ARTICLE INFO

Article Type

Original Research

Authors

Nayyeri   M (1)
Rajaee   A (*)
Meschi   F (2)
Sodagar   S (3)






(*) Psychology Department, Torbat -e - Jam Branch, Islamic Azad University, Torbat -e - Jam, Iran
(1) Health Psychology Department, Karaj Branch, Islamic Azad University, Karaj, Iran
(2) Health Psychology Department, Karaj Branch, Islamic Azad University, Karaj, Iran
(3) Health Psychology Department, Karaj Branch, Islamic Azad University, Karaj, Iran

Correspondence

Address: Psychology Department, torbat -e - jam Branch, Islamic Azad University, torbat -e - jam, 5 km to Torbat-e-Jam, Torbat-e-Jam to Mashhad Road, Khorasan Razavi, Iran. Postal Code: 9576174814
Phone: +98 (51) 52510222
Fax: +98 (51) 52510080
rajaei.46@yahoo.com

Article History

Received:  September  17, 2017
Accepted:  May 2, 2018
ePublished:  May 16, 2018

BRIEF TEXT


Diabetes is one of the most common reported endocrine disorders worldwide, including Iran. Diabetes is now the fifth leading cause of death, and according to the World Organization for Disease Report (ICA), it is estimated that its prevalence will rise from 336 million in 2011 to 552 million in 2030 [1].

... [2-7]. One of the common problems of diabetic patients is depression. In the last two decades, the prevalence of depression among diabetic patients was reported twice as high as non-diabetic patients [8]. ... [9-14]. Nowadays, different ways are used to treat depression, which are generally divided into two categories of biological and psychosocial treatments [15]. Dynamic-supportive therapy used in this study has been used to reduce symptoms and improve self-esteem, self-efficacy and adaptive skills, and consequently to improve the quality of life. In this perspective, in terms of causality, both external and internal events are emphasizes including a range of analytic-psychotherapy therapies [16]. Dynamic-supportive therapy is often the best way to achieve long-term improvement according to the chronic cases and in turn affects all aspects of life [17]. Maina et al. also conducted a study on patients with depression, and concluded that those who followed analytic-psychotherapy therapy and continue to receive treatment show better results during follow-up [16]. .... [18-22].

The aim of this study is comparison of effectiveness of dynamic-supportive psychotherapy and pharmacotherapy on type 2 diabetes patients’ depression.

This research is a semi experimental study with pre-test and post-test design using control group

The present study was carried out in the first and second half of 2016 on type 2 diabetic patients at diabetes control centers and clinics in Torbat Jam and Mashhad.

In this research, 30 subjects were selected by convenience sampling and were randomly assigned into groups.

The present study was conducted in three groups (two experimental and one control group). The age range of participants was 45-60 years, who were suffering from depression at least two years and they had not experienced a serious problem due to depression through the last few months and they met the inclusion criteria for research. After diagnosis of mild to severe depression by depression, anxiety and stress scale (DASS), 30 patients were selected with convenience sampling and were randomly assigned into the groups. The number of men and women was almost equal (16 women and 14 men). Inclusion and exclusion criteria in this research included: 1) the consent to participate in the research; 2) At least 2 years of suffering from depression; 3) no other chronic diseases, such as AIDS, hepatitis, cancer, and other chronic diseases; 4) no serious injury that has led to depression over the past few months, and 5) no addiction to alcohol and drugs. In the next stage, dynamic-supportive therapy was performed for the first experimental group in ten 45-min sessions, the other experimental group received pharmacotherapy and the control group did not receive any treatments and remained in the waiting list for dynamic-supportive therapy after the research. Depression, anxiety and stress scale (DASS) by Lovibond & Lovibond was used to determine the depression of diabetic patients. It has a short form (21 questions) and a long form (42 questions), of which the long form was used in this study..... [23-24]. Two intervention programs were conducted in this study. Dynamic-supportive therapy was performed in ten 45-min sessions. The summery of content of the sessions are as follows: At the beginning of the treatment, after taking the biography, the therapist first sets out a therapeutic alliance to maintain the patient in treatment and increase the good prognosis. In the first few sessions, the psychotherapist should find an understanding of the subject's main and clinical symptoms in order to find out the strengths, weaknesses, and mechanisms of the individual's defense as well as his function. He then assesses “evaluation, formulation of the case, and determining the objective”. Following the mutual agreement and understanding in treatment according to the case, he follows a dynamic to supportive range and in addition to its own techniques, he uses more components of the treatment simultaneously. Dynamic-supportive psychotherapy is a therapeutic method, in which therapeutic alliance is likely a basis for treatment, not a means of change. Therefore, unity with the patient is a fundamental factor during the therapy. Unifying with the patient can help him and gives the sense of follow-up by the therapist [16]. Also, the therapeutic alliance and its process help the patient to be aware of the thoughts and feelings outside her awareness in order to develop a sense of mastery and adaptive life. This therapy is a dialogue and involves the review of current and past experiences, reactions and feelings of the patient [25]. In the middle stages of treatment, understanding and protecting the patient can help him as a corrective emotional experience, after which the goals are specifically addressed. The ending phase will begin almost as long as the patient feels that he is able to resolve the present situation, which does not happen in patients at the same sessions. Through the overall process of treatment for all three phases, if the referral or patient is evaluated as the candidate for supportive treatment in the initial sessions, the transition is as follows: positive transfer: no comment and no negotiation. Negative: should be resolve (directly). Candidate for analytical therapy: We ask for the meaning of the present state. Although formal termination is not included in dynamic-supportive therapy, but the treatment ends when the goals are achieved (it may be ended due to external factors, such as displacement or another event of life). In summary, treatment is organized as an organized set of courses, including initiation, middle stages, and an ending [16]. In pharmacotherapy, according to the psychiatrist, it has been tried to use drugs that have less obesity complications. The results of pre-test and post-test of groups were analyzed by SPSS 18 software using one-variable covariance analysis. First, Kolmogorov-Smirnov test was used to test the normal distribution of data. Covariance analysis was used to observe the assumptions, one way ANOVA was used to assess homogeneity of the three groups in the base line, and Levene's Test was employed homogeneity variances.

30 diabetic patients were studied in this research. Of these, 10 patients were randomly assigned in the experimental group (1) (dynamic-supportive therapy), 10 patients in the experimental group (2) (pharmacotherapy) and 10 subjects were assigned in the control group. The age range of participants was between 45 and 60 years. Of these, 36.66% were in the age range of 45-50, 40% in the range of 51-55 and 23.33% in the age range of 56-60. The number of men and women was almost equal (16 women and 14 men). Before intervention, three groups showed almost equal depression scores in the pre-test, however, after intervention, the mean depression score of two experimental groups compared with the control group reduced and no significant change was observed in the control group. In this regard, in the experimental groups, there was a significant difference between the dynamic-supportive therapy and control groups (p≤0.01) and pharmacotherapy with the control group (p≤0.01). However, there was no significant difference between two therapy groups (dynamic-supportive therapy and pharmacotherapy) to reduce depression (p≤0.226). However, comparing the effect of these two treatments suggests that dynamic-supportive therapy with an effect size of 0.52 compared with the pharmacotherapy (0.48) has a slightly higher effectiveness (Table 1).

According to the results of dynamic-supportive therapy and pharmacotherapy, both owed a significant difference in comparison with the control group and was effective in improving depressed patients, which is consistent with the results of other relevant research [18, 19, 20, 21, 22].

Follow-up studies to measure long-term effects of treatment are suggested.

All the disturbing variables could not be controlled, which is one of the limitations of this study.

In type 2 diabetic patients, who have to use drug to control their diabetes, dynamic-supportive treatment can be an appropriate alternative to decrease depression instead of pharmacotherapy.

We are grateful to all patients who participated and helped us as the subjects in this study.

None declared.

None declared.

This article was not funded by any organization.

TABLES and CHARTS

Show attach file


CITIATION LINKS

[1]Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311-21.
[2]King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414-31.
[3]Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.
[4]Diabetes Research Center. Diabetes and depression. Endocrinology and Metabolism Research Institute of Medical Sciences. Tehran: Vis Pre; 2011. [Persian]
[5]Kessing LV, Nilsson FM, Siersma V, Andersen PK. No increased risk of developing depression in diabetes compared to other chronic illness. Diabetes Res Clin Pract. 2003;62(2):113-21.
[6]Afshar M, Isaac Hosseini M. What is diabetes?. 6th.Ed. Kashan: Morsal; 2008. [Persian]
[7]Turner J, Kelly B. Emotional dimensions of chronic disease. West J Med. 2000;172(2):124-8.
[8]Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069-78.
[9]Steele TE, Finkelstein SH, Finkelstein FO. Marital discord, sexual problems, and depression. J Nerv Ment Dis. 1976;162(4):225-37.
[10]Katon WJ. The comorbidity of diabetes mellitus and depression. Am J Med. 2008;121(11 Suppl 2):S8-15.
[11]Li C, Ford ES, Zhao G, Ahluwalia IB, Pearson WS, Mokdad AH. Prevalence and correlates of undiagnosed depression among U.S. adults with diabetes: the behavioral risk factor surveillance system, 2006. Diabetes Res Clin Pract. 2009;83(2):268-79.
[12]Sarshar N, Chamanzari H. Diabetes complications in patients referred to Gonabad Diabetes Clinic. Horiz Med Sci. 2003;9(1):62-9. [Persian]
[13]Unknown author. Epidemiology of Diabetes. Diabetes and depression, atrocious cycle. 2001;21(9).
[14]Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000;23(7):934-42.
[15]Allen F, Fisher M, Phipps N. The correlation between depression and diabetes. US Pharma. 2014;39(10):12-15.
[16]Winston A, Rosenthal RN, Pinsker H. Learning supportive psychotherapy: an illustrated guide. Arlington: American Psychiatric Pub; 2012.
[17]Crown S. Supportive psychotherapy: a contradiction in terms. Br J Psychiatry. 1988;152:855-7.
[18]Markowitz SM, Gonzalez JS, Wilkinson JL, Safren SA. A review of treating depression in diabetes: emerging findings. Psychosomatics. 2011;52(1):1-18.
[19]Petrak F, Baumeister H, Skinner TC, Brown A, Holt RIG. Depression and diabetes: treatment and health-care delivery. Lancet Diabetes Endocrinol. 2015;3(6):472-85.
[20]Ucok K, Acay A, Coskun KS, Alpaslan AH, Coban NF, Akkan G, et al. Evaluation anxiety, depression, and health-related quality of life in male and female patients with newly diagnosed type 2 diabetes. Bullet Clin Psychoph. 2015;25(1):169-70.
[21]Kiadaliri AA, Najafi B, Mirmalek-Sani M. Quality of life in people with diabetes: a systematic review of studies in Iran. J Diabetes Metab Disord. 2013;12(1):54.
[22]Khodabakhshi Koolaee A, Navidian A, Baiati Z, Rahmatizadeh M. Effectiveness of supportive psychotherapy on quality of life in patients with type2 diabetes. J Diabetes Nurs. 2015;3(3):31-41. [Persian]
[23]Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-43.
[24]Sahebi A, Asghari MJ, Salari RS. Validation of Depression Anxiety and Stress Scale (DASS-21) for an Iranian Population. J Dev Psychol. 2005;1(4):36-54. [Persian]
[25]Misch DA. Basic strategies of dynamic supportive therapy. J Psychother Pract Res. 2000;9(4):173-89.