title: What is the relationship between diabetes and depression? a qualitative meta-synthesis of patient experience of co-morbidity.
abstract: OBJECTIVE
  To develop an explanatory framework concerning patient experience of diabetes and depression and the relationship between these disorders; to better understand how interventions and health services should be delivered for this group of patients.
  
  
  METHODS
  The study used meta-synthesis. Published qualitative studies were identified using a structured search, and themes synthesized across studies to develop a new explanatory framework.
  
  
  RESULTS
  Searches of three databases identified 5506 papers, and 22 were included. Diagnosis of diabetes and the impact of symptoms on functioning were associated with varied psychological reactions, not all of which are negative, and the concept of 'depression' only captures aspects of the experience. Similarly, the relationship between diabetes and relationships with professionals and family were variable, with relationships serving as both a buffer of the effects of diabetes and potentially as a cause of further difficulties for patients. Depression and other psychological states were significant barriers to effective coping. Definition of 'self' emerged as a key potential moderator of the relationship between depression and diabetes.
  
  
  CONCLUSIONS
  The variability in psychological reactions to diabetes suggested three key clinical implications, reflecting increasing levels of complexity for practitioners.
authors.affiliation: School of Community Based Medicine, National School for Primary Care Research, Manchester Academic Health Sciences Centre, University of Manchester, UK. Linda.Gask@manchester.ac.uk
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.forename: Wendy
authors.initials: W
authors.lastname: Macdonald
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
mesh_terms: D000223:Adaptation, Psychological; D000884:Anthropology, Cultural; D015897:Comorbidity; D003866:Depressive Disorder / Q000209:etiology* / Q000523:psychology*; D003920:Diabetes Mellitus / Q000523:psychology* / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology; D012649:Self Concept; D012944:Social Support; D013315:Stress, Psychological