Sleep Quality and Mental Health Outcomes in Adults with Type-2 Diabetes

Abstract

Disturbances in sleep and psychological morbidity are now emerging as important and understudy issues in people with Type 2 Diabetes Mellitus (T2DM). This study examined sleep quality in adults with T2DM, and its association with mental health outcomes (depression, anxiety, and stress) while considering the role of sociodemographic and clinical factors, based on the Biopsychosocial Model. A descriptive, cross-sectional research design was used with a sample of 139 adults with T2DM for greater than 6 months from Lahore, Pakistan. Demographic and Clinical Information Sheet, Pittsburgh Sleep Quality Index (PSQI) Urdu Version, Depression, Anxiety and Stress Scales (DASS-21) Urdu Version were used to collect data. Once the data were found to be normally distributed, only robust parametric statistical methods were used, specifically Pearson Product-Moment Correlations for bivariate relationships, Independent Samples t-tests and One-Way Analysis of Variance (ANOVA) for comparisons of groups, and Hierarchical Multiple Linear Regressions to determine independent predictors. The results indicated a highly fragmented clinical picture with high levels of psychological distress and poor sleep quality across the board. Importantly, sociodemographic factors (being female, lower education level, and low monthly income) and clinical severity markers (poor glycemic control and high BMI) were significant factors that aggravated patients' burden of disease. Importantly, the hierarchical regression models showed that poor sleep quality was the top and independent behavioural factor that accounted for additional variance in clinical depression, anxiety, and stress. These findings support evidence for the Biopsychosocial approach and highlight the need of incorporation of sleep hygiene interventions and psychological screening in routine endocrinology clinics to protect the mental health of diabetic patients in Pakistan.