In contemporary Ghana, several medical problems are being reported at the general hospitals and clinics for treatment. Most of these medical problems are accompanied by mental health problems. However, the mental health elements of the medical conditions are usually neglected though researches have demonstrated that the associated mental health problems can influence the prognosis and the course of such illnesses. This study sought to explore the relationships that exist between patients’ illness perception, religiosity and their mental health. The target population of the study was all diabetic patients attending a health facility numbering 250, seeking treatment for diabetes in the Cape Coast Metropolis in the Central Region of Ghana. A sample size of 103 diabetic patients from 250 patients was selected through the convenience sampling technique from the population. Descriptive survey design involving the quantitative approach was used in the study. Quantitative data were gathered through questionnaires and were analyzed using descriptive statistics (frequencies and percentages, means and standard deviation) and inferential statistics (Pearson correlation and independent sample t-test). The study revealed that, generally, diabetic patients’ in the metropolis have a high level of religiosity. Again, result indicated that there was a negative correlation between diabetic patients’ religiosity and their mental health (r = -.286**, n = 103, p < 0.05, p=0.003, 2-tailed). Results also indicated that there was a weak positive relationship between illness perception of diabetic patients and their mental health(r=.080, n=103, p < 0.05, p = 0.421, 2-tailed). Based on the findings, a holistic and comprehensive model of healthcare such as the Biopsychosocial model should be incorporated at the various health centres across the nation.

Background of Study
Diabetes can be defined as a situation where an individual’s body is incapable of producing the hormone insulin in levels required by the body cells to take up optimal glucose (Kumar & Clark, 2005). Also, Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.

Further, diabetes mellitus is characterized by gross loss of weight, frequent urination, excessive thirst and slow healing of wounds. Some other symptoms of diabetes include chronic fatigue and changes in vision. Therefore, if the diabetic condition is not well managed it can lead to complications such as loss of blood circulation to the heart and limbs (Darkwa, 2011). Failure of circulation of blood to the heart and limbs could pose serious threats to the lives of those suffering from the condition. These serious complications of diabetes are likely to predispose the diabetes patients to mental health problems that are commonly found among sufferers of chronic illnesses (Darkwa, 2011).

There are three broad categories of diabetes mellitus and these are the Type -1, Type-2 and Gestational diabetes. Type 1diabetes indicates the processes of beta–cell destruction that may ultimately lead to diabetes mellitus in which “insulin is required for survival” to prevent the development of ketoacidosis, coma and death (World Health Organization, 1999). Type II diabetes is the commonest form of diabetes and is characterized by disorders of insulin secretion and insulin resistance. Gestational Diabetes (GD) mellitus refers to the onset or initial recognition of glucose intolerance during pregnancy, usually in the second or third trimester (American Diabetes Association, 2001).

Diabetes is one notable long term illness that is strongly associated with mental health such as depression and anxiety. People living with diabetes are two to three times more likely to have depression than the general population (Fenton and Stover 2006; Simon, Shear, Thompson, Zalta, Perlman, Reynolds, Frank, Melhem, Silowash, 2007; Vamos, Mucsi, Keszei, Kopp, Novak, 2009). As observed for cardiovascular disease, prevalence estimates vary but the proportionate increase is consistent (Anderson et al 2001).

Analysis of more than 13,000 twins in Sweden found that mid- and late-life onset of diabetes was associated with a respective 176 per cent and 63 per cent increase in the risk of dementia (Xu et al 2009). Another study in Japan reported that over an 11-year period 27 per cent of a group of people over 60 with diabetes developed dementia compared with 21 per cent of a matched cohort without diabetes (Ohara, Doi, Ninomiya, Hirakawa, Hata, Iwaki, Kanba, Kiyohara 2011). The risk of developing dementia is even higher among people who have depression as well as diabetes (Katon, 2011).

In sub-Saharan Africa (SSA), chronic illnesses are on the increase, however, growth rates of diabetes mellitus (DM) and hypertension are among the highest chronic diseases worldwide (Danquah, Bedu-Addo, Terp, Micah,

Amoako, Awuku, Dietz, Giet, Spranger, Mockenhaupt, 2012). In Ghana, it is estimated that 4 million people are living with diabetes and this number is expected to rise in the near future (National Diabetes Association of Ghana, 2012). Thus, several people are living with diabetes and its attendance complications. It is therefore believed that by 2025, more than 75% of the world population with diabetes will reside in developing countries and the countries with the largest populations of adults with diabetes will include: India, China and the United States (King, Aubert, & Herman, 1998).

Living with any type of chronic disease, the person either has to make minor or major lifestyle adjustments. Diabetes, in particular, can eventually take its toll on the emotional, psychological, and physical wellbeing of any person. These adjustments can lead to either successful adherence to medical regimens and control of the disease, or among other things, ineffective or maladaptive coping (Duangdao & Roesch, 2008). How the individual adjusts to the diabetic condition depends on the resources available to the individual at personal, community and societal levels.

Several factors have been identified to have a significant influence on the mental health and illness outcome of diabetic patients. Some of these factors include illness perception, level of patients‟ religiosity as well as the patients‟ demographic characteristics. In the case of diabetic patients, Mosorovic, Brkic, Nuhbegovic and Pranjic (2012) asserted that diabetes mellitus is a disease that is no longer just an individual problem, but it is assuming psychological and socio-medical significance of mass disease. Thus, in trying to reduce the rate of complications associated with diabetes, both psychological as well as socio-medical factors should be taken into consideration.

Several factors have been found to influence the levels of mental health problems among diabetic patients. One of these variables is how the diabetic patients perceive their illness. Illness perception has been studied extensively in relation to several medical and psychological conditions. Perception is described as the process by which an individual interprets and organizes sensations and events to produce a meaningful experience of the world (Lindsay & Norman, 1977). These interpretations are guided by the specific knowledge, beliefs and expectations characterizing the individual (Alsén, 2009). Perception in terms of illness may be conceptualised as how people understand and make sense of their diseases and/or disabilities, e.g. illness perceptions. In this respect, illness perceptions to some extent correspond to the conceptualizations of illness in contrast to disease (Alsén, 2009).

There are several determinants of health outcomes among patients suffering from any form of illness and as such, outcomes of medical management in patients with chronic illness are determined not only by objective factors but also by behavioural and social factors (Leventhal, Weinman, Leventhal &Phillips, 2008). Some of these behavioural and social factors are related to how the patients appraise their illness on several dimensions. Some of these perceptual dimensions of the illness perception include the causal attribution, timeline, severity, consequences, understanding as well as the personal control of the individual over the condition. The extent of these perceptions to a large extent determines how the individual patients react to treatment as well as other management regiments.

Furthermore, research has shown that people vary in how they perceive their health status and that these perceptions often are independent of the actual physical conditions that are being suffered (Taylor, Kemeny, Reed, Bower & Gruenewald, 2000). For example, people vary in how they perceive their possibilities to influence or control their health (Wallston, 2004), whether their condition is acute or chronic (Lau & Hartman, 1983) or whether or not their specific situation is hopeful (Scheier & Carver, 1985). Such perceptions may in turn determine individuals‟ behaviour as well as their response to managing health threats related to a disease or a symptom (Alsén, 2009). Thus, the individual’s active role in terms of thought processes affect their health outcomes and therefore, Schrag, Jahanshashi and Quinn (2001) asserted that patients‟ perceptions of their condition are likely to play an important role in how they adjust to their illness.

Additionally, the individual’s level of religiosity has been shown to have significant influences on his/her psychological wellbeing. However, the study of religion in psychology has not been without disagreements as it is seen as not being scientific. In the past years there has been a change from negative attitudes in psychology, concerning religion, to the identification of more positive relations between religion and different aspects of mental health (Rusu &Turliuc, 2011). Religiosity is a multi-layered concept involving cognitive, emotional, motivational and behavioural aspects (Hackney & Sanders, 2003). Richards and Bergin (1997) see religion as a subset of the spiritual, considering that is possible for someone to be spiritual without being religious and to be religious without being spiritual. Being spiritual means having a transcendental relation with a superior being, whereas being religious means adopting a certain religious creed or church (Rusu &Turliuc, 2011). However, this separation of religiosity and spirituality is not the case in our context as spirituality and religiosity cannot be decoupled. Thus, a religious person in the Ghanaian setting is seen as spiritual and vice versa.

Furthermore, religion is seen to have important influence on the individual as well as the society at large. For instance, Frey and Stutzer (2002) asserted that religion raises happiness because church attendance is an important source of social support. Also, religion can instill life with meaning and purpose, and religious people are better at dealing with negative circumstances in life and church members live healthier lives and live longer which also contributes to happiness (Frey & Stutzer, 2002). As result of these influences of religion on the individual, Krause and Wulff (2005) noted that that church-based friendship may promote a sense of belonging and thus enhance physical and mental health.

More so, research evidence has pointed to the fact that some forms of religiosity are associated with specific health related issues. For example, religiosity has been associated with low levels of depression (McCullough & Larson, 1999), a personal well-being (Koenig, 2001), positive social attitudes (Baton et al., 1993), a low risk of divorce and an increase in the degree of marital functionality (Mahoney, Pargament, Tarakeshwar & Swank, 2001). Tsang and McCullough (2003) in their analysis of the relationship between religiosity and health related issues, it was shown that religiosity correlates significantly with physical and mental health, tolerance, pro-social behaviour and positive interpersonal relationships. These significant influences of religiosity on several aspects of individual’s life is worth exploring to ascertain the extent to which religiosity affects these aspect of existent.

More so, some demographic characteristics of the diabetic patients have been shown to predispose them to mental health problems. Some of these demographic characteristics of the diabetic patients include sex, age, marital status, duration of illness and type of diabetes among others. For instance, Jimenez-Garcıa et al., (2011), Guruprasad, Niranjanand and Ashwin (2012) and Hermanns et al., (2005) found among diabetic patients that the female sex is a risk factor for development of psychological distress. Other researchers have also found significant age differences in the development of mental health problems among diabetic patients (Paddison, 2010; Jimenez-Garcıa et al, 2011; Jadoon et al., 2012).

From the discussions of the variables above, it becomes necessary to investigate how these variables relate with one another. That is, an individual perception of the illness may result in dependence on his/her religious faith to adjust to the illness. Perceiving the illness as threatening is usually accompanied by psychological distress. However, these perceptions and reactions to the illness are usually influenced by individual characteristics. Therefore, the individual characteristics of the diabetic patients influence their mental health significantly.

Statement of the Problem
In contemporary Ghana, several medical problems are being reported at the general hospitals and clinics for treatment. Most of these medical problems are accompanied by mental health problems. However, the mental health elements of the medical conditions are usually neglected though researches have demonstrated that the associated mental health problems can influence the prognosis and the course of such illnesses (Lin et al., 2004). Even though there has been researches done, there has been a continuous neglect on the need to adopt holistic measures to health care provision, such as considering the patient’s religious and psychological needs. Many diabetes patients find it challenging to make the lifestyle changes necessary to stay healthy. Making healthy lifestyle choices is important for people with type 2 diabetes.

Additionally, with the high prevalence of diabetes mellitus predicted to be very high by 2030 (Shaw, Sicree & Zimmet, 2010) and affecting people mostly in developing countries, the psychological care and intervention that is required alongside other orthodox treatment of diseases. The individual patients may have their own ways of dealing with the mental health challenges that accompany their illness but the question is, which individual resources do they use, how do they use them and how these individual resources affect their general mental health. Therefore, there is the need to identify the factors that are likely to have significant influence on mental health of diabetic patients to inform therapy.

In the management of these physical conditions, one would think that all health-related professionals would be brought on board but the opposite is what we are facing in Ghana. Thus, psychological care is very critical in the management of diabetic patients.

Furthermore, one crucial aspect of health that seems to be ignored in healthcare delivery in the country is the interpretations and beliefs held by the patients about their illness (diabetes). This is because the beliefs and perceptions held by an individual about their health conditions to a large extent influence their health outcomes and treatment regimen. That is, if the individual perceives his/her illness to be more or less threatening, how does this affect his/her wellbeing? Therefore, when these beliefs and perceptions about the illness (diabetes) are not understood and incorporated into the care of diabetic patients, a lot of problems are neglected as several researchers have demonstrated a significant association between illness perception and mental and physical health outcomes (e. g. Broadbent, Donkin & Stroh, 2011; Petricek, Vrcić-Keglević, Vuletic 2009; Leventhal, Leventhal, & Cameron, 2001).

More so, a central part of the Ghanaian which is religion (Gyekye, 1996) seems to be neglected in the provision of healthcare especially in the physical illnesses. However, as the complications of diabetes are not limited to only the medical ones, most people rely on their individual resources such as religion to cope with the illness. The question that arises is whether the diabetic patients‟ religious resources are utilized in providing healthcare services as it is well known that prayer camps and healing centers continue to serve as refuge for patients. To address this shortfall however, research is needed to examine whether indeed the individual’s level of religiosity protects him/her against unfavorable consequences of diabetes.

In a nutshell, it is very important to consider factors such as patients’ perception of an illness and their level of religiosity in relation to their mental wellbeing in order to streamline an effective treatment regimen that would ensure both psychological and medical wellbeing. For this to be realized there is an urgent need to clearly spell out the roles or functions of illness perception and levels of religiosity and its influence on the mental wellbeing among patients. To rule out or discredit the relevance of these two actors will be a grave error and miscalculation on the part of health care providers and can lead to more serious complications. So far, very limited studies have been conducted on the perception and religiosity on the mental health patients’ mental health. This study however, extends the scope to include mental health.

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