title: Written emotional disclosure for adults with Type 2 diabetes: a primary care feasibility study.
abstract: OBJECTIVE
  To test the feasibility of written emotional disclosure (WED) for UK primary care patients with Type 2 diabetes.
  
  
  BACKGROUND
  WED holds potential to address depressive symptoms in diabetes, yet its feasibility, and potential benefit, for primary care patients has not been established.
  
  
  METHODS
  Forty-one adults with Type 2 diabetes were randomised to WED (n=23) or neutral writing (n=18). Principal outcomes were feasibility of recruitment, compliance, acceptability and intervention fidelity. Potential benefit was assessed on between-group differences in depressive symptoms (Centre for Epidemiological Studies Depression scale), diabetes distress (Problem Areas in Diabetes scale), diabetes self-management behaviours (Summary of Diabetes Self-care Activities questionnaire) and perceived health status (EQ-5D) at three-month follow-up.
  
  
  RESULTS
  Recruitment was modest (6%), yet an unmet treatment need was identified. Fourteen intervention (61%) and 13(72%) control participants returned their writing, while 12 in each group (89%) then completed all sessions. Intervention fidelity was confirmed. Acceptability to patients was mixed. Exploratory effectiveness analyses suggested that relative to improvement in controls, WED is associated with a potentially clinically important worsening in depressive symptoms (P=0.006) and a non-significant trend for a reduction in healthy dietary behaviour (P=0.057). There was no significant effect on other outcomes. The exploratory nature of the study, however, necessitates that the observed effects are interpreted with caution, and both the feasibility and effectiveness findings may be an artefact of the sample obtained. The evidence for the feasibility of WED in primary care diabetes was hence mixed, and in an unevaluated environment it may cause iatrogenic harm. On balance, WED is apparently not appropriate for use in this context in its current format. At most, further research with a more appropriate sample is required. The feasibility that was demonstrated and the unmet need identified suggest that this may be a worthy endeavour.
authors.affiliation: 1Research Associate,Florence Nightingale School of Nursing and Midwifery,King's College London,London,UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dennick
authors.affiliation: 2Director of Research and Professor of Human Behavioural Science,Department of Sport and Exercise Science,Aberystwyth University,Ceredigion,UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Bridle
authors.affiliation: 3Professor of Behavioural Medicine in Nursing,Florence Nightingale School of Nursing and Midwifery,King's College London,London,UK.
authors.forename: Jackie
authors.initials: J
authors.lastname: Sturt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D030881:Disclosure; D004644:Emotions; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D033262:Narration; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000379:methods*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014956:Writing
keywords: written emotional disclosure