Effect of person centered counselling on depressive symptoms among Type II diabetic patients attending the general outpatient Clinic of A Tertiary Hospital in North Central Nigeria

Abstract

Background: According to the International Diabetes Federation, the prevalence of Type II diabetes mellitus in Nigeria has risen from 2.2% in 1997 to 5% in 2013. Depression is twice as likely to occur in individuals with diabetes mellitus compared with apparently healthy controls. Co-morbid depression among individuals with diabetes is associated with poorer outcomes such as poor glycemic control, poor quality of life and lower adherence to medication. .Diabetic complications are also greater among individuals with depression.3Current management for these patients involves a combination of chemotherapy and psychotherapy. Person-centred counselling has been suggested to be an effective strategy for managing depression in these patients. This study was undertaken to determine the effect of person centered counselling on depressive symptoms among type II diabetic patients attending the General Outpatients Clinic of Federal Medical Centre Keffi, North Central Nigeria in order to improve their quality of care.

Materials and Method: 88 consecutive patients aged 18 to 65 years with type II diabetes mellitus who were found to be depressed according to the Beck's  Depression Inventory were randomised into an Intervention group that had person-centered counselling and a Control group that had usual care, with 44 participants in each group. The clinic visits in both groups were repeated at weeks 2, 4, 6, 8, 10 and 12 making a total of six sessions for both groups. At the end of 12 weeks, the Beck's Depression Inventory was used to reassess the level of depression in both groups. The proportion of patients with depression in the two groups was compared using the Chi square test. Association between confounding variables and  depression was tested using Fisher exact test and student t test. Data was analysed on intention to treat basis.

Results: At baseline, all the study participants were depressed. The results at the end of the study indicate that the proportion of participants with depression was significantly lower (18.2%) among those in the Intervention group compared to those in the Control group (34.1%). This difference was statistically significant when compared between the two groups (p: 0.001).

Conclusion: Person-centered counselling may contribute to producing enduring,  clinically meaningful benefits in type II diabetes mellitus patients with depression. It is recommended that family physicians be trained to provide person centered counselling for depressed type II diabetes mellitus patients.