DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20183836

Correlation of types of diabetic retinopathy and its psychosocial impact

Chinmay T. Jani, Tejas H. Desai, Sonal Parikh, Ashka S. Shah

Abstract


Background: Diabetic retinopathy affects majority (70% to 90%) of diabetic patients, causes visual impairment which leads to severe psycho-social disruption in life. Our objective was to study the patients of diabetic retinopathy, co-relate between the types of diabetic retinopathy and the extent of psychosocial impairment in these patients.

Methods: Data of the diabetic patients attending the Retina Clinic of C.H. Nagri Eye Hospital, Ahmedabad was collected using a pretested questionnaire. It included ocular history, history related to diabetes, data of ocular examination and type of retinopathy (if present). For psycho-social assessment, the patients were asked to fill the validated Gujarati language version of “General Health Questionnaire -28 (GHQ 28).” Selfscoring was done ranging from 0-1-2-3 (lower to higher disability respectively). Analysis of significance was carried out by Mann-Whitney Test using statistical software.

Results: Total 308 patients were studied. The subjects were divided into 3 groups: (A) Diabetes mellitus type-2 (DM-2) patients without retinopathy. (B) DM-2 patients having non-proliferative retinopathy (C) DM-2 patients having proliferative retinopathy. According to the accepted scoring pattern of GHQ-28 (cut of point 25), it was observed that 80.26% of patients having non-proliferative retinopathy in both eyes and 93.75% patients having proliferative retinopathy in both eyes were psychosocially impaired. The impairment was found to be more severe in proliferative retinopathy patients as compared to non-proliferative retinopathy patients. (p value <0.005) (mean GHQ score in PDR=41.88 >NPDR = 35.74). It was also found that in DM-2 patients without retinopathy the average mean score was 25.22 which showed less impairment (p value <0.005).

Conclusions: Patients of Diabetic Retinopathy had more psychosocial impairment which shows its significant impact on quality of life and overall health. Psychiatric counselling must be given to the impaired patients to decrease the impact of the disease on the psychosocial aspect of health. It is necessary to decrease the psychosocial suffering along with the control of disease.


Keywords


Diabetic retinopathy, GHQ-28 questionnaire, Psychosocial impact

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References


Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378(9785):31-40.

Global status report on non-communicable diseases 2010. Geneva: World Health Organization, 2011. Available at: http://www.who.int/nmh/publications/ ncd_report2010/en/.

Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Archives Ophthalmology. 1984;102(4):520-6.

Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. British J Ophthalmol. 2012;96(5):614-8.

Gavard JA, Lustman PJ, Clouse RE. Prevalence of depression in adults with diabetes. An epidemiological evaluation. Diabetes care. 1993;16(8):1167-78.

Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes care. 2001;24(6):1069-78.

Wulsin LR, Jacobson AM, Rand LI. Psychosocial correlates of mild visual loss. Psychosomatic medicine. 1991;53(1):109-17.

Raman R, Rani PK, Reddi Rachepalle S, Gnanamoorthy P, Uthra S, Kumaramanickavel G, et al. Prevalence of diabetic retinopathy in India: Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetics study report 2. Ophthalmology. 2009;116(2):311-8.

Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychological Med. 1979;9(1):139-45.

Walders-Abramson N. Depression and quality of life in youth-onset type 2 diabetes mellitus. Current diabetes reports. 2014;14(1):449.

Siddiqui S. Depression in type 2 diabetes mellitus-a brief review. Diabetes Metabolic Syndrome. 2014;8(1):62-5.

Ashraff S, Siddiqui MA, Carline TE. The psychosocial impact of diabetes in adolescents: a review. Oman Medical J. 2013;28(3):159-62.

Joseph N, Unnikrishnan B, Raghavendra Babu YP, Kotian MS, Nelliyanil M. Proportion of depression and its determinants among type 2 diabetes mellitus patients in various tertiary care hospitals in Mangalore city of South India. Indian J Endocrinol Meta. 2013;17(4):681-8.

Joshi A, Maseeh A, Jha PK, Bhatt M, Vyasa B. A study of prevalence of depression in diabetes mellitus: analysis from urban India. Indian J Med Sci. 2011;65(11):497-501.

Hirai FE, Tielsch JM, Klein BE, Klein R. Relationship between retinopathy severity, visual impairment and depression in persons with long-term type 1 diabetes. Ophthalmic Epidemiology. 2012;19(4):196-203.

Nyman SR, Dibb B, Victor CR, Gosney MA. Emotional well-being and adjustment to vision loss in later life: a meta-synthesis of qualitative studies. Disability and rehabilitation. 2012;34(12):971-81.

Nyman SR, Gosney MA, Victor CR. Psychosocial impact of visual impairment in working-age adults. British J Ophthalmol. 2010;94(11):1427-31.

Ash DD, Keegan DL, Greenough T. Factors in adjustment to blindness. Canadian J Ophthalmol. 1978;13(1):15-21.

Fenwick E, Rees G, Pesudovs K, Dirani M, Kawasaki R, Wong TY, et al. Social and emotional impact of diabetic retinopathy: a review. Clinical Exp Ophthalmol. 2012;40(1):27-38.

Yu Y, Feng L, Shao Y, Tu P, Wu HP, Ding X, et al. Quality of life and emotional change for middle-aged and elderly patients with diabetic retinopathy. International J Ophthalmol. 2013;6(1):71-4.

Makowska Z, Merecz D, Moscicka A, Kolasa W. The validity of general health questionnaires, GHQ-12 and GHQ-28, in mental health studies of working people. Inter J Occu Med Environ Health. 2002;15(4):353-62.

Richard C, Lussier MT, Gagnon R, Lamarche L. GHQ-28 and cGHQ-28: implications of two scoring methods for the GHQ in a primary care setting. Social psychiatry and psychiatric epidemiology. 2004;39(3):235-43.

Koeter MW. Validity of the GHQ and SCL anxiety and depression scales: a comparative study. J affective disorders. 1992;24(4):271-9.

Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, et al. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Med. 1997;27(1):191-7.

Wulsin LR, Jacobson AM, Rand LI. Psychosocial adjustment to advanced proliferative diabetic retinopathy. Diabetes care. 1993;16(8):1061-6.

Bernbaum M, Albert SG, Brusca SR, Drimmer A, Duckro PN, Cohen JD, et al. A model clinical program for patients with diabetes and vision impairment. Diabetes Educator. 1989;15(4):325-30.

Bernbaum M, Albert SG, Duckro PN. Psychosocial profiles in patients with visual impairment due to diabetic retinopathy. Diabetes care. 1988;11(7):551-7.

Barton W. Role of ophthalmic nurses with visually impaired patients. Insight. 1998;23(1):5-10.

Williams AS. A focus group study of accessibility and related psychosocial issues in diabetes education for people with visual impairment. Diabetes Educator. 2002;28(6):999-1008.

Jain S, Preetha K, Jain SC, Jain A. Diabetic retinopathy: a preventable scourge. J Indian Med Asso. 2008;106(5):303-4.