Diyabetik ve Non-diyabetik Kişilerde Sosyo-Demografik ve Klinik Faktörlerin Depresyon ve Anksiyete Düzeyleri ile İlişkisi

Year 2017, , 96 - 105, 06.07.2017

Fatma Yeşim Adakan , Ramazan Vural , Şerife Mehtap Boylubay Üstün Yılmaz Burak Kulaksızoğlu Bayram Yeşil Yasin Şahintürk Aysun Ünal

https://doi.org/10.18521/ktd.289610

Cited By: 1

Abstract

Amaç: Diyabetik ve non-diyabetik kişilerde anksiyete ve
depresyon prevalansının sosyo-demografik ve klinik risk faktörleri ile ilişkili
olarak belirlenmesi

Yöntemler: Bu kesitsel ankete dayalı çalışmaya toplam 217 tip 2
diabet hastası (ortalama (SS) yaş: 53.7(8.1) yıl, %56.7’si kadın) ve non-diyabetik
100 sağlıklı kontrol (ortalama (SS) yaş: 36.9(10.6) yıl, %67.0’si kadın) dahil
edildi. Hastane Anksiyete ve Depresyon Ölçeği (HADS) için anksiyete (HADS-A) ve
depresyon (HADS-D) alt ölçek skorları sosyo-demografik ve diyabete ilişkin
özellikler bağlamında diyabetik ve non-diyabetik hastalarda, değerlendirildi.

Bulgular: Sınırda veya anormal anksiyete ve depresyon
prevalansları açısından diyabetik (sırasıyla %42.4 ve %35.5) ve non-diyabetik
(sırasıyla %49.0 ve %39.0) gruplar arasında anlamlı bir farklılık saptanmadı. Diyabetik
grupta, kadın cinsiyeti (sırasıyla, p<0.001 ve p=0.009) ve düşük gelir
düzeyi (sırasıyla, p=0.035 ve p=0.025) daha yüksek HADS-A ve HADS-D skorları
ile ilişkili bulundu. Kontrol grubunda HADS-A ve HADS-D skorları gençlerde daha
yüksekti (<45 yaş, her biri için p=0.008). Diyabetik hastalarda ≥1 diyabetik
komplikasyon varlığında anlamlı şekilde daha yüksek bulunan HADS-A skorları
(p=0.009) dışında, HADS skorlarında hastalık özelliklerine göre anlamlı bir farklılık
saptanmadı.

Sonuç: Sonuç olarak, bulgularımız diyabet hastalarında diyabete
ilişkin faktörlerden ziyade sosyo-demografik faktörlerin anksiyete ve depresyon
üzerine etkin değişkenler olduğunu ve bu bağlamda diyabet hastaları ve kontrol
olguları arasında depresyon ve anksiyete düzeyleri açısından bir farklılık
olmadığını göstermektedir. 

Keywords

Anksiyete, depresyon, diyabetik komplikasyonlar, Hastane Anksiyete ve Depresyon Ölçeği, sosyo-demografik

The Relation of Socio-Demographic and Clinical Factors to Depression and Anxiety Levels in Diabetic Patients

Abstract

Objective: To determine the
prevalence of anxiety and depression in diabetic versus non-diabetic persons in
relation to socio-demographic and clinical risk factors

Methods: A total of 217 patients
with type 2 diabetes mellitus (mean(SD) age: 53.7(8.1) years, 56.7% were
females) and 100 age-matched non-diabetic control subjects (mean(SD) age:
36.9(10.6) years, 67.0% were females) were included in this cross-sectional
questionnaire based survey. Hospital Anxiety and Depression Scale (HADS)
subscale scores for anxiety (HADS-A) and depression (HADS-D) were evaluated in
diabetic patients in comparison to non-diabetics as well as in relation to
socio-demographic and diabetes related characteristics.

Results: Similar prevalence of  anxiety and depression was noted in diabetic
(42.4% and 35.5%, respectively) and non-diabetic (49.0% and 39%, respectively)
groups. In the diabetic group, female gender (p<0.001 and p=0.009,
respectively) and low income status (p=0.035 and p=0.025, respectively) were
associated with higher scores for both HADS-A and HADS-D, while in the control
group, both HADS-A and HADS-D scores were significantly higher in the younger
age (<45 years, p=0.008 for each). Apart from significantly higher scores
for HADS-A in diabetic patients in case of ≥1 diabetic complications (p=0.009),
no significant difference in HADS scores was noted with respect to disease
characteristics.

Conclusion:  Our findings revealed socio-demographic
rather than diabetes related factors to be important correlates of anxiety and
depression among patients with diabetes and thereby no difference between
diabetics and controls in terms of depression and anxiety levels. 

Keywords

Anxiety, depression, diabetic complications, Hospital Anxiety and Depression Scale, socio-demographic

References

• 1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14.
• 2. International Diabetes Federation (IDF). The Global Burden. [Online] February 2014;6. URL: http://www.idf.org/diabetesatlas/5e/the-globalburden.
• 3. Satman I, Yilmaz T, Sengul A, et al., The TURDEP Group. Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care 2002;25:1551-6.
• 4. Satman I, Omer B, Tutuncu Y, et al., TURDEP-II Study Group. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28:169-80.
• 5. Koç EM, Başer DA, Özkara A ve ark. Diyabet Tanısıyla İzlenen Hastalarda Yaşam Kalitesi ve İlişkili Faktörlerin İncelenmesi: Türkiye İçin Bir Pilot Çalışma. Konuralp Tıp Dergisi, 2015, 2015.2: 76-82.
• 6. Khuwaja AK, Lalani S, Dhanani R, Azam IS, Rafique G, White F. Anxiety and depression among outpatients with type 2 diabetes: a multi-centre study of prevalence and associated factors. Diabetol Metab Syndr 2010;2:72.
• 7. Collins MM, Corcoran P, Perry IJ. Anxiety and depression symptoms in patients with diabetes. Diabet Med 2009;26:153-61.
• 8. Nichols l, Barton PL, Glazner J, McCollum M. Diabetes, minor depression and health care utilization and expenditures: a retrospective database study. Cost Eff Resour Alloc 2007;5:4.
• 9. Khowaja LA, Khuwaja AK, Cosgrove P: Cost of diabetes care in out-patient clinics of Karachi, Pakistan. BMC Health Serv Res 2007; 21:189.
• 10. Lin EH, Rutter CM, Katon W, et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care 2010;33:264-69.
• 11. van Dijk SE, Pols AD, Adriaanse MC, et al. Cost-effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: design of a cluster-randomized controlled trial. BMC Psychiatry 2013;13:128.
• 12. Pouwer F. Should we screen for emotional distress in type 2 diabetes mellitus? Nat Rev Endocrinol 2009;5:665-71.
• 13. Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000;160:3278-85.
• 14. Gonzalez JS, Safren SA, Cagliero E, et al. Depression, self-care, and medication adherence in type 2 diabetes: relationship across the full range of symptom severity. Diabetes Care 2007;30:2222-7.
• 15. Mikaliūkštienė A, Žagminas K, Juozulynas A, et al. Prevalence and determinants of anxiety and depression symptoms in patients with type 2 diabetes in Lithuania. Med Sci Monit 2014;20:182-90.
• 16. Lustman PJ, Griffith LS, Clouse RE. Depression in adults with diabetes. Results of 5-yr follow-up study. Diabetes Care 1988;11:605-12.
• 17. Twist K, Stahl D, Amiel SA, Thomas S, Winkley K, Ismail K. Comparison of depressive symptoms in type 2 diabetes using a two-stage survey design. Psychosom Med 2013;75:791-7.
• 18. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983;67:361-70.
• 19. Aydemir O. Validity and reliability of Turkish version of Hospital Anxiety and Depression Scale. Turkish J Psychiatry 1997;8: 280-7.
• 20. Ganasegeran K1, Renganathan P, Manaf RA, Al-Dubai SA. Factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia: a descriptive cross-sectional single-centre study. BMJ Open 2014;4:e004794.
• 21. Chapman Z, Shuttleworth CM, Huber JW. High levels of anxiety and depression in diabetic patients with Charcot foot. J Foot Ankle Res 2014;21;7:22.
• 22. Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006;23:1165-73.
• 23. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001;24:1069-78.
• 24. Masmoudi J1, Damak R, Zouari H, et al. Prevalence and impact of anxiety and depression on Type 2 diabetes in Tunisian patients over sixty years old. Depress Res Treat 2013;2013:341782.
• 25. Bouwman V, Adriaanse MC, van ‘t Riet E, Snoek FJ, Dekker JM, Nijpels G. Depression, anxiety and glucose metabolism in the general Dutch population: the new Hoorn study. PloS One 2010;5:e9971.
• 26. Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care 2002;25:464-70.
• 27. Fettahoglu EC, Koparan C, Ozatalay E, Turkkahraman D. The psychological difficulties in children and adolescents with insulin dependent diabetes mellitus. Psych in Türkiye 2007;9:32-6.
• 28. Gulseren L, Hekimsoy Z, Gulseren S, Bodur Z, Kultur S. Depression-anxiety, quality of life and disability in patients with diabetes mellitus. Turkish J Psych 2001;12:89-98.
• 29. Lin EH, Korff MV, Alonso J. Mental disorders among persons with diabetes results from the World Mental Health Surveys. J Psychosom Res 2008,65:571-80.
• 30. Aarts S, van den Akker M, van Boxtel MP Jolles J, Winkens B, Metsemakers JF. Diabetes mellitus type II as a risk factor for depression: a lower than expected risk in a general practice setting. Eur J Epidemiol 2009;24:641-8.
• 31. Tuncay T, Musabak I, Gok DE, Kutlu M. The relationship between anxiety, coping strategies and characteristics of patients with diabetes. Health Qual Life Outcomes 2008;6:79.
• 32. Stein DJ, Gureje O. Depression and anxiety in the developing world: is it time to medicalize their suffering. Lancet 2004;364:233-4.
• 33. Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systemic review. BMJ 2004;328:794.
• 34. Khuwaja AK, Kadir MM. Gender differences and clustering patterns of behavioral risk factors for chronic non-communicable diseases: community-based study from a developing country. Chronic Illn 2010;6:163-70.
• 35. Engum A, Mykletun A, Midthjell K, Holen A, Dahl AA. Depression and diabetes: a large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes. Diabetes Care 2005;28:1904-9.
• 36. Rajala U, Keinanen-Kiukaanniemi S, Kivela SL. Non-insulin-dependent diabetes mellitus and depression in a middleaged Finnish population. Soc Psychiatry Psychiatr Epidemiol 1997;32:363-7.
• 37. Fisher L, Chesla CA, Mullan JT, Skaff MM, Kanter RA. Contributors to depression in Latino and European-American patients with type 2 diabetes. Diabetes Care 2001;24:1751-7.
• 38. Lustman PJ, Anderson RJ, Freedland KE, De Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000;23:934-42.
• 39. Mosaku K, Kolawole B, Mume C, Ikem R. Depression, anxiety and quality of life among diabetic patients: a comparative study. J Natl Med Assoc 2008;100:73-8.
• 40. Lin EH, Heckbert SR, Rutter CM, et al. Depression and increased mortality in diabetes: unexpected causes of death. Ann Fam Med 2009;7:414-21.
• 41. Tellez-Zenteno JF, Cardiel MH. Risk factors associated with depression in patients with type 2 diabetes mellitus. Arch Med Res 2002;33:53-60.
• 42. Jenkins R, Bebbington P, Brugha T, et al. The national psychiatric morbidity surveys of great Britain– strategy and methods. Int Rev Psychiatry 1997,15:5-13.
• 43. Ganatra HA, Zafar SN, Qidwai W, Rozi S. Prevalence and predictors of depression among an elderly population of Pakistan. Aging Ment Health 2008;12:349-56.
• 44. Kaur G, Tee GH, Ariaratnam S, Krishnapillai AS, China K. Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting. BMC Fam Pract 2013;14:69-81
• 45. Tovilla-Zarate C, Juarez-Rojop I, Jimenez YP, et al. Prevalence of anxiety and depression among outpatients with type 2 diabetes in the Mexican population. PLoS ONE 2012;7:e36887
• 46. Bener A, Al-Hamaq AO, Dafeeah EE. High prevalence of depression, anxiety and stress symptoms among diabetes mellitus patients. Open Psychiatry J 2011;5:5-12.
• 47. Almawi W, Tamim H, Al-Sayed N, et al. Association of comorbid depression, anxiety, and stress disorders with type 2 diabetes in Bahrain, a country with a very high prevalence of type 2 diabetes. J Endocrinol Invest 2008;31:1020-4.
• 48. Santos FR, Bernardo V, Gabbay MA, Dib SA, Sigulem D. The impact of knowledge about diabetes, resilience and depression on glycemic control: a cross-sectional study among adolescents and young adults with type 1 diabetes. Diabetol Metab Syndr 2013;5:55.
• 49. Balhara YP, Sagar R. Correlates of anxiety and depression among patients with type 2 diabetes mellitus. Indian J Endocrinol Metab 2011;15(Suppl 1):S50-4.
• 50. Roupa Z, Koulouri A, Sotiropoulou P, et al. Anxiety and depression in patients with type 2 diabetes mellitus, depending on sex and body mass index. Health Sci J 2009;3:32-40.