Psychiatric Aspects of Diabetes Mellitus

Abstract

We studied the psychiatric morbidity in 47 insulin-dependent diabetic patients who attended the Diabetic Clinic at King Fahd Hospital of the University, Al-Khobar, in eastern Saudi Arabia. Clinical psychiatric assessment and the Hospital Anxiety and Depression Scale (HAD Scale) were used in assessing the patients. The physiological characteristics of the patients were studied by physicians running the Diabetic Clinic. The prevalence of psychiatric illness was high (44.7%). The most common diagnoses were anxiety and depression. In addition, fatigability and loss of energy (40%), irritability (47%), sexual dysfunction (36%), and cognitive deficit (15%) were noticed. Psychiatric morbidity does not appear to be related to the duration of the illness or age at diagnosis.HBA Hafeiz, G Al-Ghassab, H Al-Freihi, F Al-Muhanna, Psychiatric Aspects of Diabetes Mellitus. 1990; 10(6): 629-632 In the past, diabetes mellitus (DM) was considered a psychosomatic illness caused by emotional stress [1,2]. In the "diabetic personality" [2], anxiety, depression, sexual dysfunction, and cognitive deficits are among the most common psychiatric aspects [3][4][5][6][7]. Disturbed family background has also been associated with DM; high anxiety levels in the mothers of diabetic children [8], overprotectiveness, rigidity, and family discord [9,10] have also been reported. The psychiatric changes reported are thought to be related to factors such as the stressful way of life of diabetics [3] or its effect on the central nervous system [11]. Family dynamics and the treatment problems of diabetes are also involved.The aim of this study was to investigate the prevalence and describe the nature of psychiatric morbidity in DM. MethodsThe study included all consecutive insulin-dependent diabetic patients who attended the Diabetic Clinic at King Fahd Hospital of the University. The patients were first examined, investigated, and assessed by the physicians (coauthors) and the relevant diabetic data recorded. A psychiatric interview consisting of a history and standard mental state examination was conducted in each subject by the psychiatrist. Assessment of cognitive function included orientation, concentration, memory, and intelligence, the last judged by general information and school and work records. The patients were rated as negative, doubtful, and positive cases. The psychiatric diagnoses were based on the criteria for anxiety neurosis and depression of the International Classification of Diseases of the World Health Organization [12]. In addition, the patients were rated blindly on the Hospital Anxiety and Depression Scale (HAD). This is a self-assessment scale that is claimed to be reliable in detecting states of anxiety and depression [13]. An Arabic version, which had been validated in Saudi patients, was used [14].Educational level was computed on the basis of one point for each level (0-5). Actual body weights were compared with ideal weights calculated from heights, and only deviations of more than 10% from the ideal were considere...