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ISSN: 2167-1044
Journal of Depression and Anxiety
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Prevalence and Associated Factors of Depression among Type 2 Diabetes Mellitus Patients on Follow up at Ambo General Hospital, Oromia Regional State, Ethiopia, Institutional Based Cross Sectional Study

Takele Tiki*

Ambo General Hospital, Diabetes Clinic, Oromia Regional state, Ethiopia

*Corresponding Author:
Takele Tiki
Ambo General Hospital, Diabetes Clinic
Oromia Regional state, Ethiopia
Tel: 251112363164
E-mail: [email protected]

Received Date: November 21, 2016; Accepted Date: January 05, 2017; Published Date: January 09, 2017

Citation: Tiki T (2016) Prevalence and Associated Factors of Depression among Type 2 Diabetes Mellitus Patients on Follow up at Ambo General Hospital, Oromia Regional State, Ethiopia, Institutional Based Cross Sectional Study. J Depress Anxiety 6:259. doi: 10.4172/2167-1044.1000259

Copyright: © 2017 Tiki T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Both diabetes and depression are associated with premature morbidity and mortality, and when these conditions co-exist, the risk of developing co-morbidities, complications, patient suffering and associated cost, escalates.

Objective: To assess the prevalence and associated factors of Depression among patients with Type 2 diabetes mellitus on follow up at Ambo general hospital, Oromia Regional State, Ethiopia.

Method: Institutional based cross-sectional study was conducted in 2016. Systematic random sampling technique was employed to select study participants and assessed for Depression and Anxiety scale using (HADS-D). The collected data was entered into Epi-info version 7 and analysis was done after the data transported to SPSS version 20. Odds ratio with the 95% confidence interval was calculated using logistic regression analysis and the level of significance of association was determined at P- value <0.05.

Results: A total of 423 participants were studied, with a response rate of 100%. The overall prevalence of depression was found to be 47%. Being female (AOR=2.94 (95%CI (1.87,4.64)),no formal education (AOR=2.48 (1.28, 4.77)),current use of alcohol (AOR=3.52 (1.64, 7.55)), T1DM (AOR= 2.77 (1.69, 4.55)), greater than five years duration of diabetes mellitus illness (AOR=2.63 (1.59,4.32),chronic complication of diabetes mellitus {AOR=2.24 (1.20,4.18} and other additional chronic illness (AOR=2.53 (1.51, 4.24)) were significantly associated factors depression among patients with type 2 diabetes mellitus.

Conclusion: Developing guidelines and training of health workers in Diabetes mellitus clinics is useful to screen and treat depression among Diabetes Mellitus patients.

Keywords

Diabetes; Depression; Sleep; Appetite; Anxiety; Psychiatry

Background and Introduction

The global prevalence of diabetes is continuously rising. It is estimated that almost 285 million people are currently suffering from diabetes worldwide and the number is expected to rise to 438 million by the year 2030; more than 70% of these people reside in developing countries [1]. Similarly, depression affects all populations worldwide, but more than two-thirds of the affected people live in developing countries [2]. Both diabetes and depression are associated with premature morbidity and mortality, and when these conditions co-exist, the risk of developing co-morbidities, complications, patient suffering and associated cost, escalates [3,4].

Depression is a significant contributor to the global burden of disease and affects people in all communities across the world. Depressive disorders often start at a young age; they reduce people’s functioning and often are recurring. For these reasons, depression is the leading cause of disability worldwide in terms of total years lost due to disability. Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. Moreover, depression often comes with symptoms of anxiety. These problems can become chronic or recurrent and lead to substantial impairments in an individual’s ability to take care of his or her everyday responsibilities [5].

Studies conducted in different countries on prevalence of depression among Diabetes mellitus patients shows that 77.6% in UK [6],48.27% in Mexican [7],23% in North India [8], 13.6% in Qatar [9], 8.7% to 21.4% in Leiden University [10], 52.1% in Allied Hospital, Faisalabad [11], 47% in JJM Medical college in Karnataka [12], 50% In Bardarabbas, Southern Iran [13],70.7% in Tehran, Iran [14], 43.4% in Iran [15],11.5% and 40.3% in Malaysia [16,17], 43.5% and 38.35% in Pakistan [18,19] and 39.5% in Nigeria [20].

Moreover, depression is independently associated with increased chronic complication among patients with type 2 diabetes mellitus. Depression has been found to be associated with a negative impact among patients with diabetes mellitus. Despite their known effect on the population, there is no data available in the study area. Therefore, this study was planned to determine the prevalence and associated factors of depression among patients with type 2 diabetes mellitus at Ambo General Hospital, Oromia Regional State, Ethiopia.

Method

Study setting and population

The study was a cross sectional design, conducted from April to May, 2016 in Ambo General Hospital, Oromia regional state, western Ethiopia. All adult patients (age ≥ 18) with type 2 diabetes mellitus who had regular follow were included in the sample. Critically ill patients were excluded from the study. Among 993 DM patients who had regular follow-up at diabetes clinics, 423 type 2 DM patients were recruited for the study. Study participants were included using systematic random sampling technique. No patients refused to participate in the study.

Inclusion criteria

All persons with type 2 diabetes mellitus 18 years and above attending this hospital for follow-up visit.

Exclusion criteria

• Persons suffering from type 1and gestational diabetes mellitus.

• Type 2 diabetes mellitus Patients who are severely ill were excluded.

Data collection

Data were collected by trained psychiatry nurses using pretested interviewer administered questionnaire. The data collection instrument had different components. The first part includes sociodemographic characteristics (age, sex, education, occupation, marital status and others). The instrument was adopted and translated to Afan Oromo language and back to English and highly reliable in the study (Cronbach’s α=0.89). An outcome variable (presence of depression) was collected by Hospital Anxiety & Depression scale (HADS-D). HADS-D is a 7-item questionnaire, commonly used to screen for symptoms of anxiety and depression 7-item sub-scales for depression. It was validated in Ethiopia and its internal consistency was 0.76 for depression subscales and 0.87 for full scale. The scales use a cut off score for depression of greater than or equal to 8 [21].

Data processing and analyses

Data were analyzed using SPSS version 20. Bivariate analysis was done to see the association of each independent variable with the outcome variable. Potential confounders (important) variables were entered into binary logistic regression model to identify the effect of each independent variable with the outcome variables. A p-value of less than 0.05 was considered statistically significant, and adjusted odds ratio with 95% CI was calculated to determine association.

Ethical considerations

Ethical clearance was obtained from the Research and Ethics Review Committee of the Institute of Public Health (University of Gondar) and Amanuel Mental Specialized Hospital. Permission letter was obtained from Oromia health bureau and submitted to Ambo general hospital. Written informed consent was obtained from each study participant and they were informed about their rights to interrupt the interview at any time. Confidentiality was maintained at all levels of the study. DM patients who were found to have moderate to severe depression were referred to psychiatry clinics for further investigations.

Results

Socio-economic and demographic characteristics

A total of 423 participants were recruited for the study which makes the response rate 100%. The mean (± SD) age of the respondents was 45.21 (± 15.72) years. Among the respondents, 244 (57.7%) were female, 287 (67.8%) were married, 171 (40.4%) were farmers, 132 (31.2%) were attended primary education, and 116 (27%) the median monthly income of the participants was 2151 (Table 1).

Parameter   Variables   Frequency   Percentage
Age <30 41 9.7
30-39 62 14.7
40-49 100 23.6
50-59 74 17.5
≥60 146 34.5
Sex Male 179 42.3
Female 244 57.7
Religion Orthodox 204 48.2
Protestant 182 43.0
Muslim 37 8.7
Others 12 2.8
Oromo 361 85.3
Ethnicity Amhara 44 10.4
Gurage 10 2.4
Tigre 6 1.4
Others 2 .5
Educational Status No formal education 94 22.2
primary school 132 31.6
secondary School 83 19.6
Diploma and above 114 27.0
Marital status Married 287 67.8
Single 61 14.4
Divorced 28 6.6
Widowed 47 11.1
Occupational status Employed 112 26.5
Merchant 83 19.6
Farmer 104 24.6
House wife 80 18.9
Others 44 10.4
Family Monthly income ≤500 105 24.8
500-1200 95 22.5
1201­-2151 116 27.4
>2151 107 25.3

Table 1: Distribution of type 2 DM patients at Ambo General Hospital, Oromia Regional State, Ethiopia, 2016.

Clinical and psychosocial characteristics of the respondents

Two hundred eight nine (68.3%) of the respondents reported less than or equal to five years duration of diabetes diagnosis, 98 (23.2%) of the study population had at least one chronic complication of diabetes mellitus and 74 (17.5%) of the respondents had at least one other additional chronic disease and 43 (10.2%) of participants were reported history of current alcohol users (Table 2).

Characteristics   Variables   Frequency   Percentage
Duration of illness ≤5 years 289 68.3
>5 years 134 31.7
Chronic Complication of diabetes (retinopathy, nephropathy, and neuropathy)   Yes   98   23.2
No 325 76.8
  Additional chronic disease Yes 74 17.5
No 349 82.5
History of substance users (Alcohol, Khat and cigarette) Yes 243 57.4
No 180 42.6
Currently substance users (Alcohol, Khat and cigarette) Yes 55 13
No 368 87

Table 2: Description of clinical, psychosocial and substance use factors among patients with type 2 diabetes mellitus at Ambo General Hospital, Oromia Regional State, Ethiopia, 2016.

Prevalence of depression among Type 2 DM patients

The prevalence of depression among Type 2 DM patients was 47%.

Factors associated with depression among patients with type 2 diabetes mellitus

Binary logistic regression analysis revealed that being female, no formal education, greater than five years duration of diabetes mellitus diagnosis, chronic complication of diabetes mellitus, have history of alcohol use were statistically significant with depression (Table 3).

Variables Depression Crud OR 95% CI Adjusted OR
Yes (%) No (%)
Sex
Male 57 122 1.00 1.00
Female 142 102 2.98 (1.99, 4.47)*** 2.94 (1.87, 4.64)***
Age groups
<30 11 30 1 1
30­-39 28 34 2.25 (0.96, 5.23) 2.13 (0.89, 4.33)
40-49 45 55 2.23 (0.99, 4.94) 2.77 (.78, 6.94)
50-59 35 39 2.44 (0.69, 3.60) 1.55 (0.66, 4.45)
>=60 80 66 3.31 (1.54, 7.09) 3.24 (0.98, 5.46)
Marital status
Married 109 178 1 1
Single 33 28 1.93 (0.93, 3.36) 1.93 (0.93, 3.36)
Divorced 20 8 4.08 (0.74, 9.59) 4.08 (0.74, 9.59)
Widowed 37 10 6.04 (0.89, 12.64) 6.04 (0.89, 12.64)
Educational status
Diploma and above
  44   70   1   1
Secondary school 33 50 1.05 (0.491, 1.584) 1.35 (0.69, 2.63)
Primary school 65 67 1.54 (0.906, 2.483) 2.09 (0.16, 2.76)
No formal education 57 37 2.45 (1.29, 3.97)** 2.48 (1.28, 4.77)**
Occupational status
Employed 42 70 1 1
Merchant 37 46 1.34 (0.75, 2.39) 1.34 (0.75, 2.39)
Farmer 46 58 1.32 (0.77, 2.28) 1.32 (0.77, 2.28)
House wife 48 32 2.50 (0.39, 4.50) 2.50 (0.39, 4.50)
Others 26 18 2.41 (0.18, 4.91) 2.41 (0.18, 4.91)
Income
<500 50 55 0.93 (0.55, 1.57) 0.93 (0.55, 1.57)
500-1200 42 53 1.12 (0.65, 1.92) 1.12 (0.65, 1.92)
1201-2151 54 53 0.87 (0.49, 1.52) 0.87 (0.49, 1.52)
>2151 53 63 1 1
Current use of Cigarette
Yes 2 4 0.56 (0.10, 3.08) 0.56 (0.10, 3.08)
No 197 220 1 1
Current alcohol use
Yes 29 14 2.56 (1.31, 4.99)** 3.52 (1.64, 7.55)**
No 170 210 1 1
Current use of khat
Yes 4 2 2.23 (0.41, 12.57) 2.23 (0.41, 12.57)
No 195 222 1 1
Duration of illness
≤5yrs 110 179 1.00 1.00
>5yrs 89 45 3.22 (2.09, 4.95)*** 2.63 (1.59, 4.32)***
Having at least one chronic complication
Yes 66 32 2.98 (1.85, 4.80)*** 2.69 (1.59, 4.68)***
No 133 192 1 1
Having at least one additional chronic disease
  Yes   50   24   2.79 (1.64, 4.76)***   2.237 (1.19, 4.18)***
No 149 200 1 1

Table 3: Factors associated with depression among patients with type 2 Diabetes mellitus at Ambo General Hospital, Oromia Regional State, Ethiopia, 2016.

Discussion

Prevalence and factors associated with depression among patients with type 2 Diabetes mellitus

This study revealed that the prevalence of depression was 47%. The finding was similar with other studies carried out in Mexican (48.27%) [7], in JJM Medical College (47%) [12], in Iran (43.4%) [15], in Pakistan it (43.5%) [18], and in Nigeria (39.5%) [20]. On the other hand, the current study finding was higher than the study done in Malaysia 11.5% [16], in North India [8], in Qatar (13.6%) [9], in Pakistan (38.35%) [19] and in Malaysia (40.3%) [17] and lower than the study was done in Allied Hospital Faisalabad [11], in UK (77.6%) [6], in southern Iran 50% [13] and in Tehran, Iran (70.7%) [14]. The variation might be due to the difference in study design, data collection tool, sample size and the socioeconomically status of participant’s in study.

One of the factors significantly associated with depression was being female and no formal education. The finding is similar with the study conducted in Allied Hospital Faisalabad, Tehran Iran and Pakistan [11,14,19], Being type 2 DM diagnosed greater than five years significantly associated similar with study done in Qatar, in JJM Medical college, in Malaysia and in Pakistan [9,12,16,18]. Hence, history alcohol user’s patients can be at higher risk of depression than have no history of alcohol use similar with study conduct in Qatar and Iran. This could be due to the fact that depression patients are more prone to use substances to relief themselves from the stress or depression symptoms [9,15].

This is similar with a study conducted in in Mexican, in Allied Hospital Faisalabad and in JJM Medical College [7,11,12]. Previous study has proven that presences of other complications (retinopathy, nephropathy, and neuropathy) are highly associated with depression.

Conclusion

The prevalence of depression 47% among Type 2 DM patients was high. Depression had statistically significant association with being female sex, history of alcohol use, no formal education, chronic complication, greater than five duration of type 2 DM diagnosis and other complication. Oromia health bureau should develop guidelines to screen and treat depression among Type 2 DM patients.

Further research on risk factors of depression should be conducted to strengthen and broaden the current findings.

Limitation of the study

This study was cross-sectional study design. It did not allow establishing a temporal relationship between depression and significant associated factors like substance (khat, cigarette and alcohol) use. Additionally, no detailed substance use related factor was not assessed by standard tool.

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