‘The chicken and egg thing’: Cognitive representations and self-management of multimorbidity in people with diabetes and depression

Abstract

Objective: Diabetes with depression is common and can lead to poorer outcomes in both conditions. The existing literature has demonstrated that patients’ single condition representations inform self-management, but less is known about the composition and impact of multimorbid representations. This study aimed to explore accounts of multimorbidity with a focus on the content of cognitive representations and reported management of diabetes and depression.

Design: Semi-structured qualitative interviews were carried out with 17 people with diabetes and depression. Data were audio-taped, transcribed and analysed using an inductive thematic analysis and elements of grounded theory.

Results: The nature of multimorbid representations varied and some participants, in particular those who prioritised other conditions, described diabetes and depression as unrelated and managed each separately. Others saw interactions between conditions, often in terms of causation, and described how diabetes and depression management could be either integrated or conflicting. Problems taking multiple-medications were frequently described, but participants differed in the confidence with which they described representations of multimorbidity.

Conclusion: People hold multimorbid representations that appear to impact on their preferred self-management. An awareness of patients’ understanding of multimorbidity could have implications for the provision of care and intervention design in this population.

Keywords:

• multimorbidity
• diabetes mellitus
• depression
• illness representations
• self-management
• qualitative research

Acknowledgements

We wish to acknowledge colleagues at the National Institute of Health Research (NIHR) School for Primary Care Research at the University of Manchester working within the broader multimorbidity theme. Recruitment was supported by the local NIHR Primary Care Research. Felicity Bishop conducted this study as part of an NIHR Research Training Fellowship. Jennifer Mc Sharry's post at the time of this project was supported by an Arthritis Research UK Fellowship (18099).