CHAPTER NO.

1
INTRODUCTION
In this research, we find out the relationship between social support,
psychological distress and quality of life in diabetic patient. Diabetes is one of the major
concerns in the third millennium, affecting more people every day. The most important method
to control this disease and prevent its hurdles is self-care. According to various studies, this
method has not found its proper place among patients with diabetes due to several reasons.
(WHO,2009).

Currently, diabetes is known as one of the major public health concerns in the third
millennium and is the fifth main mortality cause in the world. Psychological distress can act as
distorted views of the personality and is disclosed by sadness, anxiety and symptoms of
psychological illness (Gundelach &Henry ,2016). Psychological distress is a condition of
emotional distress, generally identified by train sick of depression and anxiety(Doran,2011).

Diabetes is a disease with high and increasing prevalence rate that can affect all
aspects of patient’s life. In this disease the patient faces many hurdles in the whole life. Health-
related quality of life provides a normless perspective that encompasses a patient’s physical,
emotional and social functioning. Several studies examining the effects of insulin use and
quality of life found that insulin was associated with significantly greater improvements in
quality of life. (FORTIN,2006).

The purpose of this study was to analyze the global quality of life in a group of
diabetes mellitus patients without major complications and to assess the correlations with
glycemic control and the difference between diet, oral therapy and insulin therapy. The quality
of life for diabetic patients can vary based on various factors such as their overall health,
disease management, support system, access to health care and psychological well-being.
Proper management of diabetes through medication, diet, exercise and regular monitoring can
significantly improve quality of life by reducing the risk of complications and promoting and
overall well-being.
1.1: Social Support:
According to Barness and Duck social support refers to Everyday behaviors that, whether
directly or indirectly, communicate to an individual that she or he is valued and cared for by
others.

Social support is defined as the perception or experience that one is loved and cared for by
others, admired and valued, and part of a social network of mutual assistance and obligations
(Wills, 1991). Social support may come from a partner, relatives, friends, social and community
ties, and even a devoted pet (Allen, Blascovich, &Mendes,2002). According to this hypothesis,
social support acts as a reserve and resource that the effect of stress or enables an individual to
deal with stress more effectively, but otherwise is less eventful for mental and physical health
(Cohen& Wills, (1985). After decades of research, evidence for both type of effects has
emerged. Measures of social integrations typically show direct associations with mental and
physical health, but not buffering effects(Thoits,1995).

There are the following types of social support:

 Informational
 Emotional
 Esteem
 Social network support
 Tangible support

Social support is affiliated with overall better mental health. There is also proof that diabetic
patients with higher social support cope better psychologically than those without such
support. However, there has been insufficient research about the effect of social support
among people who have knowledgeable diabetic patients. There is considerable evidence that
those with greater social support (defined as the social resources that persons perceive to be
available or that are actually provided to them by non-professionals (Cohen and Gottlieb ,2000
cited in Gottlieb and Bergen,2010) have better mental health than those with less social
support (Kawachi and Berkman,2001, Barrera,1986, Lakey Orehek,2011, Cohen and Wills,1985).
Social support has been imagined in many ways –but has commonly been measured. Social
support can be categorized into different types.

1.1.2: Emotional support:

Involves providing empathy, love, care and concern to someone in need. Example…
listening to a friends, offering a shoulder to cry on, or expressing understanding.

1.1.3: Instrumental support:

According to social support theory, diabetic patients benefits from various forms of
support, including emotional, information and instrumental support. The theory suggests that a
strong social support system can appreciate a diabetic patients coping abilities and improve
overall health outcomes. Social support refers to the material, emotional and informational
assistance obtained from one’s social networks, which usually reflects the closeness and quality
of a person’s connectedness with others (Depression perceived by Zhiya Hua).

Diabetes is considered to be the leading cause of heart disease, stroke kidney failure,
lower limb amputation and blindness among US adults. According to the American Diabetes
Association, the management of diabetes can be costly, generating both large direct and
indirect medical cost. Social support plays a crucial role in managing diabetes affectively. Social
support can provide emotional encouragement, practical assistance, and information sharing,
which can help individuals cope with the challenges of living with diabetes, adhere to treatment
plans, make healthy lifestyle choices, and reduce stress.

Today, this disease is being paid more attention due to its high prevalence,
imposed costs on health systems, and various negative effects on the patients. Suffering from
chronic complications of diabetes leads to the decrease in life expectancy and increase in
death, imposes high economic burden on the person, family, and society and effects the life
quality of the person and his/her family (Esteghamati et.al,2008).

As diabetes is a chronic disease which requires extensive behavioral changes

and adherence to a complex diet, social support is considered as one of the influential and
important factors for performing self –care and for adherence to the treatment and disease
control which can facilitate self-care behaviors can compatibility with the disease. On the other
hand, a major part of a care for this disease is done at home and inside the family. Therefore,
diabetes is sometimes called a family disease because its control and demands influence all
family members. Thus, social support, especially family support, can be a vital component in the
successful control of diabetes(FunnallMM,2004).

Social support is multidimensional concept referring to the support a patient

perceives and receives from his or her social network such as family or friends, is usually
measured in three dimensions. The first is objective support, also known as practical or visible
support. The second is subjective support, which refers to the emotional and subjective
experience of being respected, supported and understood. The third dimension is the extent of
social support utilization, including access and acceptance to various aspects of support (A.H.
Mokdad,2001).

Many educational and counselling interventions have been developed to support

behavior change and to improve self-management of people with long-term conditions. Many
of the available educational and counseling interventions are expected to increase self-
management capabilities, such as insight in disease mechanisms, self-monitoring, knowledge,
and skills, making use of behavior change techniques (such as goal setting) (P. Zimmet,2001).

1.2: Psychological Distress:

Psychological distress is defined as a state of emotional hardship often

characterized by depressive symptoms anxiety or psychological functioning psychological
distress differs from other psychiatric mental disorders in that it is sensitive to external stressor.
(Arvidsdotter et al,2015).Psychological distress is defined as distress that is causing moderate to
serve impairment in functioning and requires treatment said dresser due to relationship
dynamic discrimination and financial hardship have all been linked with psychological
distress(Lincoln et al,2010).Financial stress is a chronic source of stress In turn, chronic stress
has been linked with mortality and mental health problems, including psychological distress.
Chronic stressors may proliferate within and across domains and the accumulation of these
stressors may deter individuals, ability to cope, leading to a depletion of their resources and in
turn, contributing to the onset of an illness or psychological distress (Tsuchiyaet al,2020).

Psychological distress is condition of emotional distress, generally identified by

trains of depression and anxiety (Doran,2011). Psychological distress is a general term used to
describe negative feelings or sentiments that affect one’s position of working and intrude with
activities of day-to day living. Psychological distress can act in distorted views of the personality
and circumstances and is manifested by sadness,anxiety,distraction and symptoms of
psychological illness(Gundelach&Henry,2016) it has been widely used as a predictor of mental
health believed that this is a short lived emotional response to stress, which ,if left
untreated ,pathologically leads to depression, Wheaton believes that psychological distress is
comparatively stable condition that will affect social functioning and daily
life(Wheaton,2007).Mental and physical work strain may affect mental health. Mental strain is
common in human service work but while working in these profession may increase the risk of
emotional the exhaustion and psychological distress it may also provide meaning in work.
Physical work strain has been found to have a stronger effect on mental health in men than in
women. A lack of social support from one’s partner and close relatives, parents and friends is a
risk factor for psychological distress. (Markkula et al,2015).

Psychological distress appears to increase the likelihood of catastrophic health

expenditures for individuals through it comorbidity with chronic illness such as diabetes and
heart disease. Psychological distress may also hinder education and skills acquisition among
youth and exacerbate gender in equalities through its disproportionate prevalence among men
and women. (Ridely et al, 2020). Distributed relationships with parents, teachers, seniors and
peer’s academic backwardness compared to the high expectations, socioeconomic status,
financial crises, curiosity to explore sexual practices and substance abuse are the main
triggering factors for psychological discord in adults. The above mentioned factors directly or
indirectly leads to emotional crises not only in the form of aggression but also in psychological
distress (et al,2019).
 Psychological distress is largely defined as a state of emotional suffering
characterized by symptoms of depression (lost interest, sadness, hopelessness) and anxiety
(restlessness, feeling tense) (Mirowsky and Ross,2002). In particular, tenants of the stress –
distress model posit that the defining features of psychological distress are the exposure to a
stressful event that threatens the physical or mental health, the inability to cope effectively
with this stressor and the emotional turmoil that results from this effective
coping(Horwitz,2007).Psychological distress would be a medical concern mostly when it is
accompanied by other symptoms that ,when added up satisfied the diagnostic criteria for a
psychiatric disorder.(Wheaton,2007).

Psychological distress associated with common mental disorders such as

depression and anxiety disorders is highly costly to the quality of life of individuals and to
societal productivity(Chisholmrtal,2016). A number of epidemiological studies have examined
trends in the prevalence of depression and psychological distress and the use of mental health
services. Some studies in the United states and Australia have shown an increase in the
prevalence and depression and psychological distress (Weinberger,2017).

Depression is one of the most important risk factors for dementia (Livingston et
al.,2020). However, evidence is scarce on whether the risk of incidents dementia may also be
elevated in people with mild or moderate psychological distress, which sometimes may indicate
the onset of depression, anxiety and other mental disorders(VandenBos,2007).Thus,
psychological distress would be a medical concern mostly when it is accompanied by other
symptoms that when added up, satisfied the diagnostic criteria for psychiatric
disorder(Horwitz,2007).Here are psychological distress can manifest in various forms are given
below:

 Anxiety: Persistence worry, fear or apprehension.

 Depression: Persistent sadness, loss of interest or pleasure in activities, feelings
of worthlessness or guilt.
 Stress: Response to pressure from the external environment that can be
physical, emotional or psychological.
 Trauma: Emotional response to a distressing event, often resulting in symptoms
like flashbacks, nightmares or hypervigilance.
 Obsessive-compulsive disorder: Intrusive, unwanted thoughts(obsessions)and
repetitive behaviors or mental acts(compulsion).
 Post- traumatic stress disorder: Develops after exposure to a traumatic event,
characterized by re-experience, avoidance, hyper arousal, and negative changes
in mood and cognition.
 Eating Disorders: Disturbance in eating behaviors and body image, such as
anorexia nervosa, bulimia nervosa and binge eating disorder.
 Substance use disorder: Patterns of substance use leading to significant
impairment or distress.
 Bipolar disorder: Episodes of mania (elevated mood, increased energy) and
depression.
 Personality disorders: Persistent patterns of thoughts, feelings and behaviors
that deviate from cultural expectations and cause distress or impairment.
1.3: Quality of life:

In 1948 the world health organization defined health from a new perspective, stating that
health was defined not only be the absence of disease and condition, but also by the presence
of physical, mental and social well-being. People with diabetes often feel challenged by their
disease and its day-to-day management demands. Patients must deal with diabetes all day,
every day, making countless decisions in an often ineffective effort to approximate the non-
diabetic metabolic state. As a consequence, researchers and health plan administrators are
focusing on shorter-term patient outcomes, including functional health status, satisfaction with
health care, and overall quality of life. The goals of monitoring psychosocial well-being and
quality of life in people with diabetes include: identification of patients who are depressed or
anxious; evaluating new treatments by identifying psychological costs and benefits; and
identifying dissatisfaction with treatment and other aspects of car (Arfken CL,1996).

The outcome of education in diabetic patients is commonly evaluated in terms of

prevalence of complications or biomedical effect variables. Thus evaluation of patient
education appears to be equal to the assessment of the overall quality of diabetes care, in fact
education of patients helps dramatically but its efficacy varies to a great extent according to
which aspect of disease has to be controlled and to the behavioral changes needed.
Consequences of diabetic patients on quality of life including changes in social status, work and
family roles, and in time organization is recognized. Also identify loss and identity decreased
social contacts, financial distress and uncertainty about the future has their role in weakening
quality of life(Wanberg,2012).

According to Petito and Cummins, subjective quality of life among adults is unusually
consistent on a population basis, while QOL is lower and unstable in adolescence. Thus it seems
important to study the development of QOL during the transformation from adolescence to
early adulthood. The concept of QOL is grounded in welfare research and can be used at both
the societal and the individual level. There is no unity about the measuring of QOL and thus no
generally accepted definition, but it is a common view that welfare is a broader concept that
includes QOL.Measuring QOL at the societal level can, for example, include variable such as
level of living, salary dispersal, suicides rate and health status in the population. At the
individual level QOL can refer to variables such as health status, standards of living, work and
housing conditions or felt satisfaction, well-being and life satisfaction.

Quality of life can be considered as a guide of whole well-being and satisfaction in life.
Self-reliance, social inclusion, and social relationships define individual’s quality of life,
experienced by emotional, physical and tangible elements of well-being. Ones quality of life is
effected by their attitudes, experiences and status in cultural and ethical framework. These are
in relation to the goals, expectations and requirements and considerations of an individual’s
(Poduzov Yazkova). Quality of life reflects a person’s satisfaction with success in life (Produzov
&Yazykova) and can also be seen as a procedure that objectives to realize their potential
(Reinders & Schalock).

The quality of life for diabetic patients can vary based on several factors including their
ability to manage their condition, access to healthcare, complications from diabetes ,support
system and overall health.Daibetic exposes people to both physical(cardiovascular
disease,neuropathy,diabetic foot and stroke etc.)and psychological complications(e.g.
Depression and emotional distress).The impact of disease and of treatment on all chronic
patients quality of life and life style is a key concern for both the patients themselves and their
physicians(Setacci& Donato,2009).Generally, individuals with well-controlled diabetes who
actively manage their condition through medication,diet,exercise and regular medical checkups
tend to have a better quality of life compared to those with poorly managed diabetes.
Complications from uncontrolled diabetes such as neuropathy, retinopathy and cardiovascular
issues, can significantly impact quality of life. Access to resources education about the
condition, psychological support and a supportive social network also play important roles in
enhancing the quality of life in diabetic patients.