Hipertansiyon ve Diyabet Hastalarının Algılanan Stres ve Depresyon Düzeyleri ile İlaç Uyumlarının Değerlendirilmesi

Öz

Amaç: Bu çalışmada; aile hekimliği polikliniğine başvuran diyabet ve hipertansiyon hastalarının algılanan stres ve depresyon düzeyini belirleyerek, bunun hastaların tedavi uyumu ile olan ilişkisini araştırmak amaçlanmıştır. Metod: Çalışma, Ekim-Aralık 2022 tarihleri arasında Aile Hekimliği polikliniğine başvuran 201 kişi ile gerçekleştirilmiştir. Hipertansif hastalar, diyabetik hastalar ve sağlıklı gönüllülerden oluşan üç farklı grup çalışmaya dahil edilmiştir. Katılımcılara Beck Depresyon Ölçeği, Algılanan Stres Ölçeği, Morisky İlaç Uyum Ölçeği-8 ve sosyodemografik veri anketi yüz yüze görüşme tekniği ile uygulanmıştır. Bulgular: Çalışmamızda sağlıklı grupta depresyon ve algılanan stres skoru diğer gruplara göre düşük bulundu (p<0,05). Morisky tedavi uyum ölçeği puanları HT ve DM hasta grubunda sırasıyla 5,7±2,18 ve 5,39±2,29 olup, %46,3’ünün uyum skoru düşük bulundu. Eğitim düzeyi, ek hastalık varlığı, diyet uyumu, fiziksel aktivite yapma durumu, sigara kullanımı gibi faktörlerin bireylerde tedavi uyumunda etkin rol aldığı saptandı (p<0,05). Depresyon ve stres skoru yüksek olan hastaların ilaç tedavisine düşük uyum gösterdikleri görüldü (p<0,001). Sonuç: Depresyon ve algılanan stres skoru yüksek olan hipertansif ve diyabetik bireylerin ilaç tedavisine uyumunun düşük olduğu saptanmıştır. Bu nedenle özellikle birinci basamakta tedavi uyumunu etkileyebilecek olası depresyon, stres gibi durumların sorgulanması açısından ruhsal tarama ölçeklerinin kullanılması büyük önem arz etmektedir.

Anahtar Kelimeler

• Diabetes Mellitus
• Hipertansiyon
• Depresyon
• Algılanan Stres
• Tedavi Uyumu

Evaluation of Perceived Stress and Depression Levels and Medication Adherence of Hypertension and Diabetes Patients

Öz

Objective: The aim of this study was to determine the perceived stress and depression level of diabetes and hypertension patients who applied to the family medicine outpatient clinic and to investigate its relationship with the treatment compliance of the patients. Methods: A total of 201 people over the age of 18 who were followed up in the family medicine outpatient clinic with the diagnosis of Hypertension and Diabetes were included in the study. The study consisted of three different groups of hypertension patients, diabetes patients and healthy volunteers. Beck Depression Scale, Perceived Stress Scale, Morisky Medication Adherence Scale-8 and sociodemographic data questionnaire were administered to the participants by face-to-face interview technique. Results: In our study, depression and perceived stress scores were lower in the healthy group compared to the other groups (p<0.05). Morisky medication adherence scale scores were 5.7±2.18 and 5.39±2.29 in the HT and DM patient groups, respectively, and 46.3% had a low compliance score. Factors such as education level, presence of additional disease, dietary compliance, physical activity status, and smoking were found to play an active role in medication compliance (p<0.05). It was observed that patients with high depression and stress scores had low adherence to medication adherence (p<0.001). Conclusion: Hypertensive and diabetic patients with high depression and perceived stress scores were found to have low adherence to medication adherence.

Anahtar Kelimeler

• Diabetes Mellitus
• Hypertension
• Medication Adherence

Kaynakça

1. 1. International Diabetes Federation. Accessed on 02.10.2022 from https://diabetesatlas.org/.
2. 2. Bahar A, Sertbaş G, Sönmez A. Determination of depression and anxiety levels in patients with diabetes mellitus. Anatolian Journal of Psychiatry. 2006;7(1):18-26.
3. 3. Turkish Society of Endocrinology and MetabolismHypertension Diagnosis and TreatmentGuideline 6th Edition (Online Publication): August 2022 (Updated Edition). https://file.temd.org.tr/Uploads/publications/guides/documents/Hipertension-Guideline-2022.pdf. Access was provided from this address on 02.10.
4. 4. Hacıhasanoğlu R, Karakurt P, Yıldırım A, Uslu S. Anxiety and depression in individuals with chronic illness applying to a health center. Turkish Armed ForcesFind a Protective Physician 2010;9(3):209-16.
5. 5. Burkhart P v, Sabaté E. Adherence to long-term therapies: evidence for action. J NursScholarsh. 2003;35(3):207.
6. 6. Akman M, Ünalan PC. Biopsychosocial Approach. In: Bozdemir N, Kara IH, editors. Diagnosis and Treatment in Primary Care. 1. Adana Nobel Bookstore 2010. p. 22-4.
7. 7. Hisli N. Reliability and Validity of the Beck Depression Inventory for University Students. Journal of Psychology. 1989;7:3-13.
8. 8. Eskin M, Harlak H, Demirkıran F, Dereboy C. Turkish adaptation of the perceived stress scale: analysis of reliability and validity. In New/New Symposium Journal 2013;51(3):132-140.

9. 9. Oğuzülgen İK, Köktürk N, Işıkdoğan Z. Study of the Turkish validity of the Morisky 8-item medication compliance questionnaire (MMAS-8) in patients with asthma and chronic obstructive lungs. Tuberculosis and Thorax, 2014;62(2):101-107.
10. 10. Kretchy IA, Owusu-Daaku FT, Danquah SA, Asampong E. A psychosocial perspective of medication side effects, experiences, coping approaches and implications for adherence in hypertension management. Clin Hypertens. 2015;21(1):19.
11. 11. Ölmez B. The Evaluation of Chronic Disease Care and Medication Compliance in Type 2 Diabetes Mellitus [Specialization Thesis in Medicine]. Ankara: Yıldırım Beyazıt University;2015.
12. 12. Mollaoglu M, Solmaz G, Mollaoglu M. Adherence To Therapy And Qualıty Of Lıfe In Hypertensıve Patıents. Acta Clinica Croatica. 2015;54(4.):438-43.
13. 13. Eryoncu B, Sayarlıoğlu M, Bilge M, Güler N, Erkoç R, Dilek İ. Evaluation of the level of knowledge about hypertension and compliance with the treatment of hypertensive patients in Van province. Van Medical Journal. 1999;6(4):11-4.
14. 14. Kara AM, Kara T. Relationship of Treatment Method with Medication Adherence, Quality of Life and Depression in Patients Diagnosed with Type 2 Diabetes. Medical Bulletin of Haseki. 2019;57(4):377–85.
15. 15. Sahin NS. Patient Compliance in the Management of Hypertension and the Effect of an Intervention on the Health Concepts of the Patients on Compliance [Specialization Thesis in Medicine]. Aydın: Adnan Menderes University; 2015.
16. 16. Sweileh WM, Saied HZ, Nab’a RJA, Deleq MI, Sana’a MN. Influence of patients’ disease knowledge and beliefs about medicines on medication adherence: finding from a cross-sectional survey among patients with type 2 diabetes mellitus in Palestine. BMC Public Health. 2014;14:94.
17. 17. Nabi G, Boral PK, Mohanta D, Mou FT, Rokonuzzaman S. Non Compliance Pattern of Anti Hypertensive Treatment. Journal of Dhaka Medical College. 2016;24(2):108- 16.
18. 18. ArulMozHi S, MAHAlAkSHMy T. Self Care and Medication Adherence among Type 2 Diabetics in Puducherry, Southern India: A Hospital Based Study. Journal of clinical and diagnostic research: JCDR. 2014;8(4):UC01.
19. 19. Al-Mehza AM, Al-Muhailije FA, Khalfan MM, Al-Yahya AA. Drug Compliance Among Hypertensive Patients; an Area Based Study. Eur J Gen Med. 2009;6(1):6- 10.
20. 20. Gün Y, Korkmaz M. Treatment compliance and quality of life in hypertensive patients. Dokuz Eylul UniversityFaculty of NursingElektronDerg. 2014;7(2).
21. 21. Shaya FT, Du D, Gbarayor CM, Frech-Tamas F, Lau H, Weir MR. Predictors of compliance with antihypertensive therapy in a high-risk medicaid population. Journal of the National Medical Association. 2009;101(1):34-9.
22. 22. Görürgöz FB, Özcan Ş. Evaluation of Adherence to Oral Medication Therapy in the Elderly with Diabetes. Journal of Nursing Forum in Diabetes, Obesity, and Hypertension 2018;10(1)37-48.
23. 23. Demir Barutcu C. Relationship between Depression and Antihypertensive Medication Adherence in the Elderly. Volue in Healt Sciences. 22;12(2):310-317.
24. 24. Menditto E, Guerriero F, Orlando V, Crola C, di Somma C, Illario M, et al. Self- Assessment of Adherence to Medication: A Case Study in Campania Region Community-Dwelling Population. J Aging Res. 2015;2015:1–6.
25. 25. Alvarez C, Hines AL, Carson KA, Andrade N, Ibe C, Marstellar JA, et al. Association of Perceived Stress and Discrimination on Medication Adherence among Diverse Patients with Uncontrolled Hypertension. Ethn Dis. 2021;31(1):97–108.