Adjuvant Psychological Therapy in Long-term Endocrine Conditions

J. Daniels; J. M. Turner-Cobb

Disclosures

Clin Endocrinol. 2017;86(6):772-777. 

In This Article

Abstract and Introduction

Abstract

Consideration of psychological distress in long-term endocrine conditions is of vital importance given the prevalence of anxiety and depression in such disorders. Poor mental health can lead to compromised self-care, higher utilization of health services, lower rates of adherence, reduced quality of life and ultimately poorer outcomes. Adjuvant psychological therapy offers an effective resource to reduce distress in endocrine conditions. While the vast majority of work in this area has focused on psychological screening and intervention in diabetes, identification and recognition of psychological distress are equally important in other endocrinological conditions, with supportive evidence in polycystic ovary syndrome and Addison's disease. Referral pathways and recommendations set out by UK guidelines and the Department of Health mandate requires greater attention across a wider range of long-term endocrine conditions to facilitate improved quality of life and health outcome.

Introduction

Psychological distress in response to significant health problems is not only common but "normal" and understandable: the disruption to life trajectories and impact on every domain of life makes adjustment difficult. Signs of compromised psychological well-being within the medical setting often include behavioural changes such as ineffective self-management, poor attendance to medical appointments and reduced treatment adherence.[1] In clinic, the distressed patient may present as tearful, withdrawn, low in mood, with reductions in sleep and appetite; they may appear anxious/panicky, excessively worried and frequently seeking reassurance or a combination of these and other symptoms (see Box 1 ). For those most affected, normal day-to-day activities will become a challenge and enjoyment of life will be much reduced, yet many will present to the clinic with a "brave" face. Distress is not always immediately evident but can be revealed with a gentle and general line of enquiry: "…and how have things been?" – an important question that should be asked of all of our patients.

Psychological distress has been detected in up to 81% of endocrine conditions, with around half representing low mood and a third anxiety related.[2] Prevalence of health-related anxiety has been reported as particularly high in endocrine patients compared to the general population,[3] which is unsurprising given the potentially life-threatening nature of many endocrine conditions and the importance of hypervigilance to bodily changes and health status.

The reciprocal relationship between physical and mental health is well documented: poor mental health leads to compromised self-care, higher utilization of health services, lower rates of adherence, reduced quality of life and ultimately poorer outcomes.[1] Thus, long-term conditions (LTCs) complicated by psychological distress require additional consideration. A recent report by the Kings Fund Centre for Mental Health[1] suggests that 12–18% of expenditure associated with LTCs in the UK is linked to poor mental health and well-being; integrated physical and mental health care would undoubtedly better meet the needs of patients and support the UK National Health Service (NHS) to meet the Quality, Innovation, Production and Prevention (QIPP) challenge as recommended. From the patient or clinician perspective, psychological and emotional well-being in LTCs have been a growing priority in recent years, with a particular focus on increasing self-management in the community and high quality care for all, including a holistic view of health and mental health.[1,4]

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