Diabetes is one of the leading causes of death in most countries. While the last 15 years have produced great public awareness of HIV/AIDS, prostate cancer and breast cancer, the fact remains that diabetes kills more people than any of them! According to a review by the American Diabetes Association (2001), diabetes was described as a chronic disease with major medical, personal and public health implications.

Presently, over 135 million individuals worldwide suffer from diabetes. Moreover, according to the WHO (2003), if nothing is done to slow the epidemic, this figure could more than double by year 2025! A recent report by the International Diabetes Foundation (2003) has revealed that, although the USA has the world’s largest adult diabetic population, there are five countries, which have the highest diabetes prevalence in their adult population. Alarmingly, Mauritius is one of them!

An important task for Health Psychology is to understand the effects of illness on an individual’s psychological well-being to identify intervention targets. Empirical studies strongly point to the fact that anxiety and depression are more prevalent among diabetic adults than among the general population. Surveys of populations with diabetes indicate that the prevalence of depression ranges between 7% and 33% and that symptoms occur in 45% of diabetics.

Feelings of depression and anxiety are often linked with the stress associated with being diagnosed. For individuals with diabetes, an ordinary day may involve regular pricks with needles to draw blood samples for glucose tests, insulin injections, medication, foot care, diet adjustment and exercise to keep blood glucose balanced. The daily lives of diabetics are complex and extremely disruptive.

Moreover, long-term complications are very common and highly stressful. Around 20% of newly diagnosed patients show signs of complications when diagnosed, including neuropathy, nephropathy, retinopathy and coronary heart disease (Skinner & Hampson, 1998). In addition, the mortality risk for Type 2 diabetics is more than twice that of age and sex-matched healthy individuals (Shillitoe, 1994). As such, feelings of anxiety, isolation, unhappiness, loss of appetite, panic and difficulty in adjusting to the illness are common among patients and very often lead to deterioration in quality of life.

<B>Less adherence to self-care behaviour</B>

Importantly, depression, stress and anxiety have been linked to poor adherence to the medical regimen. These psychological problems may influence motivation and low motivation may in turn impact on the will of the patient to get better, thereby interfering with the patient’s adherence to the treatment regimen. Patients suffering from depression, stress and anxiety have worse glycemic control and are less adherent to other self-care behaviours like losing weight, adopting a diabetic diet, taking physical exercise and medication than patients, who are not anxious, stressed or depressed. A study by Ciechanowski, Katon & Russo (2000) examined the impact of depressive symptoms on adherence in 367 Type 1 and Type 2 diabetics. Depressive symptom severity was associated with poor diet and medication adherence. In fact, a cycle of hopelessness and helplessness may lead to neglect of treatment.

Owing to these facts, it is vital that patients’ psychological needs are attended to, both to enhance psychological well-being and improve adherence. Psychotherapeutic interventions have been found useful in treating diabetics with anxiety, depression and stress. Cognitive behaviour therapy, which involves a collaborative patient-therapist examination of the validity of certain cognitions, principally through retrospective examination of relevant evidence and discussion of the implication of those beliefs along with behavioural modification have been found particularly effective. While some patients may benefit from individually administered interventions, others may find group-based therapeutic sessions more helpful.

Diabetes is a complex disease with respect to its management and requires considerable motivation and effort on the part of the sufferer. Since diabetes impinges on many areas of an individuals’ life, it is important to identify appropriate targets for intervention. Indeed, public health, whether physical or psychological, remains the number one priority of any society and every attempt has to be made to promote it.

<B>Doreyya Mohungoo</B>