Psychiatric morbidity among diabetic patients: A hospital-based study.

BACKGROUND: The relationship between glucose metabolism and psychiatric illness is under the focus of clinicians for centuries. Depending on the definition used, the prevalence of depression among diabetics ranges from 8.5% to 32.5%, while that for anxiety disorders it is up to 30%. AIMS AND
OBJECTIVES: To assess the prevalence of psychiatric morbidity among diabetic patients using standardized rating scales for depression and anxiety.
MATERIALS AND METHODS: One hundred diagnosed patients of diabetes were assessed on the Hamilton rating scale for depression and the Hamilton rating scale for anxiety, who were attending the diabetic clinic. They were assessed on sociodemographic profile, duration of illness, type of treatment, and oral vs insulin, and then the data were analyzed on different domains.
RESULTS: About 84% of the patients had comorbid depression. Females showed a high percentage of depression and anxiety, and the severity level was also higher in the females. Genital symptoms were usually reported by the males, while somatic symptoms were more prevalent in the females.

Anxiety and depressive disorders belong to the most common psychiatric disorders worldwide, and they usually occur to individuals who suffer from chronic disease, such as diabetes mellitus (DM), a disease spreading quickly throughout the world, and often coexist with anxiety and depression. The prevalence of psychiatric morbidity among insulin-dependant patients is 18%, and consists of depression, anxiety, and attendant symptoms.[1] It has been estimated that people with DM are twice as likely as the general population to suffer from depression, with the risk higher in women than in men.

About 80% of the diabetic patients with major depression have a high rate of recurrent depressive episodes within the following 5 years.[23] Both depression and diabetes are known to activate the hypothalamic adreno–cortical axis and, thus, depression may enhance the risk of depression through increased sympatho–adrenal system activity or a dysregulation of the hypothalamic–pituitary axis.[4] Adolescents suffering from DM and depression have a higher incidence of suicidal ideations.[5]

AIM

The aim of this study was to assess the prevalence of anxiety and depression in the diabetics using standardized rating scales of anxiety and depression.

MATERIALS AND METHODS

One hundred diagnosed patients of diabetics were assessed, after taking their informed consent, on the Hamilton rating scale for depression (HDRS) and the Hamilton rating scale for anxiety (HARS). They were assessed on sociodemographic profile, duration of illness, and type of treatment, whether oral hypoglycemic drugs or injectable insulin, and the data were analyzed on different domains.

Inclusion criteria

Patients above the age of 20 years at the time of study.

Patients of both the sexes were taken

Patient having diagnosis of diabetes.

Patients with absence of diagnosis of depression/anxiety before the diagnosis of DM.

Exclusion criteria

Associated drug and alcohol dependence.

Presence of any serious organic illness.

Any other major psychiatric illness, like Schizophrenia and mental retardation.

Patients with severe cognitive impairment.

Patient already on any psychotropic drug.

Any past history of psychiatric disorder.

DISCUSSION

Table 1 shows the sociodemographic profile, indicating that most of the men and women are above the age of 50 years and are educated up to matriculation.

Table 1

Sociodemographic variables

Table 2 shows that overall 84% of the patients with diabetes had comorbid depression. Many studies have proven that there is a high incidence of depression in diabetics.[467] On HDRS, males showed a higher percentage in the mild depression category (27.27%) as compared with females (14.29%), while moderate to severe depression was found to be more prevalent in females (71.43%) as compared with males (54.55%).{Table 2}

Table 2

Hamilton depression rating scale

Table 3 shows the common symptoms found in patients with diabetes and depressed mood, anxiety, gastrointestinal symptoms, and genital symptoms such as loss of libido and erectile dysfunction on the symptom check list of HDRS. Genital symptoms are usually reported by males (79.5%) than by females (28.57%), which is consistent with the findings of Sorren Buus,[8] in which significantly more men than women reported sexual dysfunction.

Table 3

Comparative distribution of positive rating on the symptom checklist of HDRS between males and females

In Table 4, on HARS, male showed a higher percentage in mild anxiety symptoms (81.8%) as compared with females (66.7%), whereas a moderate to severe level of anxiety symptoms is two-times higher in females (39.25%) as compared with males (18.18%). These findings are consistent with the surveys performed by many researchers,[9-12] in which women presented three-times higher percentages of anxiety in comparison with men.

Table 4

Hamilton anxiety rating scale

Table 5 shows that on the symptoms checklist of HARS, anxious moods is mostly reported by females (8035%) than by males (45.45%). This is inconsistent with the findings of surveys of Lloyd and Ali[1314] in which women exhibit three-times higher anxiety symptoms than males.

Table 5

Comparative distribution of positive rating on the symptom checklist of HARS between males and females

Table 6 A and B show that while calculating the impact of treatment in diabetics (oral vs injectable) on the psychopathology of the patients, in both depression and anxiety, there was no significant difference, (t=0.515, P>0.05) and (t=0.118, P>0.05), in both the depression and the anxiety rating scales, respectively. This shows that the mode of treatment (oral vs injectable) has nothing to do with the symptoms of anxiety and depression in diabetic patients. But, the literature reported a significant difference. This may be due to cultural differences and the available social support.

Table 6

Treatment method of diabetes and HDRS and HARS scores

CONCLUSION

In conclusion, the present study showed that individuals with DM are more prone to comorbid disorders like depression and anxiety, with females having a two-fold greater risk than males. The presence of staff specialties in psychiatric-mental health at diabetic clinics should be a positive step toward the recognition and treatment of emotional disorders. In this way, patients suffering from manifestations of anxiety and depression symptoms could be identified and given care. This can lead to beneficial results in supporting patients with DM by health professionals.