is to investigate whether people with diabetes who smoke and/or drink alcohol heavily and/or are overweight have worse mental health outcomes in terms of depression and anxiety following being told they have diabetes than people who do not.
This is important for understanding if some people with diabetes are at higher risk of depression/anxiety so that they can be offered appropriate prevention and/or treatment
Type 2 diabetes is a common chronic condition where appropriate management has a significant impact on patient outcomes.
Smoking, harmful alcohol use and obesity are risk factors for many conditions including type 2 diabetes. These risk factors have a high potential for negative social perceptions (stigma) relating to perceptions of disease attribution or patient “blame” for their condition since there is may be a perception that these factors are related to an individual’s behaviour and therefore under their control despite evidence that behaviour change is extremely complex.
Where health conditions are associated with stigma this can lead to worse mental health outcomes as well as worse physical health outcomes through variation in patient pathways, at both a patient and the healthcare level.
It is not known whether patients who type 2 diabetes and also smoke, drink alcohol in a harmful way have a higher risk of experiencing symptoms of common mental disorders post diagnosis.
The aims of this project is to investigate incidence and impact of common mental disorders (depression and anxiety) by smoking status, alcohol use and body mass index in people with type 2 diabetes.
Appropriate regression modelling (for example poisson or negative binomial) will be used to estimate hazard ratios for the outcomes by the exposure status adjusting for confounding variables. Choice of model will depend on distribution of the outcome and whether model assumptions are met.
Common mental disorders:
Depression (incidence; number of consultation post diagnosis of type 2 diabetes; anti-depressant prescriptions)
Anxiety (incidence; number of consultation post diagnosis of type 2 diabetes; anxiolytic prescriptions)
Jennifer Quint - Chief Investigator - Imperial College London
Sarah Cook - Corresponding Applicant - Imperial College London
Pete Lam - Collaborator - Imperial College London
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation