Living with Type II Diabetes and Mental Health in Pakistan: An Interpretative Phenomenological Analysis

Authors

  • Sohail Aslam Postgraduate Resident in Endocrinology, Services Hospital, Lahore, Pakistan.
  • Amna Rizvi Associate Professor, Endocrinology Unit, Services Hospital, Lahore, Pakistan.
  • Sadaf Rehman Senior Lecturer, Riphah Institute of Clinical and Professional Psychology, Riphah International University, Lahore, Pakistan. https://orcid.org/0000-0002-3875-097X

DOI:

https://doi.org/10.52053/jpap.v6i3.380

Keywords:

Interpretative Phenomenological Analysis, Mental Health, Pakistani Culture, Type II Diabetes

Abstract

In the Pakistani cultural context, Type II Diabetes is an increasing issue that poses a significant risk to mental health. This qualitative study aimed to explore the experiences and expressions of individuals recently diagnosed (6 months to 2 years) with Type II diabetes and their mental health issues, with a focus on providing counseling and early intervention. A non-probability, purposive sampling strategy was used to select the sample. Interpretative phenomenological analysis of semi-structured interviews with 15 individuals (eight men and seven women), recently diagnosed (6 months to 2 years) with Type II diabetes, aged 35-65 years, from diverse socioeconomic backgrounds was done. The superordinate themes of the emotional burden of diabetes, cultural influences on the diabetes experience, impact on mental health and well-being, coping mechanisms, and resilience were identified. The subordinate themes consisted of shame and guilt, stigma and social isolation, anxiety and fear, cultural beliefs and values, family and social support, healthcare system and provider interactions, depression and low mood, anxiety, stress and resilience, positive coping strategies, maladaptive coping strategies, and resilience. This study highlights the need for culturally sensitive diabetes care and awareness programs that address the unique emotional, social, and cultural needs of individuals with Type II diabetes in Pakistan. Healthcare providers should be aware of the cultural influences and emotional burden associated with diabetes, and provide supportive and non-judgmental care to their patients.

References

Ahad, A. A., Sanchez-Gonzalez, M., & Junquera, P. (2023). Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review. Cureus, 15(5). https://doi.org/10.7759/cureus.39549

Akhaury. K., & Chaware, S. (2022). Relation between Diabetes and Psychiatric Disorders. Cureus, 14(10). https://doi.org/10.7759/cureus.30733

Akhtar, S., Nasir, J. A., Abbas, T., & Sarwar, A. (2019). Diabetes in Pakistan: A systematic review and meta-analysis. Pakistan Journal of Medical Sciences,35(4), 1173-1178. https://doi.org/10.12669/pjms.35.4.194

Akif, A., Qusar, M. M. A. S., & Islam, R. (2024). The impact of chronic diseases on mental health: An overview and recommendations for care programs. Current Psychiatry Reports, 26(7). https://doi.org/10.1007/s11920-024-01510-7

Akshatha, S., & Nayak, U. B. (2024). The psychological distress associated with type 2 diabetes mellitus represents an unmet need for drug discovery. Medicine in Drug Discovery, 23. https://doi.org/10.1016/j.medidd.2024.100196

Ali, T. S., Ali, S. S., Nadeem, S., Memon, Z., Soofi, S., Madhani, F., Karim, Y., Mohammad, S., & Bhutta, Z. A. (2022). Perpetuation of gender discrimination in Pakistani society: results from a scoping review and qualitative study conducted in three provinces of Pakistan. BMC Women’s Health, 22(540). https://doi.org/10.org/10.1186/s12905-022-02011-6

Al-Mamun, F., Hasan, M., Quadros, S., Kaggwa, M. M., & Mubarak, M., Sikder, M. T., Hossain, M. S., Muhit, M., Moonajilin, M. S., Gozal, D., & Mamun, M. A. (2023). Depression among Bangladeshi diabetic patients: a cross-sectional, systematic review, and meta-analysis study. BMC Psychiatry, 23(369). https://doi.org/10.1186/s12888-023-04845-2

Almubaid, Z., Alhaj, Z., Almosa, O., Marikh, M., & Khan, W. (2024). The impact of social support on health outcomes of diabetic patients: A systematic review. Cureus, 16(8). https://doi.org/10.7759/cureus.67842

Alramadhan, F., Herrinh, R. P., Beeson, W. L/. Nelson, A., & Shah. H. (2023). Religiosity and type 2 diabetes self-management among Muslims residing in California. Heliyon, 9(9). https://doi.org/.10.1016/j.heliyon.2023.e19725

Alwani, A. A., Kaur, R., Bairwa, M., Misra, P., & Nongkynrih, B. (2024). Diabetes distress and associated factors among adults with diabetes mellitus residing in a metropolitan city of India: A community-based study. Clinical Diabetes and Endocrinology, 10(40). https://doi.org/10.1186/s40842-024-00203-7

Antar, S. A., Ashour, N. A., Sharaky, M., Khattab, M., Ashour, N. A., Zaid, R. T., Roh, E. J., Elkamhawy, A., & Karamalawy, A. A., (2023). Diabetes mellitus: Classification, mediators, and complications; A gate to identify potential targets for the development of new effective treatments. Biomedicine & Pharmacotherapy, 168. https://doi.org/10.1016/j.bipha.2023.115734

Ashraf, M. N., & Cheng, A. Y. Y. (2024). Impact of living with stigma in people with Type 1 Diabetes: A Patient-Physician Perspective. Diabetes Therapy, 15(311- 316). https://doi.org/10.1007/s13300-023-01528-9

Azeem, S., Khan, U., & Liaquat, A. (2022). The increasing rate of diabetes in Pakistan: A silent killer. Annals of Medicine & Surgery, 79(7). https://doi.org/10.1016/j.amsu.2022.103901

Basit, A., Fawwad, A., Qureshi, H., & Shera, A. S. (2018). Prevalence of diabetes, pre diabetes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016-2017. BMJ Open, 8(8). https://doi.org/10.1186/s12902-023-01421-3

Busebaia, T. J. A., Thompson, J., Fairbrother, H., & Ali, P. (2023). The role of family in supporting adherence to diabetes self-care management practices: An umbrella review. Journal of Advanced Nursing, 79(10), 2652-3677. https://doi.org/10.111/jan.15689

Busily, A., Kumar, K., Kudrna, L., & Busaily, I. (2024). The risk factors for mental health disorders in patients with type 2 diabetes: An umbrella review of systematic reviews with and without meta-analysis. Heliyon, 10(7).https://doi.org/10.1016/j.heliyon.2024.e28782

Chandrasekaran, P., & Weiskirchen, R. (2024). The Role of Obesity in Type 2 Diabetes Mellitus—An Overview. International Journal of Molecular Science, 25(3), 1882. https://doi.org/10.3390/ijms25031882

Das, U., & Kar, N. (2023). Prevalence and risk factor of diabetes among the elderly people in West Bengal: evidence-based LASI 1st wave. BMC Endocrine Disorders, 23(170). https://doi.org/10.1186/s12902-023-01421-3

Denton, J. J., & Fernandez, J. R. (2021). The role of family history of diabetes as a predictor of insulin activity in a sample of diverse, normal weight children. Endocrine and Metabolic Science, 3. https://doi.org/10.1016/j.endmts.2021.100090

Dolezal, L. (2022). Shame anxiety, stigma and clinical encounters. Journal of Evaluation and Clinical Practices, 28(5), 854-860. https://doi.org/10.1111/jep.13744

Du, S., Sullivan, V. K., Fang, M., Appel, L. J., Selvin, E., & Rebholz, C. M. (2024). Ultra-processed food consumption and risk of diabetes results from a population based prospective cohort. Diabetologia, 67(10), 2225-2235. https://doi.org/10.1007/s00125-024-06221-5

Engel, G. L. (1977). The Need for a New Medical Model: A Challenge for Biomedicine. Science, 196, 129-136. https://dx.doi.org/10.1126/science.847460.

Eysenck, M. W., & Fajkowska, M. (2018). Anxiety and depression: toward overlapping and distinctive features. Cognitive and Emotion, 32(7), 1391-1400. https://doi.org/10.1080/02699931.2017.1330255

Farooqi, A., Gillies, C., Sathanapally, H., Abner, S., Seidu, S., Davies, M. J., Polonsky, W. H., & Khunti, K. (2022). A systematic review and meta-analysis to compare the prevalence of depression between people with and without Type 1 and Type 2 diabetes. Primary Care of Diabetes, 16(1), 1-10. https://doi.org/10.1016/j.pcd.2021.11.001

Galindo, R. J., Trujillo, J. M., Wang, C. C. L., & McCoy, R. G. (2023). Advance in the management of type 2 diabetes in adults. Bmjmedicine, 2(1).

https://doi.org/10.1186/s12888-023-04991-7

Garg, P., & Duggal, N. (2022). Type 2 diabetes mellitus, its impact on quality of life and how the disease can be managed -a review. Obesity Medicine, 35. https://doi.org/10.1016/j.obmed.2022.100459

Goyal, R., Singhal, M., & Jialal, I. (2023). Type 2 Diabetes. StatPearls. https://doi.org/10.1136/bmjopen-2017-020961

Hasan, A. A., Ismail, A., & Noor, H. (2024). The influence of Social Support on Self Care Behavior among T2DM Patients. SAGE Open Nursing, 10. https://doi.org/10.1177/23779608231219137

International Diabetes Federation (2019). IDF Diabetes Atlas (9th ed.). https://www.diabetesatlas.org/en/

Latif, A. S. (2020). The importance of understanding social and cultural norms in delivering quality health care—A personal Experience Commentary. Tropical Medicine Infectious Disease, 5(1), 22. https://doi.org/10.3390/tropicalmed5010022

Liu, Y., Huang, S. Y., Liu, D. L., Zeng, X. X., Pan, X. R., & Peng, J. (2024). Bidirectional relationship between diabetes mellitus and depression: Mechanisms and epidemiology. World Journal of Psychiatry, 14(10), 1429-1436. https://doi.org/10.5498/wjp.v14.i10.1429

Lu, X., Xie, Q., Pan, X., Zhang, R., Zhang, X., Peng, G., Zhang, Y., Shen, S., & Tong, N. (2024). Type 2 diabetes mellitus in adults: pathogenesis prevention and therapy. Signal Transduction and Targeted Therapy, 9(262). https://doi.org/10.1038/s41392-024-01951-9

Luga, L. C., Nerisanu, R. A., & Luga, H. (2024). The impact of healthcare system quality and economic factors on the older adult population: a health economics perspective. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1454699

Maina, P. M., Pienaar, M., & Reid, M. (2023). Self-management practices for preventing complications of type II diabetes mellitus in low and middle income countries: A scoping review. International Journal of Nursing Studies Advances, 5. https://doi.org/10.1016/j.ijnsa.2023.100136

Mansoor, N., & Warsi, A. (2023). Battling the social stigma of mental illnesses in Pakistan; what needs to be done? Journal of the Pakistani Medical Association, 73(9). https://doi.org/10.47391/JPMA.9095

Matin, B. K., Williamson, H. J., Karyani, A. K.,Rezaei, S., Soofi, M., & Soltani, S. (2021). Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies. BMC Women Health, 21, 44. https://doi.org/10.1186/s12905-021-01189-5

Morales-Brown, L. A., Algorta, G. P., & Salifu, Y. (2024). Understanding Experiences of Diabetes Distress: A Systematic Review and Thematic Synthesis. Journal of Diabetes and Research, 14. https://doi.org/10.1155/2024/3946553

Naz, N., Gulab, F., & Aslam, M. (2022). Development of Qualitative Semi-Structured Interview Guide for Case Study Research. Competitive Social Science Research Journal, 3(2), 42-52. https://sccrjournal.com/index.php/cssrjournal/article/view/170

Ortiz-Martínez, M., González-González, M., Martagón, A. J., Hlavinka, V., Willson, R. C., & Rito-Palomares, M. (2022). Recent Developments in Biomarkers for Diagnosis and Screening of Type 2 Diabetes Mellitus. Current Diabetes Reports, 22(3), 95–115. https://doi.org/10.1007/s11892-022-01453-4

Owen-Gary, M., Zhang, X., Jawanda, S., Bullard, K. M., Allweiss, P., & Smith, B. D. (2018). The importance of addressing depression and diabetes distress in adults with type 2 Diabetes. Journal of General Internal Medicine, 34(2), 320-324. https://doi.org/10.1007/s11606-018-4705-2

Padhi, S., Nayak., A. K., & Behera, A. (2020). Type II diabetes mellitus: a review on recent drug-based therapeutics. Biomedicine & Pharmacotherapy, 131. https://doi.org/10.1016/j.biopha.2020.110708

Paudel S., Khanal P. S., Gautam, S., Chalise, A., Kirala, T. N., & Marahtta, S. B. (2023). Anxiety and depression among people with type 2 diabetes visiting diabetes clinics of Pokhara Metropolitan, Nepal: a cross-sectional study. BMJ Open, 13(1). https://doi.org/10.1136/bmjopen-2022-064490

Prizeman, K., Weinstein, N., & McCabe, C. (2023). Effects of mental health stigma on loneliness, social isolation, and relationships in young people with depression symptoms. BMC Psychiatry, 23, 527. https://doi.org/10.1186/s12902-023-01421-3

Sander, J., Moessner, M., & Bauer, S. (2021). Depression, Anxiety and eating Disorder Related Impairment: Moderators in Female Adolescents and Young Adults. International Journal of Environmental Research and Public Health, 18(5), 2779. https://doi.org/10.3390/ijerph18052779

Sharif, H., Jan, S. S., Sheikh, S. S., Seemi, T., Naeem, H., & Jawed, Z. (2023). Depression and suicidal ideation among individuals with type-2 diabetes mellitus, a cross-sectional study from an urban slum area of Karachi, Pakistan. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1135964

Shiyanbola, O. O., Ward, E., & Brown, C. (2018). Sociocultural Influence on African Americans’ Representations of Type @ Diabetes: A Qualitative Study. Ethnicity & Disease, 28(1), 25-32. https://doi.org/10.18865/ed.28.1.25

Smith, J. A., & Osborn, M. (2015). Interpretive Phenomenological Analysis as a Useful Methodology for Research on Lived Experiences of Pain. British Journal of Pain, 9, 41-42. https://doi.org/10.1177/2049463714541642

Tariq, O., Rosten, C., & Huber, J. (2022). Experiences of living with type 2 diabetes in Pakistan: the role of culture and family in physical activity. International Journal for Equity in Health, 21(1), 103. https://doi.org/10.1186/s12939-022-01706-4

Ulambayar, B., Ghanem, A. S., Toth, A., & Nagy, A. C. (2025). Impact of Physical Activity and Dietary Habits on Mental Well-being in patients with Diabetes Mellitus. Nutrients, 17(6), 1042. https://doi.org/10.3390/nu17061042

Waumans, R. C., Muntingh, A. D. T., Draisma, S., Huijbregts, K. M., Balkom, A. J. L. M., & Batelaan, N. M. (2022). Barriers and facilitators for treatment-seeking in adults with depressive or anxiety disorder in a Western-European health care setting: a qualitative study. BMC Psychiatry, 22, 165. https://doi.org/10.1186/s12888-022-03806-5

Xu, T., Zuo, F., & Zheng, K. (2024). Parental educational expectations, academic pressure, and adolescent mental health: An empirical study based on CEPS Data. International Journal of Mental Health Promotions, 26(2), 93-103. https://doi.org/10.32604/ijmhp.2023.043226

Zhang, J., Zhang, Z., Zhang, K., Ge, X., Sun, R., & Zhau, X. (2023). Early detection of type 2 diabetes risk: limitations of current diagnostic criteria. Frontiers in Endocrinology, 14. https://doi.org/10.3389/fendo.2023.1260623

Downloads

Published

2025-09-30

How to Cite

Aslam, S., Rizvi, A., & Rehman, S. (2025). Living with Type II Diabetes and Mental Health in Pakistan: An Interpretative Phenomenological Analysis. Journal of Professional & Applied Psychology, 6(3), 375–391. https://doi.org/10.52053/jpap.v6i3.380