Spiritual Well-Being and Depression of Indonesian Adults with

Diabetes Mellitus

Nunung Febriany Sitepu

, Febriani Khairunisa Pohan

Department of Medical Surgical Nursing, Faculty of Nursing, University of Sumatera Utara, Jalan Prof. T. Maas, Kampus

USU, Medan, Indonesia

Undergraduate Program of Nursing Study, Faculty of Nursing, University of Sumatera Utara, Jalan Prof. T. Maas,

Kampus USU, Medan, Indonesia

Key Words: Spiritual Well-being, Depression and Diabetes Mellitus

Abstract: Diabetes mellitus is a chronic disease characterized by increased blood sugar levels. Complementary

complaints arising from chronic complications experienced and complex diabetes management can affect

the patient's physiological and psychological conditions. One psychological disorder that can arise is

spiritual well-being and depression. The spiritual well-being of the situation that underlies satisfaction in life

and the ability to express relationship with the creator is called His spiritual prosperity. Psychological

changes such as anxiety and depression experienced by people with diabetes mellitus can adversely affect

the development of diabetes mellitus. This study aims to determine the description of spiritual well-being

and depression in diabetes mellitus patients at primary health care center. This research is a descriptive

study conducted on 52 respondents with purposive sampling technique, data collection using spiritual

wellbeing scale and PHQ-9 questionnaires and statistic by descriptive analysis. Based on the results of the

study and a description of the discussion in this study it can be concluded that diabetes mellitus patients

have a high spiritual wellbeing of 48 people (92.3%) and experienced mild depression as many as 26 people

(53.8%). The high spiritual wellbeing because respondents still have hope, that hope is a multi-dimensional

concept that provides comfort as long as individuals experience life-threatening situations. Activities need

to be made to stimulate patients to care about mental health and physical health, such as screening the health

condition of people with diabetes mellitus at the primary health care center.

1 INTRODUCTION

Diabetes mellitus (DM) is a degenerative disease,

which is predicted to continue to increase in

prevalence. According to WHO in 2011, diabetes

mellitus is one of the most common diseases

suffered by people worldwide for degenerative

diseases. The prevalence of diabetes mellitus in

adult populations around the world is expected to

increase by 35% in two decades and contract 300

million adults by 2025. The biggest part of this

increased prevalence will occur in developing

countries (Gibney, 2009). Based on the data from

the International Diabetes Federation (2014) that the

prevalence of diabetes mellitus (DM) in 2011 was

366 million sufferers and increased in 2013 to 382

million sufferers with the notion that 46% of

sufferers did not realize that they had been

conditioned diabetes mellitus (IDF, 2014). North

Sumatra Province is one of the provinces with the

highest prevalence of diabetes mellitus in Indonesia

with a 2.3% prevalence diagnosed by doctors based

on symptoms, this makes North Sumatra Province

one of the top 10 provinces with the highest

prevalence of diabetes mellitus in Indonesia

(Ministry of Health, 2014). In 2012, the city of

Medan included the largest number of patients with

diabetes mellitus, which continued to increase in

number. Based on data obtained from the Medan

City Health Office in 2012, the highest number of

cases after hypertension was diabetes mellitus. Until

2012 there were 10.347 people with diabetes

mellitus who went to 39 health centers in the city of

Medan. These data show that diabetes mellitus

patients in Medan City are very high (Medan City

Health Office, 2012).

250

Sitepu, N. and Pohan, F.

Spiritual Well-Being and Depression of Indonesian Adults with Diabetes Mellitus.

DOI: 10.5220/0008397100002442

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 250-254

ISBN: 978-989-758-413-8

Primary health care center in Indonesia has a DM

clinic with 1.010 visits and a total of 115 patients.

This shows that DM patients at the DM clinic at the

primary health care center often tend not to carry out

outpatient treatment routinely according to the

prescribed schedule. DM Clinic Health Center of

Community of Health is the first DM clinic in

Medan, DM primary health care center often

established in 2008 and is one of the hopes of the

Medan City Health Office to prevent an increase in

DM cases and all complications of DM. One of the

supporters of spiritual resources is the fulfillment of

spiritual wellbeing. Spiritual well-being is stated by

Ellison (1983) that the conditions underlying

satisfaction in his life and the ability to express His

relationship with the creator are called His spiritual

prosperity. Also affirmed by the National Interfaith

Coalition on Aging (NICA) in Washington

proposing spiritual wellbeing as an affirmation of

life in establishing a special relationship with God,

oneself, society and the environment by nurturing

faith, integrity to be together in personal peace

(Fisher, 2009).

Spiritual well-being is an integrated aspect of

humanity as a whole which is characterized by

meaning and hope. Spiritual health or well-being is a

sense of harmony that is close together between

oneself and others, nature and with the highest life.

This sense of harmony is achieved when one finds a

balance between the values, goals and belief systems

of individuals with their relationships within

themselves and with others. This belief is often

rooted in the person's spirituality. Throughout the

life of an individual may be spiritual will grow more

so that individuals become more aware of the

meaning, purpose and value of life (Ellison, 1983).

Spirituality gives a broad dimension to a holistic

view of humanity. The definition of spirituality or

dimension of spirituality will be unique and different

for each individual. Individual definitions of

spirituality are influenced by their own culture,

development, life experiences and ideas about life.

The spiritual dimension seeks to maintain harmony

or harmony with the outside world, trying to answer

or gain strength when facing emotional stress,

physical illness, or death, which is a force that arises

beyond human strength. Depression is a serious

mental disorder characterized by feelings of sadness

and anxiety. This disorder will usually disappear

within a few days but can also be sustainable which

can affect daily activities (National Institute of

Mental Health, 2010).

According to WHO, depression is a mental

disorder characterized by the appearance of

symptoms of decreased mood, loss of interest in

something, feelings of guilt, sleep disturbances or

appetite, loss of energy, and decreased concentration

(World Health Organization, 2010). Depression is a

mood disorder with sadness, feeling alone, low self-

esteem, despair, usually accompanied by signs of

psychomotor retardation or sometimes agitation,

withdrawal and physiological disorders such as

insomnia and anorexia (Kaplan, 2010). Depression

is a mood disorder characterized by loss of feeling of

control and subjective experience of severe

suffering. Mood is an internal emotional state that

permeates a person (Kaplan, 2010).

Psychological changes such as anxiety and

depression experienced by people with diabetes

mellitus can adversely affect the development of

diabetes mellitus. The prevalence of depression may

be higher in DM patients who have multiple

complications. Depression in DM patients is often

undetectable, and depression is a major barrier to

effective diabetes management.

The purpose of this research is to find out the

description of spiritual well-being and depression in

diabetes mellitus patients at the Primary Health Care

Center Indonesia.

2 METHODS

The time of this research was conducted in January -

June 2018. Sampling technique in this study uses

non probability sampling. Inclusion of the criteria

specified in the study are diabetes mellitus patients

who got treatment frequently at health care centers,

DM patients ≥2 years old, can read and write, can

communicate as well, the sample in this study were

52 patients with diabetes mellitus, data collection

using spiritual well-being scale and PHQ-9

questionnaire, statistic by descriptive analysis

3 FINDINGS

Based on the research that has been done, the

following are the results of respondent characteristic,

their spiritual well-being and their level of

depression.

The results on patient characteristics obtained

data that female patients were 26 people (50.0%)

and male sex as many as 26 people (50.0%). Other

patients, 18 people (34.6%). Most patients were 41-

60 years old as many as 27 people (51.9%). The

Spiritual Well-Being and Depression of Indonesian Adults with Diabetes Mellitus

251

majority of respondents who were the subject of this

study had a long history of suffering from 6-10 years

of diabetes mellitus as many as 34 people (65.4%).

The majority of other respondents' jobs were 24

people (46.2%). Furthermore, data on the spiritual

well-being of the respondent presented in table 2.

Table 1: Respondent characteristics (N=52).

Characteristics Frequency Percentage (%)

Sex

Male 26 50

Female 26 50

Race

Javanese 14 26.9

Bataknese 15 28.8

Sundanese 5 9.6

Others 18 34.6

Age (years)

21-40 20 38.5

41-60 27 51.9

61-80 5 9.6

Duration of diabetes (years)

6-10 34 65.4

11-15 17 32.7

16-20 1 1.9

Occupation

Government employee 7 13.5

Non-Government employee 12 23.1

Table 2: Respondent’s level of spiritual well-being and depression (N=52).

Level Frequency Percentage (%)

Spiritual well-being

Medium 4 7.7

High 48 92.3

Depression

Minimum 20 38.5

Mild 28 53.8

Moderate 4 7.7

Total 52 100

Spiritual well-being as shown in table 2, the

majority of diabetes mellitus patients have a high

spiritual welfare of 48 people (92.3%). According to

researchers, high spiritual well-being in patients

shows that patients have a hope of spiritual

strengthening in the patient According to Utama

(2015) the spiritual well-being of patients before

heart surgery approaches the highest value. From the

results of this study it can be concluded that spiritual

well-being is in the high category, this is influenced

by the age of respondents who are generally in

middle age and elderly. The results of the study

found that the majority of diabetes mellitus patients

in Primary Health Care Center had a high spiritual

wellbeing of 48 people (92.3%).

Based on the results of research on depression in

patients with diabetes mellitus data obtained that at

least 20 people depression (38.5%), mild depression

as many as 28 people (53.8%), moderate depression

as many as 4 people (7.7%).

4 DISCUSSION

According to Nugroho's opinion (2008), most of the

spiritual level in an elderly person has increased,

where the elderly are more organized in living their

daily spiritual lives. Research by Ellison (1983) that

the middle age group and the elderly have and

provide more time for religious activities and try to

understand religious values which are believed to be

a response to individual awareness in living religious

life. This can happen because the patient feels a

meaningful relationship with God through prayer

and the emergence of hope, strength in healing the

disease. This is supported by Eom( 2011) personal

communication with God can provide strength, hope

and is part of trust. This is evidenced in patient

statement that "I believe that God loves me and

cares about me. According to Chandler, Cynthia K,

Holden, Janice Miner, &Kolander, Cheryl. (1992

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252

(2004), hope is a multi-dimensional concept that

provides comfort as long as individuals experience

life-threatening situations.

Hope is energy that can give individuals

motivation so that they help patients overcome life

pressure. Improving spiritual welfare also occurs

because the patient feels his life is prosperous and

God is watching what happens to him and there is a

meaningful belief in his life. This is also supported

by McEvoy (2005) that spiritual beliefs will create a

sense of self so that it can provide a purpose and

meaning in life and gain a positive outlook and

surrender to the disease that is natural.

This is in line with Gray (2006), that spiritual

well-being will create spiritual health. Individuals

get spiritual health by finding a balance between

values, goals, beliefs and relationships in themselves

and others. The spiritual well-being that has been

explained above illustrates the need for meaning

from life, whether it is from the creator or the

individual effort de Wildman, (2012) that existential

spiritual well-being is a process of how individuals

respond to themselves and their lives. An existential

welfare indicator of a good individual is that the

individual can interpret the purpose of life and feel

peaceful in his life.

Another thing that can affect is that culture in

Indonesia is very thick with doctrine and puts

forward a relationship with God in spiritual

improvement. This is in accordance with the opinion

of Bredle et al., (2011) that spiritual well being

based on religious doctrine is more visible than

based on the ex-Depression in patients with diabetes

mellitus is a complex condition, where the known

etiology is still very lacking. But many factors

influence the occurrence of depression. Depression

is also a risk factor of the most important

psychological aspects in patients with diabetes

mellitus that can reduce the quality of life of

patients. This can occur because related to serotonin.

In the neurons the presence of serotonin that binds to

serotonin receptors can activate chemical signals

that are believed to affect a person's psychological

function (regulation of mood, sexual desire, sleep,

appetite) (Bredle and Jason M,2011).

Depression in DM patients is the result of the

fact that someone diagnosed with DM will

experience (Paloutzian, R., Bufford, R., & Wildman,

A. 2012) a pattern of life and the danger that

threatens they life ( This is as stated by depression is

expected in 2020 to be the second most common

cause of disability. Based on the results of the study,

there was also a correlation between the occurrence

of depression and age, which reminded health

workers of the importance of examining all factors

related to aging and not only paying attention to one

aspect. Depression screening in the elderly will help

diagnose depression in the elderly better and be able

to provide needed care (Singh, Padmanabhan &

Arora, Pratap (2010). Elderly people aged 85 and

older are more susceptible to depression than other

age groups. Elderly patients with DM often have to

deal with a variety of health problems and various

complex health check schedules. In addition, the

patient's family and elderly patients will find it

difficult to differentiate the decline in the physical

condition of the patient whether it is physiologically

due to old age or due to the progression of DM

complications experienced by the patient Eom, et.all

(2011) that disease is a life threatening condition.

For that disease is often a source of depression that

is very high, and people who are suffering from a

disease that does not understand what is experienced

and treatment. On the other hand, diabetes and

depression can be said to be a couple who often

appear.

5 CONCLUSION

Based on the results of the study and a description of

the discussion in this study it can be concluded that

diabetes mellitus patients have a high spiritual

welfare of 48 people (92.3%) and experienced mild

depression as many as 26 people (53.8%). The high

spiritual welfare because respondents still have

hope, that hope is a multi-dimensional concept that

provides comfort as long as individuals experience

life-threatening situations.

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