A prospective study of the effect of fasting during the month of Ramadan on depression and diabetes distress in people with type 2 diabetes

  • Ebaa Al-Ozairi
    Correspondence
    Corresponding author at: Chief Medical Officer, Dasman Diabetes Institute, Faculty of Medicine, Kuwait University, P.O. Box: 24923, 13110, Kuwait.
    Affiliations
    Dasman Diabetes Institute, PO Box 1180, Dasman, Kuwait

    Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait University, Faculty of Medicine, Department of Medicine, PO Box 24923, Safat 13110, Kuwait
    Search for articles by this author
  • Manar M. AlAwadhi
    Affiliations
    Dasman Diabetes Institute, PO Box 1180, Dasman, Kuwait

    Department of Public Health Practice, Faculty of Public Health, Kuwait University, Kuwait University, Faculty of Public Health, Department of Public Health Practice, PO Box 24923, Safat 13110, Kuwait
    Search for articles by this author
  • Abdulla Al-Ozairi
    Affiliations
    Department of Psychiatry, Faculty of Medicine, Kuwait University, Kuwait University, Faculty of Medicine, Department of Medicine, PO Box 24923, Safat 13110, Kuwait
    Search for articles by this author
  • Etab Taghadom
    Affiliations
    Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait University, Faculty of Medicine, Department of Medicine, PO Box 24923, Safat 13110, Kuwait
    Search for articles by this author
  • Khalida Ismail
    Affiliations
    Institute of Psychiatry, Psychology and Neurosciences, King’s College London Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, United Kingdom
    Search for articles by this author

      Abstract

      Aims

      Depression in diabetes has been associated with hyperglycemia and an increase risk for metabolic disorder complications. Ramadan is a period of self-discipline, self control, and spirituality, which has shown benefits in physical, mental, and social well being. The aim of this study is to examine the association between fasting during the month of Ramadan and depression.

      Methods

      Data from 463 participants were collected at three time points. A paired t-test was used to examine the difference between PHQ-9 score and difference of PAID score before and after Ramadan to measure depression. A multivariable regression with adjusting for potential confounders was used to study the association between fasting and depression.

      Results

      The difference in PHQ-9 score before and after Ramadan was −3.5 points (95% Confidence Interval (CI) −4.05 to −2.95). The difference in PAID score before and after the Ramadan was −5.02 points (95% CI −6.38 to −3.69). For every one year increase in diabetes diagnosis PHQ-9 score decreased by 0.09 (95% CI −0.17 to 0.003) after Ramadan. Female participants had 1.17 more points (95% CI −0.23 to 0.02) decrease in PHQ-9 score compared to male participants.

      Conclusion

      Improving depression in people with diabetes is crucial in controlling blood glucose and metabolic disorder complications in people with diabetes. People with diabetes who experience depression may improve their depression by increasing self discipline, self control, and manage disease.

      Keywords

      To read this article in full you will need to make a payment

      References

      1. World Health Organization. Depression; 2018 [cited 2019 Feb 10]; Available from: <https://www.who.int/news-room/fact-sheets/detail/depression>.

        • Association A.P.
        Diagnostic and statistical manual of mental disorders.
        5th ed. American Psychiatric Publishing, Arlington, VA2013
        • Anderson R.J.
        • et al.
        The prevalence of comorbid depression in adults with diabetes.
        A meta-analysis. 2001; 24: 1069-1078
        • Lustman P.J.
        • et al.
        Depression and poor glycemic control: a meta-analytic review of the literature.
        Diab Care. 2000; 23: 934-942
        • Katon W.J.
        • et al.
        The association of comorbid depression with mortality in patients with type 2 diabetes.
        Diab Care. 2005; 28: 2668-2672
        • Egede L.E.
        • Nietert P.J.
        • Zheng D.
        Depression and all-cause and coronary heart disease mortality among adults with and without diabetes.
        Diab Care. 2005; 28: 1339-1345
        • Lustman P.J.P.G.
        • Linda S.
        • Clouse
        • Ray E.
        • Freedland
        • Kenneth E.
        • Eisen Seth A.
        • Rubin Eugene H.
        • Carney Robert M.
        • Janet B.
        Effects of nortriptyline on depression and glycemic control in diabetes: results of a double-blind, placebo-controlled trial.
        Psychosom Med. 1997; 59: 241-250
        • Jaimie C.
        • Hunter B.M.D.
        • Jordan Joanne M.
        • Sue Kirkman M.
        • Linnan Laura A.
        • Rini Christine
        • Fisher Edwin B.
        The association of depression and diabetes across methods, measures, and study contexts.
        Clin Diab Endocrinol. 2018; 4
      2. El-Menouar Y. The five dimensions of muslim religiosity. Results of an empirical study 2014;8(1).

        • Huber S.
        • Huber O.W.
        The centrality of religiosity scale (CRS).
        Religions. 2012; 3: 710
        • Jawad F.
        • Kalra S.
        Diabetes care in Ramadan: an exemplar of person centered care.
        J Pak Med Assoc. 2015; 65
        • Schielke S.
        Being good in Ramadan: ambivalence, fragmentation, and the moral self in the lives of young Egyptians.
        J Roy Anthropol Inst. 2009; 15: S24-S40
        • Mohammed Abdul Jaleel S.A.R.
        • Fathima Farah Naaz
        • Jaleel Bushra Naaz Fathima
        Ramadan and diabetes: As-Saum (the fasting).
        Ind J Endocrinol Metab. 2011; 15: 268-273
      3. IDF, IDF Atlas, IDF, Editor, IDF; 2017. p. 11, 32.

        • Consultation W.
        Definition diagnosis and classification of diabetes mellitus and its complications.
        World Health Organization, Geneva (Switzerland)1999: 31-33
        • Spitzer R.
        • Kroenke K.
        • Williams J.
        Validation and utility of a self-report version of PRIME-MD. The PHQ primary care study: primary care evaluation of mental disorders. Patient Health Questionnaire.
        JAMA. 1999; 282: 1737-1744
        • Becker S.A.Z.K.
        • Al Faris E.
        Screening for somatization and depression in Saudi Arabia: a validation study of the PHQ in primary care.
        Int J Psych Med. 2002; 32: 271-283
        • Welch G.W.
        • Jacobson A.M.
        • Polonsky W.H.
        The Problem Areas in Diabetes Scale. An evaluation of its clinical utility.
        Diab Care. 1997; 20: 760-766
        • Miller S.T.
        • Elasy T.A.
        Psychometric evaluation of the Problem Areas in Diabetes (PAID) survey in Southern, rural African American women with Type 2 diabetes.
        BMC Public Health. 2008; 8: 1471-2458
        • Hermanns N.
        • et al.
        How to screen for depression and emotional problems in patients with diabetes: comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment.
        Diabetologia. 2006; 49: 469-477
        • Kinser P.A.
        • et al.
        “A feeling of connectedness”: perspectives on a gentle yoga intervention for women with major depression.
        Iss Ment Health Nurs. 2013; 34: 402-411
        • Kinser P.A.
        • et al.
        Feasibility, acceptability, and effects of gentle Hatha yoga for women with major depression: findings from a randomized controlled mixed-methods study.
        Arch Psych Nurs. 2013; 27: 137-147
        • Prathikanti S.
        • et al.
        Treating major depression with yoga: a prospective, randomized, controlled pilot trial.
        PLoS ONE. 2017; 12 (e0173869–e173869)
        • Arnason T.G.
        • Bowen M.W.
        • Mansell K.D.
        Effects of intermittent fasting on health markers in those with type 2 diabetes: a pilot study.
        World J Diab. 2017; 8: 154-164
        • Argyle B.-H.B.a.M.
        The psychology of religious behaviour, belief and experience.
        Routledge, London1997
        • Kawachi I.B.
        • Berkman L.F.
        J Urban Health. 2001; 78 (Social ties and mental health. Journal of Urban Health, 2001. 7): 458https://doi.org/10.1093/jurban/78.3.458
        • Lumpkins C.Y.
        • et al.
        Promoting healthy behavior from the pulpit: clergy share their perspectives on effective health communication in the African American Church.
        J Relig Health. 2013; 52: 1093-1107
        • Whisenant D.
        • Cortes Cyndi
        • Hill John
        Is faith-based health promotion effective? Results from two programs.
        J Christ Nurs. 2014; 31: 188
        • Braam A.W.
        • Hein E.
        • Deeg D.J.
        • Twisk J.W.
        • Beekman V.T.A.T.W.
        Religious involvement and 6-year course of depressive symptoms in older Dutch citizens.
        J Aging Health. 2004; 16: 467-489
        • Idler E.L.
        • Kasl S.V.
        Religion among disabled and nondisabled persons I: cross-sectional patterns in health practices, social activities, and well-being.
        J Gerontol Ser B Psychol Sci Soc Sci. 1997; 52: S294-S305
        • Idler E.L.
        • McLaughlin J.
        • Kasl S.
        Religion and the quality of life in the last year of life.
        J Gerontol Ser B Psychol Sci Soc Sci. 2009; 64: 528-537
        • Norton M.C.
        • Singh A.
        • Skoog I.
        • Corcoran C.
        • Tschanz J.T.
        • Zandi P.P.
        • et al.
        attendance and new episodes of major depression in a community study of older adults: the Cache County Study.
        J Gerontol Ser B Psychol Sci Soc Sci. 2008; 63: P129-P137
        • Strawbridge W.J.
        • Shema S.J.
        • Cohen R.D.
        • Roberts R.E.
        • Kaplan G.A.
        Religiosity buffers effects of some stressors on depression but exacerbates others.
        J Gerontol Ser B Psychol Sci Soc Sci. 1998; 53: S118-S126