2010, Number 2
Prevalence of symptoms of anxiety and depression in patients with diabetes mellitus type 2 and its association with treatment type, diabetes complications and comorbidities
Fabián SMMG, García SFMC, Cobo AC
Full text
Language: Spanish
References: 40
Page: 100-108
PDF size: 226.08 Kb.
ABSTRACT
Background: Since the year 2000, type 2 diabetes mellitus (DM2) has been the most common cause of death among women, and the second most common cause of death for men in Mexico. In addition, it is also the principal causative factor behind such problems as premature retirement, blindness and renal failure. In Mexico’s National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición) conducted in the year 2006, the prevalence of diabetes in adults confirmed by prior medical diagnosis at the national level was 7.0%, with the rate for women being slightly higher (7.3%) than the rate for men (6.5%). Daily self-care is the cornerstone of DM2 management. Psychosocial factors play an important role in the self-management of patients with DM2. DM2 demands a lot of the patient and his or her relatives in terms of motivation and adaptation. Adaptation problems may occur in response to the diagnosis, but also when the patient is confronted with repeated hypoglycaemic episodes, or when switching to insulin treatment and when complications develop. Psychological comorbidities are prevalent among people with DM2. Adherence to treatment for DM2 can be affected by the presence of symptoms such as anxiety or depression.Objective: To determine the prevalence of symptoms of anxiety and depression in patients with type-2 diabetes mellitus (DM2) and their association with treatment type, complications of diabetes and comorbidities.
Methods: A cross-sectional, epidemiological study in which seven hundred and forty-one adult patients (≥18 years, both sexes) with DM2 (indicated by a physician’s diagnosis or the use of diabetes medication), selected from among the participants in an annual sporting event called the “Walk for the Diabetic Patient,” which is organized at a third-level hospital center in Mexico City, were first asked to fill out a structured questionnaire designed to gather information on their demographic, clinical and epidemiological characteristics, as well as on the presence of symptoms of anxiety and depression. The health personnel involved in organizing the “Walk” had earlier received training in the application of the structured questionnaire that participants in this event are asked to fill out each year. Before the “Walk” began, patients were evaluated by a nutritionist, a cardiologist and a specialist in internal medicine, in order to establish their general physical and metabolic condition, and determine the recommended distance that they could walk during the event. The questionnaire is also structured to provide basic sociodemographic data such as participants’ age and sex, as well as information on such topics as the methods they utilize in treating DM2 (oral medications, current use of insulin, diet, exercise, acupuncture, “naturistic” therapies, homeopathy), behavioral characteristics (current alcohol and tobacco consumption), complications resulting from DM2 (chronic renal disease, chronic ocular disease, chronic neuropathic pain), other comorbidities [dyslipidemias (elevated cholesterol or triglycerides), hypertension, history of cardiovascular disease], and chronic respiratory illnesses [bronchitis, chronic obstructive pulmonary disease (COPD)]. Another important area covered by the questionnaire is the current manifestation of symptoms of anxiety or depression, or the co-occurrence of symptoms of both of these conditions. Pshychological status of participants was evaluated on the basis of two questions: a) “Are you experiencing problems with your pshychological state?”; and, if the response to this question is affirmative, then b) “Is the problem anxiety, depression, or both?” For the present study, only information on symptoms of anxiety and depression was gathered because of the difficulty involved in applying any kind of standardized scale in an attempt to more accurately diagnose cases of depression or anxiety in the patients who come to participate in this sporting event due to time restrictions. Those patients that reported symptoms of anxiety, depression, or both, were referred to appropriate health service facilities where they could be diagnosed and receive treatment. The present study was approved by all relevant institutional committees, and the informed consent of all participants was obtained. Statistical analysis. A bivariate analysis was conducted to evaluate the clinical, epidemiological and treatment characteristics associated with the symptoms of anxiety, depression, and anxiety and depression together. The categorical variables were analyzed on the basis of X2 tests; while the continuous variables were summarized in the form of means and standard deviations, and then compared using the Student T test. Odds ratios and 95% confidence intervals were calculated using non-conditional regression logistics. The reference group for all calculations was made up of those patients (n=459) who reported no symptoms of anxiety or depression. The variables to be introduced into the models were selected in accordance with a p value of ‹ 0.20, or their biological relevance. The analysis was performed using the STATA statistical package version 9.0.
Results:Of the 909 patients with DM2 registered in the annual “Walk for the Diabetic Patient” in the year 2007, 741 agreed to participate in the study (response rate 81.5%). The mean age for these 741 patients was 57.5 (± 13.3) years; and 76.0% (563/741) of them were women. The data on the prevalence of symptoms were as follows: a) anxiety, 8.0%; b) depression, 24.7%; and, c) anxiety with depression, 5.4%. Among 183 DM2 patients with depressive symptoms, 89.6% were women. In this study, depressive symptoms were more common among women than men [33.7% versus 12.2%, p‹ 0.0001, for female and male, respectively]. After adjusting for potential confounding factors, logistic regression analysis revealed that symptoms of anxiety were significantly and positively associated with acupuncture treatment for diabetes [OR =13.8 (95%CI 2.0-93.7), p=0.007], and chronic neuropathic pain [OR =4.0 (95%CI 1.9-8.4), p‹ 0.0001]; that symptoms of depression were significantly and positively associated with female sex [OR =4.1 (95%CI 2.1-7.9), p‹ 0.0001], “naturistic” therapies for diabetes [OR =4.3 (95%CI 1.9-9.6), p‹ 0.0001], chronic ocular disease [OR=2.0 (95%CI 1.3-3.2), p=0.002], and chronic neuropathic pain [OR =2.1 (95%CI 1.4-3.3), p=0.001]; and that the presence of symptoms of anxiety and depression together was associated, also significantly and positively, with “naturistic” therapies for diabetes [OR =8.9 (95%IC 2.3-34.7), p=0.002], a history of cardiovascular disease, hypertension and dyslipidemia [OR =5.0 (95%IC 1.8-13.7), p=0.002], chronic renal disease [OR =3.3 (95%CI 1.3-8.7), p=0.01], and chronic neuropathic pain [OR=5.2 (95%CI 1.9-14.0), p= 0.001].
Conclusion: Our findings show that symptoms of anxiety and depression are more common among those Mexican patients with type 2 diabetes mellitus who suffer complications and comorbidities associated with this disease. These results also show that patients who manifest symptoms of anxiety and depression tend to turn to non-pharmacological therapies more frequently as means of treating this illness.
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