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      The Relation Between Depressive Symptoms and Self-Care in Patients with Diabetes Mellitus Type 2 in Kosovo

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          Abstract

          Background:

          The depression is a significant problem in patients with diabetes. This research is the first of it’s kind conducted in the Republic of Kosovo to determine the prevalence of depression diagnosed in people with diabetes mellitus type 2 (DMT2) and interrelation between depressive symptoms and behavior of diabetes self-care (glucose monitoring, exercise, diet, and self- health care).

          Methods:

          Research was conducted in the University Clinical Center of Kosovo (UCCK), in Pristine. The sample consisted of 200 individuals. Data collection was done through structured questionnaires. HANDS (Harvard Department of Psychiatry / National Depression Screening Day Scale) questionnaire was used to assess depressive symptoms and DSMQ (The Diabetes Self-Management Questionnaire) was used to assess self-care behavior. Data analysis was run through SSPS program, version 21.

          Results:

          The results showed that the prevalence of depression in diabetic patients was 66.5% in Kosovo. Being a woman, a resident of rural areas or with low level of education, there were significant predictors and were associated with increased chance of developing the symptoms of major depression. Significant relations were found between major depression and physical activity (p<0.05). While between major depression and management of blood glucose level, dietary control and self health care, no significant correlation was found.

          Conclusion:

          This paper concluded the involvement of psychological aspect in health care plan for diabetics, in order to reduce the number of individuals affected by depression, to diagnose and to treat these individuals for a better quality of life.

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          Most cited references21

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          The prevalence of comorbid depression in adults with diabetes: a meta-analysis.

          Judy Anderson, P Lustman, Melvin E. Clouse … (2001)
          To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes. MEDLINE and PsycINFO databases and published references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used chi(2) statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design. A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0, 95% CI 1.8-2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%). The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.
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            Depression in diabetic patients: the relationship between mood and glycemic control.

            Patrick J. Lustman, Ray Clouse (2015)
            Evidence from prospective and cross-sectional studies demonstrates that the presence of diabetes doubles the risk of comorbid depression. This commonly overlooked comorbidity affects more than one quarter of the diabetic population, making its recognition and treatment in diabetic patients clinically relevant. PubMed, PsycINFO, and MEDLINE databases were searched (search words: diabetes, depression, metabolic control, hyperglycemia, hypoglycemia) for articles that evaluated outcomes, relationships, and/or management of comorbid depression and diabetes published between 1980 and 2002. This review represents a synthesis of the findings including treatment recommendations. Concurrent depression is associated with a decrease in metabolic control, poor adherence to medication and diet regimens, a reduction in quality of life, and an increase in health care expenditures. In turn, poor metabolic control may exacerbate depression and diminish response to antidepressant regimens. Psychotherapy and pharmacotherapy are effective in the presence of diabetes; both cognitive behavior therapy and selective serotonin reuptake inhibitors are weight neutral and have been associated with glycemic improvement in some studies. Depression is common in both type 1 and type 2 diabetes and has significant effects on the course and outcome of this medical illness. Conventional antidepressant management strategies are effective and the regimen should be tailored to the individual patient. Enhanced efforts toward good glycemic control may also contribute to improvements in mood and perceptions of well-being.
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              Behavioral and clinical factors associated with depression among individuals with diabetes.

              Edward Walker, Terry Bush, Michael Von Korff … (2004)
              The goal of this study was to determine the behavioral and clinical characteristics of diabetes that are associated with depression after controlling for potentially confounding variables. A population-based mail survey was sent to patients with diabetes from nine primary care clinics of a health maintenance organization. The Patient Health Questionnaire was used to diagnose depression, and automated diagnostic, pharmacy, and laboratory data were used to measure diabetes treatment intensity, HbA(1c) levels, and diabetes complications. Independent factors that were associated with a significantly higher likelihood of meeting criteria for major depression included younger age, female sex, less education, being unmarried, BMI > or = >30 kg/m(2), smoking, higher nondiabetic medical comorbidity, higher numbers of diabetes complications in men, treatment with insulin, and higher HbA(1c) levels in patients or = 30 kg/m(2), smoking, longer duration of diabetes, and a higher number of complications in older (> or = 65 years) patients. Smoking and obesity were associated with a higher likelihood of meeting criteria for major and minor depression. Diabetes complications and elevated HbA(1c) were associated with major depression among demographic subgroups: complications among men and HbA(1c) among individuals <65 years of age. Older patients with a higher number of complications had an increased likelihood of minor depression.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Arch
                Journal ID (iso-abbrev): Med Arch
                Title: Medical Archives
                Publisher: AVICENA, d.o.o., Sarajevo (Bosnia and Herzegovina )
                ISSN (Print): 0350-199X
                ISSN (Electronic): 1986-5961
                Publication date (Print): December 2016
                Volume: 70
                Issue: 6
                Pages: 425-428
                Affiliations
                [1 ]Nursing Faculty, AAB College, Pristine, Kosovo
                [2 ]University of Pristine. Kosovo
                [3 ]University Clinical Center, Pristine, Kosovo
                Author notes
                Corresponding author: Idriz Sopjani, Nursing Faculty, AAB College, Pristine, Kosovo. Phone: +377 44 112 582 E-mail: idriz.sopjani@ 123456universitetiaab.com
                Article
                Publisher ID: MA-70-425
                DOI: 10.5455/medarh.2016.70.425-428
                PMC ID: 5292218
                SO-VID: 3842a8df-441f-4a30-8c88-8113dea91114
                Copyright © Copyright: © 2016 Idriz Sopjani, Shemsedin Vehapi, Daut Gorani, Miradije Imeri, Sidita Vitoja, Shqipe Tahiri
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 October 2016
                Date accepted : 15 December 2016
                Categories
                Subject: Original Paper

                Keywords: depression,diabet mellitus type 2,self-care
                Data availability:
                Keywords: depression, diabet mellitus type 2, self-care

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