title: Psychological outcomes of patients with screen-detected type 2 diabetes: the influence of time since diagnosis and treatment intensity.
abstract: OBJECTIVE
  The objective of this study was to investigate how time since diagnosis and treatment intensity influence psychological outcomes in patients with screen-detected type 2 diabetes.
  
  
  METHODS
  A 2 x 2 factorial cross-sectional design was used to examine psychological outcomes in 196 patients with screen-detected diabetes diagnosed 3-33 months previously who were receiving usual care or intensive multifactorial pharmacological treatment. Outcomes included anxiety, depression, diabetes-related distress, perceived seriousness and vulnerability, self-efficacy, and self-care. Multivariate analysis was used to examine variations in outcomes based on time since diagnosis (<1 vs. 2-3 years) and treatment intensity.
  
  
  RESULTS
  Most patients reported little distress, low perceived seriousness and vulnerability, high self-efficacy, and low self-care, but outcomes varied considerably across conditions. Time effects were found for perceived vulnerability, which increases significantly with time since diagnosis. Time x treatment interactions were found for anxiety, diabetes-related distress, and self-efficacy; notably, intensively treated patients showed more distress and less self-efficacy in the 1st year, and usual-care patients reported more distress and less self-efficacy 2-3 years after diagnosis.
  
  
  CONCLUSIONS
  Screen-detected patients generally do not experience much difficulty with their condition in the first few years, but early and intensive treatment can influence patients' psychological outcomes, leading to relatively more anxiety and less self-efficacy in the 1st year after diagnosis but not necessarily improving self-care. This suggests that intensive treatments confront patients with their diabetes earlier on whereas milder treatments may delay confrontation. This finding should be taken into account in the development and timing of psychological interventions for patients with newly diagnosed diabetes.
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, Netherlands. b.j.thoolen@fss.uu.nl
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Thoolen
authors.forename: Denise T
authors.initials: DT
authors.lastname: de Ridder
authors.forename: Jozien M
authors.initials: JM
authors.lastname: Bensing
authors.forename: Kees J
authors.initials: KJ
authors.lastname: Gorter
authors.forename: Guy E
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012648:Self Care; D013997:Time Factors; D016896:Treatment Outcome