Anger and mental health in type 2 diabetes

Diabetes and Primary Care, Summer, 2004 by Andrew Kolbasovsky

Implications

The high rate of anger among people with diabetes who also have a mental health diagnosis should be of great concern to all members of the diabetes treatment team working within the primary care setting. Treatment for many mental health services, particularly in the US, are now primarily provided within the primary care setting (Coyne, 2001) and many people with type 2 diabetes also have a diagnosed or undiagnosed comorbid mental health condition (Anderson et al, 2001). The quantitative results from this study and the qualitative results of other studies (McCord and Brandeburg, 1995; Choe et al, 2001; Snoek et al, 2002) suggest that many people receiving care for type 2 diabetes in the primary care setting are also dealing with strong feelings of anger, particularly those who also have a mental health diagnosis.

It is important for members of the primary care treatment team, as well as mental health providers to identify and discuss issues of anger when working with people with diabetes, especially as anger has the potential to become a barrier to proper self-management of diabetes and can interfere with the healthcare provider-patient relationship. People with diabetes who often feel frustrated, angry, or irritable may also benefit from knowing that feelings of anger can be common for people coping with diabetes, and that there are effective therapies available to address anger. Healthcare providers can also help these people to identify ways in which anger may become a barrier to the management of diabetes.

Addressing issues of anger

There are effective therapies available for anger management. These typically involve teaching people to recognise situational and physiological cues of anger. By recognising rising anger earlier it is easier to intervene. Interventions that are taught to be implemented after early recognition include cognitive restructuring, relaxation techniques, and self-statements.

Qualitative studies have demonstrated that people with diabetes (irrespective of receiving mental health care) report a great deal of anger in interviews. Additional quantitative studies documenting the level of anger for people with diabetes who do not have a mental health condition are also needed.

Conclusion

Further quantitative studies are needed to demonstrate the connection between diabetes and anger across a greater variety of settings. In addition, future research should identify the extent to which anger impacts Hb[A.sub.1c] levels. The benefits of providing anger management or other psychotherapy for people with diabetes who report a high level of anger should also be assessed.

Table 1. Participant characteristics

Characteristics                     Patients       Patients
                                    with diabetes  without
                                                   diabetes

Mean (SD) age                       55.51 (8.53)   47.95 (14.43)*
Gender, n(%)
        Male                        24 (61.5)      25 (44.6)
        Female                      15 (38.5)      31 (55.4)
Type of insurance, n(%)
        Commercial                  27 (69.2)      43 (76.8)
        Medicare                    11 (28.2)      10 (17.9)
        Medicaid                     1 (2.6)        3 (5.4)
DSM-IV Diagnostic Category, n(%)
        Depressive disorder         17 (43.6)      30 (53.6)
        Anxiety disorder            10 (25.6)      14 (25.0)
        Adjustment disorder          6 (15.4)      11 (19.6)
        Psychotic disorder           5 (12.8)       0 (0)
        Bipolar disorder             0 (0)          1 (2.6)
        Developmental disorder       1 (2.6)        0 (0)
Additional medical diagnosis other
than diabetes, n (%)**
        Yes                         18 (46.2)      12 (21.4)
        No                          21 (53.8)      44 (78.6)

*p<0.01, **p<0.05. Analyses were conducted using Chi-square and t tests
for independent samples.

Table 2. Summary of hierarchical regression results for anger

Variable               Mean (SE)       Beta     t(90)

Diabetes status      -12.75 (3.24)    -0.38    -3.94*
Age                    0.26 (0.12)     0.20     2.07**
Medical diagnosis     -2.05 (3.39)    -0.05    -0.60
(yes/no)
DSM-IV diagnostic      2.62 (1.41)     0.17     1.86
category

[R.sup.2]=0.27, *p<0.01, **p<0.05