By RACHEAL NINSIIMA
KAMPALA – Dr Dickens Akena, a Senior Lecturer at the Makerere University School of Medicine, Department of Psychiatry is rooting for the development of peer support programs to support treatment adherence for patients with diabetes who also have depression. This follows research he conducted in 2019 to determine the acceptability of providing peer support to patients with diabetes who are newly diagnosed with depression. It is titled; ‘The development and tailoring of a peer support program for patients with diabetes mellitus and depression in a primary health care setting in Central Uganda.’
According to Dr Akena, up to 40% of patients with diabetes suffer from depressive disorders during the course of their illness which further complicates treatment.
Moreover, the low levels of mental health literacy and high stigma levels remain significant barriers to treatment uptake and adherence to medications used in treating diabetes. Yet, depressed patients need to adhere to prescribed treatment in order for them to achieve symptom reduction and attain social functionality.
“This study showed that a peer support program is an acceptable means of delivering assisted care to support treatment adherence and management, especially in settings where there are severe staff shortages and psycho-education may not be routinely delivered,” he explained.
The peer support model
For the study, all patients with diabetes who were aged 18 and above and attended the Diabetes Mellitus clinic of Nsambya Hospital, were recruited. The clinic has over 1500 registered patients with an average of 40-60 patients receiving care daily. The patients were then screened for depression and those with major depression started on antidepressant treatment. Later, some of the treated patients, who were in clinical remission (recovered), volunteered to be a peer support partner to patients who were newly diagnosed with depression.
Study participants reported that for one to be a peer-support partner, he or she needed to be elderly, consistently attend clinic appointments and free from any active mental or substance abuse disorder. Ten people met this criterion and were trained to offer support.
Peer support sessions were scheduled on days patients returned to the clinic for review and each lasted an hour. They were delivered by one peer to five participants.
“These sessions involved peer partners talking to patients about the fact that Diabetes is a chronic medical condition for which treatment is to be taken for a long time (sometimes for life),” Dr Akena said.
The sessions involved dispelling myths about Diabetes using myth cards, a set of 16 educational materials consisting of pictures and text about the cause, complication and treatment options of the disease. The peer support model allowed patients with diabetes who were diagnosed with depression to express worry and anxiety so that these can be adequately dealt with by healthcare workers. Furthermore, it allowed patients to frequently refer to their success rate in adhering to their treatment regimen in order to promote their self-efficacy and confidence.
Participants described the intervention as valuable.
“When I was suffering from depression, my life was terrible. No one understood me and I felt indescribable pain. Things only changed after telling my support partner. We need to share this experience with others who have the same problem and tell them that if they take their medicine well and stop worrying, then all will be fine,” said a 45 old participant quoted in the study.
Another, a 55-year-old male said that peer support should be an ongoing process as along as one is still accessing care because, ‘these problems really never go away.’
Diabetes is a global health pandemic that currently affects more than 463 million people according to the International Diabetes Federation. It is expected that by the year 2045, 700 million people will be living with diabetes. Up to 40% of these will eventually develop depression. However, depression is rarely identified and inadequately treated among patients with diabetes in low resourced Sub-Saharan Africa. Staff shortages make it difficult for one to screen for, diagnose, initiate on treatment and provide psycho-education to individuals with depression.
“This study indicates that peer support interventions are strategically poised to improve treatment uptake and adherence. However, more work will be needed to examine the long-term impact of the intervention on treatment outcomes,” Dr Akena emphasized.
The study was supported by NURTURE Research Training and Mentoring Program for Career Development at Makerere University’s College of Health Sciences (D43TW010132).