@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2017;23(4):311-317

Background
Type 2 diabetes refers to a group of metabolic diseases whose common feature is an increase in blood glucose levels due to insufficiency in the secretion and function of insulin [1].
Previous Studies
… [2-6]. One of the personality variables that alleviates the stress of everyday life and has attracted many researchers in recent years is the feeling of sense of coherence [7]. … [8-13]. The progression of chronic diseases has significant effects on some aspects of psychology, including mental health, and the higher the level of disability in the individual is, the lower is the quality of life of the individual [14]. Miller and Dishon showed that the level of disability of disease also has significant relationship with physical, mental and psychological aspects of life quality. Diabetes also afflicts a person with a variety of physical and mental disabilities [15].
Aim(s)
Given the importance of psychological problems of diabetes, individuals with a growing sense of coherence are expected to be able to cope with the physical complications of their illness, and prolong the course of disease can endanger their mental health. Therefore, the purpose of this study was to investigate the role of mediation of the sense of coherence in relation to the duration and number of morbidities of the disease with mental health in type 2 diabetic patients.
Research type
This applied research is descriptive-correlation type.
Research society, place and time
This study was performed in 2012 among type II diabetic patients referring to Persian Diabetes Clinic in Mashhad.
Sampling method and number
According to the Cochran sampling table, which suggested at least 113 people, and similar studies, at first, information was collected about 180 people who, after deleting the incomplete questionnaires, eventually reached 150 in the research. Sampling method was convenience sampling method. The criteria for entering the research included having at least the literacy of understanding and comprehension of questionnaires, type 2 diabetes for at least one year, age range of 30-80 years, willingness to participate in research, failure to receive any psychological treatment in the last year, and lack of cases of other chronic diseases, such as Parkinson and Alzheimer.
Used devices&materials
The tools used in the research were: 1- A questionnaire on personal information and a checklist of physical complications of diabetes: this questionnaire contains demographic information. At the end of the questionnaire, there is a table contains the most important and most frequent complications of diabetes which include 10 indicators of diabetes mellitus control [16]. The score is between zero and 10 that subjects must complete the questionnaire in accordance with their current status. 2- Goldberg Mental Health Scale (GHQ): This questionnaire contains 28 questions, four subscales of physical injury, anxiety, depression, and social dysfunction and is designed to screen non psychiatric psychological disorders in health centers and other communities. Each of the scales has seven questions with four alternatives. For scoring, the Likert method was used that options a to d, are given score zero to 3 respectively, with a minimum score of zero and maximum score of 84 [17]. In a study, the Cronbach's alpha coefficient in the diabetic and non-diabetic groups were 0.92 and 0.83 respectively [18]. The GHQ is scored negatively, so that the upward score indicates a lack of mental health. 3. Felsenberg Sense of Coherence Scale (SOD): This 35-item questionnaire is scored on a 3-degree Likert scale. So that each of the first two options gets the score of 3 and the last two ones receive the score of one. In this questionnaire, the minimum score is 35 and the maximum score is 105. The questionnaire contains of three subscales of comprehensibility (ability to understand), ability to manage and meaningfulness. The 29 question and 13 questions version of this questionnaire were made by Antonovsky, and this questionnaire was revised by Felsenberg et al. in 2006 [19]. In this study, a revised version of the sense of coherence was used. For the reliability of the questionnaire, Felsenberg reported Cronbach Alpha coefficient of 0.87 in one study and 0.86 in another study [20]. Erikson et al. in a systematic study on a collection of 458 articles and 13 PhD questionnaire published between 1992 and 2003, concluded that sense of coherence questionnaires (29 question and 13 question versions) are reliable and valid, and they have intercultural applicability. The alpha coefficient for the 29 item questionnaire in 124 studies showed a digit equal to 0.70-0.95. The test-retest showed the stability of the questionnaire and showed a correlation between 0.69 and 0.78 in one year, 0.64 for two years, 0.42 to .45 for 4 years, 0.59 to 0.67 for 5 years and 0.54 for 10 years [21]. In the research stage, the researcher, after the introduction of himself and full explanation about the purpose of the research and how to complete the questionnaires, emphasized that the questionnaires would be anonymous and their information would remain confidential, and the results of the research would be published without specifying them and at any time those who wish can be excluded. All questionnaires were completed individually and the researcher was available to resolve the possible ambiguities of the subjects. Also, if the patients did not know much about his diabetic problems, the researcher with the help of the head nurse of nursing department, completed the checklist for the complications of diabetic mellitus. Data were analyzed by Lisrel and SPSS 18 software. In addition to descriptive indexes, Pearson correlation coefficient test was used to examine the correlation between variables and the path analysis method was used to examine the proposed pattern in relation to relationship between duration and number of diabetes mellitus complications with mental health with the sense mediation.
Findings by Text
The age range of the samples was between 30 and 80 years old with a mean age of 61.59±6.45 years. 95 subjects were women and 55 were men. The duration of the diseases was at least one year and at most 25 years and 82.3% of them had more than 2 years’ experience of disease. 90.6% of patients in this center suffered from chronic complications of diabetes, of which 65.8% had neuropathy, 35.3% had ocular complications, 24.7% had renal complications and 38.4% had cardiac complications. Also, 50.1% had other complications. There was a significant correlation between all the predictive variables (duration of diabetes, number of complications of diabetes, and sense of coherence) with criterion variable (lack of mental health; p<0.05). The sense of coherence had the most negative correlation with number of physical complications (Table 1). Regarding the indicators of fitness test, the proposed model, the mediation of the sense of coherence in the relationship between the duration and number of diabetes mellitus complications, had a good fit with mental health in diabetics (Table 2) The duration of illness and the number of complications of diabetes had a direct and significant relationship with sense of coherence. Also, these variables had a significant and direct, and indirect relation with mental health in diabetic patients. There was a direct and significant relationship between the sense of coherence and mental health in diabetic patients as well. Regarding path coefficients, the indirect effect of duration and number of diabetes mellitus complications on mental health was significantly higher than the direct effect (p<0.05; Figure 1).… [22-25]. Togari et al. in a study, traced the effects of sense of coherence on the physical health of Japanese students. Low scores of sense of coherence was associated with a high prevalence of psychosomatic complaints. The risk of progression of psychosomatic symptoms in teenage boys who had low scores in feeling of coherence was 15 times higher than those with high scores for sense of coherence [26]. … [27]. Crontz and Astergren also stated that a high sense of coherence would tend to better and more effective control of stress, and the person feels a higher personal well-being. However, low sense of coherence would increases the vulnerability to diseases [28]. … [29].
Main comparison to the similar studies
… [22-25]. Togari et al. in a study, traced the effects of sense of coherence on the physical health of Japanese students. Low scores of sense of coherence was associated with a high prevalence of psychosomatic complaints. The risk of progression of psychosomatic symptoms in teenage boys who had low scores in feeling of coherence was 15 times higher than those with high scores for sense of coherence [26]. … [27]. Crontz and Astergren also stated that a high sense of coherence would tend to better and more effective control of stress, and the person feels a higher personal well-being. However, low sense of coherence would increases the vulnerability to diseases [28]. … [29].
Suggestions
It is suggested to consider the role of other moderating variables such as the role of caregivers in drug use and nutrition, the amount of social support received from the family and environment, the amount of diabetes health insurance services, etc. that can affect mental health.
Limitations
Among the limitations of this research, the use of convenience sampling method and non-compliance with gender equality can be mentioned. Therefore, caution should be observed in generalizing the findings to other populations. Other limitations of this research are the lack of control of other influential variables such as family support and living conditions, type of diabetes care services, etc. that can affect the mental health and sense of coherence of individuals.
Conclusions
The sense of coherence as a mediator in relation to the duration of the disease and the number of physical complications with mental health of type 2 diabetic patients plays an important role in controlling the physical and psychological complications of diabetes.
Acknowledgments
All members and staff of the Mashhad Persian Specialized Center of Diabetes Mellitus, especially nursing unit, are honored and thanked.
Conflict of interest
Non-declared
Ethical Permissions
The consent of participants for participation in the study was obtained and they were assured that the questionnaires would be anonymous and their information would remain confidential.
Funding Sources
All stages of the study were funded without any special organization and center.

TABLES and CHARTS

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