Transcript Handbook of Health Social Work, 2 nd Edition

ADHERENCE AND MENTAL
HEALTH ISSUES IN CHRONIC
DISEASE: DIABETES, HEART
DISEASE AND HIV/AIDS
Chapter 20
Handbook of
Health Social
Work, 2 nd
Edition
ADHERENCE AND MENTAL HEALTH ISSUES IN
CHRONIC DISEASE
 Chapter Objectives:
 Exhibit knowledge about the epidemiology of heart disease,
HIV/AIDS, and diabetes in the United States, including racial and
ethnic disparities
 Identify and assess psychosocial factors that influence adherence to
treatment among individuals with chronic disease
 Incorporate a systematic model of adherence counseling in practice
with individuals with chronic disease
 Understand the importance of communication techniques in patient
education and adherence counseling for individuals with chronic
disease
 Understand the relationship between mental health and chronic
disease
CURRENT TRENDS IN THE CARE OF PATIENTS
WITH A CHRONIC DISEASE
 INDIVIDUALS ARE LIVING LONGER
 AVERAGE LIFE SPAN IN THE U.S. INCREASED BY 27 YEARS FROM 49.2
IN 1900 TO 76.5 IN 2000
 DUE TO PUBLIC HEALTH MEASURES:
 VACCINATIONS
 ANTIBIOTICS
 & OTHER METHODS FOR CONTROLLING INFECTIOUS DISEASES
 INCREASE IN THE NUMBER OF INDIVIDUALS LIVING WITH
CHRONIC DISEASE BECAUSE ADVANCES IN MEDICAL
TREATMENT
 CHRONIC DISEASES HAVE REPLACED INFECTIOUS DISEASES AS
THE LEADING CAUSES OF DEATH IN THE U.S.
HEART DISEASE, DIABETES AND HIV/AIDS
HEART DISEASE IS THE NUMBER 1 CAUSE OF DEATH IN THE
UNITED STATES
DIABETES IS RANKED NUMBER 7 FOR CAUSES OF DEATH IN THE
UNITED STATES
HIV/AIDS RANKS NUMBER 20 FOR CAUSES OF DEATH IN THE
UNITED STATES
SHIFT FROM VIEWING INDIVIDUALS AS
CONSUMERS OF HEALTH CARE TO
PROVIDERS OF HEALTH CARE
 MOST OF THE RESPONSIBILIT Y FOR PREVENTING &
MANAGING CHRONIC DISEASE LIES WITH THE PATIENT AND
THE PATIENT’S FAMILY
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HEALTHCARE TEAM
DAY TO DAY ACTIVITIES
CARRY OUT TREATMENT REGIMENS
PROMOTION OF PATIENT ADHERENCE
PREVENTION OF DISEASES:
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WEIGHT LOSS
EXERCISE
DIETARY CHANGES
REDUCTION OF RISKY SEXUAL BEHAVIORS
OTHER ISSUES RELATED TO CHRONIC
DISEASE IMPORTANT FOR SOCIAL WORKERS
 THERE ARE NO KNOWN CURES FOR DIABETES, HIV/AIDS, OR
HEART DISEASE
 THEY ARE PROGRESSIVE IN NATURE
 THEY FLUCTUATE IN SYMPTOMS AND DISEASE -RELATED
COMPLICATIONS
 DISEASE SPECIFIC COMPLICATIONS CAN BE VIEWED AS
“PREDICTABLE CRISES” BECAUSE THEY CAN CAUSE ANXIET Y
AND DISEQUILIBRIA THAT IS EXPECTED
 DEVELOPMENTAL AND LIFEST YLE CHANGES
EPIDEMIOLOGY OF DIABETES, HEART
DISEASE, AND HIV/AIDS
 SOCIAL WORKERS ENCOUNTER PEOPLE WITH CHRONIC
DISEASES IN VIRTUALLY ALL HEALTHCARE SETTINGS:
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EMERGENCY ROOMS
HOSPITALS
OUTPATIENT CLINICS
COMMUNITY CENTERS
HOSPICES
NURSING HOMES
REHABILITATION CENTERS
HEART DISEASE: A LEADING KILLER
HEART DISEASE CAN REFER TO SEVERAL CARDIAC CONDITIONS
INCLUDING CORONARY ARTERY DISEASE, CONGESTIVE HEART
FAILURE, AND HEART ATTACK
 HEART DISEASE IS A T YPE OF CARDIVASCULAR DISEASE, ALONG
WITH HYPERTENSION AND STROKE
GENDER: FATALITIES FOR MEN HAVE DECREASED, BUT HEART
DISEASE HAS BECOME THE LEADING CAUSE OF DEATH FOR WOMEN
RACIAL AND ETHNIC DISPARITIES: HEART DISEASE
DISPROPORTIONATELY AFFECTS CERTAIN RACIAL AND ETHNIC
MINORIT Y GROUPS
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SOME FACTORS INCLUDE: DIFFERENCES IN ACCESS TO MEDICAL AND
EMERGENCY CARE, DIET, EXERCISE, RISK BEHAVIORS (I.E. SMOKING),
HEALTH BEHAVIORS (I.E. CHECKING BLOOD PRESSURE REGULARLY), AND
PHYSICIAN BIAS
DIABETES: A GLOBAL EPIDEMIC
DIABETES MELLITUS AFFECTS THE BODY’S ABILIT Y TO
METABOLIZE BLOOD GLUCOSE (SUGAR).
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THEREFORE, PERSON EITHER FAILS TO USE INSULIN PROPERLY OR
PRODUCE IT AT ALL
 WHEN DIABETES IS UNCONTROLLED AND BLOOD SUGAR
LEVELS GET TOO HIGH THE INDIVIDUAL MAY EXPERIENCE
 SHORTNESS OF BREATH
 NAUSEA
 VOMITING
 EXCESSIVE THIRST
 LIFE-THREATENING, PRECOMA CONDITION CALLED DIABETIC
KETOACIDOSIS
CONTINUED…
DIABETES: A GLOBAL EPIDEMIC
 CONTROLLED DIABETES ALWAYS CARRIES RISK OF
HYPOGLYCEMIS OR LOW BLOOD SUGAR CAUSED BY TOO MUCH
INSULIN OR MEDICATION
 SYMPTOMS OF HYPOGLYCEMIA: SHAKINESS, IRRITABILITY, HEART
PALPITATIONS, HUNGER, SWEATING, LOSS OF CONSCIOUSNESS,
SEIZURES AND COMA
• PEOPLE WITH DIABETES COMMONLY DEVELOP COMPLICATIONS LIKE,
CARDIVASCULAR DISEASE, VISION PROBLEMS, AMPUTATIONS,
KIDNEY FAILURE, AND NERVE DAMAGE
DIABETES: FOUR MAJOR T YPES
 T YPE 1 DIABETES (JUVENILE DIABETES):
 CHILDREN AND YOUNG ADULTS
 ACCOUNTS FOR 5-10% OF ALL DIABETES
 AUTOIMMUNE DISEASE (ONE’S IMMUNE SYSTEM INAPPROPRIATELY
ATTACKS NECESSARY TISSUES)
 IMMUNE SYSTEM DESTROYS THE CELLS THAT PRODUCE HORMONE
INSULIN, WHICH METABOLIZES BLOOD SUGAR
 MUST TAKE INSULIN EVERYDAY
 T YPE 2 DIABETES (ADULT-ONSET DIABETES):
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90-95% OF ALL DIABETES CASES
BODY PRODUCES INSULIN, BUT CELLS CANNOT ABSORB IT
ASSOCIATED WITH BEING OVERWEIGHT AND PHYSICALLY INACTIVE
CONTROL BLOOD SUGAR BY: DIET, LOSING WEIGHT, EXERCISING
REGULARLY, AND ORAL MEDICATIONS
CONTINUED…
DIABETES: FOUR MAJOR T YPES
 GESTATIONAL DIABETES:
 14% OF WOMEN DURING PREGNANCY
 DISAPPEARS AFTER CHILDBIRTH
 SOME DEVELOP T YPE 2 DIABETES AFTER CHILDBIRTH
 OTHER T YPES OF DIABETES INCLUDE CONDITIONS CAUSED BY
GENETIC DEFECTS, DRUG USE, INFECTION, OR LESS COMMON
FORMS OF AUTOIMMUNE ILLNESS
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LEAST COMMON T YPES
MAKE UP ONLY 1-5% OF DIABETES CASES IN THE US
DIABETES: EPIDEMIOLOGY, RISK FACTORS
AND RACIAL & ETHNIC DISPARITIES
 17.9 MILLION PEOPLE IN THE US HAVE DIABETES, AND 5.7
MILLION MORE ARE BELIEVED TO HAVE DIABETES
 50% INCREASE IN DIABETES CASES FROM 1997 -2004
 RISK FACTORS:
 TYPE 2 DIABETES IS CONSIDERED TO BE PREVENTABLE
 PARALLELS INCREASES IN OBESIT Y, SUGAR AND FAT CONSUMPTION, AND
PHYSICAL INACTIVIT Y
 DIABETES IS TWICE AS COMMIN IN DEVELOPED COUNTRIES THAN
DEVELOPING COUNTRIES (HIGHER SOCIOECONOMIC STATUS)
 RACIAL AND ETHNIC DISPARITIES
 HISPANIC PEOPLE ARE 1.5, AFRICAN AMERICANS ARE 1.6, &
AMERICAN INDIANS & ALASKA NATIVES ARE 2.3 TIMES MORE LIKELY
TO HAVE DIABETES
 ATTRIBUTED TO LESS ACCESS TO HEALTHCARE AND GENETIC
DIFFERENCES IN GLUCOSE TOLERANCE
HIV/AIDS: FROM TERMINAL ILLNESS TO
CHRONIC DISEASE
 HIV & AIDS ARE 2 DIFFERENT, BUT OVERLAPPING DISORDERS
 HIV INFECTS BODY’S IMMUNE SYSTEM; AIDS IS MOST
ADVANCED STAGE OF HIV AND IS DEFINED AS A SPECIFIC
GROUP OF DISEASES OR CONDITIONS THAT SEVERELY
SUPPRESS THE BODY’S IMMUNE STSTEM
 HIV IS TRANSMITTED THROUGH CONTACT WITH INFECTED
BLOOD:
 SEXUAL CONTACT, SHARING NEEDLES, OR BLOOD TRANSFUSIONS
 WOMEN CAN PASS THE VIRUS TO THEIR INFANTS DURING PREGNANCY OR
BIRTH
HIV/AIDS: EPIDEMIOLOGY
 FIRST CASE OF AIDS WAS REPORTED IN 1981 , AND WITHIN 4
YEARS 16,000 PEOPLE WERE DIAGNOSED (8,000 OF WHOM
DIED)
 DEATH RATE SLOWED DOWN IN 1996 IN THE US BECAUSE OF
HAART
 HAART IS HIGHLY ACTIVE ANTIRETROVIRAL THERAPY
(COMBINES DIFFERENT MEDICATIONS)
 CALLED ‘DRUG COCKTAIL’
 REVERSE TRANSCRIPTASE INHIBITORS (PREVENT VIRUS FROM MAKING COPIES OF ITSELF)
 DOES NOT CURE HIV/AIDS, BUT IT DOES PROLONG THE QUALITY AND LENGTH OF LIFE
AIDS WORLDWIDE: A LEADING CAUSE OF
DEATH
 AT LEAST 20 MILLION PEOPLE WORLDWIDE HAVE DIED
FROM AIDS
 HIV/AIDS RANKS #6 LEADING CAUSE OF DEATH
 SOUTH AFRICA ACCOUNTS FOR 22 OF THE 33 MILLION
CASES OF AIDS IN THE WORLD
 2008: 1.4 MILLION PEOPLE IN S. AFRIDCA DIED OF AIDS
 ALMOST ALL NEW HIV INFECTIONS OCCUR IN WORLD’S
DEVELOPING COUNTRIES & COMMONLY SPREAD
THROUGH HETEROSEXUAL CONTACT
GENDER & AIDS, RACIAL & ETHNIC
DISPARITIES AND AIDS IN THE U.S.
 OFTEN IDENTIFIED AS A “GAY DISEASE”
 THE DISEASE DISPROPORTIONATELY AFFLICTS MEN WHO
HAVE SEX WITH MEN IN THE U.S.
 2008: 1/3 NEWLY INFECTED PEOPLE CONTRACTED THE
DISEASE THROUGH HETEROSEXUAL CONTACT
 75% OF CASES OCCUR IN MEN, 25% IN WOMEN
 DECLINE IN DEATHS WAS LOWEST AMONG AFRICAN
AMERICAN WOMEN & HIGHEST AMONTH WHITE
AMERICAN MEN
 THE DISPARITIES LARGELY REFLECT DIFFERENCES IN HIV TESTING PATTERNS AND ACCESS TO NEW DRUGS
AIDS IN THE UNITED STATES: A CONTINUING
PUBLIC HEALTH PROBLEM
 THE NUMBER OF HIV CASES REPORTED EACH YEAR CONTINUES
TO GROW
 HIV PRIMARILY AFFECTS YOUNG PEOPLE, ESPECIALLY
MINORITIES
ADHERENCE TO TREATMENT REGIMENS
“THE SUCCESSFUL MANAGEMENT OF DIABETES, HEART DISEASE,
AND HIV/AIDS DEPENDS LARGELY ON THE EXTENT TO WHICH
PATIENTS ADHERE TO AND TAKE RESPONSIBILIT Y FOR THEIR
TREATMENT REGIMENS.”
 SOCIAL WORKER MUST FACILITATE PATIENT ADHERENCE TO
MEDICAL REGIMENS
 ADHERENCE: EXTENT TO WHICH A PATIENT’S BEHAVIOR
CORRESPONDS WITH MEDICAL ADVICE; ACTIVE & COLLABORATIVE
 TREATMENT EFFECTIVENESS FOR PATIENT’S WITH A CHRONIC
DISEASE IS TRONGLY INFLUENCED BY THE PATIENT’S WILLINGNESS &
ABILITY TO ADHERE TO A COMPLICATED MEDICAL REGIMEN
 NONADHERENT PATIENTS AVERAGES AT 75.2%
CONTINUED…
ADHERENCE TO TREATMENT REGIMENS
 PREDICTORS OF ADHERENCE AMONG INDIVIDUALS WITH
DIABETES, HEART DISEASE, & HIV/AIDS
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FAMILIAL
MENTAL HEALTH
HEALTH BENEFITS
LITERACY
DEMOGRAPHIC FACTORS
 BARRIERS TO ADHERENCE (HIV)
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COMPLICATED DOSING SCHEDULES AND FOOD RESTRICTIONS
MEDICATION SIDE EFFECTS
PSYCHODSOCIAL ISSUES
UNSUPPORTIVE RELATIONSHIPS WITH PROVIDERS
 ADHERENCE WITH HEART DISEASE PATIENTS
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PERSONAL RISK
DECISION SUPPORT
MOTIVATION
SELF-EFFICACY
CREDIBLE HEALTH INFORMATION
A SYSTEMATIC MODEL OF ADHERENCE
COUNSELING
 FOUR DISTINCT PHASES
1 . ASSESSMENT AND IDENTIFICATION OF
ADHERENCE PROBLEMS
2. PLANNING THE MEDICAL TREATMENT REGIMEN
3. FACILITATING BEHAVIORAL CHANGE
4. MAINTAINING PATIENT ADHERENCE
PHASE 1: PATIENT AND FAMILY ASSESSMENT
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SOCIAL SUPPORT
LIFESTLYE AND DAILY SCHEDULE
PSYCHOLOGICAL FACTORS
HEALTH BELIEFS
PRIOR ADHERENCE HISTORY AND TREATMENT SATISFACTION
PHASE 2: PLANNING THE TREATMENT
REGIMEN
 PROMOTE A REALISTIC MEDICAL REGIMEN
 ENCOURAGE PATIENT PARTICIPATION IN REGIMEN
PLANNING
 FACILITATE COMMUNICATION
 ENCOURAGE JOINT DECISION MAKING
PHASE 3: FACILITATE BEHAVIORAL CHANGE
 INITIATE NEW BEHAVIORS
 TRANSLATE TREATMENT GOALS INTO BEHAVIOR GOALS
 ENCOURAGE SELF-MANAGEMENT STRATEGIES
 TEACH PATIENTS TO PLAN FOR HIGH RISK SITUATIONS
 ACTIVATE SOCIAL SUPPORT
 FAMILY SUPPORT: INCREASE FAMILY INVOLVEMENT, PROMOTE
SHARED RESPONSIBILITY
 STRENGTHEN EMOTIONAL SUPPORT
 SOCIAL SUPPORT OUTSIDE OF THE FAMILY
 ENHANCE PATIENT’S ABILITY TO ACTIVATE SOCIAL AND MEDICAL
SUPPORT
PHASE 4: STRATEGIES FOR LONG TERM
ADHERENCE
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DEVELOP SKILLS FOR MAINTAINING ADHERENCE
COPING WITH LAPSES OF ADHERENCE
INCREASE ACCESSIBILIT Y TO HEALTHCARE
REINFORCE POSITIVE HEALTHCARE BEHAVIORS
ADHERENCE AND PATIENT-PRACTITIONER
COMMUNICATION
 OUTCOMES:
 WHEN PRACTITIONERS ENGAGE IN MORE POSITIVE AND LESS NEGATIVE
TALK, ASK FEWER QUESTIONS, AND OFFER MORE INFORMATION, PATIENTS
ARE MORE LIKELY TO BE ADHERENT
 MORE INFORMATION GIVING IS ASSOCIATED WITH BETTER PATIENT
RECALL AND MORE PARTNERSHIP BUILDING
 STRONGEST PREDICTOR OF PATIENT SATISFACTION:
 HOW MUCH INFORMATION IS PROVIDED TO THE PATIENT
 THEY NEED KNOWLEDGE ABOUT THEIR CONDITION, SO THEY ARE MUCH
MORE PLEASED WITH THEIR MEDICAL CARE
INFORMATION GIVING AND THE
EDUCATOR ROLE
 PATIENTS WITH CHRONIC DISEASES ARE CONTINUALLY
ADAPTING TO CHANGES
 CHANGES IN: MEDICAL CONDITION, MENTAL HEALTH, TREATMENT
REGIMEN, OR DEVELOPMENT OR LIFESTYLE CHANGES
APPLICABILIT Y TO DIVERSE
POPULATIONS
 THIS APPROACH HOLDS PROMISES FOR INDIVIDUALS FROM
DIVERSE SOCIOECONOMIC & ETHNIC BACKGROUNDS
 IT USES AN ECOLOGICAL APPROACH FOR ASSESSING
BARRIERS & FACILITATORS TO ADHERENCE
 IT ACKNOWLEDGES & EXAMINES THE INFLUENCE OF THE
BROADER SOCIAL CONTEXT, SUCH AS SOCIETAL & CULTURAL
FACTORS
 IT CAN ALSO BE USED AS A STRATEGY TO PREVENT
ADHERENCE PROBLEMS FROM DEVELOPING WITH NEWLY
DIAGNOSED PATIENTS OR PATIENTS WHO ARE CHANGING
THEIR REGIMENS.
OUTCOMES ASSOCIATED WITH POSITIVE
PATIENT-PRACTITIONER COMMUNICATION
 PATIENTS ARE DISSATISFIED & NONADHERENT WHEN
 THEY DO NOT UNDERSTAND WHAT THEY ARE TOLD AND DO NOT ASK QUESTIONS
 THEY FORGET WHAT THEY ARE TOLD AND
 TOO MUCH TIME IS SPENT ON ASSESSING PERSONAL HISTORIES AS OPPOSED TO
PROVIDING PATIENT EDUCATION
 COMMUNICATION TECHNIQUES TO ENHANCE INFORMATION
RECALL
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USE EXPLICIT CATEGORIZATION
REPETITION OF MOST IMPORTANT INFORMATION
PROVIDE SPECIFIC INSTRUCTIONS
PRESENT MOST IMPORTANT INFORMATION EARLY IN THE VISIT
EXPLAIN WHY A TREATMENT IS RECOMMENDED
ELICIT PATIENT EXPECTATIONS AND INVOLVEMENT
THE RELATIONSHIP BETWEEN MENTAL
HEALTH AND CHRONIC DISEASE
ONE OF THE MOST IMPORTANT ISSUES FOR SOCIAL WORKERS
WHO WORK WITH CHRONICALLY ILL PAATIENTS IS THE CO OCCURRENCE OF MENTAL HEALTH PROBLEMS
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HIGHER RATES OF EMOTIONAL PROBLEMS
FEELINGS OF GRIEF
ANXIETY
DEPRESSION (INDIRECTLY AND DIRECTLY)
PREVALENCE OF MENTAL DISORDERS
AMONG PEOPLE WITH HEART DISEASE
 15-20% OF PEOPLE WITH HEART DISEASE HAVE DEPRESSION
 DEPRESSION CAN EXACERBATE HEART DISEASE
 BECAUSE OF BEHAVIORAL CONSEQUENCES OF DEPRESSION, LIKE
 POOR EATING HABITS AND POOR EXERCISE HABITS
 OR BECAUSE OF PHYSIOLOGICAL CORRELATES, SUCH AS
 DECREASED HEART RATE VARIABILITY AND PLATELET ACTIVITY
PREVALENCE OF MENTAL DISORDERS
AMONG PEOPLE WITH DIABETES
“STUDIES SHOW THE RISK OF DEPRESSION IS 2 TIMES HIGHER
AMONG PEOPLE WITH T YPE 1 OR T YPE 2 DIABETS COMPARED
WITH THOSE WHO DO NOT HAVE DIABETES”
 IN ONE STUDY, 11% OF PEOPLE WITH DIABETES HAD
DEPRESSION AND AN ADDITIONAL 31% HAD A HIGH NUMBER
OF DEPRESSION SYMPTOMS
 DEPRESSION IS RELATED TO
 POOR NUTRITION, LACK OF MEDICAL ADHERENCE, INCREASED HEALTH
PROBLEMS, AND LOWER QUALIT Y OF LIFE
 GREATER LIKELIHOOD OF HYPERGLYCEMIA, EYE DAMAGE, HEART DISEASE
AND HOSPITALIZATION
 OTHER EMOTIONAL PROBLEMS RELATED TO DIABETES
 ANXIETY AND GENERAL PSYCHOLOGICAL DISTRESS
CONTINUED…
PREVALENCE OF MENTAL DISORDERS
AMONG PEOPLE WITH DIABETES
 14% OF PEOPLE WITH DIABETES HAVE GENERALIZED ANXIET Y
DISORDER
 40% HAVE ELEVATED SYMPTOMS OF ANXIETY
 AMERICAN INDIANS WITH DIABETES HAVE HIGHEST RATES OF
DEPRESSION, FOLLOWED BY WHITE, HISPANIC, AFRICAN AMERICANS,
THEN ASIAN AMERICANS
 INSULIN PURGING: REGULATING WEIGHT BY WITHHOLDING
INSULIN, AND THUS PURGING THEMSELVES OF FOOD THAT
WOULD BE STROED AS FAT
 WOMEN WITH TYPE 1 DIABETES ARE AT TWICE THE RISK FOR
BULLIMIA NERVOSA THAN WOMEN WHO DO NOT HAVE TYPE 1
DIABETES
PREVALENCE OF MENTAL DISORDERS
AMONG PEOPLE WITH HIV/AIDS
 HIV- ASSOCIATED DEMENTIA AND MINOR COGNITIVE -MOTOR
DISORDER CAN RESULT FROMT THE VIRUS’ INVOLVEMENT
WITH THE CENTRAL NERVOUS SYSTEM
 THE RISK FOR SUICIDE IS T WO TIMES HIGHER
 TREATMENT FOR HIV/AIDS CAN TRIGGER PSCHIATRIC
PROBLEMS
 EX. ANTIRETROVIRAL THERAPY CAN INDUCE OSYCHOSIS IN SOME
PATIENTS
DEPRESSION AND OTHER MENTAL ILLNESS:
CAUSE OR CONSEQUENCE OF HEART
DISEASE?
 HEART DISEASE
 DEPRESSION INCREASES
RISK OF HEART DISEASE BY
1.5-2 TIMES
 EPIDEMIOLOGIC CATCHMENT
AREA STUDY FOUND: NO
HISTORY OF HEART DISEASE,
BUT HISTORY OF DEPRESSION
WERE 4 TIMES MORE LIKELY
TO HAVE HEART ATTACK
 RELATIONSHIP BETWEEN
DEPRESSION & HEART
DISEASE COMPLICATIONS
MORE PROFOUND FOR MEN
THAN WOMEN
 PHYSIOLOGIC EFFECTS OF
DEPRESSION ENCOURAGE
HEART PROBLEMS
 ALTERATIONS IN BLOOD
PLATELET ACTIVITY
 SEROTONIN
DYSREGULATION
 INFLAMMATION
 DIABETES, OBESITY,
HYPERTENSION
DEPRESSION AND OTHER MENTAL
ILLNESS: CAUSE OR CONSEQUENCE OF
DIABETES?
 DEPRESSION CAN LEAD TO DIABETES BECAUSE DEPRESSION
CAN CONSIST OF POOR DIET, LACK OF EXERCISE, SMOKING,
SOCIAL ISOLATION, AND STRESS
 PEOPLE WITH SCHIZOPHRENIA HAVE HIGHER RATES OF
IMPAIRED GLUCOSE
 THOSE WHO TAKE MEDICATION (OLANZIPINE, RISPERIDONE,
QUETIAPINE) FOR SCHIZOPHRENIA ARE AT AN ELEVATED RISK FOR
DIABETES
 WEIGHT GAIN MAY ALSO HELP EXPLAIN THE INCREASED RISK
FOR DIABETES
DEPRESSION AND OTHER MENTAL
ILLNESS: CAUSE OR CONSEQUENCE OF
HIV/AIDS?
 MENTAL ILLNESS INDIRECTLY INCREASES CHANCES OF
ACQUIRING MENTAL ILLNESS BECAUSE MANY PEOPLE WITH
SERIOUS ILLNESSES ENGAGE IN
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HIGH RATES OF RISKY BEHAVIORS
UNPROTECTED SEX
DRUG USE INVOLVING NEEDLES
PROSTITUTION
 FEELINGS OF HOPELESSNESS AND LETHARGY PRODUCED BY
DEPRESSION CAN INSPIRE RISKY SEXUAL BEHAVIOR
MENTAL ILLNESS AND ADHERENCE TO
TREATMENT REGIMENS
 MENTAL ILLNESSES WHICH AFFECT PATIENT’S COMPLIANCE
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DEPRESSION
ANXIET Y
SCHIZOPHRENIA
SUBSTANCE ABUSE DOSORDERS
 DEPRESSION IS THE LARGEST CULPRIT BECAUSE IT
 LESSENS MOTIVATION
 LESSENS CONCENTRATION
 LESSENS ENERGY AND HOPEFULNESS
PROTECTIVE FACTORS AND MENTAL
HEALTH IN CHRONIC ILLNESS
 WHAT HELPS PEOPLE COPE WITH THEIR CHRONIC ILLNESS
WITHOUT EXPERIENCING DEPRESSION, ANXIET Y, OR ANY
OTHER MENTAL DISORDER?
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MARRIAGE
HIGHER LEVELS OF EDUCATION
INCOME
SOCIAL SUPPORT
INTERVENTIONS TO IMPROVE MENTAL
HEALTH IN PEOPLE WITH CHRONIC DISEASE
 SOCIAL WORKERS HAVE NUMEROUS INTERVENTIONS
AVAILABLE TO HELP PEOPLE WITH MENTAL HEALTH
PROBLEMS
 1. MEDICAL CRISIS COUNSELING
 2. PSYCHOTHERAPY
 3. RELAXATION TRAINING
MEDICAL CRISIS COUNSELING
 SHORT-TERM INTERVENTION THAT CENTERS ON FEARS,
ANXIETIES, & DISABILITIES
 PREMISE: 8 FEARS IMPEDE A PERSON’S ABILIT Y TO COPE
WITH ILLNESS
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1. LOSS OF CONTROL
2. LOSS OF SELF-IMAGE
3. DEPENDANCY
4. STIGMA
5. ABANDONMENT
6. EXPRESSING ANGER
7. ISOLATION
8. DEATH
PSYCHOTHERAPY
 VARIOUS STUDIES ATTEST TO PSYCHOTHERAPY’S
EFFECTIVENESS, BUT EVIDENCE IS MIXED REGARDING IT AND
PEOPLE WITH SPECIFIC ILLNESSES
 MAY VARY BY:
 ORIENTATION (COGNITIVE-BEHAVIORAL OR PSYCHODYNAMIC)
 MODE (INDIVIDUAL OR GROUP)
 FOCUS (COGNITIVE DISTORTIONS, GRIEF, OR STRESS)
 MORE RESEARCH IS NEEDED INTO THE EFFECTIVENESS OF
DIFFERENT T YPES, MODES, AND FOCI OF PSYCHOTHERAPY
RELAXATION TRAINING
 MEDITATING 10-20 MINUTES A DAY CAN PRODUCE
PHYSIOLOGIC CHANGES SUCH ASLOWER BLOOD PRESSURE
AND HEART RATE
 RELAXATION TECHNIQUES ARE ASSOCIATED WITH IMPROVED
BLOOD GLUCOSE CONTROL
 MEDITATION PROCESS
 A PERSON SITS STILL WHILE CONCENTRATING ON COUNTING, REPEATING
A PHRASE, OR VISUALIZING AN OBJECT
 PROGRESSIVE MUSCLE RELAXATION
 A PERSON BREATHES DEEPLY AND RELAXES SPECIFIC MUSCLE GROUPS
ONE AT A TIME, STARTING EITHER FROM THE HEAD AND GOING DOWN TO
THE FEET OR VICE VERSA
 HYPNOTHERAPY (DEEP RELAXATION)
 ANOTHER PERSON INDUCES RELAXATION IN THE PATIENT BY DIRECTING
THE PATIENT TO FOCUS ATTENTION ON AN OBJECT OR A VISUALIZATION