Date of Award

6-2024

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr.Muslima Ejaz

Second Advisor

Dr. Nargis Asad

Third Advisor

Dr. Rehana siddiqui

Department

Community Health Sciences

Abstract

Background: Diabetic retinopathy (DR) is a complication of diabetes that affects the blood vessels of the retina and leads to blindness. People with uncontrolled diabetes mellitus have diabetic retinopathy. The diabetic retinopathy patients are at risk for the development of depression, it is therefore this study has explored the association between DR and depression among patients living with type II Diabetes mellitus.
Methods: An analytical cross-sectional study was carried out at the Aga Khan University Hospital in Karachi between August 2023 to October 2023. This study was conducted in the endocrinology department at AKUH. The study included patients diagnosed with diabetes mellitus type II, and two groups were formed: one group all diabetic patients with DR (the exposed group) and the other group was DM patients with no DR (non-exposed group). The source population included all diabetes mellitus patients who visited the endocrinology department in AKUH. Patients who visited the outpatient endocrinology department were asked to complete a screening form to check their eligibility for the study. If they met the criteria and fulfilled all the requirements, they were formally invited to participate and enrolled in the study. The outcome variable was depression and study explored the relationship between DR and depression. The study used a nonprobability purposive sampling strategy. Depression, the outcome variable was assessed using the validated PHQ-9 scale and was measured in the ordinal form. Out of 510 screened subjects, 10 were not eligible for the study and 4 did not provide consent, resulting in a final sample size of 496 patients who were recruited and assessed in the study.
Results: Out of 496 patients, 55% were females, 44% were males and 1% were others who had diabetes. Among the 496 patients living with DM, 124 (25%) had diabetic retinopathy, while 372 (75%) had no DR The mean age of recruited patients was 53.27 ± 8.56 (range: 36 - 67) years. 70% of the patients used medication for type 2 diabetes, while the remaining 30% did not. Almost 48% of diabetic retinopathy patients had depression (moderate), and was found more in females than males. Patients with diabetic retinopathy were 1.15(0.79,1.66) times more likely to have depression than those who did not have diabetic retinopathy. For the factors associated with 8 outcome of interest, age and duration of diabetes mellitus did not significantly affect the frequency of depression in type 2 diabetic patients while the duration of type 2 diabetes is significantly associated with depression.
Conclusion: Based on the study findings, we emphasize the importance of personalized interventions to alleviate depression in these patients, leading to improved overall well-being. To ensure comprehensive evaluations of patients with diabetes, internists, and endocrinologists should include the assessment of depression. Screening among diabetic patients, especially those with diabetic retinopathy, is a mandatory step for better outcomes. Early detection of complications from the disease and improved glycemic management with optimal frequency and number of medications can help to reduce the level of depression in diabetes patients.

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