Prevalence, Severity, and Predictors of Depression and Anxiety in Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study at a Tertiary Endocrinology Clinic
DOI:
https://doi.org/10.48047/s7d31727Keywords:
Type 2 diabetes, Depression, Anxiety, Glycaemic controlAbstract
Background: Depression and anxiety are highly prevalent and underrecognised in adults with type 2 diabetes mellitus (T2DM), exacerbating glycaemic control, medication non-adherence, quality of life, and cardiovascular risk. Prevalence data from Indian tertiary care endocrinology settings are limited, and the bidirectional nature of the diabetes-mental health relationship is incompletely documented in this population. This study quantified the prevalence, severity, and predictors of depression and anxiety in T2DM adults at a tertiary care hospital. Methods: A cross-sectional study of 300 adults with T2DM attending an endocrinology outpatient clinic. Depression was screened with PHQ-9 (≥10 = depression; ≥15 = moderate-severe), anxiety with GAD-7 (≥10 = clinically significant). Sociodemographic, glycaemic, complication, adherence, and social support variables were collected. Multivariable logistic regression identified independent predictors of depression (PHQ-9 ≥10). Results: Depression prevalence was 31.0% (n=93); anxiety 26.0% (n=78); comorbid depression+anxiety 19.3%. PHQ-9 severity: 69.0% no depression, 19.0% mild-moderate, 7.0% severe. Independent predictors of depression: ≥2 diabetic complications (aOR 2.8), low social support (aOR 2.4), poor medication adherence (aOR 2.2), HbA1c ≥9% (aOR 2.0), and female sex (aOR 1.9). EQ-5D-3L utility was significantly lower in depressed patients (0.58 vs 0.76; p<0.001). Conclusion: Psychological comorbidity is prevalent in Indian T2DM patients, with over 30% meeting criteria for depression. Diabetic complications, social isolation, poor glycaemic control, and medication non-adherence are key risk factors, suggesting that integrated diabetes and mental health care is essential for optimising clinical outcomes. Routine PHQ-9 and GAD-7 screening should be incorporated into all diabetes clinic assessments.
Downloads
References
Murray CJ, Barber RM, Foreman KJ, Ozgoren AA, Abd-Allah F, Abera SF, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013. Lancet. 2015;386(10010):2145–91.
Scott KM, Lim C, Al-Hamzawi A, Alonso J, Bruffaerts R, Caldas-de-Almeida JM, et al. Association of mental disorders with subsequent chronic physical conditions: World mental health surveys from 17 countries. JAMA Psychiatry. 2016;73(2):150–8.
International Diabetes Federation. IDF Diabetes Atlas, 10th ed. Brussels: IDF; 2021.
World Health Organization. Depression: Key facts. Geneva: WHO; 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/depression
Lustman PJ, Clouse RE. Depression in diabetic patients: The relationship between mood and glycemic control. J Diabetes Complications. 2005;19(2):113–22.
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care. 2001;24(6):1069–78.
Barnard K, Skinner T, Peveler R. The prevalence of co-morbid depression in adults with Type 1 diabetes: Systematic literature review. Diabet Med. 2006;23(4):445–8.
Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: A systematic review. J Psychosom Res. 2002;53(6):1053–60.
Hermanns N, Kulzer B, Krichbaum M, Kubiak T, Haak T. Affective and anxiety disorders in a German sample of diabetic patients: Prevalence, comorbidities and risk factors. Diabet Med. 2005;22(3):293–300.
Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154–60.
Ismail K, Winkley K, Rabe-Hesketh S. Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet. 2004;363(9421):1589–97.
Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: The search for shared mechanisms. Lancet Diabetes Endocrinol. 2015;3(6):461–71.
Knol MJ, Twisk JW, Beekman AT, Heine RJ, Snoek FJ, Pouwer F. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia. 2006;49(5):837–45.
Singh H, Verma S, Dubey S. Mental health integration in Indian diabetes care: A nationwide survey. Diabetes Ther. 2022;13(8):1521–30.
Löwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses. J Affect Disord. 2004;78(2):131–40.
Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med. 2006;166(10):1092–7.
Poongothai S, Anjana RM, Pradeepa R, Ganesan A, Unnikrishnan R, Rema M, et al. Prevalence of depression in relation to glucose intolerance: The Chennai Urban Rural Epidemiology Study (CURES-76). Diabetes Technol Ther. 2010;12(12):989–94.
Rajput R, Gehlawat P, Gehlan D, Gupta R, Rajput M. Prevalence and predictors of depression and anxiety in patients of diabetes mellitus in a tertiary care center. Indian J Endocrinol Metab. 2016;20(6):746–51.
Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61.
DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101–7.
Safren SA, Gonzalez JS, Wexler DJ, Psaros C, Delahanty LM, Blashill AJ, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care. 2014;37(3):625–33.
Katon WJ, Von Korff M, Lin EH, Simon G, Ludman E, Russo J, et al. The Pathways Study: A randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61(10):1042–9.
Lustman PJ, Freedland KE, Griffith LS, Clouse RE. Fluoxetine for depression in diabetes: A randomized double-blind placebo-controlled trial. Diabetes Care. 2000;23(5):618–23.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Dr. Sandeep Perli (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
