Lloyd, Catherine Elizabeth; (1991) Psychosocial factors and diabetes. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Chronic illnesses have a significant impact on psychosocial status and on quality of life, and may have important consequences on the life-chances of young adults. In order to evaluate these effects, two groups of young people, aged 16-25 years, were interviewed by the author in-depth, using semi-structured psychosocial questionnaires, including the Self Evaluation and Social Support Questionnaire (SESS). A group of 40 young adults with insulin- dependent diabetes mellitus, registered with two North London hospital diabetic clinics, were matched with 40 randomly recruited healthy controls from a local general practice. State of health during the previous year was assessed for both groups by analysing their hospital out-patient and general practice case-notes respectively. Results showed that young adults with diabetes were significantly more likely to have low self-esteem, compared with their matched controls. In a matched pairs analysis, 12 subjects with diabetes had low self-esteem when their matched controls did not, compared with 3 healthy controls who had low self-esteem when their matched diabetic subjects did not (p<0.05). Those with low self-esteem were somewhat less likely to have obtained higher educational qualifications (1 vs 9; p=0.08). More than half (61%) of the subjects with diabetes reported experiencing difficulties at school, and this was also related to self-esteem. Although there was no difference in the unemployment rate between the two groups, one-third of those with diabetes did report problems in their search for employment. Chronic illnesses have a significant impact on psychosocial status and on quality of life, and may have important consequences on the life-chances of young adults. In order to evaluate these effects, two groups of young people, aged 16-25 years, were interviewed in- depth, using semi-structured psychosocial questionnaires, including the Self Evaluation and Social Support Questionnaire (SESS). Young adults with insulin-dependent diabetes mellitus, registered with two North London hospital diabetic clinics, were matched with randomly recruited healthy controls from a local general practice. State of health during the previous year was assessed for both groups by analysing their hospital out-patient and general practice case-notes respectively. Results showed that young adults with diabetes were significantly more likely to have low self-esteem, compared with their matched controls. Those with low self-esteem were less likely to have obtained higher educational qualifications. Many of the subjects with diabetes reported experiencing difficulties at school, and this was also related to self-esteem. Although there was no difference in the unemployment rate between the two groups, some of those with diabetes did report problems in their search for employment. Information on family and social relationships was collected, which demonstrated that subjects with diabetes were more likely to feel socially isolated compared with their matched controls (48% vs 25%; p<0.05). At the same time, a matched pairs analysis demonstrated that 14 diabetic subjects exhibited strong feelings against having close relationships when their matched controls did not, compared with 3 controls who reported these feelings when their matched diabetic subjects did not (p<0.01). Although both subjects with diabetes and healthy controls were equally committed to marriage and parenthood, subjects with diabetes were somewhat less likely to be married (2% vs 10%; p=0.06), and were significantly less likely to have children (2% vs 27%; p<0.01) compared with their matched controls. The methods used in this study did not permit the direct observation of the nature of family and peer interactions. Differences in state of health, both in terms of metabolic control and the presence of diabetic complications, were investigated within the diabetic group, and showed some trends in relation to these psychosocial variables. There are limitations with regard to the interpretation of these findings due to the small sample size, which had not been estimated prior to the commencement of the study. In particular, the diabetic subjects were a clinic-based sample so it is not possible to generalise these findings to the wider population. Having taken this into account, this study suggests that there may be important effects of chronic disease in many areas of the lives of young adults. Confirmation of these findings should be carried out in a larger, more representative sample, using a prospective design.

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