Abstract
Background: Psychological disorders are common in diabetes mellitus with associated increased adverse disease outcome, economic burden on patient and family and poor quality of life. Psychological well being among T2DM patients has been poorly evaluated in Nigeria.
Objective: The study set out to determine the prevalence and pattern of psychological disorders of Anxiety and Depression as well as evaluate the relationship between psychological well being and diabetes related factors in our diabetic population.
Materials and Methods: This was a prospective study carried out among T2DM patients attending the Endocrine Clinic of OOUTH between September and November 2009 using the GHQ-12 and HADS questionnaires, and patients’ medical records.
Results: One hundred and two patients were evaluated (56 females, 46 males) with mean age of 60.4±9.2years. Females generally scored significantly higher on the GHQ-12 (29.6 vs 9.1 p<0.05), HADS for anxiety (18.5 vs 4.5 p<.05), as well as HADS for depression (25.9 vs 4.5 p<0.05). The commonest comorbidity of diabetes mellitus in the study was hypertension 56.9%, with 68.6% being overweight and obese (BMI>25). Complications commonly observed were retinopathy (19.6%), neuropathy (15.7%), diabetic foot syndrome (11.8%), stroke (9.8%), erectile dysfunction and nephropathy (5.9%). The presence of these (except BMI) increased the prevalence and scores on all the parameters.
Conclusion: The prevalence of psychopathologies of depression and anxiety was high in this study. The presence of complications and co-morbidities contributed positively to the high prevalence. It is recommended that early identification of these conditions and prompt referral for treatment is imperative for improved overall disease outcome.
Keywords: Type 2 diabetes, psycho-morbidity, prevalence, improved-outcome, Nigeria
Résumé
Contexte: Les troubles psychologiques sont fréquents en ce qui concerne le diabète dû à l’excès, accentuent des effets indésirables, la mauvaise qualité de la vie et les problèmes économique sur le patient et sa famille. Le bien-être psychologique parmi les patients atteints de DT2 n’a pas été évalué à Sagamu, au Nigeria.
Objectif: Cette étude visait à déterminer la prévalence et les caractéristiques de troubles psychologiques, l’anxiété et la dépression, et d’évaluer la relation entre bien-être psychologique et les facteurs liés à la maladie parmi les nouveaux sujets présentant DT2.
Matériel et méthodes: Il s’agissait d’une étude prospective des nouveaux patients atteints de DT2 présentant à la clinique endocrinienne de OOUTH entre Juillet et Novembre 2009, en utilisant le GHQ-12, les questionnaires HADS et les dossiers médicaux des patients.
Résultats: Quatre-vingt dix huit (98) patients ont été évalués (54 femmes, 44 hommes) avec un âge moyen de 60,4 ± 9,2 ans. La prévalence globale de la psychopathologie à l’aide du GHQ-12 parmi les participants était aux échelles de 21,6% , 15,7% sur le HADS-D et de 11,8% sur le HADS-A. Les femmes ont de manière significative les hommes au niveau du GHQ-12 (29,6 contre 9,1 p <0,05), HADS-A pour l’anxiété (18,5 contre 4,5 p <0,05), et HADS-D pour la dépression (25,9 contre 4,5 p <0,05). La plus fréquente co-morbidité parmi les sujets était l’hypertension (56,9%), 68,6% d’obésités (IMC> 25). Les complications fréquentes observées étaient la rétinopathie (19,6%), la neuropathie (15,7%), le syndrome du pied diabétique (11,8%) et les accidents cérébrovasculaires (9,8%). LA Présence de la co-morbidité (l’hypertension) et les complications ont augmenté la prévalence et les résultats.
Conclusion: La prévalence des psychopathologies de la dépression et l’anxiété était élevée dans cette étude. La présence de complications et de comorbidités ont accentué la prévalence élevée. L’identification précoce suivie d’un traitement rapide de ces conditions devrait améliorer les résultats globaux de la maladie.
Correspondence: Dr. O Odusan, Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, PMB 2022, Sagamu, Nigeria. E mail: tunsan2001@yahoo.com
References
Alberti KGMM, Aschner P, Assal JP et al: Report of a WHO Consultation Part 1: Diagnosis and Classification of Diabetes Mellitus .WHO: Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications 1999.
National Expert Committee on Non-Communicable Disease (NCD) in Nigeria. Report of National Survey. Ed. Akinkugbe OO; 1997: 64-90.
Ogun SA, Adelowo OO, Familoni OB, Jaiyesimi AEA and Fakoya EAO: Pattern and outcome of medical admissions at Ogun State University Teaching Hospital – a three year review. W.A.M.J 2000; 19: 304-308.
Rubin R.R and Peyrot M.: Quality of life and Diabetes. Diabetes Metab Res Rev. 1999; 15: 205-218
Linda SG, Lustman PJ: Depression in women with Diabetes. Diabetes Spectrum 1997; 10(2): 216-223
Gavard JA, Lustman PJ and Clausse RE: Prevalence of depression in adults with diabetes: an Epidemiological evaluation. Diabetes Care. 1993; 16: 1167-1178.
Marcus M.D; Wing R.R; Guare J; Blair E.H and Jaward A: Lifetime prevalence of Major Depression and its effect on treatment outcome in obese type 2 diabetic patients. Diabetes Care 1992; 15: 253-255.
Lustman PJ, Griffith LS and Clause RE; Recognizing and managing depression in patients with Diabetes. In Practical Psychology for Diabetes Clinicians. Rubin RR, Anderson BJ eds.Va, American Diabetes Association 1996 pgs 143-152.
Lustman PJ, Griffith LS, Clouse RE and Cryer BE: Psychiatric illness in diabetes in relationship to symptoms and glucose control.J.Nerv Ment Dis 1986;174:736-742.
de Groot M and Lustman PJ: Depression among African-Americans with diabetes: A dearth of Studies. Diabetes Care 2001; 24: 407-408.
Famuyiwa OO, Edozien MM and Ukoli CO: Social, Cultural and Economic factors in the management of Diabetes Mellitus in Nigeria. Afr. J. Med and Med Sci 1985; 14: 141-154
Akinlade KS, Ohaeri JU and Suberu MA; The psychological condition of a cohort of Nigerian Diabetes Mellitus subjects in Nigeria. Afri. J. Med and Med Sci. 1996; 25: 61-67.
Lloyd CE, Dyer PH and Barnet AH; Prevalence of symptoms of depression and anxiety in a Diabetes clinic population. Diabetes Med, 2000; Mar 17; 3: 198-202.
Clark CM Jnr, Franklin JE, Hiss RG, Lorenz RA et al: The National Diabetes Education Programme – Changing the way Diabetes is treated; Comprehensive diabetes care. Diabetes Care 2001; 24: 617-618.
Lustman PJ and Harper GW: Non-psychiatric physician’s identification and treatment of Depression in patients with diabetes. Compr. Psychiatry 1987; 28: 22-27.
McCulloh DK, Glasgow RE, Hampson SE and Wagner E: A systematic approach to diabetes management in the post DCCT era. Diabetes Care 1994; 17: 765-769.
Hermann C. International experiences with the Hospital Anxiety and Depression Scale-a review of validation data and clinical results.
J.Psychosomatic Res. 1997; 42: 17-41.
Abiodun OA. A validity study of the Hospital and Depression Scale in general hospital units and a community sample in Nigeria. Brit. J. Psychiatry. 1994; 165 (5): 669-672.
IDF: Worldwide definition of the metabolic syndrome. http://www.idf.org/webcast.
Van Drass DD and Litchy W: Correlates of depression in diabetic adults. Behav. Health Aging. 1990; 1: 79-84.
Ryan J, Anderson BA, Ray E. et al.: The prevalence of co-morbid depression in adults with diabetes. Diabetes Care 2001; 24 (16): 1070-1078.
Sridhar GR; Psychiatry co-morbidity and diabetes. Indian J. Med Research 2007;125:311-320.