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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2015 Nov 1;106(8):e496–e501. doi: 10.17269/CJPH.106.5170

Investigation of anxiety and depression symptom co-morbidity in a community sample with type 2 diabetes: Associations with indicators of self-care

Kimberley J Smith 110,210,, Maxime Pedneault 310, Norbert Schmitz 310,410,510
PMCID: PMC6972267  PMID: 26986910

Abstract

OBJECTIVES: Ascertain the association of elevated co-occurring anxiety and depression symptoms, elevated anxiety symptoms alone or elevated depression symptoms alone with indicators of self-care behaviours in people with type 2 diabetes.

METHODS: Data from a community sample of 1,990 people diagnosed with type 2 diabetes for less than 10 years were assessed. All participants took part in a telephone interview. Questionnaires examined depression, anxiety, health, and indicators of self-care (physical activity, blood glucose monitoring, diet and smoking). Data were assessed with cross tabulations, ANOVA and logistic regression.

RESULTS: Groups who met criteria for elevated co-occurring anxiety and depression symptoms, elevated anxiety symptoms and elevated depression symptoms were more likely to report poor eating habits. Meeting criteria for either elevated depression symptoms (with and without anxiety) was also associated with an increased likelihood of not meeting physical activity recommendations. Those people with elevated depression and anxiety scores were more likely to be a current smoker.

CONCLUSIONS: Those people who meet criteria for elevated anxiety and/or depression symptoms are less likely to report adhering to self-care recommendations. These associations are particularly marked in those people with elevated depression symptoms with or without co-occurring anxiety symptoms. There is a lot of evidence emphasising the importance of monitoring depressive symptoms in people with diabetes. Our results add to this, indicating that adherence to self-care recommendations should be carefully monitored in people with depression and anxiety symptoms.

Keywords: Depression, anxiety, type 2 diabetes

References

  • 1.World Health Organization. Diabetes Factsheet: Number 312. 2011. [Google Scholar]
  • 2.Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care. 2001;24:1069–78. doi: 10.2337/diacare.24.6.1069. [DOI] [PubMed] [Google Scholar]
  • 3.Smith KJ, Beland M, Clyde M, Gariépy G, Pagé V, Badawi G, et al. Association of diabetes with anxiety: A systematic review and meta-analysis. J Psychosom Res. 2013;74(2):89–99. doi: 10.1016/j.jpsychores.2012.11.013. [DOI] [PubMed] [Google Scholar]
  • 4.Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ, et al. Depression and diabetes treatment nonadherence: A meta-analysis. Diabetes Care. 2008;31:2398–403. doi: 10.2337/dc08-1341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.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;33:264–69. doi: 10.2337/dc09-1068. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Schmitz N, Gariepy G, Smith KJ, Malla A, Boyer R, Strychar I, et al. Longitudinal relationships between depression and functioning in people with type 2 diabetes. Ann Behav Med. 2014;47(2):172–79. doi: 10.1007/s12160-013-9534-2. [DOI] [PubMed] [Google Scholar]
  • 7.van Dooren FE, Nefs G, Schram MT, Verhey FR, Denollet J, Pouwer F. Depression and risk of mortality in people with diabetes mellitus: A systematic review and meta-analysis. PLoS One. 2013;8:e57058. doi: 10.1371/journal.pone.0057058. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Park M, Katon WJ, Wolf FM. Depression and risk of mortality in individuals with diabetes: A meta-analysis and systematic review. Gen Hosp Psychiatry. 2013;35:217–25. doi: 10.1016/j.genhosppsych.2013.01.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–27. doi: 10.1001/archpsyc.62.6.617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Deschênes SS, Burns RJ, Schmitz N. Associations between diabetes, major depressive disorder and generalized anxiety disorder comorbidity, and disability: Findings from the 2012 Canadian Community Health Survey— Mental Health (CCHS-MH) J Psychosom Res. 2015;78:137–42. doi: 10.1016/j.jpsychores.2014.11.023. [DOI] [PubMed] [Google Scholar]
  • 11.Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29:147–55. doi: 10.1016/j.genhosppsych.2006.11.005. [DOI] [PubMed] [Google Scholar]
  • 12.Collins MM, Corcoran P, Perry IJ. Anxiety and depression symptoms in patients with diabetes. Diabet Med. 2009;26:153–61. doi: 10.1111/j.1464-5491.2008.02648.x. [DOI] [PubMed] [Google Scholar]
  • 13.Balhara YP, Sagar R. Correlates of anxiety and depression among patients with type 2 diabetes mellitus. Indian J Endocrinol Metab. 2011;15:S50–54. doi: 10.4103/2230-8210.83057. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Khuwaja AK, Lalani S, Dhanani R, Azam IS, Rafique G, White F. Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors. Diabetol Metab Syndr. 2010;2:72. doi: 10.1186/1758-5996-2-72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Smith KJ, Gariepy G, Pedneault M, Beland M, Clyde M, Schmitz N. Exploring the association of psychological status with self-rated diabetes control: Results from the Montreal Evaluation of Diabetes Treatment Study. Psychosomatics. 2013;54:35–43. doi: 10.1016/j.psym.2012.08.002. [DOI] [PubMed] [Google Scholar]
  • 16.Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13. doi: 10.1046/j.1525-1497.2001.016009606.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): A meta-analysis. CMAJ. 2012;184:E191–96. doi: 10.1503/cmaj.110829. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Lowe B, Decker O, Muller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46:266–74. doi: 10.1097/MLR.0b013e318160d093. [DOI] [PubMed] [Google Scholar]
  • 19.Canadian Diabetes Association. Diabetes and You: Living with Diabetes. 2011. [Google Scholar]
  • 20.Brez S, Berard L, Blumer I. Monitoring glycemic control. Can J Diabetes. 2008;32(Suppl1):S32–36. doi: 10.1016/j.jcjd.2013.01.017. [DOI] [PubMed] [Google Scholar]
  • 21.Smith KJ, Page V, Gariepy G, Béland M, Badawi G, Schmitz N. Self-rated diabetes control in a Canadian population with type 2 diabetes: Associations with health behaviours and outcomes. Diabetes Res Clin Pract. 2012;95:162–68. doi: 10.1016/j.diabres.2011.10.019. [DOI] [PubMed] [Google Scholar]
  • 22.Fincke BG, Clark JA, Linzer M, Spiro A, 3rd, Miller DR, Lee A, et al. Assessment of long-term complications due to type 2 diabetes using patient self-report: The Diabetes Complications Index. J Ambul Care Manage. 2005;28:262–73. doi: 10.1097/00004479-200507000-00010. [DOI] [PubMed] [Google Scholar]
  • 23.Statistics Canada: Canadian Community Health Survey Mental Health and Well-being Cycle 1.2. Master File Documentation. Statistics Canada 2003, Ottawa, Canada. 2003.
  • 24.Lepine J-P. Epidemiology, burden, and disability in depression and anxiety. J Clin Psychiatry. 2001;62(Suppl13):4–10. [PubMed] [Google Scholar]

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