الفهرس 
DEPRESSIONOnly 14 pages are availabe for public view
 |  | from | 94 |  |  |
| | | from | 94 | | |
Abstract
Diabetes mellitus is a chronic debilitating disease, with prevalence estimates that are approaching epidemic proportions worldwide. Depression also is highly prevalent worldwide and associated with significant morbidity and mortality. The combination of diabetes and depression is linked to higher all-cause morbidity and mortality versus diabetes or depression alone.
Aim of the study: The aim of the present research was assessment of depression among type 2 diabetes mellitus patients aged (20-60) years through family practice in Alexandria governorate by:
1. By determining prevalence of depression among type 2 diabetic patients attending family health centers in Alexandria.
2. By determining the association of depression with some risk factors as sex, age, duration of diabetes, and depressogenic drugs in type 2 diabetic patients attending family health centers in Alexandria.
3. By assessing the knowledge and practice of family physicians concerning occurrence, early detection and management of depression in type 2 diabetic patients attending family health centers in Alexandria.
To conduct the present study, the following techniques were used:
1. An interview questionnaire was designed for depression assessment by using the Hamilton Depression Rating Scale (HAM-D) among type II diabetic patients in the age category (20-60Ys) including:
a) Personal data: age, sex, occupation, and educational level.
b) History: present history, medical history, drug history, and family history.
c) Criteria for Depressive Episode.
2. A self-administered questionnaire was designed for family physicians to assess their knowledge and practice about early detection & management of depression in type 2 diabetic patients.
The results of the present study could be summarized as follows:
1. The study was conducted in seven family health facilities distributed in the (7) health districts of Alexandria, the total number of patients included in this study was 336 patients.
2. This study include (65.8%) male and (34.2%) females, the most of the studied patients (54.5%) their age ranged between 40 to less than 60 most of them were married (75.0%), can only read and write (33.9%), and not working (70.5%).
3. Regarding to type of medications received, the highest number was in NSAID (73.5) followed by (38.4%) in ACE inhibitors, then (27.1%) for Statins, then (19%) for calcium channel blockers (CCB), both corticosteroids and antibiotics were (8.9%) for each, while beta-blockers (BB) were used with only (4.2%) patients, no cases were taking any antidepressants.
4. Regarding total score of Ham-D17 items scale for diagnosis the presence & degree of severity of (D). It illustrated that the number of the normal studied sample were (47.6%) while (52.4%) were depressed which were subdivided into mild (12.2%), moderate (20.8%) and severe (19.4%) with mean value 22.5±11.8.
5. There was significant correlation between medical history (suffering other chronic disease – number of associated chronic diseases) and the total score of the scale.
6. Regarding to the group of medications taken, there was statistical significant correlation between total score of Ham-D17 items scale with ACE inhibitors, statins, calcium channel blockers & corticosteroids. (P < 0.0001). There was no statistical significant correlation between total score of Ham-D17 items scale and Beta-blockers.
7. Regarding to personal characteristics among the physicians’ sample. Total number of studied physicians were 42, males were (23.8%) and females were (76.2%), Only (83.3%) subjects had received training in DM and only (71.4%) had received training in mental health.
8. Testing for knowledge about (D) & DM among the studied physicians shows Poor scores were (9.5%), fair (81.0%) and good (9.5%).
9. Testing for practice of care for patients with DM among the studied physicians shows Poor scores were (54.8%), fair (45.2%) and good 0
10. There was no significant correlation between knowledge and practice score with different characteristics among the studied physicians (P> 0.05), but correlation between knowledge versus practice score among the studied physicians was significant (P< 0.0001).
Accordingly the following can be recommended:
1. Great efforts must be done to increase awareness of the presence of a big health problem with diabetics, especially those of type 2 (T2DM) being associated with depression that magnifies both morbidity & mortality.
2. The implementation of professional medical networks between family physicians, medical database and specialty consultants may have a major impact on effective continuous medical education programs.
3. Ministry of health (MOH) should allocate more budgets in health sector for integrated health packages and should ensure proper functioning of health programs and health workers.
4. The family health facilities should organize more training courses on mental health & the use of depression scales as the (PHQ-9), frequently and attendance of family health care team should be made mandatory, followed by MCQs to test knowledge & practice abilities.
5. Drug companies that arrange seminars for diabetics should stress on the point of association with depression & what is the correct way to solve this problem, together with the cooperation in the research work to invent new lab methods for diagnosis of depression instead of the present questionnaires, time & effort consuming methods.