Association Of Depression And Anxiety Among The Adult Diabetic Patients In King Abdulaziz University Hospital, Jeddah, Saudi Arabia (Preprint)
Authors: Aldauig Badreyah Ahmad 
Published: July 2018

BACKGROUND

Diabetes is a critical compound of diseases which affect different systems of the body. It needs constant self-management by the patient to prevent or even delay the consequences that may develop. The Kingdom of Saudi Arabia and all the middle east countries are ranked among the countries with highest risk of developing diabetes mellitus (1). With adequate care and compliance to medications in addition to lifestyle modification, achieving good quality of life is possible. (2). The main types of diabetes are type 1, type 2 and gestational diabetes (3). Type 2 diabetes is typically due to insulin resistance, eventually leading to loss of pancreatic production of insulin altogether. (4-11). Diabetes has been associated with the increasing prevalence in the clinical symptoms of depression. That lead to growing the obstacles to control diabetes (12-16). Depressive disorders are prevalent in patients who have any medical problems. Thus, it is beneficial to apply the screening tools for depression and anxiety. Hospital Anxiety and Depression Scale (HADS) is an example of such a scale, which is first discovered and published by Zigmond & Snaith in 1983. This tool has been translated and validated in many countries. The screening of anxiety and depression has been widely recognized by this tool with many patients in different medical conditions. (17-21).
A recent local study investigated the importance and the reliability of this score in two tertiary hospitals in Riyadh, Saudi Arabia to translate the original English HADS into Arabic by using the systematic translation process. The result was the development of a reliable and valid Arabic version of HADS tool (22).
Depression can precipitate diabetes through altered dietary habits, decreased physical activity resulting in weight gain, and possibly elevated stress hormones levels (17,18). Lack of access to health care, in particular a diabetes care team in the presence of the chronic comorbid depression in patients with diabetes has a significant role in worsening the hyperglycemia contributes to the development of complications (19-24). Some studies observed that diabetes and anxiety and depression are associated with increase the complications earlier than others (25). Anxiety is one of the most common psychiatric disorders that can affect patients with diabetes (26). A study done by Keita examining depression and anxiety among patients with type 2 diabetes mellitus, showed that the prevalence of depression and anxiety were higher among women more than men with a p value less than 0.05 (27). A meta-analysis done in 2012 collected all the available longitudinal and prospective studies in diabetes and depression looking at mortality rate due to poor management in diabetic patients with depression, included over 48,000 patients and showed increased hazard of mortality in the diabetes patients with episodes of depression (28). A study was done by Peyrotin among 245 diabetic patients and follow up them three times in the clinic to assess the risk of depressive symptoms. By the end duration of the last visit the deppressive symptoms appeared in 93 patients which is equal 38% from the study sample. The participants of the study have higher rate of missing educations with two or more complications (29).
The prevalence of the development of depressive symptoms in adults with type 2 diabetes has been studied formally in Saudi Arabia. AA El Mahalli showed in her cross-sectional study that almost fifty percent of people with diabetes were depressed (49.6%) with the conclusion that people with diabetes should be regularly assessed for depression (29).
Although the occurrence of depression and anxiety in diabetic patients can lead to severe complications, few studies correlated glycemic control with the severity of depression and anxiety among diabetic patients.
This study aimed to determine the prevalence of depression among the diabetic adult patients in King Abdulaziz university hospital by distributing a self-filling questionnaire about the depressive symptoms and correlate the result with the last HbA1c to find the association between the appearance of depressive disorder and the level of glycemic control.

OBJECTIVE

Objectives: This study aims to determine the prevalence of depression and anxiety among the diabetic adult patients in king abdulaziz university hospital

METHODS

Methods: This cross-sectional study enrolled a total of 186 patients from king Abdelaziz university hospital, Jeddah. Data was collected by using validated self- filling Hospital Anxiety and Depression Scale (HADS) questionnaire. A chi-square test was used to analyze the data.

RESULTS

Results: The study included 186 diabetic patients, 132 (71.0%) were female and 54 (29.0%) were male with a mean age of 56 years. Among the participants, 48 (25.8%) were depressed and only 9 (4.8%) of them have a symptom of anxiety.

CONCLUSIONS

Conclusions: The results of our study suggest that there is an increased in the prevalence of depression and anxiety risk among diabetic patients relative to the general population.