Association Between Depression, Anxiety and Adherence to Treatment Among Patients Attending the Kenyatta National Hospital (KNH) Diabetes Outpatient Clinic.

Abstract

Introduction: General medical clinical settings face a challenge in the identification, screening, diagnosis and linkage to treatment of patients with psychiatric comorbidities. The psychological and emotional distress in these patients, when not promptly addressed, affects their adherence to prescribed treatment plans. In diabetes patients, the setback in diagnosis and treatment of comorbid mental illnesses impairs their adherence to treatment thus disrupting the control of their blood sugar. This potentiates an increase in morbidity and mortality with ultimate negative effects on their quality of life. Despite this evident challenge, there is a paucity of data and information on the effects of depression and anxiety on levels of adherence to treatment in diabetes‟ outpatient healthcare settings. Objectives: The objectives of this study were two pronged; to assess the prevalence of depression and anxiety to evaluate the association between them and levels of adherence to treatment among diabetes patients on treatment at the Kenyatta National Hospital (KNH) diabetes outpatient clinic. Method: This was a cross-sectional study carried out at the KNH diabetes outpatient clinic. 213 patients with confirmed diagnoses of diabetes and who had been on treatment for at least 6 months were recruited. The patients were evaluated using a researcher designed social demographic questionnaire. The Hospital Anxiety and Depression scale (HADs) was used to assess the patients‟ levels of depression and anxiety. The Medication Adherence Report Scale 5 (MARS-5) was used to assess the patients‟ levels of treatment adherence. The Diabetes Distress Scale 17 (DDS-17) and Diabetes Quality of Life (DQOL) scale were integrated to assess the corresponding psychometric measures and treatment outcomes. Results: Statistical analysis was done using R Software (RStudio Version 4.1.2) to derive descriptive and inferential statistics. The study established a comorbid prevalence of anxiety at 100 (47.4%) and depression at 84 (39.6%) out of 213 patients. The comorbid prevalence of anxiety and depression in the same sample was at 76 (36.2%). Being diagnosed with anxiety decreased the odds of adherence to treatment by a factor of 0.05 (p < 0.0001) while being diagnosed with depression decreased the odds of adherence to treatment by a factor of 0.06 (p < 0.0001). Conclusion and recommendations: Given the significant correlation between anxiety, depression and adherence to treatment in diabetes patients, it imperative to optimize the identification, screening, diagnosis and linkage to care of these patients with psychiatric comorbidities. There is a fundamental role of hospitals and policy makers to integrate collaborative clinical care models in order to provide the patients with holistic care. To achieve that, it will be crucial to develop integrated and multidisciplinary clinical care guidelines in order to facilitate comprehensive care of patients with medical conditions while having comorbid mental illnesses. Keywords: Diabetes, depression, anxiety, adherence, treatment