Psychosomatic aspects on diabetes and chronic pain Alexithymia, depression and salivary cortisol The Affect School and Script Analysis Therapy
Abstract: This thesis explores links between psyche and soma in diabetes and in chronic benign pain (CBP). Interventions with Affect School and Script Analysis (ASSA) compared to Basic Body Awareness Therapy (BBAT) are tried. In a feasibility and treatment efficacy study we offered ASSA to 59 patients with CBP, and 54 (92%) completed. Alexithymia prevalence went from 33% to 11% (p = 0.013), depression from 59% to 48% (p = 0.18), and anxiety from 78% to 50% (p = 0.002) in 46 respondents, and social relations improved (p <0.001). We have established a protocol of a treatment efficacy, multicenter, open-labelled, randomized controlled trial with two intervention arms, ASSA and BBAT. Inclusion criteria: T1D or T2D; HbA1c ?62.5 mmol/mol; psychological symptoms; age 18-59 years; diabetes duration ?1 year. Exclusion criteria: pregnancy; severe somatic or psychiatric disorder; cognitive deficiency; inadequate knowledge of Swedish. Primary outcome measure: depression prevalence. Secondary outcome measures: HbA1c, midnight salivary cortisol (MSC), alexithymia and anxiety prevalence, self-image measures, diabetes complications and mortality in 6 year follow up. In a cross sectional study of 292 T1D patients, associations between high HbA1c and psychological factors, life style factors and obesity were tried. 80 patients (27%) had HbA1c >70 mmol/mol, which was associated with depression (AOR 4.8), abdominal obesity (AOR 4.3), and smoking (AOR 3.0). Alexithymia and anxiety were linked with depression. In a cross sectional study of 196 T1D patients, associations between high MSC (?9.3 nmol/L), depression, HbA1c, and intra individual, behavioural and environmental factors were explored. 34 patients (17%) had MSC ?9.3 nmol/L, which was associated with smoking (AOR 5.5), spring season (AOR 4.3), physical inactivity (AOR 3.9), depression (AOR 3.1), and older age (AOR 1.08; (per year)). HbA1c >70 mmol/mol (AOR 4.2) and MSC ?9.3 nmol/L (AOR 4.4) were independently linked with depression. Conclusions are that alexithymia was linked with depression, which in sum was associated with both high HbA1c and high MSC in T1D patients. ASSA showed reduced alexithymia, anxiety and depression and improved social relations in CBP patients. ASSA for selected patients with diabetes will be further evaluated in an RCT.
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