Summary
Background
Type 2 diabetes is not limited to its physical effects; it encompasses behavioural, psychological, and social dimensions. The integration of mental health support into Type 2 diabetes self-management is complex but essential. Thus, there is a strong argument for incorporating basic mental health support into diabetes care pathways. There is a notable lack of emphasis on mental health support within clinical settings for patients with type 2 diabetes in Saudi Arabia. The absence of input from both patients and healthcare providers in the development of mental health policies and planning underscores the pressing need for a more inclusive approach.
Aim/objectives
A mixed-methods explanatory sequential study combining quantitative (Quan) and qualitative (Qual) data was designed to better understand how to improve mental health support for patients with Type 2 diabetes in clinical settings.
Methods
In the quantitative phase of this study, a descriptive, cross-sectional, correlational design was employed, utilizing a self-report survey administered to patients in five diabetes clinics across five hospitals and one diabetes centre in Jazan, Saudi Arabia. Survey respondents completed a self-administered questionnaire, which included demographic characteristics, along with four instruments: The Patient Health Questionnaire-9, Generalized Anxiety Disorder (GAD-7), Insomnia Severity Index (ISI), and four questions from the Office for National Statistics' (ONS) personal well-being survey. The survey was conducted in Arabic. Linear regression analysis was carried out to identify factors explaining variance in the outcome variables.
The qualitative phase of the study utilized a descriptive, qualitative design employing individual interviews to gather patients' experiences regarding access to mental health support in the clinical setting, as well as barriers and facilitators to addressing mental health needs in patients with type 2 diabetes through screening and referral from the perspective of healthcare providers. Patients who completed the survey, divided into groups based on their mental health and wellbeing scores, were eligible to volunteer for an interview, while all healthcare providers delivering direct care to patients with type 2 diabetes in the clinics were eligible to participate. A thematic analysis approach was used for qualitative data analysis. The quantitative and qualitative datasets are analysed separately and will subsequently be examined concurrently to compare findings, focusing on points of convergence and divergence.
Results
The survey participants (N=365) were adult patients with type 2 diabetes, with 55.9% being females, most of them married (71.7%), and a significant portion falling into the medium-income category (46%). A notable percentage were not currently employed (32.9%), and 75.3% had diabetes for over 5 years. Oral tablets were the most used medication (42.8%), and 40.3% reported other chronic diseases, with 49% having experienced infections with COVID-19. Linear regression analysis showed that GAD-7 scores, ISI-7 scores, the availability of informal health assistance, and rest hours significantly predicted PHQ-9 scores in individuals with type 2 diabetes, explaining 57.1% of the variance. Analyses for GAD-7 indicated that gender, education level, type of healthcare setting, availability of informal health assistance, PHQ-9 scores, and ISI-9 scores were influential factors in anxiety among individuals with T2DM (adjusted R2 = 0.538, F (18.040), p < 0.001). Additionally, the analysis of ISI-7 scores identified contributing factors, including unemployment, Saudi nationality, dissatisfaction with online appointments, decreased happiness, elevated anxiety levels, increased PHQ-9 scores, and heightened GAD-7 scores, collectively explaining 57.7% of the variance.
Qualitative phase result (Ongoing)