Psychosomatic aspects on diabetes and chronic pain Alexithymia, depression and salivary cortisol The Affect School and Script Analysis Therapy

This thesis explores links between psyche and soma in diabetes and in chronic benign
pain (CBP). Interventions with Affect School and Script Analysis (ASSA) compared to
Basic Body Awareness Therapy (BBAT) are tried.
In a feasibility and treatment efficacy study we offered ASSA to 59 patients with CBP,
and 54 (92%) completed. Alexithymia prevalence went from 33% to 11% (p = 0.013),
depression from 59% to 48% (p = 0.18), and anxiety from 78% to 50% (p = 0.002) in
46 respondents, and social relations improved (p <0.001).
We have established a protocol of a treatment efficacy, multicenter, open-labelled,
randomized controlled trial with two intervention arms, ASSA and BBAT. Inclusion
criteria: T1D or T2D; HbA1c ≥62.5 mmol/mol; psychological symptoms; age 18-59
years; diabetes duration ≥1 year. Exclusion criteria: pregnancy; severe somatic or
psychiatric disorder; cognitive deficiency; inadequate knowledge of Swedish. Primary
outcome measure: depression prevalence. Secondary outcome measures: HbA1c,
midnight salivary cortisol (MSC), alexithymia and anxiety prevalence, self-image
measures, diabetes complications and mortality in 6 year follow up.
In a cross sectional study of 292 T1D patients, associations between high HbA1c and
psychological factors, life style factors and obesity were tried. 80 patients (27%) had
HbA1c >70 mmol/mol, which was associated with depression (AOR 4.8), abdominal
obesity (AOR 4.3), and smoking (AOR 3.0). Alexithymia and anxiety were linked with
depression.
In a cross sectional study of 196 T1D patients, associations between high MSC (≥9.3
nmol/L), depression, HbA1c, and intra individual, behavioural and environmental
factors were explored. 34 patients (17%) had MSC ≥9.3 nmol/L, which was associated
with smoking (AOR 5.5), spring season (AOR 4.3), physical inactivity (AOR 3.9),
depression (AOR 3.1), and older age (AOR 1.08; (per year)). HbA1c >70 mmol/mol
(AOR 4.2) and MSC ≥9.3 nmol/L (AOR 4.4) were independently linked with
depression.
Conclusions are that alexithymia was linked with depression, which in sum was
associated with both high HbA1c and high MSC in T1D patients. ASSA showed
reduced alexithymia, anxiety and depression and improved social relations in CBP
patients. ASSA for selected patients with diabetes will be further evaluated in an RCT.