Mental Health and Environmental Coping Mechanisms of the Diabetic Patient and Implications on Hospitalization Duration

Abstract


Abstract: Introduction
Mental health is a state of emotional, psychological and social well-being, where the individual manages to successfully manage daily life, valuing himself and others, while being socially integrated, happy and fulfilled.Adaptability to the environment is the ability of the person or organism to adjust, to transform, according to the changes and demands of the environment.These skills require learning from experiences, finding creative solutions and developing the ability to cope with stressors.Integration into the environment requires constant personal development.Unfortunately, we live in times when the environment is changing at a speed that is difficult for the human body and psyche to manage and follow.

Material and method
In this study, part of a larger study, 80 diabetic patients aged between 19 and 70 years were included.The longitudinal research period was 2015-2022, following the number of days of hospitalization and the length of hospitalization for each hospitalization in "Sf.Ap.Andrei" Emergency Clinical Hospital Galati.The patients, in compliance with data protection and legislation in force, were administered a psychological questionnaire tracking their adaptability to the environment and their rational and irrational beliefs in relation to life.The data were centralized and analysed in the SPSS statistical software, looking for correlations between psychological aspects and hospitalization duration/frequency, assuming that patients with significant test results are patients suffering from diagnosed or not yet diagnosed psychosomatic disorders.

Conclusions
The results of the questionnaire and the anamnesis revealed that most of the patients had irrational beliefs and attitudes towards themselves, others and life, completely dysfunctional.Extrapolating that these patients also have psychosomatic disorders, we can state that the statistical results obtained predict that a person with psychosomatic disorders will have more frequent presentations to the doctor, while each hospitalization will be longer than that of patients with the same pathology, without associated psychosomatic disorders.In this sense, both the correlations obtained and the linear regression with predictive value, force us to think in the long term and bring to light the need to implement a diagnostic tool at the disposal of the diabetologist, internist and emergency physician, for further collaboration with the psychiatric physician, all for the ultimate good of the patient.

Introduction
The diabetic patient, unlike others, is not in pain.Diabetes does not hurt; it is a silent enemy.At most, the complications of the disease become painful.
Possibly because of the lack of pain, the patient sometimes finds it hard to understand his/her condition.
During the course of the research, I wanted to find out the diabetic patient's opinion about his disease.The diabetic is able to sustain a thorough anamnesis, is open in communication, willing to talk about himself, and is not tormented by pain.Particularly interesting were the discussions with diabetics.The questions asked to each one: What is diabetes?Please explain to me, what disease do you suffer from?Why do you think you got sick? received some of the most interesting, if not shocking answers.Overwhelmingly, patients explained that diabetes is a disease of grief, stress, trauma.They explained the onset of the disease in mystical ways: I have diabetes because my neighbour cast spells on me, I have diabetes because God is angry, I've done a lot of wrong deeds... Some put diabetes down to trauma: I have diabetes since the year my mother died, etc.
Patients' responses made me realize that I cannot clinically manage these beliefs.I consider patient involvement to be very important in treatment.Not medication alone and not the doctor is enough in healing.The role of the patient is overwhelming.Healing is a two-person dance at least, if we don't take into account here and now the environmental implications.Thus, we consider health education to be paramount in healing.The diabetic must understand what his disease is, what the pancreas is, what diet means and what the role of prophylaxis is in the occurrence of pathological decompensation.
Since the attitude of the diabetic patient towards the disease is a key element in the present study, I chose to find out whether dysfunctional attitudes can have an impact on glycemic elevations from the perspective of diet and treatment compliance.
At the same time, could rational or irrational beliefs have an impact on the average hospitalization duration or frequency?The presented research is an integral part of a larger study, started within the PhD thesis entitled Impact of psychological disorders in patients with polymorphic pathology and implications on the average hospitalization duration, author Hincu Lescai Alina-Maria.

Material and method
The doctoral thesis was not yet publicly defended at the time of writing the article.The author of the PhD thesis is also the main author of this article.
The research group consisted of 80 patients diagnosed with type I or type II diabetes, aged between 19 and 70 years.Of these, 40 subjects were female and 40 male.The follow-up period of the cases (number of hospitalization days, hospitalization frequency, associated diagnoses) was [2015][2016][2017][2018][2019][2020][2021][2022] The ABSs questionnaire is based on the theories of A. Ellis who studied individual behaviours and cognitions of making rigid and absolutist evaluations of life, leading to irrational beliefs and dysfunctional behaviours by studying the person's adaptive behaviour.
The scale has eight items measuring four rational beliefs and four irrational beliefs, scoring from 0-4 straight and 4-0 reversed, with a possible minimum score of 0 and a maximum of 32.
Prior to starting the investigation, the steps of the legislation in force were followed:  Non-disclosure agreement  Agreement of the health facility management to use the computer database  Agreement of the management of the health facility to apply accredited psychological questionnaires to inpatients for research purposes  Ethics Committee Opinion obtained  Patient's informed consent

Results
Descriptive statistics of the group will be performed on the following variables: age, gender, diagnostic type and associated diagnoses.The frequencies of the age variable show an increase of the share in the sample for ages 62-68, which could be explained by the stages of human psychosocial development.According to the statistical data shown in Figure 4, only 12.5% of the group surveyed were diagnosed with a psychosomatic disorder.
Of the diagnoses associated with diabetes mellitus in the researched group, there is a clear association with the pathology of hypertension, 58.8% (according to Table 1 and Figure 5).

Database checking and calculation of basic statistical indicators
Statistical indicators such as mean, median, standard deviation, Skewness and Kurtosis will be generated using SPSS in order to identify data distribution and possible associations between variables.
The variables of the database are: hospitalization_days, admission frequency, irrationality and rationality.As we can see in Table 2 all 4 variables have the assumption of normal distributions of the data, the Skewness and Kurtosis indicators are close to 1 and -1 respectively which shows a symmetric skewness of the data.

Statistical hypothesis testing
The objective of identifying an underdiagnosis of a patient with a psychosomatic disorder can be achieved using statistical testing with twoway hypotheses, with homogeneity of data as a condition.
We will establish the following statistical hypotheses:  H0: There is no correlation between hospitalization frequency/hospitalization days and psychosomatic disorders for patients with diabetes;  H1: There is a correlation between patients with diabetes-related psychosomatic disorders and hospitalization frequency and/or number of hospitalization days We set the significance threshold at 0.05.

Testing the normality of the collected data distribution
The Kolmogorov-Smirnov test will check the normality of the data distribution of the variables hospitalization days and hospitalization frequency.

Correlational analysis
In order to identify and quantify the size of the link effect for normally distributed variables we use the Pearson correlation coefficient (r).

Conclusions:
The number of hospitalization days increases as the irrationality score is higher in the diabetic patient.
The number of hospitalization days decreases as the rationality score is higher for the patient with diabetes.
The hospitalization frequency of patients with diabetes increases when the irrationality score is high.
The frequency of diabetes patient hospitalizations increases when the rationality score is high.
Analysing the data, we can say that in the case of patients with diabetes, it would be desirable to give importance to the way they think and the impact on somatization.

Simple linear regression
Simple linear regression, an extension of Pearson correlation, is optional in research with predictive value.
The intention is to predict the number of hospitalization days/frequency of physician attendance based on the value of scores obtained in psychological testing.Y=a+b•X=5.911+(-0.516)•X=5.911+(-0.516)•10=5.911-5.16=0.751 times a patient with diabetes and somatization disorder (high rationality = 10) will be hospitalized in 8 years .

Linear regression with dependent variable -hospitalization days and independent variables -ABSs test values rationality scale, irrationality scale respectively
Beta = -0,765 -correlation coefficient between rationality and hospitalization frequency.

Discussions and conclusions
Medicine can never be replaced by artificial intelligence.A robot will never be able to truly and deeply empathise, to comfort, to connect with humans.Medicine is of man, about man.It is not about sickness, it is about the sick.Looking at it from this angle, the doctor's aim is not limited to treatment, but the scope of interests must extend to the whole of life.To take an interest in the patient's emotions, in the patient's feelings and experiences is an integral part of bio-psycho-social medicine.It is not only if a wound hurts that interests us, it is not only the analysis report that attracts our attention, but also the patient's look from the bed, his present or absent smile, his desire to heal and to live.
Medicine is about evolution, curiosity and research.Limiting it to what is known is dangerous.The medical act must always be integrated into the context of the patient both biologically and emotionally.
 Given the results obtained in this research, we can state that psychosomatic disorders are underdiagnosed.Given that the results of the applied instrument reveal a very low level of unconditional self-acceptance and the presence of irrational beliefs, we can consider that diabetes, at least in the studied group, is aggravated by irrational beliefs, beliefs that can prevent compliance with a diet, a lifestyle or compliance with treatment.If my patient is convinced that the disease has been generated by spells or curses, can we hope that he will comply with a diet? Psychosomatic disorders will lead to an increase in the number of hospitalization days  Psychosomatic disorders will result in the patient presenting to the doctor more frequently, given the lack of compliance with treatment and lack of understanding of their own illness. The implementation of a tool to assist the clinician in the assessment of psychosomatic disorders is desirable -a tool that can be applied or self-applied and help the diabetologist, emergency physician, internal medicine physician, to raise the suspicion of psychosomatic disorder for further collaboration with the psychiatrist or clinical psychologist.
Just as an organ will generate disease throughout the body, so will the soul generate disease, because yes....the soul speaks through the body.(Sator, 2016) Unfortunately, the psychosomatic disorder does not appear on the test report.The term itself is almost unknown to the clinician, belonging only to psychiatry and psychology.But this therapeutic approach is profoundly mistaken, given that this type of disorder almost exclusively ends up in the emergency room or in the office of the diabetologist or internist.The diabetic patient arrives at the diabetologist without knowing or accepting that his pathology has a psychological component.
Going even further with clinical thinking and based on the research of the famous doctor Gabor Mate, we can ask ourselves if trauma or irrational beliefs or low self-acceptance led to the development of this pathology or vice versa?Answering this question does not bring any benefit now.
In fact, Prof. Daniel David has also so graphically described this impossibility and futility of determining whether it was the chicken or the egg first.
Medicine is based on the obligation to paraclinically prove any diagnosis.Perhaps this is precisely why the incidence of psychosomatic disorders is so rarely diagnosed in non-psychiatric hospitals.In this regard, we once again highlight the need to implement a diagnostic tool at the fingertips of the internal medicine physician, diabetologist or emergency physician, in the current situation where the patient can easily question the medical act or the diagnosis, with accusations of malpractice.

Figure 1 -
Figure 1 -Diagnosis trend -Type 2 Diabetes mellitus with poor control Source: The computer database of the hospital "Sf.Ap.Andrei" Galati County Emergency Clinical Hospital

Figure 21 -
Figure 21 -Batch distribution by age Authors' own conception

Table 1 -
Distribution of reported frequencies of associated diagnoses Authors' own conception Mental Health and Environmental Coping Mechanisms of the Diabetic … Alina-Maria LESCAI et al. 695 Figure 5 -Chart of diagnoses associated with diabetes mellitus Authors' own conception

Table 2 -
Descriptive indicators of variables, irrationality, rationality, hospitalization days and hospitalization frequencyAuthors' own conception

Table 3 -
Kolmogorov-Smirnov test results for the variable Hospitalization days

Table 4 -
Kolmogorov-Smirnov test results for the variable Hospitalization frequency

Table 6 -
Pearson correlation coefficient between the variables hospitalization days,

Table 8 -
Linear regression of the variable number of hospitalization days depending on rationality

Table 9 -
Linear regression of the variable number of hospitalization days depending on irrationality

Table 12 -
B coefficients depending on rationality

Table 13 -
B coefficients depending on irrationality

Table 18 -
Anova test indicators of the hospitalization frequency against rationality F (1, 78)=110.064-the chance that the prediction is random is very low.

Table 19 -
Beta indicators of the variable hospitalization frequency relative to rationality

Table 20 -
Residual values of hospitalization frequency relative to rationality

Table 21 -
Linear regression of the variable hospitalization frequency relative to irrationality

Table 22 -
Anova test indicators of hospitalization frequency relative to irrationality

Table 23 -
Beta indicators of the variable hospitalization frequency relative to irrationality

Table 24 -
Residual values of the hospitalization frequency relative to irrationality