Screening for Anxiety and Depression in type 2 diabetes
Karan Jolly, Tanveer Chohan, Jaskanwal Sara & Jayadave Shakher
Introduction: Patients with diabetes are twice as likely to have anxiety and depression compared to general population. Diabetic patients with depressive symptoms are less likely to adhere to dietary recommendations and treatment regime leading to poor glycaemic control. Evidence has shown that the treatment of psychological conditions can lead to improvement in health outcomes.
Aims: To investigate the effectiveness of using a brief questionnaire to screen for anxiety and depression in a diabetic population attending a busy outpatient clinic and to determine the prevalence of the psychological symptoms.
Method: Adults (both male and female) with diagnosed Type 2 diabetes were asked to fill in a questionnaire (the Hospital Anxiety and Depression Scale HADS) whilst visiting the hospital diabetic clinic appointment. The patients medical records were then used to collate information on diabetic complications.
Results: Overall, there was a high prevalence anxiety and depression with 24% of patients reporting either moderate-severe anxiety or depression or both. There was a slight preponderance of males (54.6%) to females (45.5%) in this study but there was no statistical difference in the degree of anxiety and depression among both groups. The presence of symptoms of mild anxiety were significantly associated with an increased duration of diabetes compared to those who had no symptoms (14 years vs 16.5 years, P<0.038). Logistic regression analysis showed that poor control of Hba1c significantly increased the likelihood of anxiety (P<0.05, OR 4.25). Also, insulin usage more than doubled the risk of any form of depression (P<0.046, OR 2.51) and nearly quadrupled the risk of anxiety (P<0.003, OR 3.82).
Conclusion: The HADS questionnaire is an appropriate tool to assess psychological symptoms in a busy outpatient diabetic clinic. Poor control of diabetes and the use of insulin both significantly increase the risk of psychological symptoms of anxiety and depression.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.