The Coronavirus Anxiety Level of Elderly Individuals with Diabetes Mellitus and Associated Factors during the COVID-19 Pandemic

Abstract

Background Individuals with chronic diseases are less often presented to hospitals due to the restrictions enforced during the pandemic period and the fear of contracting the disease. The purpose of the present study was to investigate the effects of the anxiety level associated with novel coronavirus on daily life, treatment compliance, and metabolic conditions in elderly diabetes mellitus (DM) patients. Methods This study included 263 patients diagnosed with type 2 DM aged >65 years. The researchers collected the study data through the face-to-face interview method. The Patient Information Form, Coronavirus Anxiety Scale (CAS), Morisky Medication Adherence Scale, Insomnia Severity Index, and the Depression Anxiety Stress Scales (DASS-21) were used for data collection. Results The mean CAS score was 4.25±3.76. Mean CAS scores were higher in the participants who reported a decrease in the frequency of shopping, grocery/market visits, public transport use, hospital visits, and attending routine checks during the pandemic (p<0.05). Furthermore, a significant positive correlation was found between the mean CAS score and the DASS-21 score (p<0.05). There was a significant negative correlation between the mean CAS score and the treatment compliance score (p<0.05). Conclusion The pandemic and coronavirus anxiety have had an adverse effect on daily life, treatment compliance, and metabolic conditions in elderly DM patients.

Keywords

• coronavirus
• diabetes
• elderly
• metabolic control
• treatment compliance

References

1. Zhou F, Yu T, Ronghui D, Guohui F, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Ca B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-62. doi: 10.1016/S0140-6736(20)30566-3.
2. WHO. World Health Organization. COVID-19: Vulnerable and high risk groups. Available at: https://l24.im/06dK. Accessed Mar 24, 2022.
3. TURKSTAT (2022). Turkish Statistical Institute. Elderly Statistics. Available at: https://data.tuik.gov.tr/Bulten/Index?p=Elderly-Statistics-2022-49667&dil=2. Accessed Oct 04, 2023.
4. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW; the Northwell COVID-19 Research Consortium; Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. JAMA. 2020 May 26;323(20):2052-9. doi: 10.1001/jama.2020.6775.
5. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020 Apr 7;323(13):1239-42. doi: 10.1001/jama.2020.2648.
6. CDC. Centers for Disease Control and Prevention. Leading causes of death. Available at: https://www.cdc.gov/injury/wisqars/LeadingCauses.html. Accessed Mar 24, 2022.
7. Mody L, Ridell J, Kaye K, Chopra T. Common infections. In: Williams B, Chang A, Ahalt C, Conant R, Chen E, eds. Current Diagnosis & Treatment: Geriatrics. 2nd ed. McGraw-Hill Education; 2014.
8. Buz S. Age discrimination against elderly persons. Electron J Soc Sci. 2015;14(53):268-78 (in Turkish). doi: 10.17755/esosder.89453.

9. IDF. International Diabetes Federation. What is Diabetes? IDF Diabetes Atlas. 10th edition. 2021;12-9.
10. Maddaloni E, Buzzetti R. Covid‐19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab Res Rev. 2020 Oct;36(7):e33213321. doi: 10.1002/dmrr.3321.
11. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-20. doi: 10.1056/NEJMoa2002032.
12. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, Qin R, Wang H, Shen Y, Du K, Zhao L, Fan H, Luo S, Hu D. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020 Oct;36(7):e3319. doi: 10.1002/dmrr.3319.
13. Kassir R. Risk of COVID‐19 for patients with obesity. Obes Rev. 2020 Jun;21(6):e13034. doi: 10.1111/obr.13034.
14. Lee SA. Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety. Death Stud. 2020;44(7):393-401. doi: 10.1080/07481187.2020.1748481.
15. Biçer İ, Çakmak C, Demir H, Kurt ME. Coronavirus Anxiety Scale Short Form: Turkish validity and reliability study. Anatol Clin. 2020;25(1):216-25 (in Turkish). doi: 10.21673/anadoluklin.731092.
16. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986 Jan;24(1):67-74. doi: 10.1097/00005650-198601000-00007.
17. Bahar G, Savaş HA, Ünal A, Savaş E, Kaya H, Bahar A. Reliability and validity of the Morisky Medication Adherence Scale for bipolar mood disorder. Anatol J Psychiatry. 2014;15:141-9 (in Turkish). doi: 10.5455/apd.39827.
18. Vural B, Acar ÖT, Topsever P, Filiz TM. Reliability and validity of Turkish version of Modified Morisky Scale. J Turk Fam Physician. 2012;3(4):17-20 (in Turkish).
19. Sayiner ZA. The validity and reliability survey of the eight item the Morisky Medication Adherence Scale in Turkish diabetic patients and evaluation of correlation between diabetes mellitus medication adherence predictors and the eight item Morisky Medication Adherence Scale. Unpublished specialty thesis in medicine (supervisor: Savaş E) Gaziantep University, Faculty of Medicine. Gaziantep, 2014 (in Turkish).
20. Morin CM. Insomnia: Psychological assessment and management. New York: Guilford Press; 1993.
21. Boysan M, Güleç M, Be L, Kalafat T. Psychometric properties of the Insomnia Severity Index in Turkish sample. Anatol J Psychiatry. 2010;11:248-52 (in Turkish).
22. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995 Mar;33(3):335-43. doi: 10.1016/0005-7967(94)00075-u.
23. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2nd ed. Sydney, Australia: Pychology Foundation of Australia; 1995.
24. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176-81. doi: 10.1037/1040-3590.10.2.176
25. Henry JD, Crawford JR. The shortform version of the Depression Anxiety Stress Scales (DASS21): Construct validity and normative data in a large nonclinical sample. Br J Clin Psychol. 2005 Jun;44(Pt 2):227-39. doi: 10.1348/014466505X29657.
26. Sarıçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. JCBPR. 2018;7(1):19-30. doi: 10.5455/JCBPR.274847.
27. Brooke J, Clark M. Older people’s early experience of household isolation and social distancing during COVID‐19. J Clin Nurs. 2020 Nov;29(21-22):4387-402. doi: 10.1111/jocn.15485.
28. Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020 May;5(5):e256. doi: 10.1016/S2468-2667(20)30061-X.
29. Santini ZI, Jose PE, York Cornwell E, Koyanagi A, Nielsen L, Hinrichsen C, Meilstrup C, Madsen KR, Koushede V. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020 Jan;5(1):e62-70. doi: 10.1016/S2468-2667(19)30230-0.
30. Pan KY, Kok AAL, Eikelenboom M, Horsfall M, Jörg F, Luteijn RA, Rhebergen D, Oppen PV, Giltay EJ, Penninx BWJH. The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts. Lancet Psychiatry. 2021 Feb;8(2):121-9. doi: 10.1016/S2215-0366(20)30491-0.
31. Montano RLT, Acebes KML. Covid stress predicts depression, anxiety and stress symptoms of Filipino respondents. IJRBS (2147-4478). 2020 Jul 3;9(4):78-103. doi: 10.20525/ijrbs.v9i4.773.
32. Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C, Roma P. A nationwide survey of psychological distress among Italian people during the COVID-19 pandemic: Immediate psychological responses and associated factors. Int J Environ Res Public Health. 2020 May 2;17(9):3165. doi: 10.3390/ijerph17093165.
33. Özdin S, Bayrak Özdin Ş. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. Int J Soc Psychiatry. 2020 Aug;66(5):504-11. doi: 10.1177/0020764020927051.
34. Liu S, Yang L, Zhang C, Xiang YT, Liu Z, Hu S, Zhang B. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020 Apr;7(4):e17-8. doi: 10.1016/S2215-0366(20)30077-8.
35. Gunlu A. Development of Social Distancing Phobia Scale and its association with anxiety and perceived stress. Int J Ment Health Addict. 2021 Oct; 21:617-37. doi: 10.1007/s11469-021-00664-2.
36. Lee SA, Jobe MC, Mathis AA, Gibbons JA. Incremental validity of coronaphobia: Coronavirus anxiety explains depression, generalized anxiety, and death anxiety. J Anxiety Disord. 2020 Aug;74:102268. doi: 10.1080/07481187.2020.1748481.
37. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC.Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020 Mar 6;17(5):1729. doi: 10.3390/ijerph17051729.
38. Al-Ajlouni YA, Park SH, Alawa J, Shamaileh G, Bawab A, El-Sadr WM, Duncan DT. Anxiety and depressive symptoms are associated with poor sleep health during a period of COVID-19-induced nationwide lockdown: a cross-sectional analysis of adults in Jordan. BMJ Open. 2020 Dec;10(12):e041995. doi: 10.1136/bmjopen-2020-041995.
39. Stanton R, To QG, Khalesi S, Williams SL, Alley SJ, Thwaite TL, Fenning AS, Vandelanotte C. Depression, anxiety and stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Int J Environ Res Public Health. 2020 Jun 7;17(11):4065. doi: 10.3390/ijerph17114065.
40. Zerbini G, Taflinger S, Reicherts P, Kunz M, Sattler S. Perceived risk of COVID‐19 exposure and poor COVID‐19 prognosis impair sleep: The mediating and moderating roles of COVID‐19‐related anxiety and knowledge. J Sleep Res. 2022 Oct;31(5):e13569. doi: 10.1111/jsr.13569.
41. Ahmed GK, Khedr EM, Hamad DA, Meshref TS, Hashem MM, Aly MM. Long term impact of Covid-19 infection on sleep and mental health: A cross-sectional study. Psychiatry Res. 2021 Nov;305:114243. doi: 10.1016/j.psychres.2021.114243.
42. Ghosh A, Arora B, Gupta R, Anoop S, Misra A. Effects of nationwide lockdown during COVID-19 epidemic on lifestyle and other medical issues of patients with type 2 diabetes in north India. Diabetes Metab Syndr Clin Res Rev. 2020 Sep 1;14(5):917-20. doi: 10.1016/j.dsx.2020.05.044.
43. Nouira N, Bahria W, Hamdi D, Lahouegue A, Demni W, Cheikh MB. Medication adherence in Elderly during COVID-19 pandemic: what role can the emergency department play? Pan Afr Med J. 2021 Feb 25;38:220. doi: 10.11604/pamj.2021.38.220.26555.
44. Alshareef R, Al Zahrani A, Alzahrani A, Ghandoura L. Impact of the COVID-19 lockdown on diabetes patients in Jeddah, Saudi Arabia. Diabetes Metab Syndr Clin Res Rev. 2020 Sep;14(5):1583-7. doi: 10.1016/j.dsx.2020.07.051.
45. Gonzalez Heredia T, González-Ramírez LP, Hernández-Corona DM, Maciel-Hernández EA. Anxious depression in patients with Type 2 diabetes mellitus and its relationship with medication adherence and glycemic control. Glob Public Health. 2021 Mar 4;16(3):460-8. doi: 10.1080/17441692.2020.1810735.
46. Ruissen MM, Regeer H, Landstra CP, Schroijen M, Jazet I, Nijhoff MF, Pijl H, Ballieux BEPB, Dekkers O, Huisman SD, de Koning EJP. 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 Jan;9(1):e002035. doi: 10.1136/bmjdrc-2020-002035.
47. Chawla U, Kashyap MK, Husain A. Aging and diabetes drive the COVID-19 forwards; unveiling nature and existing therapies for the treatment. Mol Cell Biochem. 2021 Nov;476(11):3911-22. doi: 10.1007/s11010-021-04200-7.
48. Falcetta P, Aragona M, Ciccarone A, Bertolotto A, Campi F, Coppelli A, Dardano A, Giannarelli R, Bianchi C, Del Prato S. Impact of COVID-19 lockdown on glucose control of elderly people with type 2 diabetes in Italy. Diabetes Res Clin Pract. 2021 Apr;174:108750. doi: 10.1016/j.diabres.2021.108750.
49. Vickery KD, Novotny PJ, Ford BR, Lantz K, Kavistan S, Singh D, Hernandez V, Sia IG, Wieland ML. Experiences of Hispanic safety net clinic patients with diabetes during the COVID-19 pandemic. Sci Diabetes Self-Manag Care. 2022 Apr;48(2):87-97. doi: 10.1177/26350106221076037.