Anxiety, Depression, and Common Chronic Diseases, and Their Association With Social Determinants in Saudi Primary Care

Introduction: Patients with chronic diseases can experience psychological conditions, including anxiety and depression. However, the association between chronic diseases and these psychological conditions remains unclear. This study aimed to identify the relationship between anxiety, depression, and common chronic diseases (hypertension, type 2 diabetes, dyslipidemia, and rheumatoid arthritis), and their association with social determinants at an outpatient primary care setting. Methods: The validated hospital anxiety and depression scale was administered electronically to eligible participants. For each condition (anxiety and depression), participants were categorized as normal, borderline abnormal, and abnormal, according to their score out of 21 (≤7 = normal, 8-10 = borderline abnormal, ≥11 = abnormal). The scores and numbers of participants in each category were analyzed and compared with their demographic characteristics and chronic diseases for associations and relationships. Results: We recruited 271 participants (mean age of 51.65 + 11.71 years) attending primary care clinics. Of these patients, 17.7% and 8.9% had borderline abnormal and abnormal depression, respectively, and 10.3% and 8.9% of patients had borderline abnormal anxiety and abnormal anxiety. Common social determinants and lifestyle factors were examined. Age, gender, and sugary drinks’ consumption significantly increased the odds of hypertension and type 2 diabetes; vigorous physical activity 3 times a week, decreased the odds of developing these chronic diseases. Adjusted regression models showed a statistically significant association between the hospital anxiety and depression scale score for borderline and abnormal anxiety and the presence of type 2 diabetes (OR 3.04 [95% CI 1.13, 8.19], P-value = .03 and OR 4.65 [95% CI 1.63,13.22], P-value <.03, respectively) and dyslipidemia (OR 5.93 [95% CI 1.54, 22.86], P-value = .01, and OR 4.70 [95% CI 0.78, 28.35], P-value = .09, respectively). The odds of developing depression were 4 times higher ( P-value .04) in patients with rheumatoid arthritis. Conclusion: Among patients attending primary care outpatient clinics, anxiety, and depression were significantly associated with type 2 diabetes and rheumatoid arthritis, respectively. Social determinants and lifestyle factors play a major role in the development of common chronic diseases in Saudi Arabia. Primary care physicians should consider the patients’ psychological status, sociodemographic status, and lifestyle risks during the management of chronic diseases.

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Sleep Characteristics in Diabetic Patients Depending on the Occurrence of Neuropathic Pain and Related Factors

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17218125 ◽

2020 ◽

Vol 17 (21) ◽

pp. 8125

Author(s):

Cristina Naranjo ◽

María Dueñas ◽

Carlos Barrera ◽

Guillermo Moratalla ◽

Inmaculada Failde

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Neuropathic Pain ◽

Sleep Quality ◽

Depression Scale ◽

Anxiety And Depression ◽

Diabetic Patients ◽

The Relationship

This study aims to compare the sleep characteristics (structure and quality) in patients with type-2 diabetes mellitus with and without diabetic neuropathic pain (DNP), and to investigate the relationship of sensory phenotypes, anxiety, and depression with sleep quality in DNP patients. A cross-sectional study was performed in patients with type-2 diabetes mellitus and neuropathy. Patients were classified into two groups—with or without neuropathic pain—according to the “Douleur Neuropathique-4 (DN4)” scale. Sleep characteristics and quality (Medical Outcomes Study—MOS-sleep), pain phenotype (Neuropathic Pain Symptom Inventory—NPSI), mood status (Hospital Anxiety and Depression scale—HADS), pain intensity (Visual Analogue Scale—VAS), and quality of life (SF-12v2) were measured. The sample included 130 patients (65 with DNP). The mean scores in all the dimensions of the MOS-sleep scale were higher (more disturbances) in the DNP patients. Higher scores in anxiety or depression, greater intensity of pain or a higher score in the paroxysmal pain phenotype were associated with lower sleep quality in DNP patients. A shorter duration of the diabetes and lower levels of glycated hemoglobin were also associated with lower sleep quality. The results show the relationship between DNP and sleep quality, and the importance of assessing sensory phenotypes and mental comorbidities in these patients. Taking these factors into consideration, to adopt a multimodal approach is necessary to achieve better clinical results.

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Prevalence of the Effects of Anxiety and Depression on People with Type 2 Diabetes Mellitus: An Analysis of Health Policy Studies in Improving the Quality of Life of Poor Families in the Urban Areas of West Lombok, Indonesia

Current Diabetes Reviews ◽

10.2174/1573399816666200802183738 ◽

2020 ◽

Vol 16 (9) ◽

pp. 1002-1010

Author(s):

Chairun Nasirin ◽

Andries Lionardo

Keyword(s):

Type 2 Diabetes ◽

Chronic Diseases ◽

Urban Areas ◽

Economic Conditions ◽

Anxiety And Depression ◽

Diabetic Patients ◽

Health Examination ◽

Number Of Patients ◽

The Government

Background: To explore the tendency of the effects of anxiety and depression that occur in type 2 diabetes patients, especially poor patients who live in the urban areas with poor economic conditions, who do not have health access from the government, and live away from the hospitals. Methods: It is a cross-sectional study which aimed to determine the number of patients who experienced anxiety and depression problems due to the declining health conditions caused by diabetes. A sample size of 98 diabetics experiencing anxiety and depression when the treatment was carried out was included. The study design included a qualitative study with in-depth interviews with respondents who were at risk of diabetes, as well as to determine the level of anxiety and depression that occurred when medical care was provided and the feelings experienced by the respondents after the completion of treatment. Results: Diabetic patients are generally unaware that their illness is a chronic disease that takes a long time to treat. When the patients are sick, most of them do not immediately go to the hospital or a specialist to get their health examination and treatment, because the hospital is far from the patients’ residence. Furthermore, some patients still use traditional medicine and non-medical treatment, so when the patients with critical conditions are taken to the hospital, they already have chronic diabetes. Conclusions: The lack of access to health for chronic patients with poor economic conditions who live far from the hospitals and the scarcity of medical staff to carry out treatment of chronic diseases such as diabetes for poor patients in urban areas certainly have an impact on increasing the number of patients with chronic diseases. Therefore, the government is expected to be able to provide easy health policies to remote rural communities in order to achieve optimal community welfare and health.

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Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial (Preprint)

10.2196/preprints.7692 ◽

2017 ◽

Author(s):

Shinyi Wu ◽

Kathleen Ell ◽

Haomiao Jin ◽

Irene Vidyanti ◽

Chih-Ping Chou ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Usual Care ◽

Diabetes Care ◽

Functional Disability ◽

Safety Net ◽

P Value ◽

Depression Care ◽

Care Model

BACKGROUND Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. OBJECTIVE The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. METHODS DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. RESULTS DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). CONCLUSIONS Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality.

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Itch in Adult Population with Type 2 Diabetes Mellitus: Clinical Profile, Pathogenesis and Disease-Related Burden in a Cross-Sectional Study

Biology ◽

10.3390/biology10121332 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1332

Author(s):

Aleksandra A. Stefaniak ◽

Piotr K. Krajewski ◽

Dorota Bednarska-Chabowska ◽

Marek Bolanowski ◽

Grzegorz Mazur ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Rating Scale ◽

Adult Population ◽

Depression Scale ◽

Adult Patients ◽

Anxiety And Depression ◽

Altered Glucose

Background: Despite growing interest in itch, data regarding itch in type 2 diabetes mellitus (DM2) are still limited, and mostly based on outdated studies. This study aimed to evaluate the clinical characteristics of itch in the adult population with DM2 and explore potential underlying causes. Methods: The study group consisted of 109 adult patients with DM2. Standardized questionnaires were completed in order to assess the itch intensity [Numerical Rating Scale (three days, 24hours) (NRS)] and the Four-item Itch Questionnaire (4IIQ) and to assess the psychological impact of itch [ItchyQoL, Six-Item Stigmatization Scale (6-ISS), Hospital Anxiety and Depression Scale (HADS)]. Skin dryness was evaluated clinically and by non-invasive assessment of epidermis moisturizing. Neuropathy was assessed using the clinical Katzenwadel neuropathy scale. Results: Itch occurred in 35.8% of adult patients with DM2, with NRSmax three days 6.31 ± 2.16 and 8.1 ± 3.5 points in 4IIQ. Itchy patients have had significantly higher FPG levels compared with the non-itchy population (p = 0.01). Patients with itch had a significantly higher possibility of neuropathy compared with non-itchy subjects (p < 0.01). Skin xerosis was significantly more advanced in patients with itch compared to those without (p < 0.01). The mean ItchyQol score was assessed as 41.2 ± 13.4 points, indicating mild life quality impairment and correlated positively with itch intensity. Itchy subjects had significantly higher scores in both anxiety and depression dimensions of HADS (in each p < 0.01). Conclusions: We suggest that the primary cause of itch is prolonged poor diabetes control with altered glucose and insulin levels, subsequently causing skin dryness and neuropathy in long-lasting DM2.

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Prevalence and Impact of Anxiety and Depression on Type 2 Diabetes in Tunisian Patients over Sixty Years Old

Depression Research and Treatment ◽

10.1155/2013/341782 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Jawaher Masmoudi ◽

Rahma Damak ◽

Hela Zouari ◽

Uta Ouali ◽

Anouar Mechri ◽

...

Keyword(s):

Type 2 Diabetes ◽

Depressive Disorders ◽

Depression Scale ◽

Anxiety And Depression ◽

Diabetic Patients ◽

Good Glycemic Control ◽

Tunisian Patients ◽

Control Versus ◽

The Impact

Objectives. To estimate the prevalence of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) in a population aged over sixty years with type 2 diabetes and to study the impact of anxiety and depression on glycemic balance and disease outcome.Results. The prevalence of anxiety and depression in the 62 subjects included in the study was, respectively, 40.3% and 22.6%. We found a relationship between these disorders and complicated diabetes. The subjects having an imperfectly balanced diabetes had a higher average anxiety score than those having a good glycemic control ( versus ; ). No relationship was found between diabetes balance and depression.Conclusion. Association between anxiety and depressive disorders and diabetes is frequent and worsens patients’ outcome, in terms of diabetes imbalance as well as in terms of diabetic complications. Our study shows that there is need for physicians to detect, confirm, and treat anxiety and depressive disorders in elderly diabetic patients.

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Determinants of Glycemic Control among Urban Patients with Type 2 Diabetes: A mediation analysis from real-world evidence

10.21203/rs.2.23586/v1 ◽

2020 ◽

Author(s):

Rubén Silva-Tinoco ◽

Teresa Cuatecontzi-Xochitiotzi ◽

Viridiana De la Torre-Saldaña ◽

Enrique León-García ◽

Javier Serna-Alvarado ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Primary Care ◽

Socioeconomic Status ◽

Low Income ◽

Self Care ◽

P Value ◽

Diabetes Knowledge ◽

Care Behavior

Abstract Background Evidence suggests there is a relationship between determinants of health and worse diabetes outcomes, especially among individuals with low socioeconomic status and education level. Few studies have shown the relationship between diabetes knowledge, self-care behaviors, and clinical outcomes in low-income urban populations. This study aimed to explore the determinants of glycemic control (GC) in a low-income urban population and to provide insight into the pathways of the effect of diabetes knowledge on GC. Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (PwD) from 28 primary care outpatient centers located in Mexico City. Using the multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses used linear regression models, where the significance of indirect effects was calculated with bootstrapping. Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, -0.029).The association between diabetes knowledge and GC was lost after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p -value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity ( p -value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income PwD, with an emphasis on the benefits physical activity has on improving GC.

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Emotional-volitional disorders in patients with type 2 diabetes mellitus, concomitant arterial hypertension and diabetic polyneuropathy

Problems of Endocrinology ◽

10.14341/probl201056420-22 ◽

2010 ◽

Vol 56 (4) ◽

pp. 20-22

Author(s):

M M Petrova ◽

O B Kurumchina ◽

E A Pronina

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Anxiety Disorders ◽

Arterial Hypertension ◽

Depression Scale ◽

Diabetic Polyneuropathy ◽

Anxiety And Depression ◽

Clinically Significant

The objective of the present work was to evaluate effects of type 2 diabetes mellitus (DM2) combined with arterial hypertension (AH) and diabetic polyneuropathy (DPN) on the development of alterations in the emotional-volitional sphere. The work was comprised of two prospective studies; one of them (study 1) included 140 women presenting with DM2, the other (study 2) enrolled 80 patients with DM2 hospitalized at the Endocrinological Department of N.S. Karpovich City Clinical Hospital No 6, Krasnoyarsk. Disturbances in the emotional-volitional sphere were evaluated based on the hospital anxiety and depression scale (HADS). Their frequency proved to be as high as 67.9 and 70.7% in studies 1 and 2 respectively. The number of anxiety disorders was on the whole greater than that of depressive ones. The latter disorders in patients with AH occurred twice as often as in DM2 patients without AH (50.5 and 25.9% respectively). The frequency of anxiety disorders was not significantly different in the two groups, but they were found to be more severe in patients presenting with combination of DM2 and AH. It is concluded that DM2 is associated with frequent clinically significant anxiety and depressive symptoms depending on the duration of the disease and insulinotherapy. Patients presenting with a combination of DM2 and AH or DPN suffer significantly more pronounced anxiety and depression disordered.

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Self-reported adherence to foot care in type 2 diabetes patients: do illness representations and distress matter?

Primary Health Care Research & Development ◽

10.1017/s1463423618000531 ◽

2018 ◽

Vol 20 ◽

Cited By ~ 1

Author(s):

M. Graça Pereira ◽

Susana Pedras ◽

Gabriela Ferreira

Keyword(s):

Type 2 Diabetes ◽

Depressive Symptoms ◽

Illness Perception ◽

Self Care ◽

Depression Scale ◽

Illness Representations ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Foot Care

AbstractAimThis study examined the differences and the predictive role of clinical variables, illness representations, anxiety, and depression symptoms, on self-reported foot care adherence, in patients recently diagnosed with type 2 diabetes mellitus (T2DM) and assessed no longer than a year after the diagnosis (T1) and four months later (T2).BackgroundThe high rate of diabetes worldwide is one of the major public health challenges. Foot care is the behavior least performed by patients although regular foot care could prevent complications such as diabetic foot and amputation. Psychosocial processes such as illness representations and distress symptoms may contribute to explain adherence to foot self-care behaviors.MethodsThis is a longitudinal study with two assessment moments. The sample included 271 patients, who answered the Revised Summary of Diabetes Self-Care Activities, Brief-Illness Perception Questionnaire, and Hospital Anxiety and Depression Scale.FindingsPatients reported better foot care adherence at T2. Having a higher duration of T2DM and the perception of more consequences of diabetes were associated with better self-reported foot care adherence, at T1. At T2, the predictors were lower levels of HbA1c, better self-reported foot care adherence at T1, higher comprehension about T2DM, as well as fewer depressive symptoms. Interventions to promote adherence to foot care should have in consideration these variables. The results of the present study may help health professionals in designing interventions that early detect depressive symptoms and address illness beliefs, in order to promote foot self-care behaviors reducing the incidence of future complications.

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Sex differences in survival of patients with type 2 diabetes in primary care (ZODIAC-50)

BMJ Open ◽

10.1136/bmjopen-2017-015870 ◽

2017 ◽

Vol 7 (10) ◽

pp. e015870 ◽

Cited By ~ 3

Author(s):

Steven H Hendriks ◽

Kornelis J J van Hateren ◽

Klaas H Groenier ◽

Gijs W D Landman ◽

Angela H E M Maas ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Sex Differences ◽

Survival Rate ◽

Relative Survival ◽

P Value ◽

Relative Survival Rate ◽

Men And Women ◽

History Of

ObjectiveTo investigate sex differences in survival of primary care treated patients with type 2 diabetes (T2D) in the Netherlands.SettingPrimary care.ParticipantsA total of 1815 patients who participated in a prospective observational cohort study (Zwolle Outpatient Diabetes Project Integrating Available Care (ZODIAC)) were included of which 56% was female. Inclusion took place in 1998, 1999 and 2001. Vital status was assessed in 2013.Main outcome measureRelative survival of men and women with T2D. The relative survival rate was expressed as the ratio of observed survival of patients divided by the survival of the general population in the Netherlands with comparable age.ResultsAfter 14 years, 888 (49%) patients had died. The relative survival rate was 0.88 (0.81–0.94) for men and 0.82 (0.76–0.87) for women with T2D after 14 years (p value for difference between sexes=0.169). In patients without a history of cardiovascular diseases (CVD), the relative survival was 0.99 (0.94–1.05) in men and 0.92 (0.87–0.97) in women (p value for difference between sexes=0.046).ConclusionsThe survival of men and women with T2D was 12% and 18% lower, respectively, after 14 years of follow-up compared with men and women in the general population. This corresponds to a decrease in median survival of 2.2 and 3.5 years in men and women, respectively. Only for patients with T2D without a history of CVD, a significantly lower relative survival in women compared with men with T2D was found.

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