Napata Scientific Journal, Vol. 4 (1), April.

2025 pp 34-47

Original Article

Psychological Disorders (Anxiety, Nervousness, and Social isolation) Among

Diabetic Patients in port Sudan

Elalim Eltayeb Abdurrahman1*, Reem Ahmed Abduraheim1, Nahla Zain Alabdin Ahmed1.
Anas Mohammed Musa1. Mohammed Salim Naif 1, Thagib Hassan Gafar2
1
Red Sea University Faculty of Medicine, medical students, port Sudan, sudan.2Port Sudan
Alahlia university Faculty of Medicine. medical students, port Sudan, sudan

*Correspondence author: Elalim Eltayeb Abdurrahman Red Sea University Faculty of

Medicine-fifth year medical student, Abou-aloum Research Center Director, port Sudan,
Sudan. Email: alalmaltyb52@gmail.com
Received: 12/ 1/2025
Accepted: 9/2/2025
.

Abstract

Background: Diabetes is a common chronic disease characterized by persistent

hyperglycemia. The International Diabetes Federation expects the number of affected
individuals to reach 783 million by 2045. The psychological aspects of diabetes management
are well-documented, particularly in relation to glycemic control and patient outcomes. This
study aimed to determine the prevalence of psychological disorders among diabetic patients
in Port Sudan.

Methods: This cross-sectional study was conducted among diabetic patients at Ahmed
Hassan Center, Port Sudan. Standardized questionnaires, including the GAD-7 for anxiety
and the UCLA 3-item scale for loneliness, were used. The Pearson chi-square test was
employed to assess associations between variables.

Results: A total of 256 diabetic patients participated in this study, with males comprising
55% of the sample. Of the participants, 28% were aged 41–60 years. The median anxiety
score on the GAD-7 was 11, indicating a significant proportion of patients experienced

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Psychological Disorders among diabetic patients Elalim Eltayeb et al

moderate-to-severe anxiety. Additionally, 53.9% reported experiencing nervousness

sometimes, while 57.4% felt socially isolated, highlighting the prevalence of mental health
concerns in this population. A significant association was found between loneliness and
nervousness (p = 0.001), suggesting that increased loneliness correlates with higher levels of
nervousness. Various sociodemographic factors were also associated with loneliness:
females were more likely to experience loneliness (p = 0.013), whereas being married was
linked to lower levels of loneliness (-0.445, p < 0.001).

Conclusion: This study underscores the importance of integrating psychological care into
routine diabetes management, as poor mental health can exacerbate glycemic control issues,
potentially leading to serious complications.

Keywords: chronic hyperglycemia, loneliness, Ahmed Hassan Center, mental disorder

2
Psychological Disorders among diabetic patients Elalim Eltayeb et al

Introduction

Diabetes is a common chronic disease The purpose of this study was to

affecting individuals worldwide. It is a determine the prevalence of the
collection of metabolic disorders referred psychological disorders among diabetes
to as chronic hyperglycemia, which is patients in Port Sudan.
brought on by flaws in insulin secretion,
1
action, or both and over time causes
major harm to the heart, eyes, blood Psychological problems may have a

vessels, and nerves. It is among the most significant impact on glycemic

significant global health crisis of the management in patients with diabetes.

twenty-first century 2. The numbers of Poor glycemic control, "brittle diabetes,"

people with the disease are expected to and diabetic ketoacidosis (DKA) have all

increase from 537 million in 2021 to been linked to psychological problems;

6
642.7 million by 2030 and 783.2 million according to the previous studies A

by 2045 worldwide, and it is one of the study found that 42% of patients with

top 10 causes of death worldwide3. It has diabetes reported feeling socially isolated,

become a global public health concern, which significantly impacts their mental

especially in low and middle-income health7.Integrating psychological cares

countries (LMIC) 4
.Diabetes mortality with diabetes management have been

rates by age increased by 3% from 2000 to emphasized by the International Diabetes

2019." In 2019, an estimated 2 million Federation3. Anxiety is a persistent

people died of diabetes-related kidney condition marked by psychophysiological

disease3. Many have suggested including symptoms that can arise at any time and

psychological counseling in routine disrupt regular daily routines.8

diabetes care as an outcome of physicians' Nervousness is a mental state marked by

increasing awareness in recent decades of anxiety, apprehension, or worry, usually

the value of psychological support for in response to a perceived threat or

individuals with diabetes and their stressor.9 Social isolation: For some

families5. people, loneliness (the sense of being

alone) can result from a lack of social
contact. Many people in the United States

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Napata Scientific Journal Vol. 4 (1) PP 34-47

suffer from loneliness and social isolation levels within the range required to prevent
in their later years, which increases their complications of the disease, indicating
chance of developing dementia and other the need for additional management
severe illnesses. Loneliness is linked to choices5. Glycemic control is negatively
increased rates of anxiety, depression, and correlated with anxiety and positively
suicide10. correlated with anxiety therapy, especially
in the subgroup of patients who
In Africa, studies have shown that
experience more severe anxiety. The
approximately 28% of diabetic patients
potential impact of anxiety management
experience anxiety symptoms,
in diabetes requires a more precise
highlighting a significant mental health
11 assessment of anxiety prevalence than is
burden .A lack of social support has
currently available14. Like other long-
been identified as a significant risk factor
term, non-communicable diseases,
for anxiety and depression in diabetic
diabetes has a noticeable psychological
patients, affecting up to 50% of
12 effect on those who have it, as well as
individuals in some African countries
their loved ones15. Numerous researches
Female diabetic patients in Africa are
have been conducted to identify the
more likely to experience anxiety and
prevalence of DAS (depression, anxiety,
depression than their male counterparts,
and stress) in patients with diabetes, it has
with rates as high as 45% for females
13 been concluded that individuals with
compared to 25% for males . Chronic
diabetes and depression have worse
hyperglycemia greatly increases the risk
outcomes when it comes to managing
of diabetic micro- and macro vascular
their conditions and this immediately
problems. Therefore, the goal of diabetes
impacts the quality of life of patients in
treatment is to maintain adequate
addition to placing a significant load on
glycemic control, and the significance of
healthcare services and costs.16. Access to
psychological and other components is
mental health services for diabetic patients
appraised in proportion to their influence
in Africa is limited, with only 10% of
on the outcome. Even with the availability
patients receiving adequate psychological
of excellent diabetes therapy, relatively
17
support , Psychological interventions
few individuals maintain blood glucose
have been found to reduce anxiety and
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35
Psychological Disorders among diabetic patients Elalim Eltayeb et al

depression symptoms in diabetic patients respective clinics were included in the

by 40% in African studies, emphasizing study. Pregnant diabetic females and
the need for integrated healthcare patients who have diabetes with other
18
approaches . Studies on the prevalence chronic diseases were excluded from the
of DAS and other psychological disorders study. The minimum sample size was
among patients with diabetes in Sudan are calculated using the following equation.
very rare. In comparison to the general
(Z^2 * P * (1-P)) / d^2
population, patients with diabetes in Port
Sudan show a notable psychological Confidence level (Z), expected

disorder. prevalence from previous studies (P), and

desired precision (margin error) (d).
Following the assumptions of a 95%
Methods confidence level (CI), an acceptable
margin of error of 5%, and an expected
Study setting and design
frequency of 18% from a similar study
This cross-sectional study was conducted conducted in Egypt 19
. The required
from 30th June to 1st august 2024 and sample size was 236. Given the lack of
aimed to determine the prevalence of previous data on the specific prevalence of
psychological illnesses (social isolation, anxiety, social isolation, and nervousness
anxiety, and nervousness) among patients among patients with diabetes in Sudan, a
with diabetes in Port Sudan. conservative estimate of 18% was used to

Study population and sample ensure an adequate sample size for

capturing potential trends and variations.
This study was conducted at Ahmed
Hassan Center for Diabetes. This center, Data collection tools and procedures

specialized for diabetic patients, is Data were collected using a self-

designed for the management and follow- administered questionnaire that assessed
up of diabetic patients, it is located in Port anxiety, nervousness, and social isolation.
Sudan, and consists of government Anxiety was assessed using General
primary care clinics. Adult patients aged ≥ Anxiety Disorder: GAD-7, a score of 0–4
18 years who were diagnosed with indicates minimal anxiety, 5–9 indicates
diabetes mellitus and follow-up at their mild anxiety, 10–14 indicates moderate

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Napata Scientific Journal Vol. 4 (1) PP 34-47

anxiety, and more than15—severe anxiety for additional analysis. Pearson chi-
20
. The maximum score is 21 points, with square test was used to measure the
a higher score indicating a higher association between the variables in the
symptom burden. A cutoff of more than10 study. Significant associations were
marks a probable diagnosis of anxiety. defined as those with a p-value <0.001.
Social isolation was assessed using the
Ethics approval and consent to
21
UCLA-3 item Loneliness Scale , and
participate
patients were screened for study eligibility
by trained clinic staff upon registration to The Declaration of Helsinki's criteria were

see the doctor. They were given a patient followed in the conduct of this study, and

information sheet that was made available Red Sea University- Research Center

in a simple language. All participants Ethics Committee authorized all

provided oral informed consent before procedures involving research study

included in the study. Patients who agreed participants. Oral informed consent, the

to participate in the study were given the voluntary nature of participation, and the

questionnaire to fill it while awaiting their confidentiality of replies were obtained

turn to be seen by the doctor; if the patient before recruiting any individuals.

illiterate the questionnaire filled out with Results

the help of data collectors they ask the
Sociodemographic characteristics of
patient questions and write his answer in
study participants
the questionnaire.
A total of 256 patients with diabetes
Data processing and analysis
participated in this study, with 142 males
After the data collection, we conducted a (55%) , aged 41-60 years (28%), and
comprehensive review to identify and married (41%) . Body Mass Index (BMI)
correct inconsistencies, errors, missing majority of Participants were overweight
values, and Participants that did not meet 87 (34%) , the BMI calculated and
the inclusion criteria. The data were coded categorized as follow: below 18.5
using numerical values (e.g., assigning 1 underweight, 18.5 to 24.9 healthy weight,
for males and 2 for females) and then 25 to 29.9 overweight and above 30
imported into SPSS software version 27 obese. and undergraduates ( 30%). About
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37
Psychological Disorders among diabetic patients Elalim Eltayeb et al

the third of participants are housewives 85 “Table 1”

(33.2%) then employees 58 (22.7%)

Table 1. Sociodemographic characteristics of study participants

Gender Male Female

142 (55%) 114 (45%)

Age 18-25 26-30 31 – 40 41 - 60 >60 years

41 (16%) 44 (17%) 66 (26%) 76 (28%) 29 (11%)

BMI Normal Thin Over weight Obese

38 (15%) 54 (21%) 87 (34%) 77 (30%)

Marital Married Single Divorced

status 105 (41%) 76 (30%) 75 (29%)

Educational Elementary Secondary Undergraduate Postgraduate Not

level educated
24 (9%) 55 (22%) 78 (30%) 55 (22%) 44 (17%)

Occupation Employee Student Free worker Housewife

58 (22.7%) 57 (22.3%) 56 (21.9%) 85 (33.2%)

Prevalence of anxiety, social isolation and nervousness

The overall median score on the anxiety subscale was 11. Based on the categorization of
participants using the GAD-7, the majority exhibited moderate anxiety (72.3%), and severe
anxiety (25.4 %). This indicates that a significant proportion of patients with diabetes
experience moderate-to-severe anxiety. The results showed that majority of the patients
(53.9%) reported sometimes experiencing nervousness. The analysis revealed that
147(57.4%) of the participants reported feeling socially isolated and 56 (21.9%) stated that
they sometimes felt isolated. “Table 2”

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Napata Scientific Journal Vol. 4 (1) PP 34-47

Table 2. Prevalence of anxiety, social isolation and nervousness among study

populations

Numbers Percentage (%)

Anxiety
Minimal anxiety 1 0.4
Mild anxiety 5 2.0
Moderate anxiety 185 72.3
Severe anxiety 65 25.4
Total 256 100.0
Social isolation (loneliness)
Always 147 57.4
Sometimes 56 21.9
Never 53 20.7
Total 256 100
Nervousness
Always 67 26.2
Sometimes 138 53.9
Never 51 19.9
Total 256 100

Factors affecting Psychological

Disorders

Gender: The Social Isolation correlation

age is associated with lower levels of
factor was 0.155 (p = 0.013), indicating a
social isolation. BMI: Nervousness was
positive correlation between being female
significantly negatively correlated
and experiencing social isolation. Age:
(correlation factor = -0.293, p < 0.001).
Social Isolation correlation factor of -
Anxiety Diagnosis there is significant
0.226 (p < 0.001), suggesting that older
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Psychological Disorders among diabetic patients Elalim Eltayeb et al

negative correlation (correlation factor = - significant negative correlation between

0.264, p < 0.001). Marital Status: Social nervousness and level of education
Isolation showed a significant negative (correlation factor = -0.465, p < 0.001).
correlation (correlation factor = -0.445, p Occupation: There was a significant
< 0.001), indicating that being married is negative correlation between occupation
associated with lower social isolation. and social isolation (correlation factor = -
Nervousness was positively correlated 0.513, p < 0.001). Social Isolation and
(correlation factor = 0.182; p = 0.004). Nervousness: There correlation factor of -
Educational Level: There significant 0.208 (p = 0.001), indicating that
positive correlation between social increased social isolation is associated
isolation and educational level (correlation with higher levels of nervousness. “Table
factor = 0.312, p < 0.001). There was a 3”

Table 3. Factors Influencing Psychological Disorders:

Social Nervousness Anxiety diagnosis

isolation(loneliness)
Gender
Correlation factor .155 0.013 0.083
Significance 0.013 0.835 0.184
Age
Correlation factor -.226 0.081 0.091
Significance <0.001 0.197 0.147
BMI
Correlation factor 0.012 -.293 -.264
Significance 0.849 <0.001 <0.001
marital status
Correlation factor -.445 .182 0.104
Significance <0.001 0.004 0.096
educational level
Correlation factor .312 -.465 -0.067

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Napata Scientific Journal Vol. 4 (1) PP 34-47

Significance <0.001 <0.001 0.289

Occupation
Correlation factor -.513 0.022 -0.076
Significance <0.001 0.721 0.223
Social isolation
(loneliness)
Correlation factor 1 -.208 0.033
Significance 0.001 0.601

Table. 4 Factors affecting anxiety prevalence among study participants

Anxiety

Variables Correlation factor P value

Gender 0.083 0.184

Age 0.091 0.147

BMI -0.264 <0.001

Marital status 0.104 0.096

Educational level -0.067 0.289

Occupation -0.076 0.223

Social isolation 0.033 0.601

Discussion

This study identifies the prevalence and nervousness, and social isolation—among
interrelationship of psychological diabetic patients in Port Sudan, revealing
disorders specifically anxiety,

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41
Psychological Disorders among diabetic patients Elalim Eltayeb et al

concerning trends that underscore the reinforces that this correlation is

need for targeted mental health statistically significant, highlighting the
interventions. According to the results of urgency of addressing social isolation in
the study we found that a high prevalence diabetic patients to prevent increased
of anxiety (72.3% moderate and 25.4% nervousness. This bidirectional
severe), alongside notable levels of relationship underscores the psychological
nervousness (26.2% always and 53.9% impact of loneliness, where the experience
sometimes) and social isolation (57.4% of being alone can lead to heightened
always and 21.9% sometimes). The anxiety states, creating a cycle that may
prevalence of anxiety among diabetic worsen both social isolation and
patients in this study is alarming, with nervousness. “Table 4”
97.7% experiencing at least mild anxiety.
The sociodemographic data highlights that
This finding aligns with previous research
a majority of the sample were males
indicating that chronic illnesses,
(55%), with a significant proportion
particularly diabetes, are associated with
(28%) aged between 41 to 60 years. This
22
elevated anxiety levels . Diabetes
demographic profile is crucial as it
management often requires constant
suggests a potential vulnerability within
caution, which can lead to increased
middle-aged males towards psychological
anxiety due to concerns about blood sugar
distress, which has been corroborated by
levels and potential complications. The
recent studies indicating that age and
finding of a correlation factor of -0.208
gender significantly influence mental
between social isolation and nervousness 23
health outcomes . Notably, the study
indicates a moderate inverse relationship.
found a positive correlation (0.155)
This means that as levels of social
between being female and experiencing
isolation increase, the levels of
social isolation, emphasizing the need for
nervousness tend to be higher, this
targeted interventions to support female
suggests that individuals who feel more
patients in coping with social isolation, a
socially isolated are more likely to
factor that can exacerbate anxiety
experience nervousness, potentially due to 24
.Interestingly, the analysis revealed that
a lack of social support and engagement.
older age was associated with lower levels
The significance of the p-value (0.001)
of social isolation (correlation factor -

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Napata Scientific Journal Vol. 4 (1) PP 34-47

0.226), suggesting that older individuals social engagement, which is essential for
may have more established social psychological well-being 28.
networks or coping mechanisms. This
This study identified a high prevalence of
contrasts with findings from other studies
psychological disorders among diabetic
which suggest that older adults often face
patients; there is a pressing need for
increased loneliness due to retirement and
integrated care approaches that address
25
loss of social roles .Moreover, the study
both physical and mental health in
identified that marital status significantly
diabetic patients. Healthcare providers
influenced social isolation, with married
should routinely screen for anxiety,
individuals exhibiting lower levels of
nervousness, and social isolation during
isolation (correlation factor -0.445). This
diabetes management visits.Implementing
underscores the protective effect of
psychological support services, such as
intimate relationships on mental health,
counseling or support groups, could
aligning with literature that advocates for
significantly improve the quality of life
social support as a buffer against anxiety
for these patients.
26
.Educational level also emerged as a
critical factor, with a significant positive This study significantly contributes to

correlation between higher educational understanding the psychological

attainment and social isolation (correlation challenges faced by diabetic patients in

factor 0.312), which may reflect the Port Sudan. This is the first study to assess

complexity of social interactions and the the psychological disorders, particularly

potential for higher educated individuals anxiety, social isolation, and nervousness,

to have different social expectations or among diabetic patients in Port Sudan. It

networks 27
.Lastly, the relationship is also one of the fewest studies to assess

between occupation and social isolation those disorders among targeted patients in

was notably strong (correlation factor - Africa and Sudan. This documentation

0.513), indicating that employment may may guide interventions and serve as a

serve as a crucial factor in maintaining reference for psychological challenges

social connections. This finding supports faced by diabetic patients.

the argument that employment not only

provides financial stability but also fosters
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Psychological Disorders among diabetic patients Elalim Eltayeb et al

The findings of this study, however, the risk of serious complications like
should be viewed in light of the diabetic ketoacidosis. Therefore,
convenience sampling limitation. The integrating psychological support into
cross-sectional nature of the study is the routine diabetes care is not only beneficial
important limitation. While it can identify but necessary to improve health outcomes
associations between psychological for these patients. Based on our findings,
disorders and diabetes management, it we recommend that healthcare systems
cannot determine whether mental health implement screening for psychological
issues lead to poor glycemic control or disorders as part of standard diabetes care.
vice versa. So adopting a longitudinal Additionally, providing access to mental
design would be more appropriate for health resources, including counseling and
establishing temporal or causal support groups, could significantly
relationships and including other enhance the quality of life for diabetic
psychological disorders could enhance the patients and improve their health
understanding and management of outcomes.
psychological disorders in diabetes care.
Acknowledgements
Conclusion and Recommendations
We are deeply grateful to all the
We found a significant prevalence of participants who took the time to be part
psychological disorders among diabetic of this study, especially Dr. Essam Aldin
patients in Port Sudan. This indicates that Ahmed, Director of Ahmed Hassan
a considerable portion of this population Center, and the other staff members at the
faces mental health challenges, which center. The study would not have been
likely complicate their diabetes possible without their invaluable
management. The correlation between participation.
psychological disorders and glycemic
control highlights the crucial role of Competing interests
mental health in managing chronic
The authors declare that there is no
conditions such as diabetes. As discussed,
conflict of interest regarding the
psychological issues can lead to poor
publication of this manuscript.
glycemic control, which, in turn, increases
Data availability

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Napata Scientific Journal Vol. 4 (1) PP 34-47

Availability of data and materials the in Hawassa Zuria Woreda, Sidama,

datasets used and/or analyzed during the Ethiopia. Diabetes Metab Syndr Obes.
current study are available from the 2020;13:4571-9. doi:
corresponding author on reasonable 10.2147/DMSO.S278531.
request.
5. American Diabetes Association.
Standards of medical care in diabetes—

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