RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

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					 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
                  KARNATAKA BANGALORE

                            ANNEXURE-II

    PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION


                                                                st
1      NAME OF THE               Mr. KURUDIMATHADA JAYARAJ. I
       CANDIDATE AND             YEAR M.sc. NURSING
       ADDRESS                   RAJEEV COLLEGE OF NURSING
                                 SHANKAR MUTT ROAD
                                 HASSAN
                                 RAJEEV COLLEGE OF NURSING
2      NAME OF THE               SHANKAR MUTT ROAD
       INSTITUTION               HASSAN


3      COURSE OF STUDY AND       MASTER IN NURSING
       SUBJECT                   PSYCHIATRIC NURSING


4      DATE OF ADMISSION TO      28.05.2007
       THE COURSE


5.1    TITLE OF THE STUDY        ASSESS THE LEVEL OF DEPRESSION
                                 SEEN AMONG THE CLIENTS
                                 DIAGNOSED WITH TYPE- II
                                 DIABETES MELLITUS AT SELECTED
                                 HOSPITALS IN HASSAN.

5.2    STATEMENT OF THE
       PROBLEM                   A DESCRIPTIVE STUDY TO ASSESS
                                 THE LEVEL OF DEPRESSION SEEN
                                 AMONG THE CLIENTS DIAGNOSED
                                 WITH TYPE- II DIABETES MELLITUS
                                 AT SELECTED HOSPITALS IN
                                 HASSAN.




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6.0 BRIEF RESUME OF THE INTENDED WORK


  6.1 INTRODUCTION
               A high incidence of depression is found among all patients hospitalized for
  medical illnesses, although its intensity and frequency is higher in more severely ill
  patients. Certain medical disorders are often associated with depression, especially
  diabetes mellitus, cancer, stroke, epilepsy, multiple sclerosis, Parkinson’s disease and
  cardiac disease. Thus depression is common accompaniment of many major medical
  illnesses1
          Type 2 diabetes is a metabolic disorder characterized by the relative deficiency of
  insulin production and a decrease in insulin action. Onset is usually insidious and family
  history is common. Amenable to treatment with diet, exercise, oral anti-diabetic
  medications and insulin.2
          A recent meta analysis has shown that among the patient with diabetes, the
  prevalence of major depression and significant depressive symptoms were found
  approximately 11% and 31% respectively.3
          A significant association was found between depression and diabetic
  complications such as diabetic retinopathy, neuropathy, nephropathy, macro vascular
  complications and sexual dysfunctions.4
          Several hypotheses have been raised to explain the association between diabetes
  and depression that mainly focus on the effects of severity complications, and poor
  glycemic control resulting from type 2 diabetes on the development of depression.5
          Among patients with type 1 and type 2 diabetes depressive symptoms were
  associated with greater diabetic symptoms reporting poorer physical functioning and less
  adherence to exercise and diet.6
          The goal of this descriptive study to assess the level of depression among sample
  of clients with type 2 diabetes mellitus using Beck Depression Inventory. (Beck, 1967).




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6.2 NEED FOR THE STUDY:
        The world health organization has predicted that India will account for
some 79 millions out of the world’s 360 millions diabetes population by the year 2030.7
Patients with depression had significantly lower adherence to oral hypoglycemic agents
compared with patients without depression. Adherence to oral hypoglycemic agent
(OHAS) is important for adequate glycemic control and prevention of future
complications in patients with type 2 diabetes.8
        Higher depressive symptoms among type 2 diabetes patients were associated with
poor self-care behaviors significantly with poor participation in education programs and
poor diet.9
Depression is associated with a decrease in metabolic control, a reduction in quality of
life, and an increase in health care expenditures. In turn poor metabolic control may
exacerbate depression and diminish response to antidepressant regimens.10
        The interaction of diabetes and depression was found to be synergistic, predicting
greater mortality, greater incidence of both macro and micro vascular complications and
greater incidence of disability in activities of daily living.11
        Depression is common among diabetic mellitus but this is largely unrecognized
and thus often untreated. Health care personal especially nurses should assess the level of
depression among clients diagnosed with type 2 diabetes mellitus to assure accurate
diagnosis, effective treatment and responsive follow-up. Keeping all these in mind this
study was undertaken in selected hospitals at Hassan
6.3. STATEMENT OF THE PROBLEM: -
        A DESCRIPTIVE STUDY TO ASSESS THE LEVEL OF DEPRESSION
SEEN AMONG THE CLIENTS DIAGNOSED WITH TYPE- II DIABETES
MELLITUS AT SELECTED HOSPITALS IN HASSAN.
6.4 OBJECTIVES OF THE STUDY:
    1. To assess the level of depression seen among the subjects diagnosed with type II
        diabetes mellitus.
    2. To study the socio demographic characteristics of study subjects.
    3. To find out the association between the level of depression and selected socio-
        demo graphic variables.


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6.5 HYPOTHESIS
          There will be a statistically significant relationship between the level of
depression and selected socio-demographics variables such as age, occupation, income,
etc.
6.6 ASSUMPTIONS
       1. Diabetic conditions require life long changes. It leads to depression.
       2. Diabetic clients may develop associated systemic illnesses related to heart, liver
          and kidney. Fear about associated illness makes them depressive.
       3. Diabetic clients require regular follow up of their blood sugar costing them in
          turns of money, time, and energy .This may lead to depression.
6.7 OPERATIONAL DEFINITIONS
       1. Level of depression: is defined on the basis of scores obtained on the Beck’s
          Depression Inventory. (Beck, 1967)
       2. Selected hospitals: Refers to general hospitals giving both medical and surgical
          treatment to clients diagnosed with type 2 diabetes mellitus.
       3. Diabetes Mellitus: is defined for the purpose of present study, that those clients
          diagnosed by treating physician as suffering from type 2 diabetes mellitus.
6.8. CRITERIA FOR SELECTION OF SAMPLES
I. Inclusion Criteria
       1. Those clients with type 2 diabetes mellitus between the age group of 40 and 60
          years.
       2. Both male and female clients diagnosed with type diabetes mellitus.
       3. Those clients having diabetic mellitus for the last one year.
II. Exclusion Criteria
       1. Those clients who are with diabetes coma.
       2. Those clients who give the history of recent episodes of significant loss. (Ex:
          death of loved one, accident etc.)
       3. Those clients who have family history of psychiatric illnesses.




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6.9.      DELIMITATION
       1. The Study is limited only to clients diagnosed with type 2 diabetes mellitus.
   2. Prescribed data collection is only 6 weeks.
   3. The sample size is limited to 100 clients.
   4. Study design is limited to survey
6.10. SIGNIFICANCE OF THE STUDY.
          The study Signifies that assesses the level of depression among sample of clients
with type 2 diabetes mellitus.
6.11.      CONCEPTUAL FRAMEWORK.
          The conceptual framework is based on modified Wetson’s Human Caring –
          Orlando’s theory of nursing process.
6.12. REVIEW OF LITERATURE:
          Literature review is standard requisition of scientific research. It means reading
and writing the pertinent information of the attempt in research topic. It also support and
explained why the proposed topic is taken for research and avoid unnecessary duplication
explore the feasibility and illuminate the way of new researcher.
             A study conducted on the prevalence of co morbid depression among adults
with diabetes in southern Iraq.          Cross sectional case control study. Center for
Epidemiologic Studies Depression Scale (CES-D) was used to scan depressive
symptoms. The total numbers of diabetic were 103 and control were 103. Results suggest
that diabetics patients depression scores 44.5 while the control was            33.4+/-6 both
diabetics & control scores more than 16, which is lower threshold for diagnosis of
depression if these figures applied, almost all population will have depression according
to CES-D.12
       A study conducted on depressive symptoms in subjects with diagnosed and
undiagnosed type 2 diabetes. Longitudinal study among inhabitants of a residential area
of a large city in the Netherlands. 4747 subjects were classified into four mutually
exclusive categories, normal fasting plasma glucose (F.P.G), impaired FPG,
undiagnosised diabetes mellitus type 2 and diagnosed diabetes mellitus type2. Presence
of depressive symptoms were measured with the depression subscale of the symptom
check list (SCl-90). Results suggest that diagnosed diabetes mellitus type 2 was


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associated with an increased risk of depressive symptoms, normal, impaired fasting
plasma glucose and undiagnosed. Diabetes mellitus type 2 were not associated with
depressive symptoms. Researcher suggest that depressive symptoms might be a
consequence of the burden of diabetes.13
        A study conducted on prevalence of depression and diabetes, in Bangladesh.
Depressive symptoms were assessed in 184 newly diagnosed diabetic subjects and in 768
randomly selected individuals without diabetes. The Montgomery and Aasberg
depression kating scale was used to assess depressive symptoms. Results suggests that
29% of male and 30.5% of female participants with diabetes and 6.0% of male and 14.6%
of female subjects without diabetes had depressive symptoms. Researcher concluded that
depression is particularly common in those with diabetes.14
       A study carried out on depression and diabetes in Iranian patients. The Condition
of depression and relationship to diabetes was assessed among in 375 individuals, 206
people with diabetes and in 169 without diabetes. Beck Depression Inventory was used
to access depression. Results suggested that major depression was present among 71.8%
of this sample with diabetes and depression was more prevalent among with women
with diabetes than men. Researchers concluded that diabetes appears to increase the risk
of developing depression.15
     A study conducted on correlates of elevated depressive symptoms among rural
African Americans adults with type 2 diabetes. It is cross sectional observational study,
Centre for Epidemiologic Studies – Depression Scale was used to assess depressive
symptoms. The results of the study shown that elevated depressive symptoms were
present in 30% of the samples, both health related psychosocial stressors contribute to the
depressive symptoms among rural African Americans adults with type to diabetes. 16
         A study conducted on correlates of depression in type to diabetic elderly
patients. The study utilized a descriptive – correlations design, subject consisted of 156
diabetic patients aged 65 years from diabetic out patients clinics at three hospitals in
kaohsiung. This study applied the personnel resources questionnaires 2000 (PQR200),
Taiwan Geriatric Depression Scale (TGDS) and from demographic data. The results of
the study shown that the mean index score for depression level was 26, indicating that
study subjects had a low level of depression, Social support and regular exercise were



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significantly and negatively correlated with depression, social support and diabetic
complications were significant correlates of depression.17
       A study conducted on independent factors associated with major depressive
disorders in national sample of individuals with diabetes in south carolia. Data on 1810,
individuals with diabetes from the 1999 national health interview survey (NHS) were
analyzed. The composite international diagnostic interview (ICDI) short form (ICDI-SF)
was used to identify individual with major depressive disorder. Multiple logistic
regression was used to determine whether independent factors were associated with
major depressive disorders. Results suggested that independent factors associated with
major depressive disorders were,       age<64 years, female sex, at-least high school
education, Lower income, perceived worsening of health status and smoking. Researcher
concluded that independent factors play an important role in the etiology of depression
among individuals with diabetes.18
7. MATERIALS AND METHODS OF STUDY
7.1 SOURCE OF DATA COLLECTION
       The data will be collected from type II diabetes mellitus clients in selected
hospitals at Hassan.
7.2 RESEARCH DESIGN
Descriptive survey , correlation in nature.
7.3 METHODS OF DATA COLLECTION
       Structured interview method, data will be collected by using close-ended
questionnaires.
7.4 SAMPLING PROCEDURE.
   1. Population: All the clients with type 2 diabetes mellitus,
   2. Sample: Patients those who fulfill the inclusion and exclusion criteria
       and receiving treatment in selected hospitals at Hassan.
   3. Sample Size: Sample comprises of 100 clients diagnosed with Type 2
       diabetes mellitus.
   4. Sampling techniques: Random sampling using lottery methods
   5. Setting : The study will be conducted in selected hospitals. Hassan.


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PILOT STUDY:
10% of the population is planned for pilot study.
8. Variable
  8.1 Independent Variable; Socio demographics variable
  8.2 Dependent Variable; Diabetes mellitus type 2, depression
9. PLAN FOR DATA ANALYSIS
       The plan for data analysis includes descriptive
       Data will be coded and entered in to the computer descriptive statistical
       Frequency in percentage (%) parametric statistical like mean, standard deviation
and analysis of variant and nonparametric test like T, (chi-sqare test) will be used.
10. ETHICAL CONSIDERATION
   1. Does the study require any intervention to be conducted on clients ?
       No.
   2. Has ethical clearance being obtained from your institution?
       Yes
   3. Has consent taken from hospital authorities?
       Yes
   4. Has consent taken from study subjects?
        Yes




11. LIST OF REFERENCES


1. Gail W, Stnart, Michele T. Laraia. Principles and practice of Psychiatric Nursing 8th
       ed. New Delhi: Elsevier: 2005. p. 332.
2. Brunner and suddarth’s. Text book of medical surgical Nursing, 9th ed.Philadelphia
2000.p.975
 3. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevelance of comorbad
 depression in adults with diabetes. Diabetes care. 2004. June : 24(6):1068 – 78.
 Available PMID:11375373 Pumed – indexed for MEDILE.


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4. De groat M, Anderson R, Freedland KR, Clouse RE, Lastman PJ. Association of
Depression and Diabetes Complication: a meta analysis, Psychosommed. 2001Jul- Aug:
63(4): 619: 30. Available PMID 11485116 Pumed – indexed for MEDLINE.
5 Gavard JA, Lustman PJ, Clouse RE. Prevalence of depression in adults with diabetics.
Diabetic care. 2005 Jun : 24 (8) : 116-79. Available PMID : 11386486 pubmed – indexed
for MIDLINE.
6. Ciechanowksi PS, Katon WJ, Ruso JE. The relationship of depressive symptoms to
symptoms reporting, self care and glucose control in diabetes. Gen.Hosp. psychiatry.
2003 Jul-Aug: 25(4): 246-52. Available PMID:12850656 Pubmed             – indexed for
MEDLINE.


7. Park K.    Park Text book of Preventive and social medicine 18th ed. Jabbalpur:
    Banarasidas Bhamot: 2005 p-399.


8. Kalseker ID, Madhavan SS, Amonkar MM. Depression in patients with type 2 diabetes
impact on adherence to oral hypoglycemic agents. Ann Pharmacother.2006 Apr: 40 (4) :
605 -11. Available PMID : 16551768 Pumed – indexed for MEDLINE.
9. Park. H, Hong Y. Lee. H, Hae, sung Y. Indiduals with type 2 diabetes and depressive
symptoms exhibited lower adherence with selfcare. J.clin , epidemiol . 2004Sep: 57 (9):
978-84. Available PMID: 15504641 Pubmed- index far MEDLINE.


10. Lust man PJ, Clouse RE. Depresion in disbetic patients: The relationship between
mood and glycemic control. J Diabetes complications. 2005 Mar-Apr: 19(2): 113-22.
Available PMID: 15745842 Pumed – indexed for MEDLINE.


11. BLACK SA, Markides KS. Ray LA. Depression and Prediets increased incidence of
adverse health out comes in alder maxican americans with Type 2 Diabetes.Diabetic
care. 2003 Oct: 26 (10): 2952-3. Avialables PMID: 14514586 Pubmed – indexed for
MEDLINE .




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12. Abbas Ali Mansour, Mansour attia Jabir. The Prevalence of co morbid depression
among adults with diabetes in Southern Iraq. Pak Journal med Sic. Apr 2007. Vol.23,
No.2 185-87
13. Knol MJ, Heerdink ER, Egberts AC, Geerlings MI, Gurter KI. Depressive symptoms
in subjects with diagnosed and undiagnosed type 2 diabetes. physchosom med. 2007 May
: 69(4): 297-9. Available PMID: 17470664 Pubmed- indexed for MEDLINE
14. Asghar S, Hussain A, Alism, khan AK,. Magnession A, Prevalance of depresson and
diabetes: a population based study from rural Bangaldesh Diabedmed. 2007 Aug : 24 (8):
872-7. Available PMID: 17403122 Pubmed – for MEDLINE.
15. Khasmeh ME, Baradaran HR. Depression and diabetes in Iranian patients: a
comparative study. Int J psychiatry med. 2007:37 (1); 81-6. Available PMID : Pubmed
indexed for MEDLINE.
16. Kogan SM, Brodly GH, Crawley C. Correlates of elevated depressive symptoms
among rural African American adults with type 2 diabetes. Ethn Dis. 2007 oct:
17(1):106-12. Available PMID: 17274218 Pubmed – indexed for MEDLINE.
17. Bai.Y.L., Chious C.P, Chang Y. Correlates of depression in type 2 diabetic elderly
patients : A Correlation study. Int J Nurs Stud. 2006 Nov.14. Available PMID : 17112523
Pubmed indexed for MEDLINE.


18. Egede LE, Zhong, D. Independent factors associated with major depressive disorders
in national sample of individuals with diabetes. Diabetic Care 2003 Jan : 26(1): 104-11.
Available PMID : 12502665 PMID Pubmed indexed for MEDLINE.




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12     Signature of the candidate



13     Remarks of the guide



14     Name and designation



14.1   Guide



14.2   Signature



14.3   Head of the department



14.4   Signature



15     Remarks of the principal



15.1   Signature




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