Skip to main content
Top
Published in: Diabetology & Metabolic Syndrome 1/2010

Open Access 01-12-2010 | Research

Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors

Authors: Ali Khan Khuwaja, Saima Lalani, Raheem Dhanani, Iqbal Syed Azam, Ghazala Rafique, Franklin White

Published in: Diabetology & Metabolic Syndrome | Issue 1/2010

Login to get access

Abstract

Background

Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes.

Methods

We conducted a cross-sectional, multi-center study in four out-patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and depression, while adjusting for confounding variables.

Results

Overall, 57.9% (95% CI = 54.7%, 61.2%) and 43.5% (95% CI = 40.3%, 46.8%) study participants had anxiety and depression respectively. Factors found to be independently associated with anxiety were physical inactivity, having hypertension and ischemic heart disease. For depression, being female, of older age, having hypertension and ischemic heart disease were significantly associated. Metabolic components found to be independently associated with both anxiety and depression were systolic blood pressure, fasting blood glucose and fasting blood triglycerides. Body mass index was independently associated with depression but not with anxiety.

Conclusion

This study identified that a large proportion of adults with diabetes had anxiety and/or depression, and identified factors associated with these entities. These results alert clinicians to identify and treat anxiety and depression as common components of diabetes care. Additional studies are needed to establish the directional nature of this relationship and to test interventions.
Literature
2.
go back to reference Khuwaja AK, Qureshi R, Azam SI: Prevalence and factors associated with anxiety and depression among family practitioners in Karachi, Pakistan. J Pak Med Assoc. 2004, 54: 45-49.PubMed Khuwaja AK, Qureshi R, Azam SI: Prevalence and factors associated with anxiety and depression among family practitioners in Karachi, Pakistan. J Pak Med Assoc. 2004, 54: 45-49.PubMed
3.
go back to reference Khowaja LA, Khuwaja AK, Cosgrove P: Cost of diabetes care in out-patient clinics of Karachi, Pakistan. BMC Health Serv Res. 2007, 21: 189-10.1186/1472-6963-7-189.CrossRef Khowaja LA, Khuwaja AK, Cosgrove P: Cost of diabetes care in out-patient clinics of Karachi, Pakistan. BMC Health Serv Res. 2007, 21: 189-10.1186/1472-6963-7-189.CrossRef
4.
go back to reference Lin EH, Rutter CM, Katon W, Heckbert SR, Ciechanowski P, Oliver MM, et al: Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care. 2010, 33: 264-269. 10.2337/dc09-1068.PubMedCentralCrossRefPubMed Lin EH, Rutter CM, Katon W, Heckbert SR, Ciechanowski P, Oliver MM, et al: Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care. 2010, 33: 264-269. 10.2337/dc09-1068.PubMedCentralCrossRefPubMed
5.
go back to reference Ali S, Stone M, Skinner TC, Robertson N, Davies M, Khunti K: The association between depression and health-related quality of life in people with type 2 diabetes: a systematic literature review. Diabetes Metab Res Rev. 2010, 26: 75-89. 10.1002/dmrr.1065.CrossRefPubMed Ali S, Stone M, Skinner TC, Robertson N, Davies M, Khunti K: The association between depression and health-related quality of life in people with type 2 diabetes: a systematic literature review. Diabetes Metab Res Rev. 2010, 26: 75-89. 10.1002/dmrr.1065.CrossRefPubMed
6.
go back to reference Nichols l, Barton PL, Glazner J, McCollum M: Diabetes, minor depression and health care utilization and expenditures: a retrospective database study. Cost Eff Resour Alloc. 2007, 5: 4-10.1186/1478-7547-5-4.PubMedCentralCrossRefPubMed Nichols l, Barton PL, Glazner J, McCollum M: Diabetes, minor depression and health care utilization and expenditures: a retrospective database study. Cost Eff Resour Alloc. 2007, 5: 4-10.1186/1478-7547-5-4.PubMedCentralCrossRefPubMed
7.
go back to reference Bouwman V, Adriaanse MC, van 't Riet E, Snoek FJ, Dekker JM, Nijpels G: Depression, anxiety and glucose metabolism in the general Dutch population: the new Hoorn study. PloS One. 2010, 5: e9971-10.1371/journal.pone.0009971.PubMedCentralCrossRefPubMed Bouwman V, Adriaanse MC, van 't Riet E, Snoek FJ, Dekker JM, Nijpels G: Depression, anxiety and glucose metabolism in the general Dutch population: the new Hoorn study. PloS One. 2010, 5: e9971-10.1371/journal.pone.0009971.PubMedCentralCrossRefPubMed
8.
go back to reference Pouwer F: Should we screen for emotional distress in type 2 diabetes mellitus?. Nat Rev Endocrinol. 2009, 5: 665-71. 10.1038/nrendo.2009.214.CrossRefPubMed Pouwer F: Should we screen for emotional distress in type 2 diabetes mellitus?. Nat Rev Endocrinol. 2009, 5: 665-71. 10.1038/nrendo.2009.214.CrossRefPubMed
9.
go back to reference Vogelzangs N, Suthers K, Ferrucci L, Simonsick EM, Ble A, Schrager M, et al: Hypercortisolemic depression is associated with the metabolic syndrome in late-life. Psychoneuroendocrinology. 2007, 32: 151-159. 10.1016/j.psyneuen.2006.11.009.PubMedCentralCrossRefPubMed Vogelzangs N, Suthers K, Ferrucci L, Simonsick EM, Ble A, Schrager M, et al: Hypercortisolemic depression is associated with the metabolic syndrome in late-life. Psychoneuroendocrinology. 2007, 32: 151-159. 10.1016/j.psyneuen.2006.11.009.PubMedCentralCrossRefPubMed
10.
go back to reference Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, et al: Adverse childhood experiences and adult risk factors for age-related disease, et al: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med. 2009, 163: 1135-1143. 10.1001/archpediatrics.2009.214.PubMedCentralCrossRefPubMed Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, et al: Adverse childhood experiences and adult risk factors for age-related disease, et al: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med. 2009, 163: 1135-1143. 10.1001/archpediatrics.2009.214.PubMedCentralCrossRefPubMed
11.
go back to reference Ciechanowski PS, Katon WJ, Russo JE: Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med. 2000, 160: 3278-3285. 10.1001/archinte.160.21.3278.CrossRefPubMed Ciechanowski PS, Katon WJ, Russo JE: Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med. 2000, 160: 3278-3285. 10.1001/archinte.160.21.3278.CrossRefPubMed
12.
go back to reference Gonzalez JS, Safren SA, Cagliero E, Wexler DJ, Delahanty L, Wittenberg E, et al: Depression, self-care, and medication adherence in type 2 diabetes: relationship across the full range of symptom severity. Diabetes Care. 2007, 30: 2222-2227. 10.2337/dc07-0158.PubMedCentralCrossRefPubMed Gonzalez JS, Safren SA, Cagliero E, Wexler DJ, Delahanty L, Wittenberg E, et al: Depression, self-care, and medication adherence in type 2 diabetes: relationship across the full range of symptom severity. Diabetes Care. 2007, 30: 2222-2227. 10.2337/dc07-0158.PubMedCentralCrossRefPubMed
14.
go back to reference Simon GE, Katon WJ, Lin EH, Rutter C, Manning WG, Von Korff M, et al: Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry. 2007, 64: 65-72. 10.1001/archpsyc.64.1.65.CrossRefPubMed Simon GE, Katon WJ, Lin EH, Rutter C, Manning WG, Von Korff M, et al: Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry. 2007, 64: 65-72. 10.1001/archpsyc.64.1.65.CrossRefPubMed
15.
go back to reference Collins MM, Corcorant P, Perry IJ: Anxiety and depression symptoms in patients with diabetes. Diabet Med. 2009, 26: 153-161. 10.1111/j.1464-5491.2008.02648.x.CrossRefPubMed Collins MM, Corcorant P, Perry IJ: Anxiety and depression symptoms in patients with diabetes. Diabet Med. 2009, 26: 153-161. 10.1111/j.1464-5491.2008.02648.x.CrossRefPubMed
16.
go back to reference Egede LE, Zheng D, Simpson K: Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002, 25: 464-470. 10.2337/diacare.25.3.464.CrossRefPubMed Egede LE, Zheng D, Simpson K: Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002, 25: 464-470. 10.2337/diacare.25.3.464.CrossRefPubMed
17.
go back to reference Katon W, Russo J, Lin EH, Heckbert SR, Ciechanowski P, Ludman EJ, et al: Depression and diabetes: factors associated major depression at five-year follow up. Psychosomatics. 2009, 50: 570-579. 10.1176/appi.psy.50.6.570.PubMedCentralCrossRefPubMed Katon W, Russo J, Lin EH, Heckbert SR, Ciechanowski P, Ludman EJ, et al: Depression and diabetes: factors associated major depression at five-year follow up. Psychosomatics. 2009, 50: 570-579. 10.1176/appi.psy.50.6.570.PubMedCentralCrossRefPubMed
18.
go back to reference Takeuchi T, Nakao M, Nomura K, Inoue M, Tsurugano S, Shinozaki Y, et al: Association of the metabolic syndrome with depression and anxiety in Japanese men, et al: a 1-year cohort study. Diabetes Metab Res Rev. 2009, 25: 762-767. 10.1002/dmrr.1041.CrossRefPubMed Takeuchi T, Nakao M, Nomura K, Inoue M, Tsurugano S, Shinozaki Y, et al: Association of the metabolic syndrome with depression and anxiety in Japanese men, et al: a 1-year cohort study. Diabetes Metab Res Rev. 2009, 25: 762-767. 10.1002/dmrr.1041.CrossRefPubMed
19.
go back to reference Dunbar JA, Reddy P, Davis-Lameloise N, Philpot B, Laatikainen T, Kikkinen A, et al: Depression: an important comorbidity with metabolic syndrome in a general population. Diabetes Care. 2008, 31: 2368-2373. 10.2337/dc08-0175.PubMedCentralCrossRefPubMed Dunbar JA, Reddy P, Davis-Lameloise N, Philpot B, Laatikainen T, Kikkinen A, et al: Depression: an important comorbidity with metabolic syndrome in a general population. Diabetes Care. 2008, 31: 2368-2373. 10.2337/dc08-0175.PubMedCentralCrossRefPubMed
20.
go back to reference Hildrum B, Mykletun A, Midthjell K, Ismail K, Dahl AA: No association of depression and anxiety with the metabolic syndrome: the Norwegian HUNT study. Acta Psychiatr Scand. 2009, 120: 14-22. 10.1111/j.1600-0447.2008.01315.x.CrossRefPubMed Hildrum B, Mykletun A, Midthjell K, Ismail K, Dahl AA: No association of depression and anxiety with the metabolic syndrome: the Norwegian HUNT study. Acta Psychiatr Scand. 2009, 120: 14-22. 10.1111/j.1600-0447.2008.01315.x.CrossRefPubMed
21.
go back to reference Dogar IA, Khawaja IS, Azeem MW, Awan H, Ayub a, Iqbal J, et al: Prevalence and risk factors for depression and anxiety in hospitalized cardiac patients in Pakistan. Psychiatry (Edgmont). 2008, 5: 38-41. Dogar IA, Khawaja IS, Azeem MW, Awan H, Ayub a, Iqbal J, et al: Prevalence and risk factors for depression and anxiety in hospitalized cardiac patients in Pakistan. Psychiatry (Edgmont). 2008, 5: 38-41.
22.
go back to reference Labad J, Price JF, Strachan MWJ, Fowkes FGR, Ding J, Deary IJ, et al: Symptoms of depression but not anxiety are associated with central obesity and cardiovascular disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetologia. 2010, 53: 467-471. 10.1007/s00125-009-1628-9.PubMedCentralCrossRefPubMed Labad J, Price JF, Strachan MWJ, Fowkes FGR, Ding J, Deary IJ, et al: Symptoms of depression but not anxiety are associated with central obesity and cardiovascular disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetologia. 2010, 53: 467-471. 10.1007/s00125-009-1628-9.PubMedCentralCrossRefPubMed
23.
go back to reference Paddison CA, Eborall HC, French DP, Kinmonth AL, Griffin SJ, Sutton S: Predictors of anxiety and depression among people attending diabetes screening: A prospective cohort study embedded in the ADDITION (Cambridge) randomized control trial. Br J Health Psychol. 2010, Paddison CA, Eborall HC, French DP, Kinmonth AL, Griffin SJ, Sutton S: Predictors of anxiety and depression among people attending diabetes screening: A prospective cohort study embedded in the ADDITION (Cambridge) randomized control trial. Br J Health Psychol. 2010,
24.
go back to reference Mosaku K, Kolawole B, Mume C, Ikem R: Depression, anxiety and quality of life among diabetic patients: a comparative study. J Natl Med Assoc. 2008, 100: 73-8.PubMed Mosaku K, Kolawole B, Mume C, Ikem R: Depression, anxiety and quality of life among diabetic patients: a comparative study. J Natl Med Assoc. 2008, 100: 73-8.PubMed
25.
go back to reference Lin EH, Heckbert SR, Rutter CM, Katon WJ, Ciechanowski P, Ludman EJ, et al: Depression and increased mortality in diabetes: unexpected causes of death. Ann Fam Med. 2009, 7: 414-421. 10.1370/afm.998.PubMedCentralCrossRefPubMed Lin EH, Heckbert SR, Rutter CM, Katon WJ, Ciechanowski P, Ludman EJ, et al: Depression and increased mortality in diabetes: unexpected causes of death. Ann Fam Med. 2009, 7: 414-421. 10.1370/afm.998.PubMedCentralCrossRefPubMed
26.
go back to reference Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diaease, and decrements in health: results from the World Health Surveys. Lancet. 2007, 370: 851-858. 10.1016/S0140-6736(07)61415-9.CrossRefPubMed Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diaease, and decrements in health: results from the World Health Surveys. Lancet. 2007, 370: 851-858. 10.1016/S0140-6736(07)61415-9.CrossRefPubMed
27.
go back to reference Maharaj RG, Reid SD, Misir A, Simeon DT: Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad. West Indian Med J. 2005, 54: 369-374.PubMed Maharaj RG, Reid SD, Misir A, Simeon DT: Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad. West Indian Med J. 2005, 54: 369-374.PubMed
28.
go back to reference Stein DJ, Gureje O: Depression and anxiety in the developing world: is it time to medicalize their suffering. Lancet. 2004, 364: 233-234. 10.1016/S0140-6736(04)16693-2.CrossRefPubMed Stein DJ, Gureje O: Depression and anxiety in the developing world: is it time to medicalize their suffering. Lancet. 2004, 364: 233-234. 10.1016/S0140-6736(04)16693-2.CrossRefPubMed
29.
go back to reference Mirza I, Jenkins R: Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systemic review. BMJ. 2004, 328: 794-10.1136/bmj.328.7443.794.PubMedCentralCrossRefPubMed Mirza I, Jenkins R: Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systemic review. BMJ. 2004, 328: 794-10.1136/bmj.328.7443.794.PubMedCentralCrossRefPubMed
30.
go back to reference Khuwaja AK, Kadir MM: Gender differences and clustering patterns of behavioral risk factors for chronic non-communicable diseases: community-based study from a developing country. Chronic Illn. 2010, 6 (3): 163-170. 10.1177/1742395309352255.CrossRefPubMed Khuwaja AK, Kadir MM: Gender differences and clustering patterns of behavioral risk factors for chronic non-communicable diseases: community-based study from a developing country. Chronic Illn. 2010, 6 (3): 163-170. 10.1177/1742395309352255.CrossRefPubMed
31.
go back to reference Almawi W, Tamim H, Al-Sayed N, Arekat MR, Al-Khateeb GM, Baqer A, et al: Association of comorbid depression, anxiety and stress disorders with type 2 diabetes in Bahrain, a country with a very high prevalence of type 2 diabetes. J Endocrinol Invest. 2008, 31: 1020-1024.CrossRefPubMed Almawi W, Tamim H, Al-Sayed N, Arekat MR, Al-Khateeb GM, Baqer A, et al: Association of comorbid depression, anxiety and stress disorders with type 2 diabetes in Bahrain, a country with a very high prevalence of type 2 diabetes. J Endocrinol Invest. 2008, 31: 1020-1024.CrossRefPubMed
32.
go back to reference Ganatra HA, Zafar SN, Qidwai W, Rozi S: Prevalence and predictors of depression among an elderly population of Pakistan. Aging Ment Health. 2008, 12: 349-356. 10.1080/13607860802121068.CrossRefPubMed Ganatra HA, Zafar SN, Qidwai W, Rozi S: Prevalence and predictors of depression among an elderly population of Pakistan. Aging Ment Health. 2008, 12: 349-356. 10.1080/13607860802121068.CrossRefPubMed
33.
go back to reference Iype T, Shaji SK, Balakrishnan A, Charles D, Varghese A, Antony TP: Cognition in type 2 diabetes: association with vascular risk factors, complications of diabetes and depression. Ann Indian Acad Neurol. 2009, 12: 25-27.PubMedCentralPubMed Iype T, Shaji SK, Balakrishnan A, Charles D, Varghese A, Antony TP: Cognition in type 2 diabetes: association with vascular risk factors, complications of diabetes and depression. Ann Indian Acad Neurol. 2009, 12: 25-27.PubMedCentralPubMed
34.
go back to reference Craft LL, Freund KM, Culpepper L, Perna FM: Intervention study of exercise for depressive symptoms in women. J Women Health (Larchmt). 2007, 16: 1499-1509. 10.1089/jwh.2007.0483.CrossRef Craft LL, Freund KM, Culpepper L, Perna FM: Intervention study of exercise for depressive symptoms in women. J Women Health (Larchmt). 2007, 16: 1499-1509. 10.1089/jwh.2007.0483.CrossRef
35.
go back to reference Craft LL, Perna FM: The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry. 2004, 6: 104-111. 10.4088/PCC.v06n0301.PubMedCentralCrossRefPubMed Craft LL, Perna FM: The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry. 2004, 6: 104-111. 10.4088/PCC.v06n0301.PubMedCentralCrossRefPubMed
36.
go back to reference Hong X, Li J, Xu F, Tse LA, Liang Y, Wang Z, et al: Physical activity inversely associated with the presence of depression among urban adolescents in regional China. BMC Public Health. 2009, 9: 148-10.1186/1471-2458-9-148.PubMedCentralCrossRefPubMed Hong X, Li J, Xu F, Tse LA, Liang Y, Wang Z, et al: Physical activity inversely associated with the presence of depression among urban adolescents in regional China. BMC Public Health. 2009, 9: 148-10.1186/1471-2458-9-148.PubMedCentralCrossRefPubMed
37.
go back to reference Thomas J, Jones G, Scarinci I, Brantley P: A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. Diabetes Care. 2003, 26: 2311-7. 10.2337/diacare.26.8.2311.CrossRefPubMed Thomas J, Jones G, Scarinci I, Brantley P: A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. Diabetes Care. 2003, 26: 2311-7. 10.2337/diacare.26.8.2311.CrossRefPubMed
38.
go back to reference Herva A, Räsänen P, Miettunen J, Timonen M, Läksy K, Veijola J, et al: Co-occurrence of metabolic syndrome with depression and anxiety in young adults: The Northern Finland 1966 Birth Cohort Study. Psychosom Med. 2006, 68: 213-216. 10.1097/01.psy.0000203172.02305.ea.CrossRefPubMed Herva A, Räsänen P, Miettunen J, Timonen M, Läksy K, Veijola J, et al: Co-occurrence of metabolic syndrome with depression and anxiety in young adults: The Northern Finland 1966 Birth Cohort Study. Psychosom Med. 2006, 68: 213-216. 10.1097/01.psy.0000203172.02305.ea.CrossRefPubMed
39.
go back to reference Perveen S, Otho MS, Siddiqi MN, Hatcher J, Rafique G: Association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan. Diabetol Metab Syndr. 2010, 2: 17-10.1186/1758-5996-2-17.PubMedCentralCrossRefPubMed Perveen S, Otho MS, Siddiqi MN, Hatcher J, Rafique G: Association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan. Diabetol Metab Syndr. 2010, 2: 17-10.1186/1758-5996-2-17.PubMedCentralCrossRefPubMed
Metadata
Title
Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors
Authors
Ali Khan Khuwaja
Saima Lalani
Raheem Dhanani
Iqbal Syed Azam
Ghazala Rafique
Franklin White
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Diabetology & Metabolic Syndrome / Issue 1/2010
Electronic ISSN: 1758-5996
DOI
https://doi.org/10.1186/1758-5996-2-72

Other articles of this Issue 1/2010

Diabetology & Metabolic Syndrome 1/2010 Go to the issue