Mental disorders in patients with osteoarthritis combined with diabetes mellitus in the practice of a family doctor

Background. Osteoarthritis is a chronic degenerative joint disease, often accompanied by pain, limited mobility and reduced quality of life. Diabetes mellitus, in turn, is a metabolic disease with systemic complications. The coexistence of these two pathologies is a frequent clinical phenomenon that aggravates the course of each disease. The purpose of the study was to assess the level of mental health in patients with osteoarthritis who have concomitant diabetes mellitus, to identify the main psycho-emotional disorders and develop recommendations for the diagnosis, treatment, prevention and improvement of psychosocial support for such people. Materials and methods. The study included 120 patients who were divided into three groups: group I — osteoarthritis without concomitant type 2 diabetes mellitus (T2DM); group II — T2DM without osteoarthritis; group III — comorbidity of osteoarthritis and T2DM. The following research methods were used: the Hospital Anxiety and Depression Scale (HADS) — to identify anxiety and depressive symptoms; Beck Depression Inventory-II — to quantify the level of depression; SF-36 Health Survey — to analyze quality of life, in particular mental and physical components; Mini-Mental State Examination (MMSE) — to screen for cognitive disorders; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) — to assess the seve­rity of pain syndrome, stiffness and functional limitation. Results. Among patients with osteoarthritis (group I), clinically significant manifestations of depression (> 11 points on the HADS) were detected in 32.5 % of cases, anxiety — in 40 %. Among patients with T2DM (group II), depression — in 27.5 %, anxiety — in 35 %. The highest level of depressive and anxiety manifestations was observed in patients with comorbidity of osteoarthritis and T2DM (group III): depression — 55 %, anxiety — 60 %. According to the MMSE, mild cognitive impairment was detected in 15 % of patients from group I, 22.5 % from group II and 37.5 % from group III. Patients with comorbidity of osteoarthritis and T2DM demonstrated the worst indicators of physical functioning and mental health according to the SF-36 scale. Decreased quality of life was mainly associated with pain syndrome, mobility limitation and emotional exhaustion. A positive correlation was established between the level of glycated hemoglobin and the severity of depression (r = 0.42; p < 0.01). A relationship was also found between the severity of pain syndrome (WOMAC) and the level of anxiety (r = 0.51; p < 0.01). The statistical power of the analysis of variance with a sample of 120 patients (3 groups of 40 patients) and a moderately high effect (f = 0.35) is 93.4 %. This indicates a high probability of detecting real intergroup differences, i.e. the sample size is statistically justified for the stated study design. Conclusions. Comorbid course of osteoarthritis and type 2 diabetes is associated with a high risk of developing depressive and anxiety disorders, which significantly reduces the quality of life of patients and requires not only medical, but also psychological support. Depressive symptoms correlate with the intensity of pain and impaired metabolic control, which complicates the overall clinical course of diseases. Socio-psychological factors (stress, loneliness) play an important role in the formation of psycho-emotional disorders in patients with comorbidity.