Tip 2 Diyabetli Hastalarda Hastalık Algısı ve Depresyon

Amaç: Çalışmamızda, Tip 2 DM\'lu vakalarda kısa hastalık algı ölçeği (KHAÖ) ve geriatrik depresyon ölçeği (GDÖ) ile hastalık algısı ve depresyon düzeylerinin belirlenmesi ve Tip 2 DM parametrelerinin bunlarla ilişkisinin araştırılması hedeflenmiştir. Gereç ve Yöntem: Çalışmamız, Çınar İlçe Hastanesi Aile Hekimliği polikliniğinde kayıtlı Tip 2 DM tanısıyla takip edilmekte olan 40 yaş ve üzeri vakalar üzerinde yapılmıştır. Örnekleme seçilen vakalara kısa hastalık algı ölçeği ve geriatrik depresyon ölçeği uygulanmıştır. Bulgular:Çalışmamızda kısa hastalık algı ölçeği ortalama skoru 50,76±10,2[aralık 32-70] ve geriatrik depresyon ölçeği ortalama skoru 14,33±5,1[aralık 5-24] bulunmuştur. Vakaların %23,6\'sında GDÖ skoru normal sınırlar içinde bulunmuştur. %57,5 vakada hafif depresyon ve %18,9 vakada şiddetli depresyon tespit edilmiştir. HbA1c değerlerine göre vakaların %35,4\'ünde diyabetin kontrol altında olduğu (HbA1c ≤ 6,9), %64,6\'sında diyabetin kontrol altında olmadığı (HbA1c ≥ 7,0) bulunmuştur. Hastalık süresi, kullanılan ilaç türü ve kan şekeri regülasyon durumu ile hastalık algısı ve depresyon düzeyleri arasında istatistiksel olarak anlamlı ilişki bulunmuştur. Sonuç:Çalışmamız, tip 2 diyabette hedef kan şekeri düzeylerine ulaşmaktan ne kadar uzak olduğumuzu göstermesinin yanı sıra hastalık algısı ve depresyonun diyabetin farklı parametreleriyle ilişkisini göstermesi açısından da önemlidir. Şurası açıktır ki; duygu durum bozukluğu olan, hastalığının oluşumunu, seyrini ve ciddiyetini tam olarak anlayamamış, tedaviye inancı olmayan ve hastalığın kontrolü üzerinde bir etkisi olmayacağına inanan bir diyabetli vakada, verilen tedavi ne kadar uygun olsa da hedef kan şekeri düzeylerine ulaşılması mümkün olmayabilir. Çalışmamız, diyabet tedavisinde hastaya özel tedavi yaklaşımı belirlenirken, hastalık algısı ve depresyon verilerinin de göz önüne alınmasının hastanın tedavi sürecine katılımını ve tedavinin başarısını artıracağını düşündürmektedir.

Anahtar Kelimeler:

Tip 2 diyabetes mellitus, hastalık algısı, depresyon, birinci basamak

Illness Perception and Depression of Type 2 Diabetic Patients

Aim:In this study illness perception and depression levels were determined in type 2 diabetic patients using brief illness perception questionnaire and geriatric depression questionnaire, and the relationship between diabetic parameters and these data were examined. Material and Methods:The study was conducted on type 2 diabetic patients that were registered in Family Medicine outpatient clinic of Çınar County Hospital. Brief illness perception questionnaire and geriatric depression questionnaire were applied to patients that were selected for sampling. Results:Mean brief illness perception scale score and geriatric depression scale score were 50,76±10,2[range 32-70] and 14,33±5,1[range 5-24] respectively. In 23,6% of cases GDS score was normal. In 57,5% of cases mild depression and in 18,9% of cases severe depression were detected. According to HbA1c values in 35,4% of cases diabetes was found under control (HbA1c ≤ 6,9), and in 64,6% of cases it was out of control (HbA1c ≥ 7,0). It was found that, the relations between illness duration, medicine type, blood glucose regulation and illness perception and depression levels were statistically meaningful. Conclusion: Our study indicates that blood glucose regulation was far away from the targets and also indicates that illness perception and deperession data were related with different parameters of diabetes. It's clear that, if the diabetic patient has mood disorder, if the patient could not understand prognosis and complications of disease and if the patient did not believe his control over disease or treatment it would be difficult to achieve target blood glucose levels. This study suggests that, during planning of customized treatment for a patient, including of illness perception and depression data to this process would improve patient involvement and treatment success.

Keywords:

Type 2 diabetes mellitus, illness perception, depression, primary care,

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Wild S, Roglic G, Green A, Sicree R, King H. Global Prevalence of Diabetes Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004; 5:1047-53.
Satman İ, Yılmaz T, Sengül A, Salman S, Salman F, Uuygur S, Bastar I, Tütüncü Y, Sargin M, Dinccag N, Karsidag K, Kalaca S, Ozcan C, King H, The TURDEP Group. Population-Based Study of Diabetes and Risk Characteristics in Turkey Results of the Turkish Diabetes Epidemiology Study(TURDEP). Diabetes Care. 2002; 9:1551-56.
Satman İ, TURDEP Çalışma Grubu. TURDEP II Çalışması Ön Sonuçlar. Endokrinoloji ve Metabolizma Hastalıkları Kongresi. Antalya. 2010.
Shaw JE, Sicree RA, Zimmet PZ. Global Estimates of The Prevalence of Diabetes for 2010 and 2030.
Diabetes Research and Clinical Practice. 2010; 87:4
Tekin O, Erarslan E, Işık B, Özkara A. Diyabetik Hastalarda Tedavi Bariyerleri ve Bunların Glisemik Kontroldeki Önemleri: Ankara-Pursaklar Bölgesinde Kesitsel Bi r Çalışma. Yeni Tıp Dergisi. 2007; 24:105
Özkan Y, Çolak R, Koca SS, Dağ S, Kan EK, Sırma N. Diyabet ve Hiperlipidemi: Tedavide Ne Kadar Başarılıyız. Fırat Üniversitesi Sağlık Bilimleri Dergisi. 2008; 22:97-99.
Deckers S, Hermans MP, Buysschaert M. Therapy, glycaemic control and complications in type 1 diabetic patients: results from a single centre cohort of 465 subjects. Acta Clin Belg. 2001; 56:289–96., Craig ME, Handelsman P, Donaghue KC, Chan A, Blades B, Laina R, Bradford D, Middlehurst A, Ambler G, Verge CF, Crock P, Moore P, Silink M, NSW/ACT HbA(1c) Study Group. Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT. Med J Aust. 2002; 177:235–38.
New JP, Hollis S, Campbell F, McDowell D, Burns E, Dornan TL, Young RJ. Measuring clinical performance outcomes from diabetes information systems: an observational study. Diabetologia. 2000; 43: 836–43.
Skinner TC, Hampson SE. Personal Models of Diabetes in Relation to Self-Care, Well-Being, and Glycemic Control. Diabetes Care. 2001; 24: 828-33.
Heisler M, Vijan S, Anderson RM, Ubel PA, Bernstein SJ, Hofer TP. Journal of General Internal Medicine. 2003; 18:893-902.
Ellis DA, Frey MA, Naar-King S, Templin T, Cunningham P, Cakan N. Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents With Type 1 Diabetes in ChronicPoor Metabolic Control. Diabetes Care. 2005; 28:1604-10.
Ponzo MG, Gucciardi E, Weiland M, Masi R, Lee R, Grace L. Gender, Ethnocultural, and Psychosocial Barriers to Diabetes Self-Management in Italien Women and Men With Type 2 Diabetes. Behavioral Medicine. 2006;:31:153-60.
Law GU, Kelly TP, Huey D, Summerbell C. Selfmanagement and well-being in adolescents with diabetes mellitus: Do illness respresentations play a regulatory role. Journal of Adolescent Health. 2002; 31: 381-85
Paschalides C, Wearden AJ, Dunkerley R, Bundy C, Davies R, Dickens CM. The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus. Journal of Psychosomatic Research. 2004; 57: 557-64.
Bahar A, Sertbaş G, Sönmez A. Diyabetes mellituslu hastaların depresyon ve anksiyete düzeylerinin belirlenmesi. Anadolu Psikiyatri Dergisi. 2006; 7:18-26.
Diefenbach MA. Illness Representations. Health Behavior Constructs: Theory, Measurement and Research, Cancer Control and Population Sciences, US. National Cancer Institute. http://cancercontrol.cancer.gov/brp/constructs. Son güncelleme tari hi:04.2008. Erişim tarihi:05.11.2011
Leventhal H, Nerenz DR, Steele DJ. Illness representations and coping with health threats. In: Baum A, Taylor SE, Singer JE, editors. Handbook of Psychology and Health, Volume IV: social psychological aspects of health. Hillsdale, NJ:Erlbaum. 1984; 219-252.
Ertan T, Eker E, Şar V ve ark. Geriatrik depresyon ölçeğinin Türk yaşlı nüfusunda geçerlilik ve güvenilirliği. Nöropsikiyatri Arşivi. 1997; 34:62-71.
Kocaman N, Özkan M, Armay Z, Özkan S. Hastalık Algısı Ölçeğinin Türkçe uyarlamasının geçerlilik ve güvenilirlik çalışması. Anadolu Psikiyatri Dergisi. 2007; 8:271-80.
Weinman J, Petrie KJ, Moss-Morris R, Horne R. The Illness Perception Questionnaire: A New Method For Assessing The Cognitive Representation of Illness. Psychology and Health. 1996; 11:431-35.
Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health. 2002; 17:1-16.
Li C, Ford ES, Strine TW, Mokdad AH. Prevalence of Depression Among U.S. Adults With Diabetes. Diabetes Care. 2008; 31:105-107.
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The Prevalence of Comorbid Depression in Adults With Diabetes. Diabetes Care. June 2001; 24:1069-78.
Lustman PJ, Anderson RJ, Freedland KE, Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000; 23:934-42.
Rezaki M. Bir Sağlık Ocağına Başvuran Hastalarda Depresyon. Türk Psikiyatri Dergisi. 1995; 6:13-20.
Özdemir H , Rezaki M. Depresyon Saptanmasında Genel Sağlık Anketi-12. Türk Psikiyatri Dergisi. 2007; 18:13-21.
Turhan H. Tip 2 Diabetes Mellitus'lu Hastalarda Tedavi Şekline ve Hastalık Süresine Göre Depresyon ve Anksiyete. Uzmanlık Tezi. 2007.
Küey L. Birinci Basam akta Depresyon:Tanıma, Ele Alma, Yönlendirme. Psikiyatri Dünyası. 1998; 1:5-12.
Kuloğlu M, Karaoğlu A, Atmaca M, Özkan Y, Tezcan AE. Tip II Diyabetik Hastalarda Psikiyatrik Belirtiler ve Kan Şekeri Kontrolü. Düşünen Adam. 2000; 13:19-23.
Sır A, Bayram Y, Özkan M. Zoraki İç Göçün Ruh Sağlığına Etkileri Üzerine Bir Ön Çalışma. Klinik Psikiyatri. 1998; 2:83-88.
Scharlooa M, , Kapteina AA, Weinmanb J, Hazesc JM, Willemsd LNA, Bergmane W, Rooijmansa HGM. Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis. Journal of Psychosomatic Research. 1998; 44:573-85.
Pearlman RA, Uhlmann RF. Quality of Life in Chronic Diseases: Perceptions of Elderly Patients. The Journal of Gerontology. 1987; 43:25-30.
Moss-Morris R, Petrie KJ, Weinman J. Functioning in chronic fatigue syndrome: Do illness perceptions play a regulatory role?. British Journal of Health Psychology. 1996; 1:15-25.
Weinman J, Petrie KJ, Moss-Morris R, Horne R. The Illness Perception Questionnaire: A New Method For Assessing The Cognitive Representation of Illness. Psychology and Health. 1996; 11:431-35.
Fortune DG, Richards HL, Griffiths EMC, Main CJ. Psychological stress, distress and disability in patients with psoriasis: Consensus and variation in the contribution of illness perceptions, coping and alexithymia. British Journal of Clinical Psychology. 2002; 41:157-74.
Scharloo M, Kaptein AA, Schlösser M, Pouwels H, Bel EH, Rabe KF, Wouters EFM. Illness Perceptions and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease. Journal of Asthma. 2007; 44:575-81.
Amato L, Paolisso G, Cacciatore F, Ferrara N, Canonico S, Rengo F, Varricchio M. Non-insulindependent diabetes mellitus is associated with a greater prevalence of depression in the elderly. Diabetes & Metabolism. 1996; 22:314-8.
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The Prevalence of Comorbid Depression in Adults With Diabetes. Diabetes Care. June 2001; 24:1069-78.
Deckers S, Hermans MP, Buysschaert M. Therapy, glycaemic control and complications in type 1 diabetic patients: results from a single centre cohort of 465 subjects. Acta Clin Belg. 2001; 56:289–96.
Craig ME, Handelsman P, Donaghue KC, Chan A, Blades B, Laina R, Bradford D, Middlehurst A, Ambler G, Verge CF, Crock P, Moore P, Silink M, NSW/ACT HbA(1c) Study Group. Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT. Med J Aust. 2002; 177:235–38.
New JP, Hollis S, Campbell F, McDowell D, Burns E, Dornan TL, Young RJ. Measuring clinical performance outcomes from diabetes information systems: an observational study. Diabetologia. 2000; 43:836–43.
Tekin O, Erarslan E, Işık B, Özkara A. Diyabetik Hastalarda Tedavi Bariyerleri ve Bunların Glisemik Kontroldeki Önemleri: Ankara-Pursaklar Bölgesinde Kesitsel Bir Çalışma. Yeni Tıp Dergisi. 2007; 24:105
Engum A, Mykletun A, Midthjell K, Holen A, Dahl AA. Depression and Diabetes: A large populationbased study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes. Diabetes Care. 2005; 28:19040
Black SA, Markides KS, Ray LA. Depression Predicts Increased Incidence of Adverse Health Outcomes in Older Mexican Americans With Type 2 Diabetes. Diabetes Care. 2003; 26:2822-28.
Lustman PJ, Anderson RJ, Freedland KE, Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000; 23:934-42.
Ciechanowski PS, Katon WJ, Russo JE, Hirsch IB. The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. General Hospital Psychiatry. 2003; 25:246
Paschalides C, Wearden AJ, Dunkerley R, Bundy C, Davies R, Dickens CM. The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus. Journal of Psychosomatic Research. 2004; 57:557-64.
Hampson SE, Glasgow RE, Strycker LA. Beliefs versus feelings: A comparison of personal models and depression for predicting multiple outcomes in diabetes. British Journal of Health Psychology. 2000: 5:27-40
Knol MJ, Twisk JWR, Beekman ATF, Heine RJ, Snoek FJ,Pouwer F. Depression as a risk factor for the onset of type 2 diabetes mellitus: A metaanalysis. Patient Education and Counseling. 2003; 51:197-206.
Saatci E, Tahmiscioglu G, Bozdemir N, Akpinar E, Ozcan S, Kurdak H. The well-being and treatment satisfaction of diabetic patients in primary care. Health and Quality of Life Outcomes. 2010; 8:67.
Winocour PH. Effective diabetes care: a need for realistic targets. BMJ. 2002; 324.
Michie S, Miles J, Weinman J. Patient-centredness in chronic illness: what is it and does it matter?. Patient Education and Counseling. 2003; 51:19720
Bernard MY, Ong LK, Cherny SS, Sham P, Annette WK, Karen SL. Diabetes Prevalence and Therapeutic Target Achievement in the United States, 1999 to 2006. The American Journal of Medicine. 2009; 122: 443-53. Y azışma Adresi / Address for Correspondence: Dr. Ersin Akpınar
Çukurova Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı ADANA e-mail: eakpinar@cu.edu.tr geliş tarihi/received :29.05.2012 kabul tarihi/accepted:09.07.2012