Medical Faculty and Health Science Muhammadiyah University of Yogyakarta 2011

Diabetic Mellitus tipe 2 is a common endocrine disease The prevalency of diabetic mellitus tipe 2 in the world and indonesia The relationship between diabetic mellitus type 2 and depression

What are the factors that contributed to depression outcome and make depression better post SHG therapy of diabetic mellitus type 2 in community health center?

Can self help group therapy which given patients of diabetic mellitus type 2 by comorbid depression: improved the quality of life controled blood glucose level controled total cholesterol level than diabetic mellitus type 2 patient by comorbid depression who is not given SHG therapy?

1.

General research To know and analyze the influence of SHG to quality of life, blood glucose level, total cholesterol level, risk factors and prognose factors on patient by diabetic mellitus type 2 in comorbid depression

2. Spesific research To know the factor which relate with quality of life and risk and prognose factors To know the influence of total cholesterol and blood glucose level To know the percentage of depression

1. Clinic : to give reference to take decision in management. 2. Community : to give information about the function of self help group as alternative therapy.

 The research about result of self help group therapy on diabetic mellitus type 2 by comorbid depression to quality of life, control blood glucose level, total cholesterol level, risk factors and prognose factors never practiced in Indonesia.

 Diabetic Mellitus is a metabolic disease group by hyperglicemic signs because it has less of of secretion insulin, insulin action, or both of them (ADA, 2010).

Classification of diabetic mellitus based on ADA, 2010. 1. DM type 1

2. DM type 2 3. DM other type (genetic defect of beta cell function, genetic defect of insulin function, ecsocrin pancreas disease, chemical medicine and imunology).

 The risk factors of depression by Maslim, 2002: Female gender, education level, married statue, income level, age, smooking, and complication.

1.

General signs Lost of willingness and fun Less of energy, fatigue, and less of activity 2. Extra signs Less of concentration and attention Think of bad future

1. 2. 3. 4.

Low depression Middle depression High depression without psychotic signs High depression with psychotic signs

Diabetic increase risk depression because of fairly and loss feeling and it is needed to change life quality to ignore the complication (Mezuk, 2008).

It is group therapy in some situtations and conditions, concious of two or more than two persons who have the same problem and share it to better.

1. Share feeling and experiance among group 3. To increase the knowlage, to change, the attitude and to increase quality of life

A. Introduction B. Problem solving C. Closing

Insulin levels in the blood too low and glucagon levels too high. Inhibited glycolysis and stimulated gluconeogenesis.

GLUCOSE LEVEL CONTROL : COMPLIANCE TO TREATMENT LAZY TO CHECKING BLOOD EATING / DRINKING EXCESSIVE MAINTENANCE COSTS GLUCOSE LEVEL CONTROLED DIABETES MELLITUS DEPRESSION SHG GLUCOSE LEVEL UNCONTROLED

A. Biologycal Factor B. Genetic factors C. Psychosocial Factors

a. b. c. d. e. f. g. h. i.

RISK FACTORS: YOUNG AGE WOMEN'S GENDER EDUCATION LEVEL INGKAT REVENUE SMOKING SOCIAL STATUS STATUS OF ETHNIC MINORITIES COMPLICATIONS COMORBID

PROGNOSTIC FACTOR REPAIR

DIABETES MELLITUS

DEPRESSION

SHG NO IMPROVEMENT

 The function of lipid based on (mayes et all, 2003) 1. Arange the cell membrane stracture 2. Substancy of energy 3. As hormone and vitamine

Cholesterol level controled : Treatment regulery Blood ecamination lazynes Over consumtion of food and drink Care payment

Cholesterol level controlled

Diabetic mellitus

Depression

SHG Cholesterol level uncontrolled

 The definition of life quality based on Dorland, 2003. it is described to measure the emotional, social, and physic condition of someone and the capibility to do task and it is function in daily life.

Diabetic Mellitus

Depression

Self help group

Improved of Life Quality

Quality of life: Physical Psychological Social Relation Family Intimace Friendship Financial

Therapy SHG (Self Help Group) capable to control blood glucose, cholesterol total, have recovery of better depression score, have recovery of better life quality levels in type 2 diabetic group with comorbid depression when compared with the control group.

 Quasi-experimental study PROBE (Prospective, randomized, open, end-Blinded Evaluation) test design

Target Population : female patients with type 2 diabetes Affordable Population : female patients with type 2 diabetes based on Perkeni 2006 criteria which control at clinic in the district of Bantul, Yogyakarta

n=

2s 2 [ Z

+ Z ]2 b
2

(m1 - m ) 2

s s2 = 1

+ 2

2 2

Sample : 50 people, Each group consisted of 25 people. To estimate the number of cases dropped out samples of each group up to 28 people.

 Inclusion Criteria: (1) Woman with Perkeni 2006 criteria; (2) >20 years old, (3) BDI score over 10; ( 4) self-help therapy group meeting at least 3 times, (5) not receiving treatment for psychiatric disorders, (6) signing an informed consent; (7) not active smokers and alcoholics; (8) can reading. 2. Exclusion Criteria: (1) Patients in a state of pregnancy, (2) patients using insulin treatment, (3) patients experienced major complications associated with diabetes.

Diabetics Population in Community Health Center

Affordable Population: Female with Diabetes Type 2 which control at Clinic

Assesement Depression Score (BDI)

Type 2 Diabetics Women with Depression Comorbidity

Type 2 Diabetics Women without Depression Comorbidity

Analize Risk Factor and Measurement Glucose, Cholesterol, Quality of life (Pretest)

Self Help Group Therapy

Without Self Help Group Therapy (Control)

Analize Prognose Factor and Measurement Glucose, Cholesterol, Quality of life (Post test)

 Independent Variable (Free): Self help group Dependent Variable (Depends): Risk and prognose factor Cholesterol levels Blood glucose levels Quality of life

Self Help Group (SHG) Type 2 Diabetes Depression Community health center Drop out

Risk Factor Prognose Factor Fasting Blood Glucose Total Cholesterol Quality of Life

 Paired Sample T-Test for normally distributed data Wilcoxon Signed Rank Test when data not normally distributed Differences considered significant if p <0.05 with 95% confidence interval.

questionnaire BDI (Beck Depression Inventory) to screen for depression that has been validated by previous research and its reliability has been recognized since been used repeatedly.

Presentase Depresi di Puskesmas

Sedayu Depresi : 36 orang Non Depresi : 16 orang Persentase depresi : 69,23% Kasihan II Depresi : 28 0rang Non Depresi : 13 orang Persentase depresi: 68,29%

NORMALITY TEST RISK FACTORS-BDI SCORE