European Journal of Cardiovascular Medicine

Diabetes mellitus (DM) is a chronic metabolic disorder in which there is persistent hyperglycemia. This all may be due to either impaired insulin secretion or resistance to the peripheral actions of the insulin, or it might be due to both of them. According to the International Diabetes Federation (IDF), In 2015 around 415 million adults where found to have diabetes mellitus and most of them were aged between 20 to 79 years of age.¹ Comorbidity of diabetes and psychiatric disorders can present in different models. First, the two can present as separate conditions psychiatric disorders collaborate in different forms also. Certain elements of abuse such as cigarette smoking and liquor consumption can modify the pharmacokinetics of the oral hypoglycemic agents. Additionally, the existence of a comorbid insane disorder like depression can likely obstruct the management of diabetes by altering therapy constancy. Likewise certain disorders like fear of needles and injections can present troubles with investigations as well as therapy courses to a degree level of glucose in blood measurement plus insulin dose. Also subjects with psychiatric disorders are little inclined to try treatment.² The predominance of depression amid issues accompanying diabetes mellitus extents from 12% to 28% in differing studies.³ The World Health Organization report suggests that there will be more than 300 million people with diabetes by 2025 and most of these will be in the developing world.⁴ Complications bring about heightened numbers of medical appointments and hospitalizations, that influence patient quality of life (QoL) and escalation of the hardship of hospital care costs. Macrovascular complications involve systemic hypertension, acute myocardial infarction (AMI), congestive heart failure, cerebrovascular accident (CVA), and peripheral artery disease (PAD).⁵ These complexities bear an emotional and physical influence overwhelmed persons with DM2, creating alterations in individual and family welfare. By way of the chronic kind of the ailment and the trouble in controlling it, DM can influence attitude and self-respect, generating disappointment and manifestations connected to depression; in addition, restraints on food and comorbidities in sexual life can bring about discords and commit negatively to the QoL of the sufferer.^6,7

AIM AND OBJECTIVES: To study the relationship between psychiatric comorbidities in individuals with type 2 diabetes mellitus and quality of life and to study the association between psychiatric comorbidity, socio demographic and clinical variables in such patients.

OBJECTIVES:

1. To evaluate the type and frequency of psychiatric disorders as comorbidities in DM Type 2 patients.
2. To correlate the psychiatric morbidity with socio demo graphic factors in DM type 2 patients.
3. To assess Quality of Life in Type 2 DM patients.

This is a hospital based observational study where 150 consecutive patients visiting the Department of Medicine OPD or admitted in ward for the treatment of Diabetes, at Rama Medical College, Hospital & Research Centre Hapur and fulfilling the inclusion criteria 1) Type 2 DM patients with in the age group of 18 to 65 years, 2) Clinically diagnosed cases of Type 2 DM , 3) Patients who have history of detailed evaluation at least once in the General Medicine/endocrinology OPD and 4) Patients who are willing to give a written consent for the study. Exclusion criteria 1) Patients with history of epilepsy, mental retardation and neuro cognitive disorder, 2) Patients with prior history of psychiatric illness or history of treatment for psychiatric illness and 3) Patients who are not willing for the study were recruited. All the subject under study were interviewed and a detailed history and clinical examination was done by using a semi-Structured performa, General Health Questionnaire 12 (GHQ12), Hospital Anxiety and Depression Scale (HADS), Brief Psychiatric rating scale (BPRS), WHO Quality Of Life BREF (Brief Hindi Version) and KUPPUSAMY SOCIO ECONOMIC STATUS SCALE. The results were tabulated and analyzed using the Chi (χ2) square test. The correlation coefficient was measured between scores of all scales using Pearson’s formula.

In our study majority of patients with psychiatric comorbidity i.e. 44 (44.5%) were in the age group of 50 years and above. While majority of patients without psychiatric comorbidity i.e. 21(41.2%) were in age group of 26-50 years of age.

Table 1 shows 51(51.5%) patients with psychiatric comorbidity and 43(84.3%) patients without psychiatric comorbidity were males. While 48(48.5%) patients with psychiatric comorbidity and 8(15.7%) patients without psychiatric co-morbidity were females

Table 1 shows 9(9.1%) patients with psychiatric comorbidity and 0(0.0%) patients without psychiatric comorbidity were uneducated. While 18(18.2%) patients with psychiatric comorbidity, 16(31.4%) patients without psychiatric comorbidity were graduates and 3(3%) patients with psychiatric comorbidity and 4(7.8%) patients without psychiatric comorbidity were postgraduates, 17(17.2%) patients with psychiatric comorbidity and 13(25.5%) patients without psychiatric comorbidity were educated till primary, 23(23.2%) patients with psychiatric comorbidity and 9(17.6%) patients without psychiatric comorbidity were educated till middle school and 29(29.3%) patients with psychiatric comorbidity and 9(17.6%)

Table 1 shows 55(55.6%) patients with psychiatric comorbidity and 27(52.9%) patients without psychiatric comorbidity were living in a joint family. While 40(40.4%) patients with psychiatric comorbidity and 22(43.1%) patients without psychiatric comorbidity were living in a nuclear family 4(4%) patients with psychiatric comorbidity and 2(4%) patients without psychiatric comorbidity were living in extended nuclear.

Table 1 shows 58(58.6%) patients with psychiatric comorbidity and 25(49%) patients without psychiatric comorbidity belonged to middle class . While 19(19.2%) patients with psychiatric comorbidity and 7(13.7%) patients without psychiatric comorbidity belonged to upper middle class and 1(1%) patients with psychiatric comorbidity and 5(9.8%) patients without psychiatric comorbidity belonged to upper class.

Table 1 Between Sociodemographic factors and Psychiatric Comorbidity

Table 2 shows that 51(34.2%) had no psychiatric comorbidity as per ICD-10 diagnostic criteria. While 48(32.0%) had generalized anxiety disorder, 30 (20%) had depression, 13(8.6%) had mixed anxiety and depressive disorder, 6(4%) had specific phobia(needle phobia) and 2(1.2%) had adjustment disorder as per ICD-10 diagnostic criteria.

Table 2 Shows the type of psychiatric comorbidity among diabetic patients

Table 3 shows that in patients without Psychiatric Co-morbidity, the mean psychological domain (mean± s.d.) of patients was 29.76± 11.532.In patients with Psychiatric Co-morbidity, the mean psychological domain (mean± s.d.) of patients was 34.49± 14.928.Distribution of mean psychological domain with Psychiatric Co-morbiditywas statistically significant (p=0.034).

Table 3 Compares the psychiatric comorbidity and quality of life

P < 0.05 significant

Table 4 shows Distribution of mean Overall quality of life with Psychiatric Comorbidity was statistically significant (p=0.032).

TABLE 4 Distribution of mean Overall quality of life: Psychiatric Comorbidity

P < 0.05 significant

The results from study show (Table 1) that 51(51.5%) patients with psychiatric comorbidity and 43(84.3%) patients without psychiatric comorbidity were males. While 48(48.5%) patients with psychiatric comorbidity and 8(15.7%) patients without psychiatric comorbidity were females. The P value was found to be significant(0.00) showing that there is a significant difference between Educational Status and Psychiatric comorbidity. In a study conducted by Perrin NE et al they found that psychiatric comorbidity was significantly higher in the female population.⁸

In (Table 2) 48(32.0%) had generalized anxiety disorder, 30 (20%) had depression, 13(8.6%) had mixed anxiety and depressive disorder, 6(4%) had specific phobia (needle phobia) and 2(1.2%) had adjustment disorder as per ICD-10 diagnostic criteria. Study conducted by In another study conducted by N Kanwar et al found the prevalence of depression to be around 41.9%.⁹ Fisher et al reported presence of depressive disorder to be around 30% and That of Generalized anxiety disorder to be 50%.¹⁰

 In our study we found that Quality of life was decreased in patients of Diabetes mellitus especially those suffering from a comorbid Psychiatric disorder.E Gómez-Pimienta et al identified that 31.8% (n = 134) of patients presented with high diabetes-related emotional distress which further impacted their life leading to decrease Quality of Life.¹¹. 

• This study concludes that in patients with Type 2 Diabetes disorder socio-demographic variables like marital status, family type , education, socioeconomic status occupation have a significant impact on patient of Type 2 Diabetes disorder with psychiatric comorbidity.
• Quality of life is poor in patients with Type 2 Diabetes disorder with comorbid psychiatric illness.

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