A Comparative Study to Assess the Level of Depression in Insulin Dependent and Non-Insulin Dependent Diabetic Patients Attending Medical OPDS at HSK Hospital and Research Center, Bagalkot

Diabetes mellitus (DM) is a chronic metabolic condition that occurs when the body cannot use insulin. It is classified as type 1 and type 2 diabetes mellitus. The onset of type 1 and 2 diabetes mellitus is usually begin in childhood and adulthood respectively. It is believed that type 1 diabetes mellitus is caused by genetics, but environmental factors like viruses might trigger the disease. Type 2 diabetes mellitus is caused by several reasons including lifestyle factors and genes. ¹ Global health statistics estimate that depression is expected to be a leading cause of disability worldwide, and is a significant contributor to the global burden of diseases, affecting about 350 million people. The World Health Organization (WHO) ranks depression as the fourth leading cause of disability worldwide and is projected that by the year 2030 will be the second leading cause of disability worldwide. Depression causes adverse complications to the affected individuals as well as society at large. Globally, it is estimated that the prevalence of depression ranges from 4.4 to 27.0%. It is higher among the population in middle and older age; females, low socioeconomic status, and poor social relationships. ² Depression, a common and often recurrent disorder has a number of risk factors which have been documented in the literature. Some of these include comorbidities with other conditions, other mental illnesses family history of depression and mental illness adverse events of childhood prior history of depression and treatment of depression and outcomes of treatment physical inactivity female gender, younger adults, smoking and having a chronic disease and unhealthy eating styles Depression is also a large burden on most economies and leads to increased mortality. ³ Depression and diabetes are complex public health challenges, marked by the interplay of physiological, psychological, and social factors. The high prevalence and associated mortality rates of both conditions have drawn significant attention in recent years. Numerous studies suggest a bidirectional relationship between diabetes and depression, with individuals with diabetes being 2–3 times more likely to develop depression than the general population. Conversely, depression increases the risk of developing type 2 diabetes by approximately 60%. The comorbidity of depression and diabetes can impair self-management and reduce treatment adherence, potentially exacerbating each other and thereby increasing healthcare costs and placing a substantial burden on families and society.⁴ Type 2 diabetes is a chronic disease; individuals with diabetes are at risk of complications, such as, nephropathy, retinopathy, and cardiovascular complications. Additionally, a long duration of strict diet limit, glucose monitoring, and medication can cause psychological maladjustment, studies have shown depressive symptoms to be higher in individuals with diabetes and the prevalence goes up with disease duration and complications. Studies have shown the percentage of depressive symptoms in newly diagnosed diabetes.⁵

OBJECTIVES

1. To assess the level of depression among insulin dependent patients  
2. To assess the level of depression non-insulin dependent patients.
3. To compare the level of depression of insulin dependent patients   and non-insulin dependent patients between the age group 18-40 and above years.
4. To find out the association between the level of depression of insulin dependent patients and their selected socio-demographic variables.
5. To find out the association between the level of depression of non-insulin dependent patients and their selected socio-demographic variables.                                                                                 

MATERIALS AND METHODS

METHODS

It was descriptive and comparative study with an intended to assess the level of depression among insulin dependent and non-insulin dependent patients among age between 18-40 years and above as perceived from the diabetic patients at attending medical OPDs HSK hospital was selected for the study.
Research Design and Participants

Study participants:

This study is a randomized controlled trial conducted in October 2024. A simple sample of 120 insulin dependent and non-insulin dependent diabetic patients from 18-40 years and above of age are attending medical OPDs HSK hospital in Bagalkot was selected for the study. Insulin and non-insulin diabetic patients were willing to participate in this study, and diabetic patients who were present at the time of data collection were also included in this study. diabetic patients who were not healthy at the time of data collection were excluded from the study.

Research Approach- This study aims to collect information about a diabetic patients and level of depression. Therefore, Followed proportionate stratified random sampling method was considered appropriate for the research.

Research Design- The term research design refers to the research plan. Research design is type of statistical analysis that helps researchers select subjects, identify variables, control variables, make observations, and interpret data. A proportionate stratified random sampling method will be used to select the sample from attending medical OPDs HSK hospital in Bagalkot.

Variables to Examine- A variable is something that can be measured and change something. The change is the mental, physical, Quality of life, Hope, Characteristics and their personality. This study identified the changes.

Research variable 1: Level of Depression of Diabetic patients.

Socio-demographic variables- Socio-demographic variables included in this research age, gender, religion, educational status, Marital status, Occupational status, family monthly income, Area of residence, Type of diabetic mellitus, Family history of diabetics, Duration of Diagnosis, Treatment, Duration of insulin injection, Frequency of insulin injection, Type of device, Insulin Provider.

Setting of the study-The setting is where the population or the portion of it is located and where the study is carried out. The present study was conducted Medical OPDs at HSK Hospital and Research center, Bagalkot.

Sample and sample Size- This sample consists of subjects in the units that constitute the population of this study. The current sample consist of 120 insulin dependent and non-insulin dependent Diabetic patients age group between18 to 40 and above years, attending Medical OPDs HSK Hospital and Research center, Bagalkot.

Sampling Technique- The sampling technique is selecting a portion of the population to obtain information about a problem. A stratified proportional random sampling technique was used in this study

Statistical Analysis- The data was analysed using SPSS version 25. The obtained data was entered in MS excel sheet. The obtained data were statistically examined in terms of the objectives of the study using inductive statistics. Frequencies and percentage was used for the analysis of demographic data. The mean and standard deviation, median and range was used as inferential statistics. The chai square test was used to determine association between level of depression scores and selected socio-demographic variables of insulin dependent and non-insulin dependent Diabetic patients. The chi-square (X2) test will be used to find out the association between the demographic variables with the insulin dependent and non-insulin dependent Diabetic patients

Ethical clearance
Ethical clearance was obtained from the Institutional Ethics Committee of BVVS Sajjalashree Institute of Nursing Sciences, Bagalkot.

INSTRUMENT

Epidemiologic Studies Depression Scale (CES-D)
The Epidemiologic Studies Depression Scale (CES-D Scale) developed by “Lauriesm S. Radloff” is used to measure the level of depression of insulin dependent and non-insulin dependent diabetic mellitus patients. Depression were scored with a total of 20 items as follows: 1: Rarely or none of the time (less than 1 day), 2: Some or a little of the time (1-2 days), 3: Occasionally or a moderate amount of the time (3-4 days), and 4: Most or all of the time (5-7 days). Diabetic mellitus patient’s confidence in depressionrelations was created by the testretest method (r = 0.96), showing that insulin dependent and non-insulin dependent patients are have equal level of depression.

Data collection process

Prior permission is obtained from the relevant organization before the data collection process begins. At the time the research was conducted, the diabetic mellitus patients were attending medical OPDs at HSK   hospital. Data collection was conducted from all diabetic patients who met the inclusion criteria. Consent is obtained at diabetic patients. Before administering the survey, the purpose of the study was explained to the participants.

Data analysis
The obtained data were analyzed according to the research purposes using comarative and objective analysis. The main data was prepared based on the participants' responses. Demographic profile analysis with frequency and percentage. Mean and standard deviation of responses to questions Chisquare test was used to determine the relationship between  level of depression in words and numbers and selected demographic variables.

RESULTS 

Part I: Socio-demographic profile of Insulin dependent Diabetic patient. Sample characteristics.

Part II: Socio-demographic profile of Non-Insulin dependent Diabetic patient. Sample characteristics

PART III: Frequency and Percentage of distribution of Insulin- Dependent Diabetic patient (Center for Epidemiologic Studies Depression Scale) =60                                  

From above table the percentage distribution of Insulin- Dependent Diabetic patient and their level of Depression shows that (1.6%) of Insulin- Dependent Diabetic patient had mild level of depression, 98.3% Diabetic patient had moderate level of depression.

 Here, above table percentage distribution the mean is 49.6, Standard deviation is about 0.76 & Mean percentage is 31.60 of Insulin- Dependent Diabetic patient in this study.

PART IV: - Frequency and percentage distribution of Non-insulin dependent diabetic patient (Center for Epidemiologic Studies Depression Scale).

N=60

The above table percentage distribution of Non-insulin dependent diabetic patient according to their level of Depression shows 50% of Non-insulin dependent diabetic patient were having mild level of depression, 41.6% of Non-insulin dependent diabetic patient were having moderate level of depression and 8.3% Non-insulin dependent diabetic patient were having sever level of depression.                        

Here, above table percentage distribution the mean is 26.18, Standard deviation is about 0.88 & Mean percentage is 32.72 of Non-Insulin- Dependent Diabetic patient in this study.

PART V: -Association between the Insulin- Dependent Diabetic patient with their selected socio-demographic variables                                                    N=60

*Significance at α = 0.05

PART VI: -Association between the Non-Insulin- Dependent Diabetic patient with their selected socio-demographic variables.                                            

N=60

*Significance at α = 0.05

PART VII: -Comparison of Level of Depression between insulin dependent diabetic patient and Non-insulin dependent diabetic patient.