every stage from being able to set more realistic goals, to an increased ability to recover from a lapse. By implication, shame is likely to interfere with self-regulation. has consistently been associated with depression (Andrews et al., 2002; Cheung et al., 2004). As noted above, both are promoted by similar attribution styles. One longitudinal study highlighted shame-related schemas as being predictive of severity of depression nine years later, suggesting that a belief about oneself that evokes shame may pre-date depression (Halvorsen et al., 2010). Therefore, as well as shame having a potentially direct effect on condition self-management as noted above, it may also be that depressive affect mediates the relationship between shame and self-care. For example, shame-related depressive affect might decrease motivation and produce problems with memory. It might also increase risk of hyperglycaemia through the physiological effects of stress (Diabetes.co.uk, Diabetes Digital Media ltd, 2014). For those who are already prone to experiencing shame, adjusting to diabetes self-management may be a perfect storm, inducing shame related affect and cognitions, which in turn enhances negative affect and reduces, both directly and indirectly the chances of engaging in condition self-management. Summary Consistent self-care is vital to maintaining good health and quality of life for people with diabetes, as well as avoiding life-limiting conditions. The emerging adult years are important for laying down the foundations for lifelong management. Independent diabetes self-care can be challenging for young people. Evidence suggests depression impacts on diabetes self-care, but research into why this might be, or what might influence this is lacking. Shame is a complex emotional and cognitive experience that has been consistently linked with depression, and may arise in young
Cheung, M., Gilbert, P., & Irons, C. (2004). An exploration of shame, social rank and rumination in relation to depression. Personality and Individual Differences, 36(5), 1143-1153. Coopersmith, S. (1967). The antecedents of self-esteem. . San Francisco: Freeman. de Wit, M., Delemarre-van de Waal, H. A., Bokma, J. A., Haasnoot, K., Houdijk, M. C., Gemke, R. J., & Snoek, F. J. (2008). Monitoring and discussing health-related quality of life in adolescents with type 1 diabetes improve psychosocial well-being: A randomized controlled trial. Diabetes Care, 31(8), 1521-1526. doi:10.2337/dc08-0394 Diabetes.co.uk, Diabetes Digital Media ltd. (2014a). Diabetes and stress. Retrieved from http://www.diabetes.co.uk/diabetes-destress.html Diabetes.co.uk, Diabetes Digital ltd. (2014b). Guide to HbA1c. Retrieved from Fritz, M. S., & Mackinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18(3), 233-239. doi:PSCI1882 [pii] Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self‐criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353-379.
The majority of studies gave no particular comment on, overall, whether the groups showed high or low self-esteem, and no standardised cut off points were set by Rosenberg (1965). However one can assume that the healthy controls provide a norm, and if the disease groups do not differ significantly from these (as the majority did not) they could be considered to have average self-esteem. This does assume that the healthy group was a representative sample, however, and in many studies these population came from a single school, so this may not be the case. The one study that found a lower average self-esteem in the adolescents with diabetes (Seigel et al., 1990) did report that across all disease groups 79% of participants were classified as having low esteem, compared to only 19% of healthy controls. None of the studies reviewed specifically recruited participants who suffered with depression, and thus no comparisons of those with clinically significant depression and those without were made. Instead, self-esteem means were averaged across groups and these Means formed the basis of the comparison. The implications of this will be discussed further in the Discussion section of this review.
Study N Sample % male Mean age % white SES Severity Seigal (1990) Healthy 100 LC No data- states groups did not differ significantly in gender, age or race Mainly low N/A Asthma 40 OC Mainly low Recently severe* Sickle Cell Disease 20 OC Mainly low Recently severe* Diabetes 20 OC Mainly low Recently severe* Jacobson (1984) Healthy 62 LS 42 14 no data 68% High SES N/A Diabetes 271 I***& SC 49.8 14 no data 24% High SES IIDM* Hauser (1979) Healthy 53 +n no data 35.8 13-14 no data mainly middle class N/A Diabetes 163 SC/C 50.3 13 no data mainly middle class no data Sullivan (1978) Healthy 100 LS 0 13.8 no data middle class N/A Diabetes 105 SC 0 13.7 no data no data
Table 4: Self-esteem in other chronic disease groups, as compared to those with diabetes. Reference Comparison group Comparison group Mean and (SD) Diabetic groups mean SE Measure Result Effect size Seigel (1990) Sickle cell 75% low† 80% low† RSES No sig difference N/A Asthma 80% low† 80% low† RSES No sig difference N/A Zashikina et al (2013) asthma 31.36 (4.16) 32.04 (4.31) RSES No sig difference d= -0.160 epilepsy 29.71 (2.95) 32.04 (4.31) RSES D group sig higher * d= -0.630 asthma 56.13 (26.46) 69.04 (33.29) ITIA D sig higher* d= -0.429 epilepsy 42.6 (23) 69.04 (33.29) ITIA D sig higher ** d= -0.924 Kellerman et al (1980) Oncology 31.4 (4.3) 30.4 (5.2) RSES No sig difference d= + 0.21 Cardiology 29.9 (3.9 30.4 (5.2) RSES No sig difference d= -0.109 Cystic Fibrosis 30.9 (3.8) 30.4 (5.2) RSES No sig difference d= + 0.110 Nephrology 32.4 (2.8) 30.4 (5.2) RSES No sig difference d= +0.479 Rheumatology 30.4 (5.1) 30.4 (5.2) RSES No sig difference d= 0 Oncology (Leukemia) 2.82 (0.92) 2.27 (1.16) RSES No sig difference d= - 0.525 Torok et al (2006) Oncology 27.19 (3.65) 28.61 (4.26) RSES No sig difference d= - 0.358
Note:*p<0.05; **p<0.001:, +comparison group had higher self-esteem;- diabetic group had higher self-esteem; †mean not given, reported as percentages of group who fell into low self-esteem category.
5 The effect of Interventions on self-esteem level Study N I Pre-test Mean (SD) Post-test Mean (SD) Result. Follow-up Result used TG CG TG CG CG- TG post T and C TG Mean(SD) CG Mean (SD) TG TG (1988) 14 GD b measured and included in analysis but not reported 18.71† 18.29† N/A N/A Borderline sig 20.57 (SD: 4.07) not reported N/A sig (1990) 6 OB CSEI. 83 (4) 75 (3) N/A N/A N/A N/A N/A 7-11 months: 84 (5) 76 (3) not sig N/A de wit et al (2008 & 2010) 81 Q &D 74.84 (10.43) 75.97 79.94 (10.44) 75.97 (8.71) TG sig TG sig higher ** 73.72 (12.77) N/A N/A sig lower* Torok 97 SC RSES 28.61 NC 30.20 (4.50) NC NC Post-test Sig higher *** NC 2 months: 29.20 (4.52) no control N/A N/A Note: N: Total number of participants in treatment group (and control if applicable), I: Intervention; GD: Group Discussion; OB: Outward bound course; Q & D: questionnaire and discussion; TG: treatment group; CG: control group; NC: No Control group;* P=0.06**p<0.05; ***p<0.01; † adjusted mean taking into account pre -treatment scores.
Discussion Groups – Process Account People – Oral Presentation of Clinical Activity and integrating strengths and values based models with clients and teams Year III Assessments assessment title Major Research Project Empirical Paper Shame, depression and self-care in emerging adults with type 1 diabetes Personal and Professional Learning – Final Reflective Account On becoming a clinical psychologist: A retrospective, developmental, reflective account of the experience of training Case report 5 - People with Learning Disabilities An integrative exploratory case report of a woman in her 20's with a learning disability and complex trauma history.