Association of Stress, Depression and Anxiety among Individuals with Microvascular Complications in Type 2 Diabetes

Abstract

Background and Aims: The impact of a chronic illness like diabetes on physical and mental wellbeing has been gaining more focus in the last few decades. This study aimed to investigate the association of stress, depression, and anxiety among individuals with type 2 diabetes mellitus (T2DM) and microvascular complications. Materials and Methods: This cross-sectional study included 315 participants aged ≥20 years with T2DM seen at a tertiary care diabetes centre who were screened for diabetic retinopathy, nephropathy, and neuropathy and assessed for stress, depression, and anxiety using the Depression, Anxiety Stress Scale 21 (DASS 21). Diabetic retinopathy was classified according to the Early Treatment Diabetic Reinopathy Study grading system diagnosed using retinal photography [Early Treatment DR Study grading system] i.e., presence of at least one distinct microaneurysm; nephropathy, if urinary albumin excretion was ≥30 mg/μg of creatinine; and neuropathy, if vibration perception threshold of the big toe using biothesiometry was ≥20 V. Results: Prevalence of stress was higher in those with neuropathy (60% vs 40%, P < 0.001), nephropathy (61% vs 39%, P < 0.001) and retinopathy (57% vs 43%, P < 0.05) compared to those without. Prevalence of depression was also higher in individuals with neuropathy (66% vs 34%,P < 0.001), nephropathy (58% vs 42%, P < 0.001) and retinopathy (55% vs 45%, P < 0.05). In multiple regression analysis, stress was significantly associated with retinopathy (OR=3.13,CI:1.75–5.58, P < 0.000), neuropathy (OR=2.50, CI:1.42–4.39,P < 0.001) and nephropathy (OR=2.06,CI:1.19–3.56, P < 0.010),depression was also significantly associated with retinopathy (OR=1.97,CI:1.04–3.73, P < 0.037), neuropathy (OR=2.77,CI:1.45–5.30,P < 0.002) and nephropathy (OR=2.59,CI:1.42– 4.70,P < 0.002). Conclusions: Individuals with microvascular complications of diabetes should be screened for stress, depression,and anxiety so that proper counselling can be given.