Journal of Psychiatry Depression & Anxiety Category: Clinical Type: Research Article

Prevalence and associated Factors of Anxiety among Type 2 Diabetes Mellitus Patients on Follow Up at Ambo General Hospital, Oromia Regional State, Ethiopia, Institutional Based Cross Sectional Study

Takele Tiki1*
1 Department Of Nursing, Amanuel Mental Specialized Hospital, Ambo General Hospital, Ambo University College Of Medicine And Health Science, Oromia Regional, Ethiopia

*Corresponding Author(s):
Takele Tiki
Department Of Nursing, Amanuel Mental Specialized Hospital, Ambo General Hospital, Ambo University College Of Medicine And Health Science, Oromia Regional, Ethiopia
Tel:+251 112363164,
Email:takesibirat14@gmail.com

Received Date: Mar 16, 2017
Accepted Date: May 03, 2017
Published Date: May 18, 2017

Abstract

Abstract
Anxiety has been shown to be associated with poor outcomes in people with diabetes. However, there has been limited data, especially from Ethiopia, which has specifically examined whether diabetes mellitus is associated with an increased likelihood of co morbid anxiety.

Objective 
To assess the prevalence and associated factors of Anxiety 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 2016.Systematic random sampling technique was employed to select study participants and Assessed for Depression and Anxiety Scale using (HADS). 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.

Result 
A total of 423 participants were studied, with a response rate of 100%. The overall prevalence of anxiety was found to be 44.2%. Being female (AOR=2.94(95%CI (1.87,4.64)), 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 anxiety 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 anxiety among type 2 Diabetes Mellitus patients.

BACKGROUND

Diabetes Mellitus (DM) is a common health problem with serious medical and economic consequences. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries [1]. Anxiety is a vague, subjective, non-specific feeling of uneasiness, apprehension, tension, (excessive nervousness) fears, and a sense of impending doom, irrational avoidance of objects or situation and anxiety attack [2]. The anxiety disorders make up one of the most common groups of psychiatric disorders and the National co-morbidity study reported that one of four persons met the diagnostic criteria for at least one anxiety disorder and that there is a 12-month prevalence rate of 17.7% [3].

Anxiety has been found to be associated with a negative impact on diabetes mellitus patients [4]. Presence of anxiety symptoms significantly impairs the Health Related Quality of Life among those with diabetes mellitus patients [5]. 

Studies conducted in different countries on prevalence of anxiety among type 2 Diabetes mellitus patients shows that 68.0% in Unit kingdom [6], 55.10% in Mexican [7], 29% in North India [8], 35.3% in Qatar [9], 44.9% in Romanian [10], 88.3% in Hospital of Lithuanian [11], 56.1% in China [12], 67% in Bardar Abbas, Southern Iran [13], 69.6% in Tehran Iran [14], 30.5% and 31,4% in Malaysia [15,16], 57.9% in Pakistan [17] and 58.7% in Guinea [18].

Being women, older, single, with a low educational level, more diabetes complications, anxiety symptoms, greater than five years duration and currently use of alcohol and smoking were significant associated factors anxiety among type 2 diabetes mellitus patients [14-17].

Moreover, anxiety is independently associated with increased chronic complication among patients with type 2 diabetes mellitus. Anxiety has been found to be associated with a negative impact among patients with type 2 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 anxiety 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.

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 socio-demographic 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 anxiety) was collected by Hospital Anxiety & Depression scale (HADS-A). HADS-A is a 7-item questionnaire, commonly used to screen for symptoms of anxiety and depression 7-item sub-scales for anxiety. It was validated in Ethiopia and its internal consistency was 0.78 for anxiety subscales and 0.87 for full scale. The scales use a cut off score for anxiety of greater than or equal to 8 [19].

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 consideration

Ethical clearance was obtained from the Research and Ethics Review Committee of the Ambo University College of medicine and health science. Permission letter was obtained from Ambo Hospital administration office. 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. Type 2 DM patients who were found to have moderate to severe anxiety 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).
 
  Variables Frequency Percentage
  <30 41 9.7
Age 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
Amhara 44 10.4
Gurage 10 2.4
Tigre 6 1.4
Others 2 0.5
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).
 
  Variables Frequency Percentage  
 
Duration of illness ≤5 years 289 68.3  
>5 years 134 31.7  
Chronic complication of diabetes 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 & cigarette) Yes 243 57.4  
No 180 42.6  
Currently substance users (alcohol, khat & 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 anxiety among Type 2 DM patients

The prevalence of anxiety among Type 2 DM patients was 44.2%.

Factors associated with anxiety among patients with type 2 diabetes mellitus

Binary logistic regression analysis revealed that being female, greater than five years duration of diabetes mellitus diagnosis, chronic complication of diabetes mellitus and other additional chronic disease were statistically significant with anxiety (Table 3).
 
Variables Anxiety Crud OR 95% CI Adjusted OR
Yes (%) No (%)
SexMaleFemale 59128 120116 12.24(1.50,3.35)** 12.13(1.39,3.29)**
Age
<30 10 31 1 1
30-39 29 33 2.72(0.14,6.50) 3.16(0.20,2.27)
40-49 41 59 2.15(0.95,4.88) 2.52(0.14,3.27)
50-59 28 46 1.89(0.80,4.43) 1.35(0.53,3.43)
≥60 79 67 3.66(0.67,8.00) 3.08(0.32,3.30)
Marital status
Married 116 170 1 1
Single 30 31 1.42(0.81,2.47) 1.42(0.81,2.47)
Divorced 16 12 1.95(0.89,4.28) 1.95(0.89,4.28)
Widowed 25 23 1.59(0.86,2.94) 1.59(0.86,2.94)
Educational status
Diploma and above 47 67 1 1
Secondary school 38 43 1.26(0.71,2.24) 1.81(0.93,3.50)
Primary school 60 74 1.16(0.69,1.92) 1.64(0.91,2.94)
No formal education 42 52 1.15(0.66,1.99) 0.96(0.50,1.82)
Occupational status
Employed 45 64 1 1
Merchant 42 45 1.33(0.75,2.34) 1.33(0.75,2.34)
Farmer 47 57 1.17(0.68,2.02) 1.17(0.68,2.02)
House wife 37 39 1.35(0.75,2.43) 1.35(0.75,2.43)
Others 16 31 0.73(0.36,1.49) 0.73(0.36,1.49)
Income
<500 47 58 1.28(0.75,2.18) 1.28(0.75,2.18)
500-1200 43 52 1.31(0.75,2.26) 1.31(0.75,2.26)
1201-2151 52 55 1.49(0.88,2.54) 1.49(0.88,2.54)
>2151 45 71 1 1
Current smoking cigarettesYesNo  4183 2234 2.56(0.46,14.12)1 2.56(0.46,14.12)1
Current alcohol useYesNo  22165  21215  1.32(0.73,2.57)1  1.64(0.82,3.30)1
Current use of khatYesNo 2185 4232  0.63(0.11,3.46)1 0.63(0.11,3.46)1
Duration of illness<=5yrs>5yrs 10087 18947 13.49(2.28,5.38)*** 12.64(1.66,4.21)***
Having at least one chronic complicationYesNo 65122 33203 3.28(2.04,5.27)***1 2.53(1.51,4.24)***1
Having at least one additional chronic diseaseYesNo 49138 25211 2.99(1.77,5.08)**1 2.45(1.36,4.407)**1

Table 3: Factors associated with anxiety among patients with type 2 diabetes mellitus on follow up at Ambo General Hospital Oromia regional, Ethiopia, 2016.

*P value is significant at P<0.05 
**P value is significant at P<0.01
***P value is significant at P<0.001

DISCUSSION

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

This study revealed that the prevalence of anxiety was 44.2%. The finding was similar with other studies carried out in Romania 44.9 % [10]. On the other hand, the current study finding was higher than the study done in Mexican 55.10% [7], in United kingdom 68% [6], in hospital of Lithuanmia 88.3% [11],in China 56.1% [12], in Bardar Abbas, Southern Iran 67% [13], in Tehran Iran 69,6% [14], in Pakistan 57.9% [17], and in Guinea 58.7% [18]and lower than the study was done in North India 29% [8],in Qatar 35.3% [9] and in Malaysia 30.5% and 31.4% [15,16]. The variation might be due to the difference in study design, data collection tool, sample size and difference in study participants.

One of the factors significantly associated with anxiety was being female. The finding is similar with the study conducted in Hospital of Lithuanian University of Health Sciences, Romania, China, Bardar Abbas, Sothern Iran Tehran Iran, Malaysia and Guinea [10,12,13,16,18], Being type 2 DM diagnosed greater than five years significantly associated similar with study done in Hospital of Lithuanian University of Health Sciences, Tehran Iran, Qatar,in Malaysia and in Pakistan [11,14-17].

This is similar with a study conducted in in Mexican, in china, in Malaysia and Pakistan [7,12,15-17]. Previous study has proven that presence of complication and other complication of chronic disease are highly associated with anxiety.

CONCLUSION

The prevalence of anxiety 44.2% among Type 2 DM patients was high. Anxiety had statistically significant association with being female sex, chronic complication, greater than five duration of type 2 DM diagnosis and additional other chronic disease. Oromia Health Bureau should develop guidelines to screen and treat anxiety among Type 2 DM patients. Further research on risk factors of anxiety 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 anxiety 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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Citation: Tiki T (2017) Prevalence and associated Factors Of Anxiety among Type 2 Diabetes Mellitus Patients On Follow Up At Ambo General Hospital, Oromia Regional State, Ethiopia, Institutional Based Cross Sectional Study. J Psychiatry Depress Anxiety 3: 007.

Copyright: © 2017  Takele Tiki, et al. 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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