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DISCUSSION OF THE RESULTS

In the present chapter, obtained results will be discussed in the light of hypotheses
which were formulated on the bases of the objectives and the variables taken by the
researcher. Discussion of the results will be focused on the following aspects of this
research.

1. Difference in the depression among type of groups (type -1, type -2 diabetics
& non-diabetics) with respect of gender.
2. Difference in the quality of life among type of groups (type- 1, type- 2
diabetics & non-diabetics) in respect of gender.
3. Relationship between the symptoms of depression and quality of life of
participants (type -1, type - 2 diabetics & non- diabetics).
4. Contribution of symptoms of depression to increase the overall depression and
decrease the quality of life of diabetic patients (type - 1 & type - 2).

1. Difference in the depression among type of groups (type -1, type -2 diabetics
& non-diabetics) with respect of gender.

Regarding the difference in the variable of depression among three groups (type-1,
type- 2 diabetics & non-diabetics). Significant differences found in the depression and
the symptoms of depression between type -1 and type -2 diabetic patients and with
non- diabetics (Table - 3). Type- 2 diabetic patients showed high depression on its
symptoms as compare to the patients of type- 1 diabetic as far as non- diabetics. The
symptoms such as; sadness, pessimism, loss of pleasure, agitation, loss of interest,
worthlessness, loss of energy, change in sleeping pattern, change in appetite,
concentration difficulty, fatigue/ tiredness and on overall depression were recorded
having significant difference in terms of groups.

Results clearly indicated that diabetic patients (type- 1 & type-2) experience more
depression than non- diabetics and type- 2 diabetics have more depression on overall
and its symptoms than the type -1 diabetics as well as non- diabetics.

In terms of gender (Table - 4.1) no significant difference was found between male and
female of type- 1 diabetic patients in the symptoms of depression and in overall
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depression. Whereas, significant difference was found between male and female of
type- 2 diabetic patients in the symptoms of concentration difficulty and tiredness
/fatigue (Table- 4.2). Female patients of type- 2 diabetes showed more depression on
above said symptoms (concentration difficulty & tiredness/fatigue) than the male
patients. Non - diabetics also showed significant difference in the symptom of loss of
interest. Female participants showed more loss of interest in their life than male
participants. However, non- significant difference found between the two (male &
female) on remaining symptoms of depression (Table- 4.3).

Apart from that significant difference exhibit among three groups of female
participants (type- 1, type- 2 diabetics and non- diabetics) on the depression and its
symptoms (Table- 4.4). Findings revealed that type- 2 diabetic female showed more
depression than type- 1 diabetic as well as female of non- diabetics in the symptoms
of loss of pleasure, loss of interest, worthlessness, loss of energy, change in sleeping
pattern, change in appetite, concentration difficulty, and in tiredness/fatigue.
Similarly, the male of type -2 diabetes showed high depression as compare to type -1
diabetics and also from non-diabetics in the symptoms of sadness, loss of pleasure,
loss of interest, worthlessness, loss of energy, change in appetite, and tiredness/fatigue
(Table- 4.5).

The previous researches conducted in this field also supported the results of the
present study.

Siddiqui, Jha, Waghdhare, Agarwal and Singh (2014) conducted a comparative study
on prevalence of depression between type - 2 diabetic patients and non-diabetics.
They found a significant difference between people with diabetes and non- diabetics
in the prevalence of depression. Diabetics had almost twofold higher risk of
developing depression as compare to non-diabetics.

The study conducted by Khan, Lutale and Moledina, (2019) also supported the results
of this research. They studied on the determining the prevalence of depression and
associated factors among patients of diabetes. A cross-sectional study was carried out
on the total of 353 participants, out of which 229 were females it was observed that
87% of the patients had depression, 56.7% had minimal depression, 22.1 percent had
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mild whereas 8.2 % had moderate depression. Although, no one was observed having
severe depression.

Briganti, Silva, Almeida and Bergamaschi (2018) conducted a study on depressive

symptoms in diabetic patients. Results indicated that symptoms of depression were
found in diabetics and level of depression was related to diabetes severity and degree
of restrictions was also found in activities of their daily living.

Chowdhary, Karim and Chowdhary (2017) carried out a study on Bangladeshi

population with the aim of measuring the strength and consistency of the relationship
between depression and diabetes. They found that 24.8% non-diabetic and 56.2%
diabetic participants were depressed. Diabetic patients showed 7-fold greater odds to
be depressed as compared to their non-diabetic counter groups. It was concluded on
the bases of their results that people with diabetes are seven times more likely to be
depressed as compared to non-diabetic participants.

Aminu, Chandrasekaran, and Nair (2017) found in their study that most of the
patients under the study had mild depression while severe depression was seen only in
very few patients. The study also found out that their depression was associated with
diabetic complications and other chronic diseases like hypertension and obesity.

Akpalu, Yorke, Ainuson-Quampah, Balogun, and Yeboah (2018) studied that diabetes
and depression are both chronic debilitating condition and their co- existence has been
associated with adverse outcome is also in line with the results of the present study.
According to the study prevalence of depression was observed 31.3 percent among
type -2 diabetes mellitus patients. This cross-sectional study was designed to assess
depression in 400 type -2 diabetes mellitus age between 30 to 60 years. The study
concluded that depression was common among patients Ghanaians with type -2
diabetes mellitus and not associated with poor glycemic control in a fully
multivariable adjusted model.

The findings of this study are similar to the results of the study conducted by Ali,
Jyotsna, Kumar and Mani, (2013) on depression between diabetic and non-diabetic
adults. Their study comprised two group of participants in the study one group was of
patients suffering from type 2 diabetes since last five years and other group was of
healthy participants. They found that the prevalence of depression was 27.05% in
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people with diabetes. While, it was 11.11% in non - diabetic participants. Diabetic
participants had high score on depression as compared to healthy control group.

The results of present research regarding depression of type - 1 diabetics and non-
diabetics may be found significant because people with type - 1 diabetes living with
lifelong illness have difficult task of caring for this lifelong condition which requires
regular monitoring of blood glucose level, taking insulin daily, health care cost and
fear of type -1 diabetes complications. All these conditions together can be
responsible for developing depression in type- 1 diabetics.

There may be certain reasons that diabetics shows more depression as compare to
non-diabetics such as deal with lifelong condition with demanding self- management
such as physical activities, restrictions of food, monitoring blood glucose level along
with fear about complication of diabetes manage the risk of complication, which can
be seem overwhelming. They struggle to cope, overwhelmed, diabetes distress
(diabetes related stress), and unmotivated, which often results in depression (WHO,
2019).

Besides the difference in type- 1 and type- 2 diabetics. Patients with type - 2 diabetes
showed high depression than patients of type -1 diabetes. One possible explanation
might be that type -1 diabetes occur in childhood or adolescence stage. People with
type -1 diabetes spent a longer time with this disease. They adapt themselves to the
changes in life style, cope with chronic illness and learn self-management. They start
living with chronic illness from the early stage of childhood or adolescence. They can
adapt a new behavior easily than type -2 diabetics. On the other hand, type- 2
diabetics spent longtime without diabetes that could be the reason that type- 2
diabetics find more difficulties to cope up with this lifelong condition. So that they
become depressed more than type- 1 diabetics.

A study conducted by Arambewela, Somasundaram, Jayasekara and Kumbukage

(2019) supported our results. They reported that high degree of depression may be
seen in initial stages of diagnosis when people with diabetes become aware about the
future complications, psychosocial demands and changes in life style.

The findings of this research are also supported in line with some previous studies as;
Hendrieckx, Halliday, Beeney and Speight (2019) reported that depression affects one
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in three people with insulin dependent type- 2 diabetes, one in four non-insulin
dependent type- 2 diabetes and one in five type -1 diabetes that indicate the high
prevalence of depression in people with diabetes. Chaudhary et al (2017) found
significant difference in the prevalence of depression in type- 1 and type -2 diabetic
patients. They found that prevalence of depression in 38 percent in type -1 and 42
percent in type -2 diabetics. Engum et al. (2005) they reported in their study that type-
2 diabetics (19%) are more depressed than type 1 diabetics (15.2%).

Regarding gender, findings revealed that significant difference found in female of

type -2 diabetics on the symptoms of tiredness/ fatigue and concentration difficulty
(Table - 4.2). It may be because females have many life roles to play as mother, wife,
caregiver, employee and many more. The complexity and responsibility of the roles
along with the burden of a chronic illness (diabetes) can causes the feeling of
overwhelm, which may lead to fatigue. While fatigue associated with concentration
difficulty. This affects ability to concentration in most people (Stoppler,2019). This
may be the reason for females suffering from fatigue and lack of concentration as
compared to their male counterparts.

2. Difference in the quality of life among types of groups (type- 1, type- 2

diabetics & non-diabetics) in respect to gender.

On the variable of quality of life results clearly showed the significant difference
among three groups (type- 1, type -2 & non - diabetics). Significant difference found
between type- 1 and type - 2 diabetics (Table- 5). Findings revealed that type- 1
diabetic patients lead better quality of life as compared to type- 2 diabetic patients. In
terms of non- diabetics, obtained results indicated that non- diabetics possess good
quality of life than both type of diabetic patients (type -1 & type- 2).

Male and female of type -1 and type- 2 diabetic patients did not show significant
difference on the variable of quality of life (Table 6.1). However, non - diabetic male
and female participants showed significant difference in the above said variable. Male
participants achieved high score as compared to female participants on the quality of
life variable.

The female of all three groups (type- 1, type- 2 diabetics & non-diabetics) also
showed significant difference among them. It was observed that females of non -
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diabetics have a better quality of life than type-1 as well as type- 2 diabetic females
(Table- 6.2). Males of the above three groups also showed the same trend as shown by
female of three groups on the aforementioned variable (Table- 6.3).

The results of the present research are supported by the study of Abedini, Bijari and
Miri (2020). They conducted a study on diabetic patients who were referred to the
diabetic clinic to determine the relationship with their demographic and clinical
characteristics. The sample of the study was selected through systematic sampling
technique. It was concluded that the quality of life for the type 2 diabetic patients is
affected by multiple factors as sex, occupation, duration, cost of treatment and
complications comorbidities. Findings revealed that diabetes affect significantly
quality of life of patients. The conclusion of study supports the result of the present
research.

Daneshvar, Khodamoradi, Ghazanfari and Montazeri (2018) conducted a comparative

study of diabetic and nondiabetic patients with reference to quality of life. The results
indicated significantly lower scores in diabetic patients in term of physical
functioning, emotional and physical role social function and bodily pain and general
health. The findings revealed that diabetic patients had lower quality of life as
compared to non- diabetics.

Prajapati, Blake, Acharya, and Seshadri (2018) conducted a study and assess the
quality of life in type 2 diabetic mellitus patients with or without complications using
the modified diabetics quality-of-life (MDQOL)- 17. The results indicated that
patients having no added complications had better quality of life and with the increase
in complications had poorer quality of life.

A study conducted by Hart et. al (2003) illustrated the quality of life for the diabetic
patients is in line with the present study. They measure health related quality of life of
people with type-1 diabetes. They comprised of a total 281 type- 1 diabetics in their
study. For the assessment of quality of life Euro-Qol and RANDA-36 were used as a
tool. They found that type- 1 diabetics had lower quality of life as compare to non-
diabetics. Hyperglycemic and macro vascular complications had negative effect on
quality of life in type- 1 diabetic patients. Likewise, Vickrey et.al, (2000) carried out a
comparative study on health related quality of life among people with epilepsy,
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diabetes, hypertension and heart disease. 166 adult patients who had previously
undergone surgical treatment for intractable epilepsy and outpatients with
hypertension, diabetes, heart disease were included in the sample. Eight self-reported
HRQOL and RAND 36-Item Health Survey 1.0 were used as tool. They found in their
study that patient with epilepsy surgery had better health related quality of life as
compare to patients with diabetes, hypertension and heart disease. Patients with
continued seizures had worse score in terms of emotional well-being and overall
quality of life as compare to all other patients, except patients with depressive
symptoms.

Eren, Erdi and Sahin (2008) investigated the effects of depression on the quality of
life in type -2 diabetes mellitus patients. They found that quality of life was
significantly low in the depressed diabetic group as compared to non-depressed
diabetic group.

Obtained results gain strength by the findings of Derakhshanpour, Vakili, Farsinia and
Mirkarimi (2015). They examined the relation between depression and quality of life
in diabetics. The study was a cross sectional survey on data of 330 diabetics, age
range 25 to 75 were selected through systematic random sampling. World Health
Organization (WHOQOL-BREF) was used to assess of quality of life and Beak
Depression questionnaire was used to measure the depression. Data was analyzed by
using Chi-square, Independent t test and linear regression. The study found that the
prevalence of depression was high in diabetics. Significant difference was found
between depressed diabetics and non-depressed diabetics on the quality of life. The
diabetes patients with depression have poorer quality of life as compared to diabetics
without depression.

Obtained results indicated that diabetic patients have poorer quality of life as compare
to non- diabetic participants. It may be because diabetes is considered as a chronic
disease it can affect quality of life in multiple ways, including physical symptoms as
well as mental symptoms. It can cause many restrictions that play significant role to
make quality of life worse for patients. Health cost, work issues, and relationship also
gets affected by diabetes. Mostly all domains of quality of life get influenced by
diabetes. Several studies also suggest that diabetes affects various domains of quality
of life such as emotional well-being, physical functioning, social functioning,
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economical status, and general health of patients (Gautam et al,2009; Snock

Hermanns et al, 2015; Thommasen & Zhang, 2006). Many diabetic patients feel
overwhelmed, frustrated and burnt out by the difficulties of diabetes and never ending
demands, often burden of self-management leads to psychological problems like
anger, hopelessness, guilt, fear, depression. Fear of complication and depression play
a significant role to reduce the quality of life of diabetes patients (Spero, 2016).

Findings of the study suggested that type - 1 diabetes possess better quality of life
than type - 2 diabetics. Obtained results may be because type-2 diabetics have higher
risk of diabetes complications. Foster (2017) found in her study that type- 2 diabetic
have higher incidence of complications and comorbidities such as, obesity, mean
arterial pressure, depression than type -1 diabetics. People with type- 2 diabetes also
have kidney disease, retinopathy and peripheral neuropathy, all these complications
and co morbidities are associated with quality of life. Verma et al, (2017) also
reported that depression and complications of diabetes could affect the quality of life
of type - 2 diabetics. In general, several studies suggested that presence of chronic
complications of diabetes is related to decrease quality of life of patients. Huang,et al
(2007) found in his study that diabetes with end-stage complications were found to
have the poorer quality of life however, comprehensive diabetes treatments also have
significant negative impact on patient’s quality-of-life. Thus, diabetes is more than
physical condition, it also had impact on behavioural, psychological and social
aspects and requires high level of resilience, self-efficacy and perceived control.
Therefore, it has negative impact on patient’s emotional well-being and quality of life
(Halliday, Speight, Beeney, & Hendrieckx, 2020).

In research, variables (depression and quality of life) do not produce significant

interaction effect between gender and type of groups. However, they may have
significant effect on phenomena independently. The obtained results showed that
interaction within type of groups were found highly significant on the both research
variables (Table 7 & 8). There was significant effect found within type of groups on
the symptoms of depression namely; sadness, pessimism, loss of pleasure, agitation,
loss of interest, worthlessness, loss of energy, change in sleeping pattern, change in
appetite, concentration difficulty, and tiredness/ fatigue within gender did not find
significant effect except tiredness/fatigue and loss of interest.
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Moreover, significant effect was found within gender on the quality of life. While,
interaction between the variables (type of groups × gender) did not find significant on
both study variables at any level of confidence. Results clearly indicated that there is a
causative difference among type of groups in terms of depression and quality of life.

3. Relationship between the symptoms of depression and quality of life of

participants (type -1, type - 2 diabetics & non- diabetics).

Observing relationship between the study variables (depression and quality of life),
Pearson correlation method was used in the study. Inter- correlation was seen among
the symptoms of depression. The correlation coefficient values showed that the
symptoms of depression had positive correlation with each other’s (Table- 9.1- 9.3).

Results revealed that negative relationship was found between symptoms of

depression and quality of life of type- 1 diabetics. The symptoms of depression like;
sadness, loss of pleasure, guilt feeling, suicidal thoughts, agitation, worthlessness,
change in appetite, concentration difficulty and tiredness/fatigue, were negatively
correlated at high level with quality of life. Obtained results showed that all above
said symptoms of depression played a significant role in reducing the quality of life of
type- 1 diabetics (Table- 9.1).

In terms of type -2 diabetics, a significant relationship was found between symptoms

of depression and quality of life. The symptoms of depression such as; sadness, loss
of pleasure, suicidal thoughts, crying, loss of interest, worthlessness, loss of energy,
change in sleeping pattern, irritability, change in appetite, concentration difficulty and
tiredness/fatigue were observed having negatively correlated with the variable of
quality of life in type - 2 diabetics (Table 9.2). Findings indicated that the
aforementioned symptoms of depression reduced the quality of life of type- 2
diabetics.

Furthermore, the results of non- diabetics showed that the symptoms of depression
like past failure, indecisiveness and irritability were negatively correlated with quality
of life (Table- 9.3). The findings of this study clearly indicated that the symptoms of
depression affected the quality of life negatively.
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The obtained results may be because the people with chronic disease were more prone
to develop depression as compared to people without chronic disease. Results from
various studies suggested that depression was strongly associated with poorer quality
of life (Berlim, Marcelo & Fleck, Marcelo,2007; Grassi et al, 1996).

Thus, the obtained results follow the same trend as, depressed patients face worse
quality of life. In the present study people with diabetes were found depressed as
compared to non- diabetics. The findings indicated that the significant relationship
between study variables appeared in diabetes participants. Literatures also confirmed
that the depressed people had worse quality of life as compared to non- depressed
people. Das et al., (2013) they found significant difference in quality of life between
depressed diabetes patients and non- depressed diabetes patients. They also found
negative relationship between depression and quality of life in people with diabetes.
Non depressed diabetic group showed better quality of life as compared to depressed
diabetic group.

Khajebishak et. al (2020) which was done to demonstrate the relationship between
depression and quality of life in diabetic patients is also in line with the present study.
They conducted a cross-sectional study on Iranian diabetic patients with the aim to
know the relationship between depression, diabetic knowledge and self -management
with quality of life. They reported that 36 % of diabetic patients were depressed. A
significant relationship was found between depression, self-care and with the quality
of life of diabetics. Male participants had high scores on the complication of diabetes
as compared to females.

Another Study done by Ai LingTang ClaireaSusan and Thomasb (2020) also

suggested our results. They investigated the relationship between symptoms of
depression and other mental health condition with quality of life. They comprised
total 559 subjects in the study. They found that both somatic and psychological
symptoms of depression were negatively associated with quality of life. Results also
indicated that somatic symptoms of depression were strongest predictors of poorer
quality of life.

The obtained were results also supported by some earlier studies as; Ranjan, Nath,
and Sarkar (2020) carried out a cross- sectional study to determine the relationship
 115

between depression, anxiety and quality of life among patients of diabetes and
hypertension. Total 123 patients were selected from tertiary care hospital of India.
They found in their results that the scores of depression were significantly negatively
correlated with the Quality of life (WHOQOL-BREF-). High correlation found
between depression and physical and psychological domains of quality of life. The
results of this study showed that anxiety and depression significantly affected the
quality of life of patients with diabetes and hypertension.

Akhtar, Uzma, Sana and Samia (2013) also studies on the relationship between
quality of life and depression in people with diabetes. Total 200 participants
comprising of 100 diabetics and 100 non- diabetic were selected from Islamabad and
Rawalpindi by using purposive sampling technique. They found that there is a
significant difference in depression and quality of life between diabetics and non-
diabetics. Findings indicated that a significant negative correlation was observed
between depression and quality of life in diabetics. They found that the majority of
diabetic participants had high score on depression and lower score on quality of life as
compared to non- diabetic participants. Gretchen (2007) also found a significant
relationship among anxiety, depression and quality of life in patients. The study
findings revealed that anxiety and depression had a significant relationship with all
domain of quality of life and the severity of depression and anxiety decreased the
patient’s quality of life. Further, Goldney, Phillips, Fisher and Wilson (2004) also
studied on the prevalence of diabetes and depression and determined the effect of
diabetes and depression on quality of life. The study conducted 3,010 personal
interviews of individuals aged ≥ 15 years living in South Australia. Some factors such
as prevalence of depression in diabetics and effects of diabetic status and depression,
quality of life were measured. Short Form Health-Related Quality-of-Life
Questionnaire (SF-36) was used in this study. The results indicated that the
prevalence of depression was higher in diabetics as compared to non-diabetics.
Individuals with diabetes and depression experienced effects on every dimension
Quality of Life Scale. Comparison of depressed diabetic and non-depressed diabetic
groups found significant differences in their quality of life. The depressed diabetic
patients were most effect in relation to quality of life as compared to non-depressed
diabetic patients.
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4. Contribution of symptoms of depression to increase the overall depression

and decrease the quality of life of diabetic patients (type - 1 & type - 2).

Results revealed the contributing of the of symptoms of depression in increasing the

overall depression and decreasing the quality of life of diabetic patients. Obtained
results showed that the symptoms of tiredness/ fatigue, sadness, self- criticalness and
past failure were the strongest predictors to increase overall depression in type - 1
diabetic patients (Table - 10.1), and the symptoms of loss of energy, sadness and
worthlessness were also found to be contributors for increasing the depression in type
-2 diabetic patients (Table - 10.2). Thus, results denoted that aforementioned
symptoms of depression play significant role for increase the depression in diabetic
patients.

Results also revealed that the symptoms of depression were the potent predictor of
quality of life of diabetics. Agitation, loss of interest and concentration difficulty
symptoms of depression were highly contributors to reduce the quality of life of type -
1 diabetic patients (Table - 10.3). Results of type - 2 diabetic patients indicated that
tiredness/ fatigue, worthlessness, sadness, loss of energy and indecisiveness were the
strong predictors of decreasing the quality of life. Above said symptoms of depression
confirm 68 % contribution in decreasing the quality of life among type -2 diabetic
patients (Table- 10.4). This predicting relationship supported by earlier studies in a
line that Mosaku, Kolawole, Mume and Ikem (2008) found in their study that
depression as a predictor of quality of life among patients with type -2 diabetes. They
reported that depression and presence of comorbid medical conditions significantly
predicted worsen quality of life in type -2 diabetic patients. Brenes, (2009) explored
the impact of anxiety and depressive symptoms on quality of life. They concluded that
patients with moderate to severe symptoms of depression and anxiety had greater
impairment in the quality of life. Findings also revealed that depression had
significant effect on all domains of quality of life. Depression accounts for 10 % to 46
% of variance to reduce the quality of life. Flores et al, (2020) they investigate the
relationship of symptoms of depression and quality of life in Friedreich ataxia
patients. They reported that depressed patients had poorer quality of life for all factors
expect the physical functioning. They concluded on the bases of their results
depressive symptoms most relevant variable for predicting quality of life in patients
 117

with Friedreich ataxia (FA). AbuRuz (2018) conducted a study to know the effect of
anxiety and depression on quality of life of patients with heart failure. Significant
relationship found among depression, anxiety and quality of life. Depression and
anxiety had a negative effect on quality of life of patients. Findings of the study
denoted that anxiety and depression were independent predictors for physical health
and mental health. The regression models confirm 49 % and 44% variance in quality
of life due to depression and anxiety respectively. Ruo, Rumsfeld and Hlatky (2003)
conducted a cross sectional study on the contributions of depressive symptoms in
health related quality of life of patient with coronary heart disease. They found that
20% of participants had depression. Results of multivariate analysis indicated that
symptoms of depression strongly associated with patient’ s health status including the
symptoms of burden, physical limitation and with quality of life.

Conclusion

Following conclusions are drawn from the present research:

1- Diabetic patients showed high depression in comparison to non- diabetics.

2- Non- diabetic participants showed better quality of life than diabetic patients.
3- Type -1 diabetic patients found to be more depressed than non-diabetics on the
symptoms of sadness, loss of pleasure, agitation, worthlessness, loss of
energy, change in appetite, tiredness/ fatigue and on overall depression.
4- Type- 2 diabetic patients showed high depression with its symptoms like;
sadness, pessimism, loss of pleasure, agitation, loss of interest, worthlessness,
loss of energy, change in sleeping pattern, change in appetite, concentration
difficulty and tiredness/fatigue as compared to non - diabetics.
5- Patients of type - 2 diabetes showed high depression in comparison to type -1
diabetics on the symptoms of sadness, loss of pleasure, agitation, loss of
interest, worthlessness, loss of energy, change in sleeping pattern, change in
appetite, tiredness/ fatigue and on overall depression.
6- Female with type- 2 diabetes had high scores in concentration difficulty and
tiredness/fatigue the symptoms of depression from male counterparts.
7- Female of non - diabetics showed high mean value than the male participants
on the loss of interest symptoms of depression. Female of non - diabetics felt
more loss of interest than male participants.
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8- Type- 1 diabetic females showed high depression in comparison to non -

diabetic females on the symptoms of loss of pleasure, worthlessness, loss of
energy, tiredness/fatigue and on overall depression.
9- Type- 2 diabetic females had high depression as compared to non - diabetic
females on the symptoms of loss of pleasure, loss of interest, worthlessness,
loss of energy, change in sleeping pattern, change in appetite, concentration
difficulty, tiredness/fatigue and on overall depression.
10- Female with type -2 diabetes had high depression as compared to type -1
diabetic females on the symptoms of depression such as; loss of interest,
worthlessness, change in sleeping pattern, change in appetite, concentration
difficulty, tiredness/fatigue and on overall depression.
11- Results revealed type- 1 diabetic males had high depression in comparison to
non - diabetic male on symptoms of loss of interest, change in appetite and on
overall depression
12- Type- 2 diabetic males experience high depression than non and non -
diabetics in the symptoms of sadness, loss of pleasure, loss of interest,
worthlessness, loss of energy, change in appetite, tiredness/ fatigue and on
overall depression.
13- Type- 2 diabetic male patients showed high depression as compared to type - 1
diabetic males in the symptoms of sadness, loss of pleasure, loss of interest,
worthlessness, loss of energy, change in appetite, tiredness/fatigue and on
overall depression.
14- Non- diabetic participants lead better quality of life as compared to type- 1
diabetics.
15- Type- 2 diabetics had poorer quality of life as compared to non- diabetics.
16- Type- 1 diabetics showed better quality of life in comparison to type -2
diabetics.
17- Results of female participants of type -1 diabetics and non - diabetics showed
that non diabetic females had better quality of life as compared to type - 1
diabetics.
18- Female with type- 2 diabetes showed poorer quality of life in comparison to
non-diabetic females.
19- Type-1 diabetic females had better quality of life than type- 2 diabetic
females.
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20- Non- diabetic male participants enjoy better quality of life than type -1
diabetic males.
21- Type- 2 diabetic males showed lower quality of life as compared to non-
diabetics.
22- Male with type-1 diabetes lead better quality of life in comparison to type - 2
diabetic males.
23- There was significant positive relationship among the symptoms of depression
of type- 1 and type- 2 diabetic patients.
24- Significant negative relationship was found between symptoms of depression
and quality of life of type -1 and type -2 diabetic patients. The symptoms of
depression play a significant role in reducing the quality of life in diabetics
(type - 1 & type -2 diabetics).
25- The symptoms of sadness, past failure, loss of pleasure, guilt feelings, suicidal
thoughts, agitation, loss of interest, worthlessness, change in appetite,
concentration difficulty and tiredness/ fatigue were high negatively correlated
with the variable of quality of life in type- 1 diabetic patients.
26- The depressive symptoms like; sadness, pessimism, loss of pleasure, suicidal
thoughts, crying, loss of interest, worthlessness, loss of energy, change in
sleeping pattern, irritability, change in appetite, concentration difficulty,
tiredness/ fatigue and loss interest in sex were high negatively associated with
the quality of life in type - 2 diabetic patients.
27- The symptoms of depression tiredness/ fatigue, sadness, self-criticalness and
past failure were found as strongest contributors to increase overall depression
in type -1 diabetic patients.
28- Loss of energy, sadness and worthlessness symptoms of depression were
highly contributors to increase the overall depression in type - 2 diabetic
patients.
29- Results revealed that the agitation, loss of interest and concentration difficulty
were highly contributors to reduce the quality of life of type -1 diabetic
patients.
30- The symptoms tiredness/ fatigue, worthlessness, sadness, loss of energy and
indecisiveness were found the strongest contributors to decreasing the quality
of life of type - 2 diabetics.
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Following hypotheses are found to be non- significant in this research:

1. Male and female of type - 1 diabetics did not show significant difference in the
overall depression.

2. No significant difference found between male and female of type -2 diabetics

in the overall depression.

3. Male and female of type- 1 diabetics did not show significant difference in the
variable of quality of life

4. No significant difference showed by type -2 diabetic male and female in the

quality of life.

5. Interaction effect of type of groups and gender of participants not found to be

significant on the depression.

6. Interaction between type of groups and gender did not showed significant on
the variable of quality of life.
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Summary

The present research is entitled “Depression and Quality of life in Diabetic Patients”.
This research was attempt to measure depression and quality of life of diabetic
patients (type -1 & type -2). It contains five chapter excluding references and
appendices.

The first chapter presents the conceptual framework of the problem and explained the
justification of the problem and its importance. The objectives of this research were to
measure depression and quality of life of diabetic patients (type -1 & type -2). The
independent and dependent variables of the study were described with relevant
studies. Both the variables of the study (independent and dependent) were defined in
great detail in the first chapter. The study contains independent variables i.e. diabetes
(type- & type- 2 diabetes) and gender of participants. The effect of these variables
was studied on the dependent variables depression and quality of life. The present
study also contains a comparison group (non - diabetics) for a better understanding of
the research variables.

The studies relevant to the present research were explored and presented in the second
chapter of the thesis for ready references.

The third chapter outlined the research methodology of the research. It deals with the
design of research which include objectives, hypotheses, sample and measurement
tools. The present study was comprised of 150 participants. Among them 50 patients
were selected from type- 1 diabetics and 50 were selected from type- 2 diabetic
population and 50 participants were non- diabetics included in the sample. Each group
of 50 further divided into gender (25 males and 25 females) were included in the
sample. All participants were selected by using purposive sampling technique. To
measure depression and quality of life, Beck depression inventory and PGI- Quality
of life scale were used in the study. IBM SPSS Version 26.0 was used to treat the data
statistically.

Through analysis of the data after processing results was presented in fourth chapter
with the help of tables and graphs. The testing of hypotheses in light of defined
objectives was done and the findings were reported accordingly.
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The fifth chapter of the study is about discussion of results. The findings of research
discussed in detailed along with previous supportive studies. The chapter focused
difference in study the variable (depression and quality of life) among type- 1, type- 2
and non- diabetics and in terms of gender of participants. Apart from that relationship
of the variables also discussed in the chapter.

Moreover, the last part of the research deals a brief of a summary along with
implementations of the study, limitations and suggestions for further research.

Limitations of the present research:

1 The sample size of diabetic patients was not enough for generalize the results.

2 The sample of present study was limited of few districts of Uttrakhand and
Uttrapradesh state. So that obtained findings cannot be generalized on the
whole population of the states.

3 Due to some limitations of the study some needful variables could not be
included in the study such as rural and urban areas, family history, socio
economic status, marital status etc.

4 Only those diabetic patients who were suffering at least five years of diabetes
were included in the sample.

5 Any type of intervention model for participants is not included in the research.

Suggestions for further researches:

1 A large sample size is suggested for further research in order to get more
reliable and valid results.
2 Sample from wider area, more cities should be chosen for better
representation of the sample.

3 In further research duration of disease can be also included in the research

design for getting more reliable results.

4 Comparison of prevalence of depression between outpatient and inpatient

diabetics can also be included in future research.
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5 Further research should be consider to include other demographic variable

like; rural/ urban areas, family history, socio- economic status, marital
status and of diabetics for getting more significant results.
6 Other study variables such as; anxiety, insomnia, cognitive impairment
and other psychosomatic problems should also be suggested for further
research.
7 Intervention based study should be conducted in future research for
reducing the level of depression and improving the quality of life in
diabetic patients.

Implementation of the study

The findings draw the attention of counselling and psychological services in primary
health care centers to reduce the burden of disease and prevent depression in
diabetics. These services will provide counselling, psychiatric and psychological
treatment as well as behavioral self-management that will help people with diabetes to
increase healthy habits such as improving diet and exercising regularly that will help
in coping with both condition (diabetes and depression) and also improving in the
quality of life. The findings also emphasize on the need of psychologist in diabetes
care centers. Hospitals and clinics should appoint sufficient number of psychologist
for diagnosis and treatment of depression. Psychological therapies will have long
lasting effect on depression than drugs (Cuijpers et al,2019). Psychologist or
psychotherapist can identify patient’s mental issues and treat with the help of
psychotherapies which will help patients to learn strategies for coping with depression
and it will also promote problem- solving skill in them. Psychologists can be aid to
diabetes management, disease awareness, change in life style, change in unhealthy
food habit thus reducing the burden of depression in diabetics.

Furthermore, the findings of the study give an understanding of the symptoms of

depression in type- 1 and type- 2 diabetic patients. It will be useful for therapists to
design intervention programs keeping in mind somatic and affective symptoms of
depression and complications of diabetes which will be helpful to reduce the level of
depression as well as useful for diabetes management. Educational and psychological
intervention must be required for type-2 diabetics through which they could be able to
improve diabetes management as well and reduce the burden of depression. Likewise,
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the intervention programs will lead to significant improvements in quality of life of

diabetics.

The findings of this study demonstrate that there is a need to improve in patient’s
quality of life. To get a good quality of life patients focused on healthy relationships,
a healthy lifestyle, regular exercises like mindfulness, and meditation. The practice of
meditation is linked with a reduction in stress and negative emotions and
improvements in attitude, health-related behavior, and coping skills. Lots of studies
evaluated the role of mindfulness-based stress reduction in diabetics and demonstrated
modest improvements in body weight, glucose control, and blood pressure (Priya &
Kalra, 2018). Programs are needed by government and non-government agencies to
help diabetic patients live better with this chronic condition and emphasize the
importance of effective coping and problem-solving for maintaining a good quality of
life with diabetes. Support from family, friends, and health professionals key to
improvement in the quality of life.

Keeping in view increasing prevalence of depression in diabetics, the government or

policymaker should campaign held at community level for diabetes and depression
awareness programs. The goal of awareness programs should be preventing mental
and physical complication of diabetes, while preserving a good quality of life.