The illness-disease dynamic: psychological wellbeing in type 2 diabetes: an interpretative phenomenological analysis

Type 2 diabetes is a common and increasing health problem. The prevalence of diabetes in England is anticipated to reach 5.9% by 2020 (Yorkshire & Humber Public Health Observatory, 2008). People with diabetes are up to twice as likely to develop depression as those without the condition (Ali, Stone, Peters, Davies, & Khunti, 2006; Anderson, Freedland, Clouse, & Lustman, 2001). Approximately 10% meet the criteria for comorbid major depression (Ali et al., 2006; Anderson et al., 2001) yet only half of people with diabetes and major depression are recognised as depressed (Katon et al., 2004). Cross-sectional studies have found a prevalence of 5-15% for subthreshold depression (elevated depressive symptoms that do not meet DSM-5 criteria for major depression) in the general population (primary care) (Kessler, Zhao, Blazer, & Swartz, 1997; Rucci, Gherardi, & Tansella, 2003). In people with diabetes the prevalence of subthreshold depression is estimated at 17-20% (Ali et al., 2006; Anderson et al., 2001). In a Dutch study of patients with diabetes and moderate to severe anxiety or depression, only 20-30% of them were recorded as having any emotional problems by their diabetes nurses (Pouwer, Beekamn, & Snoek, 2006). Many factors contribute to under-recognition of depressive symptoms, with detection further complicated in patients with comorbid physical health problems (Prince, Patel, Saxena, Maj, Maselko, Phillips, & Rahman, 2007). Social and self-stigma are prevalent (Sherwood, Salkovskis, & Rimes, 2007) and are associated with reluctance to seek professional help (Barney, Griffiths, Jorm, & Christensen, 2006; Corrigan & Watson, 2002). Lustman and Clouse (2004) suggest that depression can also be regarded as an inevitable consequence of chronic illness by both patient and practitioner, and this might become a basis for not requesting or providing treatment (Lustman & Clouse, 2004). Addressing this under-recognition, and promoting help-seeking behaviour before depressive illness develops, requires a multifaceted approach. Two approaches identified as potentially beneficial are (a) mass media campaigns that stress that it is possible to prevent the onset of depressive disorders and (b) utilising the Internet as a stigma-reducing platform for depression, enabling targeting of tailored interventions for subgroups such as those with specific medical conditions (Cuijpers, van Straten, Warmerdam, & van Rooy, 2010). Online psychological support can be cost-effective and time-efficient (Christensen, Griffiths, & Jorm, 2004; Spek, Cujipers, NyklAycek, Riper, Keyzer, & Pop, 2010). Helping patients with subthreshold depression to better understand depression and recognise its early signs might also assist in long-term reduction in unmet need for treatment (Wells, Sherbourne, & Duan, 2005). The purpose of the present study, which was conducted as part of my PhD research, was to develop an Internet platform for people with Type 2 diabetes to promote psychological wellbeing. To facilitate the design of a platform that would engage patients and promote emotional literacy, I undertook a qualitative interview study to tap into their lived experience (Husserl, 1970). The aim of this qualitative study was to investigate the psychological symptoms experienced by adults with Type 2 diabetes, with special attention to the relationships patients made between physiological changes and psychological distress and the vocabulary used by patients to describe their distress.MethodsInterpretative Phenomenological Analysis (IPA)Interpretative Phenomenological Analysis (IPA) is an experiential qualitative approach with a strong idiographic focus. Its theoretical roots lie in European phenomenological philosophy and hermeneutics. Its ontological foundation directs attention to the world as it is lived, represented by the phenomenological phrase "Lifeworld. " The analytical principles of IPA as a distinct research methodology were first developed by Jonathan Smith (Smith, 1996a). …