Unconscious loss processing in diabetes: associations with medication adherence and quality of care

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Abstract
Recent psychodynamic research hypothesises a connection between diabetes adaptation and the feeling of loss and damage enacted by such a chronic disease. This study aims at exploring the associations between damaged ego-related strategies in persons with diabetes and: 1) age, gender, type and duration of diabetes, and related treatment, 2) depressive symptoms, 3) indicators of adherence and quality of care. A convenience sample of 109 persons (56% female; n = 61 with type 2 diabetes) with a mean age of 56.12 years (SD = 15.30) was enrolled. Participants completed measures of damaged ego-related strategies (empathic identification, mania, frustration, destructiveness) (PET), depression (BDI-II), self-care (SDSCA), medication adherence (Morisky Scale) and quality of care (Score-Q index). Linear multiple stepwise regressions and Pearson’s correlations were performed. Age was negatively associated with empathic identification (β = .317, p < .01) and positively with destructiveness (β = .323, p < .01). Depressive symptoms negatively correlated with empathic identification (r = −.34, p < .01). Moreover, medication adherence was associated with higher empathic identification (r = .22, p < .05) and lower mania (r = −.30, p < .01), while quality of care was negatively associated with destructiveness (r = −.25, p < .05). Overall, a successful loss processing seems promising in lowering depression and non-adherence in persons with diabetes. Specifically, the need for psychological support for older persons is advocated.

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