The incidence and mediating links between adverse psychosocial and lifestyle behaviours, in Pre-Diabetes, and post diagnosis of Type 2 Diabetes Mellitus: a lifespan continuum perspective

The aim of the current thesis is to understand the relationships and prevalence of adverse psychosocial and lifestyle constructs of people with Pre-Diabetes, by comparing to those with existing Type 2 Diabetes and those with no health problems. The study will also explore the lived experiences of those with Pre-Diabetes, attempting to gamer a greater understanding of their lives leading up to, and after their diagnosis, in an attempt to illuminate the mediating relationships between mental health and poor lifestyle. This thesis incorporates three studies. Study one Study one was a cross-sectional survey, which compared a healthy control group (N=1,IIO), extracted from an existing population data set (The Northern Ireland Health and Social Wellbeing Survey, 2001) (NIHSWS) with patients diagnosed with Pre-Diabetes (N=127) and Type 2 Diabetes Mellitus (N=216) (both recruited from the Western Health and Social Care Trust), on a number of psychosocial, behavioural and lifestyle variables. Results indicated that both clinical groups, that is, the Pre- Diabetes and the Type 2 Diabetes participants, had significantly higher levels of psychological morbidity, alcohol consumption, perceived obesity, reduced activity levels, but with non-significant (nevertheless moderate) levels of social support, when compared to a healthy population control group. Of note, both clinical groups indicated lower social economic status (SES) overall. SES in both clinical groups was determined on the basis of having a higher incidence of being on state benefits, less educational qualifications and higher likelihood of being unemployed. When both clinical groups were compared to each other, they displayed a similar profile overall, with no significant differences found on any of variables highlighted above (as determined by a post hoc least significant differences (LSD) test). Secondary data analysis attempted to understand why both clinical groups had such significantly raised levels of psychological morbidity, by carrying out two linear regression analyses. These indicated that psychological morbidity in the Pre-Diabetes group (R=.445, R2=.198), and the Type 2 Diabetes group (R=.450 , R2= .202), were linear functions of the same three (of six) variables, namely social support, age and being on state benefits. The study concluded by highlighting that whilst the continuum of raised psychological morbidity in both Pre-Diabetes and Type 2 Diabetes was a significant and noteworthy finding, psychological morbidity was not a discrete measure of depression. Hence, a future recommendation was to explore the incidence and prevalence of, not only depression in both clinical groups. but also emotional overeating, as an additional negative coping mechanism, before (thereby increasing the risk of Type 2 Diabetes onset), and after a diagnosis of Type 2 Diabetes (thereby increasing the risk of Diabetes related complications). Therefore, the weaknesses of Study one led to the design of Study two. As the previous population healthy control group, extracted from the NIHSWB (2001) survey, did not measure depression, nor emotional overeating, control group comparisons could not be made with Pre-Diabetes and Type 2 Diabetes groups. Therefore, it was established that a new survey was required, where all three groups, that is, Pre-Diabetes, Type 2 Diabetes, and a new healthy control group would measure the incidence of depression and emotional overeating. Study two Study two was also a cross-sectional survey design, which gathered a new healthy control group (N=151). and compared these participants to those diagnosed with Pre-Diabetes (N=127) and Type 2 Diabetes (N=162) on measures relating to depression and emotional overeating. The study found that both the Pre-Diabetes, and the Type 2 Diabetes groups had significantly higher levels of depression (OR 6.3 respectively) and emotional overeating (OR 1.8 & 1.5 respectively), when compared to a healthy control group. When both clinical groups were compared to each other, using a post hoc LSD tests, no differences were noted between the Pre-Diabetes and the Type 2 Diabetes groups on depression and emotional overeating. These findings suggest that poor mental health (depression) with associated poor coping mechanisms (emotional overeating) may be operating on a continuum, before, in the Pre• Diabetes state, as well as after a diagnosis of Type 2 Diabetes, and not necessarily as a result of the burden of the condition. The risk of having a higher prevalence of depression and emotional overeating in the Pre-Diabetes state are that these factors may accelerate the onset of Type 2 Diabetes, if not treated appropriately. The study ends with highlighting the lack of knowledge which exists regarding how and when these adverse psychosocial and associated poor coping mechanisms develop in the years preceding the onset of Pre• Diabetes. Hence, the design of Study three was born, which considered the need to explore the potential mediating factors, from a lifespan perspective, in those with Pre• Diabetes only. Study three Study 3 was a qualitative inquiry, aiming to understand the lifeworlds of those with Pre• Diabetes, from a lifespan perspective, in an attempt to understand and unravel the ~ antecedents which may have led to the onset of their condition. Study three reached data saturation by interviewing eight participants diagnosed with Pre-Diabetes. Using Interpretive Phenomenological Analysis (IPA), the findings indicate that people with Pre- Diabetes were, not only, receiving inadequate support and information at the time of their diagnosis of Pre- Diabetes, but they were also not aware that they may be able to prevent the onset of Type 2 Diabetes, which resulted in them requesting more professional input and support. Furthermore, participants with Pre- Diabetes shared their lived experiences by disclosing a lifespan of social hardship, with early life adversities influencing the onset of depression (in some cases chronic depression), anxiety or chronic stress, a reduced self-efficacy, and a general lack of care for one's health and general lifestyle, using ineffective coping mechanisms, across their lifespan. Other themes suggest that all of the above early and current life adversities contribute to poor diet, binge eating as a coping mechanism, and lack of exercise; all of which are not conducive to preventing the onset of Type 2 Diabetes. The study ends with integrating the findings to the existing literature. Conclusion In general, the findings from all three studies, support the application of bio-psychosocial theory, as well as the life-course model, and the 'allostatic load model of stress', to assist in the development of a revised understanding of the epidemiology of Pre-Diabetes, which leads to the development of Type 2 Diabetes. Each study presents its own limitations and future recommendations. The thesis ends with a summary conclusion, highlighting the clinical and health care policy implications, in particular psychosocial factors such as depression and emotional overeating, which may need to be considered within current Diabetes Prevention programmes. Furthermore, social • inequalities in early life are also acknowledged as having an affect on long-term health. Whilst childhood obesity policies are already targeting this, the fundamental outcome may also positively influence the long-term fight against the Diabetes epidemic.EThOS - Electronic Theses Online ServiceGBUnited Kingdo