High Prevalence of Depression, Anxiety and Stress Symptoms Among Diabetes Mellitus Patients

Background: Few studies have documented the rates of psychiatric symptoms in patients with Diabetes Mellitus (DM) patients and compared them with healthy controls. Aim: To determine whether there is a relationship between high depression, anxiety, and stress symptoms in Diabetes Mellitus (DM) patients in comparison to a group of controls. Design: This was a matched case-control study. Setting: Primary Health Care (PHC) Centres of the Supreme Council of Health, State of Qatar. Subjects: 889 DM patients and 889 healthy subjects matched for age, gender and ethnicity, from September 2009 to August 2010 were included in this study. Methods: Face to face interviews were conducted with DM patients and controls using a questionnaire which captured the socio-demographic characteristics of subjects and the short version of the Depression Anxiety Stress Scales (DASS)-21 questionnaire. Furthermore, we used the questionnaire based on the Hospital Anxiety and Depression Scale (HADS) to assess the validity of DASS-21. Results: The study findings revealed that most of the studied diabetic cases (33.6%) and healthy controls (30.9%) were in the 40-49 years age group. Significantly larger proportion of DM subjects had severe depression scores (13.6% vs 5.9%; p<0.001); severe anxiety scores (35.3% vs 16.3%; p<0.001); and severe stress scores (23.4% vs 10%; p<0.001) compared to healthy controls. The major predictors for high depression scores among diabetic cases were systolic blood pressure (OR 3.91; p=0.001), duration of diabetes (OR 2.68; p=0.011) and obesity (OR 2.50; p=0.001). The major predictors for high anxiety scores among diabetic cases were systolic blood pressure (OR 2.8; p=0.001), obesity (OR 2.27; p=0.001), and smoking (OR 1.78; p=0.04). The leading predictors for high stress scores were systolic blood pressure (OR 3.57; P=0.001), diastolic blood pressure (OR 2.80; P=0.001) and physical activity (OR 2.11, P=0.025). Diabetic women had higher depression (63.3% vs 50.4%), anxiety (70.1% vs 61.6%) and stress (73.3% vs 61.4%) scores than men. No significant association was observed between the diabetic complications and depression, anxiety or stress scores. Conclusion: The present findings revealed that diabetic cases had significantly higher depression, anxiety and stress scores compared to healthy controls. In particular anxiety scores were higher more frequently among diabetic patients in comparison to depression and stress scores.