title: Psychological effects of prevention: do participants of a type 2 diabetes prevention program experience increased mental distress?
abstract: OBJECTIVE
  To evaluate the mental health outcome of a lifestyle intervention for the prevention of type 2 diabetes and to exclude possible harmful psychological effects.
  
  
  BACKGROUND
  There is little empirical data on potential harmful effects of prevention programs. However, information, education, diagnostic procedures, phenotyping and risk assessment may cause or intensify psychological distress such as anxiety, depression or somatization in vulnerable individuals.
  
  
  METHODS
  The Tuebingen Lifestyle Intervention Program (TULIP) for the prevention of type 2 diabetes has assessed mental health outcome in the participants after 9 months of program participation using the Symptom Checklist-90-R (SCL-90-R). The 24-months lifestyle intervention TULIP comprises regular exercise and changes in nutrition and assesses both, a broad range of somatic parameters as well as psychometric variables. For an interim analysis of psychological outcome, complete data sets of the SCL-90-R assessed at baseline and after 9 months of intervention were available for 195 participants (125 females, 70 males; age: 46.1 +/- 10.6 years). Data on somatization, anxiety, depression and overall psychological distress were compared to baseline levels.
  
  
  RESULTS
  SCL-90-R scores of the TULIP-participants did not significantly differ from the German healthy reference population. Compared to baseline, a significant decrease in SCL-90-R scores was found for anxiety, depression and overall psychological distress at re-assessment after 9 months.
  
  
  CONCLUSIONS
  The interim analysis on mental health outcome of a type 2 diabetes prevention program comprising extensive phenotyping and risk assessment rules out adverse psychological effects, suggesting rather beneficial changes concerning symptoms of anxiety, depression and overall psychological distress.
authors.affiliation: Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Germany. katrin.giel@med.uni-tuebingen.de
authors.forename: Katrin E
authors.initials: KE
authors.lastname: Giel
authors.forename: Paul
authors.initials: P
authors.lastname: Enck
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.forename: Markus
authors.initials: M
authors.lastname: Schrauth
authors.forename: Anna
authors.initials: A
authors.lastname: Bury
authors.forename: Marjo
authors.initials: M
authors.lastname: Graf
authors.forename: Sabine
authors.initials: S
authors.lastname: Kümmerle
authors.forename: Martina
authors.initials: M
authors.lastname: Guthoff
authors.forename: Norbert
authors.initials: N
authors.lastname: Stefan
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Häring
authors.forename: Andreas
authors.initials: A
authors.lastname: Fritsche
mesh_terms: D000328:Adult; D003863:Depression / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000523:psychology* / Q000534:rehabilitation; D005858:Germany; D018149:Glucose Intolerance / Q000517:prevention & control / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D008019:Life Style; D008603:Mental Health; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D010353:Patient Education as Topic; D018570:Risk Assessment; D013315:Stress, Psychological / Q000209:etiology*