Determinants of Psychological Distress in Chinese Older People with Type 2 Diabetes Mellitus Y.L. TSANG 1, Doris, S.F. YU 2 1 Accident and Emergency Medicine Academic Unit, 2 The Nethersole School of Nursing, Chinese University of Hong Kong
Background Illness experience of Elderly Patients with Type 2DM Handling a life-long complex treatment regimen E.g. Self-control of diet, exercise, body weight, B-glucose, regular administration of OHA, insulin injection, etc Suffering from multiple medical comorbidities (Engum et al., 2005) E.g. Heart disease, stroke, hypertension, visual problems, physical disabilities Experiencing recurrent disease exacerbation & hospital readmissions (Katon et al., 2004) Suffering from DM-related complications (de Groot et al., 2001)
Background Prevalence of psychological distress in elderly patients with Type 2 DM Around 31% in western countries (Anderson et al., 2000) About 26% in Hong Kong (Chou & Chi, 2005) Presenting with: Depressed and anxious mood, malaise (Mirowsky, & Ross, 2003) Pessimism due to physical, social and emotional losses (Ryff, & Keyes, 1995)
Background Detrimental impact of psychological distress Physiological Trigger sympathetic nerve system Secrete stress hormones Inhibit the production of insulin Behavioral Poor compliance of treatment regimen Reduced social functioning
Aim of the study To identify the significant correlates of psychological distress in elderly patients with Type 2 DM.
Significance of the study Inform the development of effective care to lower psychological distress, and hence, eliminate the associated detrimental consequences of elderly patients with Type 2 DM
Research Design Cross-sectional Descriptive Correlational
Subjects A convenience sample of patients attending the medical outpatient clinic (Dec 2005 to Feb 2006) Inclusion criteria: aged 65 diagnosed with type 2 DM for 3 months Communicable in Cantonese Exclusion criteria: Cognitive impairment / acute psychiatric disorders
Predictive variables for psychological distress Demographic variables: age, gender, educational level, marital status, living arrangement, financial support religious belief
Predictive variables for psychological distress Clinical variables: Duration of DM, comorbidities HbA1C, treatment characteristics DM complication & DM-related readmission rate physical functioning
Predictive variables for psychological distress Psychosocial variables: social network size perceived adequacy of social support
Study instruments Collect data by a set of instruments Abbreviated mental test (AMT) (Hodkinson, 1972) Barthel Index (BI) (Mahoney, & Barthel, 1965) Hospital Anxiety and Depression Scale (HADS) (Leung, et al., 1999) Medical Outcomes Study Social Support Survey (MOS-SSS-C) (Yu, et al., 2004) Standardized demographic sheet
Data analysis To identify categorical/ ordinal/ interval variables which were associated with psychological distress: Independent-sample t-test One-way ANOVA Spearman rank-order Product moment correlation coefficient
Data analysis To identify the signifcant correlates of psychological distress: Stepwise multiple regression
Clinical demographics of 106 participants Characteristics Categories Percentage Gender Marital status Educational level Male Female Married Single/ divorced/ widowed Literate Unable to read/write 39.6% 60.4% 61.3% 38.7% 60% 40% Living arrangement Alone Family Others 7.6% 76.4% 16%
Clinical demographics of 106 participants Characteristics Categories Percentage Financial support Religious belief Children Government Others Yes No 61.3% 30.2% 1.9% 5.8% 94.2% Mean age = 74.3 years (SD = 7.07) Mean DM duration = 11.8 years (SD= 8.17)
Results (1) Categorical variables significantly associated with HADS Gender (p<0.016) History of stroke (p<0.001) DM nephropathy (p = 0.005) DM retinopathy (p=0.01)
Results (2) Continuous variables significantly associated with HADS Characteristics Correlation coefficient p-value Number of DM complications.319.001 Barthel Index -.239.014 Perceived social support -.273.005 Affectionate support -.300.002 Informational-emotional support -.291.002 Positive social interaction -.335 <.001 Size of social network -.276.004
Results (3) Stepwise regression of correlates with psychological distress Variables Beta t Sig. F Cumulative R square Comorbity of stroke.639 8.476 <.001 71.841.409 Size of social network -.241-3.350.001 45.064.467 Complication of nephropathy.180 2.454.016 33.514.496 Gender.156 2.246.027 27.393.520
Key messages Type 2 DM patients who are female, have stroke, DM nephropathy and small social network have higher risk of having psychological distress and need more attention.
Key message Effective health care to optimize psychological status of Type 2 DM patients should target at preventing stroke, DM complications and bolstering their social network (e.g. self-help group).
Acknowledgement Professor Doris S.F. Yu & Dr. C.M. Leung for their permission to use their translated instruments Professor C.C. Chow (Medical COS), Dr. David Dai (Geriatric consultant), Mr. Albert Ng (Medical DOM) and Ms Lisa Cheung (Medical OPD N.O.) for their permission to conduct the study in their department
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