Anxiety and Depression in Diabetes Sufferers

INTRODUCTION

The activities involved in identifying and searching for information on a topic and developing a comprehensive picture of a state of knowledge and attitude on a topic is called review of literature.

Polit & Hungler (2006).

The review of literature is an extensive systematic scuritinization of potential sources of previous study and work. This is a previous study work. This process help in identification and selection of problems, background of the study formation of tool choosing methodology, formulate hypothesis. Based on review of the literature, investigator developed a conceptual frame work for the study. The review of the literature was from published articles, text books, net sources; reports are organized and presented under following heading:

Literature review related to relationship between anxiety and depression with type 2 diabetes mellitus.

Literature review related effectiveness of Jacobson’s progressive muscle relaxation technique for anxiety and depression.

Literature review related the effectiveness of Jacobson’s progressive muscle relaxation technique for anxiety and depression among type 2 diabetes mellitus.

LITERATURE REVIEW RELATED TO RELATIONSHIP BETWEEN ANXIETY AND DEPRESSION WITH TYPE 2 DIABETES MELLITUS.

Elizabeth H.B.Lin & Michail Von Korlt (2008) in their cohort study, examined the association of depression with all cause of specific mortality in type 2 diabetes. Out of four thousand one hundred and eighty five patients, five hundreds and eighty four died during the follow up period. Death occurrence was 428(12.9%) patients with no depression, 88(17.8%) major depression, and 65(18.2%) patient minor depression. Adjusting for demographic characteristics base line major depression was significantly associated with cause of mortality.

Shazia Parvenu & Juanita Hatcher (2007), in their case control study focused the association between depressions with newly diagnosed type 2 Diabetes mellitus, in the Out Patient Department (OPD) of civil Hospital Karachi in Pakistan with Hamilton Depression Rating Scale (HDRS), (n = 592). Results reviewed significance association between depression and type 2 diabetes. Biofeedback and Jacobson Progressives Muscle Relaxation (JPMR) were associated with significant in mortality and morbidity results in type 2 Diabetes mellitus.

Khuwaja AK, et al (2010), conducted cross-sectional, multi-center study in four out-patient clinics in Karachi in Pakistan (n= 889) in adults with type-2 diabetes. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Overall, 57.9% (95% CI = 54.7%-61.2%) and 43.5% (95% CI = 40.3%- 46.8%) of study, participants had anxiety and depression respectively. This study identified that a large proportion of adults with type 2 diabetes mellitus had anxiety and/or depression. These results identified the for treatment anxiety and depression as common components of diabetes care.

Pawaskar & Balkrishnan (2007), in their prospective cohort study to determined predictors of depressive symptomatology with diabetes mellitus clients administrating with the Epidemiologic Studies Depression Scale on 792 respondents. About 17% had depressive symptoms. Overall, increased risk of depression was associated with lower health related quality of life (HRQoL) (OR: 0.97; 95% CI: 0.96-0.98) and higher impairments in instrumental activities of daily living (IADLs) (OR: 1.31; 95% CI: 1.14-0.52) in elderly patients. Poor health related quality of life (OR: 0.97, 95%CI: 0.95-0.99) was associated with higher risk of depression in patients on insulin therapy.

Kamel K et al (2008), in their cross sectional study examined the association of depression anxiety and stress with type 2 diabetes mellitus .(DA&S-21) Depression ,anxiety and Stress Scale was administered to type 2 diabetes mellitus patients in 132 Heath Centers In Bahrain an Island country with very high prevalence of type 2 diabetes mellitus. Logistic regression analysis had shown significant association of type 2 diabetes mellitus with anxiety, depression and stress.

Wanger (2009), studied 55 people considers at risk for type 2 diabetes mellitus controlled in dietary prevalence programme. Widely accepted test for depression was used to measures the level of depression. One in three study participants were, found clinically depressed and one in four of type 2 diabetes mellitus patients, were lacking antidepressant drugs. Depressed participants who were not taking treatment lead significantly incidence resistance of type 2 diabetes mellitus.

Engum A (2007), in his prospective population based study (n=37,291) investigate the risk of depression and anxiety in the event of type 2 diabetes mellitus and examined the mediating factors association. The author concluded that diabetes mellitus did not predict symptoms of depression or anxiety but symptoms of depression and anxiety emerged as risk factors onset to type 2 diabetes mellitus. Independent significance established the risk of, type 2 diabetes mellitus such as socioeconomic factors, lifestyle factors and makers of the metabolic syndrome. The co morbidity between depression and anxiety may be the most important factors.

Baskar & Balakrishnan (20 07), prospective cohort study explained predictors of depressive symptomatology in an elderly population (age 55-65years) with type 2 diabetes mellitus. The Short Form Center for Epidemiologic Studies Depression scale was used to (n=792) respondents, about 17% had depressive symptoms. Overall, increased risk of depression was associated with lower Health Related Quality of Life (HRQoL) (OR: 0.97; 95% CI: 0.96-0.98) and higher impairments in Instrumental Activities of Daily Living (IADLs) (OR: 1.31; 95% CI: 1.14-0.52) in elderly patients. Poor health related quality of life (OR: 0.97, 95%CI: 0.95-0.99) was associated with higher risk of depression in patients on type 2 diabetes mellitus with insulin therapy. Results showed that impairments in lower Health Related Quality of Life (HRQoL) were predictors of depressive symptomatology in elderly with type 2 diabetes mellitus. Determinants of depression varied according to class of anti diabetic medications.

Tellez-Zenteno JF & Cardiel MH: (2008), in their cross-sectional study reported the risk factors association with depression and type 2 diabetes mellitus, at the Department of Neurology and Psychiatry of the Institution National de Cadencies Medicos y Nutrition Salvador Zurbaran in Mexico City. Beck Depression Inventory scale was used (n=189)to measured, the independent variables evaluated to explain depression were socio demographic and characteristics of the disease were disease duration, co morbidity, compliance, and glycemic control. Prevalence of depression was 39% (74 patients).On the other hand, the most constant associations were presence of blood glucose at the last appointment >or=200 (OR 3.23, CI 1.59-6.60, p = 0.0003) and >or=250 (OR 2.15, CI 0.93-5.03, p = 0.05), as the average of the last five blood glucoses >or=200 (OR 3.67, CI 1.76-7.73, p = 0.0001), >or=250 (OR 4.07, CI 1.61-10.49, p = 0.0007) and >or=300 (OR 2.12, CI 1.48-3.02, p = 0.003). The study indicated that frequency of depression in patients with type 2 diabetes mellitus was high (39%) and high level of blood glucose stands out as a variable associated with presence of depression.

LITERATURE REVIEW RELATED EFFECTIVENESS OF JACOBSON’S PROGRESSIVE MUSCLE RELAXATION TECHNIQUE FOR ANXIETY AND DEPRESSION.

Dellora et al (2007), in their open uncontrolled trial anxious patients with type 1 diabetes mellitus were allotted to receive Jacobson Progressive Muscle Relaxation (JPMR) techniques (n=143). Duration of relaxation therapy was 6 weeks and they were followed up one month of after completion of JPMR techniques. Significant reduction of anxiety was observed in state anxiety and trait anxiety. The authors concluded that, Jacobson Progressive Muscle Relaxation (JPMR) technique may be effective technique in improving the psychological health and quality of life in anxious type 1 diabetes mellitus patients.

Collins Nitz (2009), conducted a study to explore the use of muscle stretching exercises in relaxation training on a clinical population. The study revealed that utility of relaxation of muscles stretching was effective in reducing the subjective anxiety.

Agbir TM et al (2010), conducted a cross sectional descriptive study between 2005 and 2006, among bronchial asthma clients, demographical data followed by clinical interview cross with Hamilton Rating Scale for depression among 160 subjects, showed 31 of 160 subjects had major depression. Depression was significantly correlated with sex (p=0.001), female to male ratio of 3:1 and was associated with unmarried type 2 diabetes mellitus (p=0.216), employment status (p=0.84), poor relationship with to partner (p=0.04), educational qualification (p=0.268), and monthly income (p=0.110). Researchers concluded that depression is a common mental health problem among bronchial asthma in unfavorable environment.

Archana Khanna & Maman Paul (2007), aimed at comparing the efficacy of two relaxation techniques studied highly stressed 30 female, randomly assigned to three group (n=10), group 1 receiving biofeedback, group 2 receiving Jacobson Progressives Muscle Relaxation (JPMR) technique, group 3 control. The stress level was determined using Comprehensive Anxiety Test Questionnaires’. Pulse rate was measured before and after the training. Results indicate that JPMR technique can significantly reduced the high pulse rate as compare to other s technique.

EFFECTIVENESS OF JACOBSON’S PROGRESSIVE MUSCLE RELAXATION TECHNIQUE FOR ANXIETY AND DEPRESSION AMONG TYPE 2 DIABETES MELLITUS.

Feingold MN, et al (2008) explained the effects of Jacobson Progressive Muscle Relaxation (JPMR) technique on patients with poorly controlled type 2 diabetes mellitus with anxiety(n=10). No improvement occurred in glucose tolerance test or blood glucose test after one week. Daily insulin therapy and practicing the Jacobson Progressive Muscle Relaxation (JPMR) techniques at home was very effective (80 %). After six weeks of practicing JPMR technique enhancing blood glucose control in patients with type 2 diabetes mellitus.

Gilmore SL & Rosenthal MJ: (2007), examined the effects of Jacobson Progressive Muscle Relaxation technique on acute glucose disposal in depression with type 2 diabetic mellitus subjects (n=20), as measured by glucose tolerance and pre-post technique versus wait-list experimental design. Effects were assessed and measured by State Anxiety, and significant changes in physiological measures of muscle activity and skin conductance compared to the control condition. The major implication of this study is that relaxation training (JPMR) to directly improve diabetic control in mildly stressed non-insulin-using type 2 diabetes mellitus patients.

A study done by Maria (2008), in Bombay to find out the effect of Jacobson Progressive Muscle Relaxation technique on patients of bronchial asthma with anxiety (n=35), showed that (JPMR) made a significant difference in reduction anxiety ( P <01), irritability (P <.01) and tension( p <0). On breathlessness it was observed that before the JPMR 80% of patients had breathlessness and 65% of patients had anxiety, breathlessness was reduced from 45% to 30% and anxiety was reduced to 30% to 25%. For patients who had breathlessness at night, on the first day it was reduced to 20%, which means the number of patients who had well sleep at night increased.

Lebo Hub & Loggia (2009) did a study to compare frontal EMG feedback training and Jacobson Progressive Muscle Relaxation (JPMR) technique in the treatment of chronic anxiety. Responses of two groups (N=26) of patients with chronic anxiety were compared to different forms of relaxation therapy. One group received 16 sessions Jacobson Progressive Muscle Relaxation technique although EMG feedback was much superior in reducing frontal EMG activity. This EMG feedback treatment was no more effective than progressive relaxation in reducing symptoms of anxiety. Few patients group showed more than marginal improvement.

Pawlow (2008) studied to determine whether a relaxation intervention (Jacobson Progressive Muscle Relaxation technique) that has been shown to significantly reduce stress levels in normal healthy adults would also benefit a night eating syndrome sample. A total of 20 adults were randomly assigned to either a relaxation training or control. All subjects attended two laboratory sessions per week apart, pre and post session indicates of stress, anxiety, relaxation and salivary cortisole were obtained as well as day first and day eight indices of mood. Food diaries and hunger ratings were also obtained. The results indicated that 20 minutes of Jacobson Progressive Muscle Relaxation technique significantly reduced stress anxiety and salivary cortisole immediately after post session. After practicing these exercise daily for a week subjects exhibited lower levels of stress, anxiety fatigue, anger and depression on day eight.

Sheik & Lin (2008) conducted a study which examined the effect of Jacobson Progressive Muscle Relaxation technique on anxiety state in patient with essential hypertension. Forty subjects from a hypertension out- patient clinic received Jacobson Progressive Muscle Relaxation technique training once in a week and practiced at home daily for 4 weeks. Jacobson Progressive Muscle Relaxation technique significantly enhanced their perception of health care and beneficial for patient’s anxiety with essential hypertension.

Shapiro (2009) did a study on psychological effects of Jacobson Progressive Muscle Relaxation technique as autogenic training for type 2 diabetes mellitus with anxiety and depression. Twenty two subjects (n=22) received live sessions of instruction in Jacobson Progressive Muscle Relaxation technique autogenic training over a 5 week period. The result showed (60%) that the Jacobson Progressive Muscle Relaxation technique decreased the intensity and number of symptoms of anxiety and depression.

Weber (2006) investigated the effects of Jacobson Progressive Muscle Relaxation technique on anxiety level in an in-patient general psychiatric unit. Convenience samples of 39 subjects were studied. Anxiety levels were measured prior to pre and post intervention with the state portion of the State Anxiety and Trait Anxiety Inventory. A significant reduction in anxiety and depression level was obtained in the post test. This study showed that progressive muscle relaxation and meditative breathing was helpful in reducing the anxiety.

Gian Mauro et al (2008) reported in their study Jacobson progressive muscle relaxation technique is a common treatment for anxiety and depression with type 2 diabetes mellitus. Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of anxiety reduction outcomes after the Jacobson progressive muscle relaxation technique. All studies (year 1997to 2007), both observational and without control group, evaluating the efficacy of relaxation trainings (Jacobson’s progressive muscle relaxation, autogenic training, applied relaxation and meditation) for anxiety and depressive problems. Primary outcome was anxiety measured with psychometric questionnaires. Meta-analysis was undertaken synthesizing the data from all trials, distinguishing within and between effect sizes27 studies qualified for the inclusion in the meta-analysis. As hypothesized, relaxation training showed a medium-large effect size in the treatment of anxiety. Cohen’s d was .57 (95% CI: .52 to .68) in the within analysis and .51 (95% CI: .46 to .634) in the between group analysis. Efficacy was higher for meditation, among volunteers and for longer treatments. Implications and limitations are discussed. The results show consistent and significant efficacy of relaxation training in reducing anxiety