Published: 2017-01-03

A cross sectional study on prevalence and factors influencing anxiety and depression among patients with type II diabetes mellitus

Krishna Kodakandla, Gopinath Maddela, Mohammed Shahid Pasha, Ramakrishna Vallepalli


Background: Numerous study findings documented higher risk of depression and anxiety that diabetic population. Anxiety and depression in turn are proven to have strong negative influence on glycemic control, complications and quality of life in diabetic patients. Major portion of evidence linking DM, depression and anxiety comes from developed countries, and there is scarcity of research in this regard in developing and low-income countries. Aim of the study was to assess the prevalence of depression and anxiety and factors associated with them in type II diabetes mellitus patients.

Methods: The study was a descriptive cross sectional study, conducted in a tertiary care teaching hospital. The study included 135 sequentially recruited type II diabetic patients. Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were used to assess the severity of depression/anxiety.

Results: A total of 135 participants were included in the study. More than half (59.3%) of the study subjects have reported history of perceived stress. The proportions of subjects, reporting either anxiety or depression were 64.4%. Depression alone was present in 60.7% of the subjects and anxiety alone was present in 44.4% of the subjects. New onset of diabetes mellitus (Odds ratio 3.51, 95% CI 1.3 to 5.38), presence of diabetic neuropathy (Odds ratio 1.64, 95% CI 1.28 to 3.57), presence of diabetic retinopathy (Odds ratio 2.70, 95% CI 1.63 to 6.78) and history of perceived stress (Odds ratio 40.32, 95% CI 10.95 to 148.32), were associated with anxiety and depression.

Conclusions: Prevalence of depression and anxiety was very high in diabetic population; hence evaluation and management should be part of routine care. Special focus should be given to patients with new onset diabetes, suffering from neuropathy or nephropathy and patients with history of stressors.



Diabetes mellitus, Anxiety, Depression

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Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387:1513-30.

Tajfard M, Ghayour Mobarhan M, Rahimi HR, Mouhebati M, Esmaeily H, Ferns GA, et al. Anxiety, depression, coronary artery disease and diabetes mellitus; an association study in ghaem hospital, Iran. Iranian Red Crescent Med J. 2014;16(9):e14589.

Degmecic D, Bacun T, Kovac V, Mioc J, Horvat J, Vcev A. Depression, anxiety and cognitive dysfunction in patients with type 2 diabetes mellitus--a study of adult patients with type 2 diabetes mellitus in Osijek, Croatia. Collegium antropologicum. 2014;38(2):711-6.

Palizgir M, Bakhtiari M, Esteghamati A. Association of depression and anxiety with diabetes mellitus type 2 concerning some sociological factors. Iranian Red Crescent Med J. 2013;15(8):644-8.

Gregory NA, Jonathan BB. Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetics. Diabetes care. 2003;26(3):744-9.

Knol MJ, Heerdink ER, Egburts AC, Geerlinks MI, Gorter KJ, Neumans ME, et al. Depressive symptoms in subjects with diagnosed and undiagnosed type 2 diabetes. Psycosom Med. 2007;69(4):300-5.

Demmer RT, Gelb S, Suglia SF, Keyes KM, Aiello AE, Colombo PC, et al. Sex differences in the association between depression, anxiety, and type 2 diabetes mellitus. Psychosomatic Med. 2015;77(4):467-77.

Hamilton M. A rating scale for depression. Journal of neurology, neurosurgery and psychiatry. 1960;23:56-62.

Hamilton M. The assessment of anxiety states by rating. The British J Med Psychol. 1959;32(1):50-5.

Pereira MAO, Pereira A, Johnson G. Depression, brain glucose metabolism and consciousness. Revista electronica informacao cognicao (Cessada). 2011;1(5):1-9.

Tovilla-Zarate C, Juarez-Rojop I, Peralta Jimenez Y, Jimenez MA, Vazquez S, Bermudez-Ocana D, et al. Prevalence of anxiety and depression among outpatients with type 2 diabetes in the Mexican population. PloS one. 2012;7(5):e36887.

de Kort S, Kruimel JW, Sels JP, Arts IC, Schaper NC, Masclee AA. Gastrointestinal symptoms in diabetes mellitus, and their relation to anxiety and depression. Diabet Res Clin Pract. 2012;96(2):248-55.

Mendenhall E, Norris SA, Shidhaye R, Prabhakaran D. Depression and type 2 diabetes in low- and middle-income countries: a systematic review. Diabet Res Clin Pract. 2014;103(2):276-85.

Lin EH, Rutter CM, Katon W, Heckbert SR, Ciechanowski P, et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes care. 2010;33:264-9.

Lin EH, Heckbert SR, Rutter CM, Katon WJ, Ciechanowski P, et al. Depression and increased mortality in diabetes: unexpected causes of death. Ann Family Med. 2009;7:414-21.

Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res. 2002;53:1053-60.

Collins M, Corcoran P and Perry I. Anxiety and depression symptoms in patients with diabetes. Diabet Med. 2009;26:153-61.

Pouwer F. Should we screen for emotional distress in type 2 diabetes mellitus? Nat Rev Endocrinol 2009;5:665-71.

Lloyd C, Dyer P, Barnett A. Prevalence of symptoms of depression and anxiety in a diabetes clinic population. Diabet Med. 2000;17:198-202.