Perceived stress level and health anxiety during COVID-19 pandemic period in patients with diabetes mellitus and hypertension: A prospective cross-sectional study

Abstract

Background/Aim: Mortality rates of Coronavirus Disease 2019 are increased in patients with chronic diseases such as diabetes mellitus (DM) and hypertension (HT). For this reason, some restrictions and lockdown measures were brought to these patients during the pandemic period, which may have disrupted their mental wellbeing. We aimed to investigate the relationship between the changes in the frequency of admissions of patients with DM, HT, DM+HT to the hospital during the pandemic and their perceived stress, health anxiety, general anxiety, and depression levels, and the change in stress burden experienced by disease type. This study intends to reveal the psychological problems that may develop due to the COVID-19 pandemic in DM, HT, and DM+HT patients and raise awareness. Methods: DM, HT, and DM+HT patients admitted to Internal Medicine Outpatient Clinic between 01.12.2020-01.02.2021, and healthy volunteers who accepted to participate were included in this prospective cross-sectional study. Patients who did not match the age range, had additional comorbidities besides DM and HT, were treated for psychiatric disease, or were pregnant, and those who did not give consent were excluded. After a psychiatric interview was performed, the participants were asked to fill in the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS), and Health Anxiety Scale (HAS). The effects of the COVID-19 pandemic on the frequency of admissions and perceived stress, health anxiety, general anxiety, and depression levels, and the change in stress burden experienced by disease type were examined. Results: There was a significant difference in all scales used between the patient groups and the healthy control group (HAS P<0.001, BDI P<0.001, BAI P=0.002, PSS P=0.001). There was a significant decrease in the frequency of admission to the outpatient clinics among DM + HT patients (P=0.002). The mean duration of disease was lower in individuals whose frequency of admission to the outpatient clinic decreased (P=0.006). Patients with a family history of COVID-19 had significant decreases in the frequency of admission to the outpatient clinic (P<0.001) and had significantly disrupted medical treatment (P=0.007). Conclusion:Patients with DM and HT, a short duration of chronic diseases, and history of COVID-19 infection in their families are more prone to be affected psychologically, and patients who are more psychologically affected refer less to the outpatient clinic. It is essential to continue treatment in consultation with psychiatry if DM and HT patients presenting to the outpatient clinic have one or more of these risk factors.

The Effect of Anxiety Levels of Type 2 Diabetes Mellitus Patients on Their Treatment Adherence in the Covid-19 Pandemic Period

“…Bozkurt et al, (2021), in their study in which they investigated the perceived stress level and health anxiety in patients with diabetes mellitus and hypertension during the COVID-19 pandemic, had similar results with our study findings. Patients had higher levels of anxiety, depression and health anxiety compared to healthy individuals [38]. Unfortunately, the pandemic process increases the stress, anxiety and fears of patients and leads to negative health behaviors [13,15,39].…”

“…Singhai et al stated that DM patients experienced anxiety in the management of their treatment processes when they were infected with COVID-19 due to their infection status and the portrayal of diabetic individuals as a risk group on the media [32]. Bozkurt et al, (2021), in their study in which they investigated the perceived stress level and health anxiety in patients with diabetes mellitus and hypertension during the COVID-19 pandemic, had similar results with our study findings. Patients had higher levels of anxiety, depression and health anxiety compared to healthy individuals [38].…”

Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence among patients with type-II diabetes mellitus: a randomized control trial

“…It is more frequent among patients with type II diabetes mellitus [5]. The prevalence of DD globally is around 45% which is quite high as it is a predictor of clinical outcomes among patients of T2DM [6] Poor self-care, poor self-management, and a reduced treatment adherence among patients with diabetes are some of the negative treatment outcomes associated with DD [7]. Depression is a mental state characterized by a pessimistic sense of inadequacy and lack of activity, usually occurring a i when the intensity of distress becomes high as frequent and unmanaged distress can sometimes lead to full-blown depression [8].…”

“…Health anxiety (HA) is another factor which causes distress; it occurs when an individual misinterprets his bodily sensations or changes as the indicators of a lifethreatening illness (Asmundson & Taylor, [11]). HA is the core of many psychological illnesses, ranging from low to severe [7]. DD leads to HA because patients with chronic illnesses such as diabetes commonly experience fears of illness or symptoms recurring or worsening.…”