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Original research
More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus
  1. Santosh K Chaturvedi1,
  2. Shayanth Manche Gowda1,
  3. Helal Uddin Ahmed2,
  4. Fahad D Alosaimi3,
  5. Nicola Andreone4,
  6. Alexey Bobrov5,
  7. Viola Bulgari6,
  8. Giuseppe Carrà7,
  9. Gianluca Castelnuovo8,9,
  10. Giovanni de Girolamo6,
  11. Tomasz Gondek10,
  12. Nikola Jovanovic11,
  13. Thummala Kamala12,
  14. Andrzej Kiejna13,
  15. Nebojsa Lalic11,
  16. Dusica Lecic-Tosevski11,
  17. Fareed Minhas14,
  18. Victoria Mutiso15,
  19. David Ndetei15,
  20. Golam Rabbani2,
  21. Suntibenchakul Somruk16,
  22. Sathyanarayana Srikanta12,
  23. Rizwan Taj17,
  24. Umberto Valentini18,
  25. Olivera Vukovic11,
  26. Wolfgang Wölwer19,
  27. Larry Cimino20,
  28. Arie Nouwen,
  29. Cathy Lloyd and
  30. Norman Sartorius
  1. 1Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
  2. 2Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
  3. 3Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
  4. 4IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
  5. 5National Research Centre for Psychiatry and Narcology, Moscow, Russia
  6. 6IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
  7. 7University of Milano-Bicocca, Bicocca, Italy
  8. 8Department of Psychology, Catholic University, Milan, Italy
  9. 9IRCCS Istituto Auxologico Italiano, Milan, Italy
  10. 10Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
  11. 11Institute of Mental Health, Belgrade, Serbia
  12. 12Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India
  13. 13University of Lower Silesia, Wroclaw, Poland
  14. 14Center for Global Mental Health, Rawalpindi, Pakistan
  15. 15University of Nairobi, Nairobi, Kenya
  16. 16Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  17. 17Pakistan Institute of Medical Sciences, Islamabad, Pakistan
  18. 18U.O. Diabetologia, ASST Spedali Civili, Brescia, Italy
  19. 19Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany
  20. 20ProConsult, Owings Mills, Maryland, USA
  1. Correspondence to Dr Santosh K Chaturvedi; skchatur{at}gmail.com

Abstract

Background Anxiety disorder, one of the highly disabling, prevalent and common mental disorders, is known to be more prevalent in persons with type 2 diabetes mellitus (T2DM) than the general population, and the comorbid presence of anxiety disorders is known to have an impact on the diabetes outcome and the quality of life. However, the information on the type of anxiety disorder and its prevalence in persons with T2DM is limited.

Aims To assess the prevalence and correlates of anxiety disorder in people with type 2 diabetes in different countries.

Methods People aged 18–65 years with diabetes and treated in outpatient settings were recruited in 15 countries and underwent a psychiatric interview with the Mini-International Neuropsychiatric Interview. Demographic and medical record data were collected.

Results A total of 3170 people with type 2 diabetes (56.2% women; with mean (SD) duration of diabetes 10.01 (7.0) years) participated. The overall prevalence of anxiety disorders in type 2 diabetic persons was 18%; however, 2.8% of the study population had more than one type of anxiety disorder. The most prevalent anxiety disorders were generalised anxiety disorder (8.1%) and panic disorder (5.1%). Female gender, presence of diabetic complications, longer duration of diabetes and poorer glycaemic control (HbA1c levels) were significantly associated with comorbid anxiety disorder. A higher prevalence of anxiety disorders was observed in Ukraine, Saudi Arabia and Argentina with a lower prevalence in Bangladesh and India.

Conclusions Our international study shows that people with type 2 diabetes have a high prevalence of anxiety disorders, especially women, those with diabetic complications, those with a longer duration of diabetes and poorer glycaemic control. Early identification and appropriate timely care of psychiatric problems of people with type 2 diabetes is warranted.

  • diabetes mellitus
  • anxiety disorders
  • panic disorders
  • multicentre study
  • prevalence

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/gpsych-2019-100076

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    Footnotes

    • Correction notice This paper has been updated since it was first published. The affiliations of Umberto Valentini and Gianluca Castelnuovo have been amended.

    • Authors contributions SKC and SMG analysed the data and prepared the first draft of the manuscript. All authors from the 15 countries contributed to the study in its planning, data collection and analysis. All authors contributed to the manuscript and approved the final versions.

    • Funding Statement The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests AB has received a research grant from Abbott, and fees for lectures from Lundbeck. CL has received travel expenses paid by unrestricted grants from Eli Lily and Sanofi to attend the World Diabetes Congress and the American Psychiatric Association conference. The Association for the Improvement of Mental Health Programs, which sponsored this programme and financially supported tasks related to its management and data analysis, received unrestricted grants from Eli Lilly and Sanofi. NS received travel support and fees from Janssen, Cilag, Lundbeck International Neuroscience Foundation, Servier: all outside the activities related to work on this study or on this paper. WW has received personal fees from Roche Pharma, outside the submitted work.

    • Patient consent for publication Not required.

    • ETHICAL APPROVAL Prior to commencing the study, ethical approval was obtained in all study settings. Ethical approval was also obtained from the Open University, UK, where the data were stored for analysis.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data available at coordinating centre