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

Background/Aim: Mortality rates of Coronavirus Disease 2019 (COVID-19) 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. Downloads Download data is not yet available. References Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in coronavirus disease 2019 patients: A systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-5. doi: 10.1016/j.ijid.2020.03.017. Demir, Ü. The effect of COVID-19 pandemic on sleeping status. Journal of Surgery and Medicine. 2020;4(5):334-9. doi: 10.28982/josam.737088. Geleta TA, Deriba BS, Beyane RS, Mohammed A, Birhanu T, Jemal K. COVID-19 Pandemic Preparedness and Response of Chronic Disease Patients in Public Health Facilities. Int J Gen Med. 2020;5(13):1011-23. doi: 10.2147/IJGM.S279705. Guo Y, Li Y, Monroe-Wise A, Yeung SCJ, Huang Y. A dynamic residential community-based quarantine strategy: China's experience in fighting COVID-19. Infect Control Hosp Epidemiol. 2020;41(11):1363-4. doi: 10.1017/ice.2020.172. Kilic R, Ataman Hatipoglu C, Gunes C. Quarantine and its legal dimension. Turkish J Med Sci. 2020;50(SI1):544-8. Applegate WB, Ouslander JG. COVID-19 Presents High Risk to Older Persons. J Am Geriatr Soc. 2020;68(4):681. doi: 10.1111/jgs.16426. Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016;38:e2016048. doi: 10.4178/epih.e2016048. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018;87:123-7. doi: 10.1016/j.comppsych.2018.10.003. Beran D, Aebischer Perone S, Castellsague Perolini M, Chappuis F, Chopard P, Haller DM, et al. Beyond the virus: Ensuring continuity of care for people with diabetes during COVID-19. Prim Care Diabetes. 2021;15(1):16-7. doi: 10.1016/j.pcd.2020.05.014. Mauro V, Lorenzo M, Paolo C, Sergio H. Treat all COVID 19-positive patients, but do not forget those negative with chronic diseases. Intern Emerg Med. 2020;15(5):787-90. doi: 10.1007/s11739-020-02395-z. Chudasama YV, Gillies CL, Zaccardi F, Coles B, Davies MJ, Seidu S, et al. Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr Clin Res Rev. 2020;14(5):965-7. doi: 10.1016/j.dsx.2020.06.042. Ruissen MM, Regeer H, Landstra CP, Schroijen M, Jazet I, Nijhoff MF, et al. Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic. BMJ Open Diabetes Res Care. 2021;9(1):e002035. doi: 10.1136/bmjdrc-2020-002035. Hajure M, Tariku M, Mohammedhussein M, Dule A. Depression, anxiety and associated factors among chronic medical patients amid covid-19 pandemic in Mettu Karl Referral hospital, Mettu, Ethiopia, 2020. Neuropsychiatr Dis Treat. 2020;16:2511-18. doi: 10.2147/NDT.S281995. Asmundson GJG, Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. J Anxiety Disord. 2020;71:102211. doi: 10.1016/j.janxdis.2020.102211. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An Inventory for Measuring Depression. Arch Gen Psychiatry. 1961;4(6):561-71. doi: 10.1001/archpsyc.1961.01710120031004. Hisli N. A reliability and validity study of Beck Depression Inventory in a university student sample. Turkish J Psychol. 1989;7(23):3-13. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56(6):893-7. doi: 10.1037//0022-006x.56.6.893. Ulusoy M, Sahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cogn Psychother An Int Q. 1998;12(2):163-72. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96. Eskin M, Harlak H, Demirkıran F, Dereboy C. The Adaptation of the Perceived Stress Scale Into Turkish: A Reliability and Validity Analysis. New Symposium Journal. 2013;51(3):132-40. Salkovskis PM, Rimes KA, Warwick HMC, Clark DM. The health anxiety inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. 2002;32(5):843-53. doi: 10.1017/s0033291702005822. Aydemir O, Kırpınar I, Satı T, Uykur B, Cengisiz C. Reliability and Validity of the Turkish Version of the Health Anxiety Inventory. Archives of Neuropsychiatry. 2013;50(4):325-31. doi: 10.4274/npa.y6383. Armitage R, Nellums LB. The COVID-19 response must be disability inclusive. Lancet Public Health. 2020;5(5):e257. doi: 10.1016/S2468-2667(20)30076-1. Siu JY. The SARS-associated stigma of SARS victims in the post-SARS era of Hong Kong. Qual Health Res. 2008;18(6):729-38. doi: 10.1177/1049732308318372. Gul ZB, Atakli HD. Effect of the COVID-19 pandemic on drug compliance and stigmatization in patients with epilepsy. Epilepsy & Behavior. 2021;114(Pt A):107610. doi: 10.1016/j.yebeh.2020.107610. Louvardi M, Pelekasis P, Chrousos GP, Darviri C. Mental health in chronic disease patients during the COVID-19 quarantine in Greece. Palliat Support Care. 2020;18(4):394-9. doi: 10.1017/S1478951520000528. Ozamiz-Etxebarria N, Dosil-Santamaria M, Picaza-Gorrochategui M, Idoiaga-Mondragon N. Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain. Cad Saude Publica. 2020;36(4):e00054020. doi: 10.1590/0102-311X00054020. Sayeed A, Kundu S, Al Banna MH, Christopher E, Hasan MT, Begum MR, et al. Mental health outcomes of adults with comorbidity and chronic diseases during the COVID-19 pandemic: A matched case-control study. Psychiatr Danub. 2020;32(3-4):491-8. doi: 10.24869/psyd.2020.491. Bergman YS, Cohen-Fridel S, Shrira A, Bodner E, Palgi Y. COVID-19 health worries and anxiety symptoms among older adults: The moderating role of ageism. Int Psychogeriatrics. 2020;32(11):1371-5. doi: 10.1017/S1041610220001258. Demiray Kara D, Mert E, Uysal Y, Bashan I. Evaluation of Medication Adherence in Adults Who Use Multiple Medications in The Context of Illness Perception, Acknowledgement and Attitude Characteristics. Turkish J Fam Med Prim Care. 2017;11(4):227-34. doi: 10.21763/tjfmpc.359675. Gallagher MW, Zvolensky MJ, Long LJ, Rogers AH, Garey L. The Impact of Covid-19 Experiences and Associated Stress on Anxiety, Depression, and Functional Impairment in American Adults. Cognit Ther Res. 2020(6);29:1-9. doi: 10.1007/s10608-020-10143-y. Cankurtaran D, Tezel N. Evaluation of Admission Diagnoses of the Patients Admitted to the Physical Rehabilitation and Medicine Outpatient Clinic at COVID-19 Pandemic. Journal of Physical Medicine & Rehabilitation Sciences. 2021;24(1):27-32. doi: 10.31609/jpmrs.2020-78021. Katon W, Lin EHB, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29(2):147-55. doi: 10.1016/j.genhosppsych.2006.11.005. Snoek FJ, Bremmer MA, Hermanns N. Constructs of depression and distress in diabetes: Time for an appraisal. Lancet Diabetes & Endocrinol. 2015;3(6):450-60. doi: 10.1016/S2213-8587(15)00135-7. De Jean D, Giacomini M, Vanstone M, Brundisini F. Patient experiences of depression and anxiety with chronic disease: A systematic review and qualitative meta-synthesis. Ont Health Techno Assess Ser. 2013;13(16):1-33.