what is diapression?

With the concept of diapression, we can begin to improve communication between patients with medical and behavioral symptoms, and their healthcare providers.

• Diapression is not a clinical diagnosis. Rather, it is a term describing the intertwining symptoms of both diabetes and depression (see Ciechanowski P, Clinical Diabetes April 2011 vol. 29 no. 2, pages 43-49).
• Diapression recognizes that patients don’t think or speak the language of checklists and codes healthcare providers use for diagnosis such as "ICD" or "DSM". Also, healthcare providers don’t "live" the day-to-day symptoms and challenges related to having a chronic condition.
• We can achieve a communication 'middle ground' where:
  • the expertise and clinical tasks of the clinician can be better understood and accepted by the patient
  • the lived daily experience of the patient can be better understood and accepted by the clinician
• Patients can teach healthcare providers about their unique daily symptoms and challenges so providers can get a better understanding of the whole patient.
• Healthcare providers can teach patients what is going on when physiology (the way the body works) and psychology (the way emotions and the mind work) come together.
• At a time when patient empowerment and patient-provider collaboration are so important for successful management of chronic health conditions, diapression is a step toward a richer, more meaningful, and more productive clinical conversation.

• If you think you have symptoms of stress, depression or anxiety, please speak to your healthcare provider who can make a diagnosis. You may also read more about each on the National Institutes of Health website (click for link): <Stress> <Depression> <Anxiety>

How medical and behavioral conditions come together.

• Behavioral conditions such as depression, anxiety and reactions to stress may come before or after the onset of a medical condition like diabetes. Sometimes the onset of a behavioral condition may result from the stress of having one or more medical conditions. Ninety percent of individuals with diabetes have at least one other chronic condition. Research also suggests that onset and worsening of medical conditions may be more likely when there are untreated behavioral conditions or symptoms.

• If you think you have symptoms of stress, depression or anxiety, please speak to your healthcare provider who can make a diagnosis. You may also read more about each on the National Institutes of Health website (click for link): <Stress> <Depression> <Anxiety>

Symptoms of medical and behavioral conditions can overlap.

• Symptoms of behavioral conditions such as being tired, sleeping too much, losing one's appetite or experiencing discomfort or pain can mimic symptoms of medical conditions such as diabetes, and associated conditions like heart disease.
• Furthermore, behavioral conditions can "turn up the volume" on the experience of physical symptoms making pain or symptoms such as fatigue worse. Daily function can become impaired.
• Affected individuals may not be aware of the impact of behavioral conditions on their physical symptoms, leading to confusion about why there are more physical symptoms.
• During a healthcare visit, affected individuals may feel bewildered, like giving up, or feel ashamed for not managing their medical condition(s) adequately. Physical examination or laboratory tests may not reflect the level of symptoms being experienced (such as fatigue). These situations may lead to challenges in the healthcare relationship. An open discussion about what factors are leading to increased medical symptoms can help patients and providers reach common ground.

Behavioral conditions can cause difficulties with self-management or with taking treatments for medical conditions.

• Behavioral conditions can cause changes in energy level, motivation, concentration (including memory and ability to organize one's tasks) and ability to effectively communicate with others. Such changes may cause difficulties in carrying out daily tasks related to diabetes and other medical condition management.
• Over time, an affected individual may feel less confident about his or her inability to manage a medical condition such as diabetes. This may happen, even if a person has had the medical condition for a long time and understands what they need to do, e.g. “I know what I am supposed to do and what I am not supposed to do, but I still do the wrong things and I don’t know why.”
• Often, clinicians may also feel discouraged – even if they don’t express it – about the person’s ability to make positive changes in their care. An open discussion about how behavioral symptoms can interfere with daily tasks related to medical care and treatment can help patients and providers reach common ground.

Symptoms of behavioral conditions may reduce the ability of affected individuals to trust others or to be satisfied with the healthcare they receive.

• Individuals with behavioral symptoms may become isolated or have greater difficulty with trust or reaching out to others. Affected individuals may be reluctant to seek support of peers, family or healthcare providers. As a result, the ability to manage medical conditions may suffer.
• Furthermore, affected individuals may be more reluctant to make healthcare appointments, show up for appointments, or seek support from their healthcare providers during healthcare visits.
• These factors can have negative implications for constructive healthcare interactions. An open discussion about how behavioral symptoms can interfere with collaboration and trust can help patients and providers reach common ground.

Behavioral conditions can lead to poorer test or monitoring results of health outcomes (e.g. elevated blood glucose or blood pressure).

• Despite their best efforts, affected individuals may find it harder to get desired results with laboratory values and other measures such as glucose levels, blood pressure, weight, or cholesterol levels.
• Individuals may begin to feel guilty and more unable to manage diabetes and other medical conditions.
• This may have significant implications on the nature of the dialogue around making lifestyle changes or adhering to a recommended treatment.

References