Depression among Patients Attending Physiotherapy Clinics in Erbil City

Transcription

1 amog Patiets Attedig.. Zaco J. Med. Sci., Vol. 13, No. (2), 2009 amog Patiets Attedig Physiotherapy Cliics i Erbil City Dr. Sirwa K. Ali * Dr. Jwa M. Zagaa ** Dr. Diyar H. Tahir *** ABSTRACT Backgroud ad Objectives: is a coditio that worses the progosis of patiets udergoig physiotherapy treatmet; it is uderestimated ad uder-recogized. The objectives of this study were to detect the prevalece, severity ad type of depressive disorder amog patiets attedig the physiotherapy cliic, ad aalysis the factors that ifluecig the occurrece of depressio ad its severity. Methods: Cross sectioal study was carried out with (200) patiets attedig physiotherapy cliic i Hawler ad Rizgary Teachig Hospitals i Erbil City from 2d Jauary -2d march Data about demographic characteristics of the sample, utilizatio of health services, ad type of physical diseases were obtaied by direct questioig the patiets. was assessed by meas of the Patiet Health Questioaire (PHQ-9). Results: Poit prevalece of depressio was estimated to be 56% (27% mild, 20.5% moderate ad 8.5% sever) amog this populatio of patiets attedig a outpatiet physical therapy cliic. Female geder, old age ad married patiets were sufferig from sever depressive disorders. Coclusios: The high prevalece of depressio i patiets attedig physiotherapy cliics suggests that cosideratio should be give to scree the psychological. Key words: depressio, physiotherapy, prevalece. INTRODUCTION: is a commo ad costly health problem. The term depressio ca refer to a mood state or a illess diagosed accordig to various criteria (eg, the Diagostic ad Statistical Maual of Metal Disorder 1V) 1. Depressive disorders are more commo amog patiets with physical illesses tha those without it, with up to oe third of medical i-patiets reported mild to moderate symptoms of depressio 2. The presece of depressive symptoms i patiets attedig physiotherapy cliics ofte idetified by questioaires such as Beck Ivetory (BDI), or Patiet Health- Questioaire (PHQ-9), rather tha through formal or structured iterviews, they do provide a simple, low cost, ad stadardized method of idetifyig people persistet pai problems, the diagosis of depressio presets particular difficulties due to shared symptomatology. I practice, depressio i such patiets has mostly bee defied by scores o questioaires 3. is commo i patiets attedig physiotherapy cliic 4, ad is associated with icreased pai itesity, icreased physical ad psychosocial disability, icreased medicatio used, ad icreased likelihood of uemploymet 5. It is clear that the presece of depressio is associated with poor outcomes 6. Accordigly,curret itervetio guidelies ecourages early detectio ad appropriate maagemet based o the premise that this may lead to better outcomes, miimize the fiacial cost to the idividual ad society ad prevet both depressio ad the physical illesses 7. *Lecturer i Psychiatric Departmet, College of Medicie, Hawler Medical Uiversity. ** Lecturer i Commuity Medicie Departmet, College of Medicie, HMU. ***Lecturer i Psychiatric Departmet, College of Medicie. HMU. 1

2 amog Patiets Attedig.. Zaco J. Med. Sci., Vol. 13, No. (2), 2009 tio betwee arthritis ad psychiatric morbidity such as axiety ad depressio. People with arthritis are more likely to report a medically cofirmed metal health problem ad to have depressio i particular accordig to a validated questioaire measure. This effect is oted i the youger age group whose expectatios of their physical abilities may be of high cocer as opposed to those i the older age groups 8. Fially, the depressive illess may be coicidetal ad urelated to physical problems, as both physical ad psychiatric coditios are commo i the geeral populatio. pre-dates the medical illess i up to 25% of patiets with co morbid depressio, ad it is associated with a icrease i somatic complaits. 3. The aims of the study was to detect the poit prevalece ad severity of depressio amog patiets attedig physiotherapy cliic ad defiig the factors that is related to the oset ad severity i order to icrease the geeral practioers attetio toward psychological distress, ad otios of the psychological distress as a possible cotributory cause of the patiet's physical METHOD: states. The preset study icluded patiets from age years, referred to the physiotherapy cliic i Erbil ad Rizgary Teachig Hospitals, from the period betwee 2d Jauary - to 2d march The study populatio cosisted of 212 cases from both geders. The medical history of each patiet was thoroughly studied ad types of physical illesses were obtaied through a data collectio form submitted by the ivestigator. Patiet read ad siged a ethical approval iformed coset before iclusio i the study. They were assessed fully whe visited the physiotherapy cliic, additioal cliical details ad demographic data were obtaied from the patiet's record. Previously diagosed patiet with study as they had previously bee diagosed with depressio ad were already receivig treatmet for this coditio, they were 12 cases the remaiig sample was 200 patiets form the preset study sample. I order to fid the psychological profile, each patiet was asked to complete a composite questioaire which iclude the use of Patiet Health Questioaire 9 (PHQ-9) 9 10, which served as a referece stadard. This is a self admiistered versio of the PRIME-MD diagostic istrumet for commo metal disorders. The PHQ-9 is the depressio module, which scores each of the 9 DSM-IV criteria as "0" (ot at all) to "3" (early every day). It has bee validated for use i Primary Care settig. The depressio scale assessed dysphoria, hopelessess, devaluatio of life, selfdeprecatio, lack of iterest or ivolvemet, ahedoia, ad iertia 11. The data were expressed as descriptive RESULT: Out of 200 patiets, 88 patiets (44%) have o sigs or symptoms of depressive illess, whereas 112 patiets (56.0%) have depressive disorder (27% mild, 20.5% moderate ad 8.5% sever depressio) by applicatio of Patiet Health Questioaire 9 (PHQ-9). (Table 1) shows the distributio of respodets o the basis of age, older age groups (46 years ad above forms 50% of the sample with higher icidece of sever depressio. (Table 2) shows the distributio of respodets o the basis of geder ad marital status. 106 cases out of the study sample (53.0%) were females ad foud to be more depressed. particularly sever depressio which was 7% i compariso to male geder were sever depressio oly detected i 3 cases. The married patiets form the majority of the studied sample (73%) with higher rate of depressio percetage of mild, moderate ad severe depressio which was: 19.5%, 14% 2

3 amog Patiets Attedig.. Zaco J. Med. Sci., Vol. 13, No. (2), % respectively. Oly 11 cases was widowed 8 of them were depressed. (Table 3) shows the relatioship betwee depressio ad duratio of the treatmet ad umber of visits to the physiotherapy uits. The preset study shows that 145 (72.5%) of the cases who were attedig physiotherapy cliic for less tha oe moth showed higher rate of depressio 38% i compariso to patiets attedig the cliic for loger period of time (18%). O the other had the daily visitors to the uit were the Majority of the studied sample (94%), sever depressio were detected amog them oly i additio to other types of depressio. (Table 4) shows the relatioship betwee differet degrees of depressio ad the physical coditio of the patiets attedig the physiotherapy uit; more tha half of the studied sample was complaiig from osteoarthritis with relatively high rate of depressio particularly moderate to sever type, also we foud higher prevalece of depressio amog patiets with cerebrovascular accidets (stroke). Table (1): Distributio of the sample accordig to age of the patiets. Age group No Mild Moderate Sever Grad total years 14 7% 12 6% 7 3.5% 2 1% % years 18 9% 8 4% 6 3% 0 0% 32 16% years % 6 3% 7 3.5% 5 2.5% % years 22 11% % % 3 1.5% % years % % 10 5% 7 3.5% % Grad total 88 44% 54 27% % % % Table (2) : Distributio of the study sample accordig to geder ad marital status of the patiets. Geder No Mild Moderate Sever Grad total Male 52 26% % 16 8% 3 1.5% 94 47% Female 36 18% % % 14 7% % Grad total 88 44% 54 27% % % % Marital status Sigle 18 9% 12 6% 5 2.5% 1 0.5% 36 18% Married 64 32% % 28 14% % % Divorced 3 1.5% 1 0.5% 3 1.5% % Widowed 3 1.5% 2 1% 5 2.5% 1 0.5% % Total 88 44% 54 27% % % % 3

4 amog Patiets Attedig.. Zaco J. Med. Sci., Vol. 13, No. (2), 2009 Table (3): Distributio of the study sample accordig to duratio of treatmet ad umber of visits to the physiotherapy cliic. No Mild Moderate Sever Grad total Duratio of whole treatmet < oe moth % % 30 15% % % > oe moth % % % 6 3% % Grad total 88 44% 54 27% % % % Number of visits to the Physiotherapy cliic uits Daily 82 41% % 38 19% % % Weekly 4 2% 2 1% 1 0.5% % Mothly 2 1% 1 0.5% 2 1% % Total 88 44% 54 27% % % % Table (4): Distributio of the study sample accordig to the cause of physical diagosis of the patiets attedig the physiotherapy cliic. Diagosis No Mild Depressi o 4 Moderate Sever Depressi o Grad total Fightig 3 1.5% 2 1% 3 1.5% 3 1.5% % Road traffic 2 1% % 4 2% accidet 0.5% Bur 1 0.5% 3 2 1% % 1.5% 0.5% Fall from height 4 2% 2 1% % - Cogeital 10 5% 4 2% 2 1% % Cerebro-vascular 2 1% 6 3% 5 2.5% 4 2% % accidet Rheumatoid 6 3% % % arthritis 2.5% Osteoarthritis % 24 12% 20 10% 8 4% % Facial pulsy 8 4% % % 3.5% Foot drop 1 0.5% % % Spasm 2 1% % Grad total 88 44% % 27% 20.5% 8.5%

5 amog Patiets Attedig.. Zaco J. Med. Sci., Vol. 13, No. (2), 2009 DISCUSSION: As depressio is strogly associated with physical illess, it ca be a complex ad challegig coditio for the medically ill patiets 12. Approximately 33% of physically ill patiets have depressive symptoms, may of which are regarded as uderstadable resposes or reactios to the physical illess. Depressive illess is ofte uder-diagosed ad uder-treated, particularly i those with coexistig physical illesses. The assessmet of both coditios ad the iteractio betwee them is critical i maagig these patiets 13. I additio, the loger the depressio is left udetected, the greater the likelihood of prologed physical therapy itervetio ad icreased disability 14. This situatio is costly to the patiet ad society i ecoomic ad social terms ad perpetuates egative mood states 15. However, because of the wide rage of aspects addressed i this paper, it is ot possible to describe the fidigs i detail e.g. i the sese of revealig predictors for each variable. The study represets the largest psychological assessmet of differet patiets i a physiotherapy care settig i Erbil city. The first major result was the high rate of depressio amog patiets ad almost half of the patiets were depressed although depressio was diagosed ad treated i oly miority of the patiets. The prevalece of depressive symptoms i this sample of patiets attedig physiotherapy cliic was foud to be 56%, the prevalece estimate i this study is higher tha some of other studies (90% of patiets who atteded pai maagemet cliics) i Australia ad Uited Kigdom studies were reported to have at least oe mood disorder ad 30% to 40% of those with a mood disorder were reported to have depressio Probably some of these cotroversies might be due to methodological differeces such as the use of various screeig tools, samplig method, ad the sample size. Still the aloe may lead to depressive symptoms, but defiite depressive disorders, as defied by psychiatric classificatio, appear to result from a combiatio of chroic social difficulties resultig from rheumatoid arthritis, osteoarthritis plus 20, idepedet social stresses 21. Prevalece rates for depressio after stroke vary eormously (from 5% to 50%) 22, 23 depedig o several factors, icludig the criteria used to diagose depressio, stroke severity ad how log after the stroke the assessmet is made. I the preset study the rate of moderate to sever depressio comprise more tha half of the patiets with stroke which is comparable with the previous studies but the sample size was too small. Both psychosocial ad physical factors appear to be importat i the developmet of depressio after stroke. Disablemet has bee show to be a strog predictor of depressio 24 ad cosequetly the various forms of disability which follow stroke are likely to be a importat factor i the developmet of depressio 25,26. Of utmost importace is the potetial egative effect of depressio o the patiet's participatio i rehabilitatio ad the associated rehabilitatio outcome. The previous similar works reveal that the patiets experieced real psychosocial problems, o which healthcare professioals eed to REFERENCES: focus their attetio Diagostic ad Statistical Maual of Metal Disorders. 4th ed. Washigto, DC: America Psychiatric Associatio; Rodi, G.& Voshart, K. i medically ill: a overview. America Joural of Psychiatry, (1986), 143, Derogatis LR, Wise TN. Axiety ad Depressive Disorders i the Medical Patiet. Washigto, DC: America Psychiatric Press; Mai CJ, Wood PL, Hollis S, et al. The Distress ad Risk Assessmet Method: a simple patiet classificatio to idetify ad evaluate the risk of poor outcome. Spie. 1992;17: Sulliva MJ, Reesor K, Mikail S, Fisher R. The treatmet of depressio i chroic low back pai: review ad recommedatios. Pai. 1992;38:

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