Cited by 609Diabetes Management and EducationAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

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Prevalence of anxiety in adults with diabetes

Grigsby, Allison B, Anderson, Ryan J, Freedland, Kenneth E, Clouse, Ray E, Lustman, Patrick J·2002·Journal of Psychosomatic Research

DOI 10.1016/s0022-3999(02)00417-8

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Abstract

Background Anxiety is associated with decreased functioning and quality of life. It may have added importance in diabetes for its potential adverse effects on regimen adherence and glycemic control.Objective To estimate the prevalence of clinically significant anxiety in adults with diabetes.Research design and methods MEDLINE and PsycINFO databases and published reference lists were searched to identify studies that determined the prevalence of anxiety in diabetes from threshold scores on self-report measures or from diagnostic interviews. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies.Results Eighteen studies having a combined population (N) of 4076 (2584 diabetic subjects, 1492 controls) satisfied the inclusion criteria. Most did not adjust for the effects of moderator variables such as gender, and only one was community-based. Generalized anxiety disorder (GAD) was present in 14% of patients with diabetes. The subsyndromal presentation of anxiety disorder not otherwise specified and of elevated anxiety symptoms were found in 27% and 40%, respectively, of patients with diabetes. The prevalence of elevated symptoms was significantly higher in women compared to men (55.3% vs. 32.9%, P<.0001) and similar in patients with Type 1 vs. Type 2 diabetes (41.3% vs. 42.2%, P=.80).Conclusion GAD is present in 14% and elevated symptoms of anxiety in 40% of patients with diabetes who participate in clinical studies. Additional epidemiological studies are needed to determine the prevalence of anxiety in the broader population of persons with diabetes.

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Sawhney, M., Gyawali, C. P., Lustman, P. J., & Clouse, R. E. (2006) · Digestive Diseases and Sciences · doi:10.1007/s10620-006-9378-8 · Cited by 91
“of diabetes [28, 29], are associated with poorer glycemic control [30, 31], and are linked with functional symptoms”
BackgroundSelf-citation
Motivational Enhancement Therapy with and without Cognitive Behavior Therapy to Treat Type 1 Diabetes: A Randomized Trial
Ismail, K., Thomas, S. M., Maissi, E., Chalder, T., Schmidt, U., Bartlett, J., Patel, A., Dickens, C. M., Creed, F., & Treasure, J. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-149-10-200811180-00005 · Cited by 91
Regional Brain Gray Matter Changes in Patients with Type 2 Diabetes Mellitus
Roy, B., Ehlert, L., MULLUR, R. S., Freeby, M., Woo, M. A., Kumar, R., & CHOI, S. E. (2020) · Scientific Reports · doi:10.1038/s41598-020-67022-5 · Cited by 92
The Relationship between stress and negative emotion: The Mediating role of rumination
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“Those negative emotions may potentially lead to poorer health outcomes and subsequent increased risk of complications [4], a decreased quality of life [5], and increased health care usage [6].”
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Association of comorbid depression, anxiety, and stress disorders with Type 2 diabetes in Bahrain, a country with a very high prevalence of Type 2 diabetes
Almawi, W. Y., Tamim, H., Al-Sayed, N., Arekat, M., Al-Khateeb, G. M., Baqer, A., Tutanji, H., & Kamel, C. (2008) · Journal of Endocrinological Investigation · doi:10.1007/bf03345642 · Cited by 89
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“comorbid with 1.3% to 8.9% of diabetic patients (Type I or Type II) (Grigsby et al. 2002, Fisher et al. 2008).”
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The Association between Diabetes-Related Distress and Medication Adherence in Adult Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
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A systematic literature review of diabetes self-management education features to improve diabetes education in women of Black African/Caribbean and Hispanic/Latin American ethnicity
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“The prevalence of mental illness such as depression and anxiety disorders is also greater in women compared to men living with diabetes [14,15].”
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Mindfulness-based cognitive therapy for people with diabetes and emotional problems: long-term follow-up findings from the DiaMind randomized controlled trial
van Son, J., Nyklíček, I., Pop, V. J., Blonk, M. C., Erdtsieck, R. J., & Pouwer, F. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.03.013 · Cited by 82
“, diabetes-specific emotional distress approximately 18%[1], anxiety symptoms approximately 40%[2] and depressive symptoms 20–40%[1,3]) and is associated with negative outcomes, such as lower quality of life, suboptimal self-care behaviors and glycemic control, risk of adverse cardiovascular outcomes, and higher morta…”
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Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis
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“Depression and anxiety, prevalent in adults with diabetes mellitus [1,2], are associated with poorer health outcomes [3–5].”
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Fear of Progression in Partners of Chronically Ill Patients
Zimmermann, T., Herschbach, P., Wessarges, M., & Heinrichs, N. (2011) · Behavioral Medicine · doi:10.1080/08964289.2011.605399 · Cited by 83
Long-Term Health-Related Quality of Life Following Gastric Bypass: Influence of Depression
Sánchez‐Santos, R., Barrio, M. D., Gonzalez, C. A., Madico, C., Terrado, I., Gordillo, M., Pujol, J., Moreno, P., & Masdevall, C. (2006) · Obesity Surgery · doi:10.1381/096089206776945084 · Cited by 77
Anxiety and depression in diabetes care: longitudinal associations with health-related quality of life
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Psychological distress, self-efficacy and glycemic control in type 2 diabetes
Indelicato, L., Dauriz, M., Santi, L., Bonora, F., Negri, C., Cacciatori, V., Targher, G., Trento, M., & Bonora, E. (2017) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2017.01.006 · Cited by 83
“anxiety disorders, anxiety symptoms and stress reactivity than individuals without diabetes [3].”
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Aiding sleep in type 2 diabetes: therapeutic considerations
Tan, X., van Egmond, L., Chapman, C. D., Cedernaes, J., & Benedict, C. (2018) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30233-4 · Cited by 72
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Shaban, M., Fosbury, J., Kerr, D. E., & Cavan, D. A. (2006) · Diabetic Medicine · doi:10.1111/j.1464-5491.2006.02012.x · Cited by 73
Diabetes and Mental Health
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“Additionally, 40 per cent of patients with diabetes exhibit elevated anxiety symptoms (Grigsby et al., 2002).”
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Association between anxiety and depression and nonalcoholic fatty liver disease
Choi, J. M., Chung, G. E., Kang, S. J., Kwak, M.-S., Yang, J. I., Park, B., & Yim, J. Y. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2020.585618 · Cited by 68
Lifetime depression and anxiety increase prevalent psychological symptoms and worsen glycemic control in type 2 diabetes: The Fremantle Diabetes Study Phase II
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“0%) in the present study were also equivalent to, or less than, those seen in other studies [3,10,14] suggesting no issues with overdiagnosis.”
Result
A randomized, controlled trial of a stress management intervention for latinos with type 2 diabetes delivered by community health workers: Outcomes for psychological wellbeing, glycemic control, and cortisol
Wagner, J. A., Bermudez-Millan, A., Damio, G., Segura-Perez, S., Chhabra, J., Vergara, C., Feinn, R., & Perez-Escamilla, R. (2016) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2016.07.022 · Cited by 67
“[13] Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ.”
Background
Association of glucose levels and glucose variability with mood in type 1 diabetic patients
Hermanns, N., Scheff, C., Kulzer, B., Weyers, P., Pauli, P., Kubiak, T., & Haak, T. (2007) · Diabetologia · doi:10.1007/s00125-007-0643-y · Cited by 66
“Negative emotional symptoms such as symptoms of depression or anxiety are more common in diabetic patients than in the non-diabetic population [1–4].”
Background
Improved Time in Range and Glycemic Variability With Sotagliflozin in Combination With Insulin in Adults With Type 1 Diabetes: A Pooled Analysis of 24-Week Continuous Glucose Monitoring Data From the inTandem Program
Danne, T., Cariou, B., Buse, J. B., Garg, S. K., Rosenstock, J., Banks, P. L., Kushner, J. A., McGuire, D. K., Peters, A. L., Sawhney, S., et al. (2019) · Diabetes Care · doi:10.2337/dc18-2149 · Cited by 64
The Antidepressant-Like Effects of Hesperidin in Streptozotocin‐Induced Diabetic Rats by Activating Nrf2/ARE/Glyoxalase 1 Pathway
Zhu, X., Liu, H., Liu, Y., Chen, Y., Liu, Y., & Yin, X. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.01325 · Cited by 65
Diabetes and mental health
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Depression, anxiety, and associated factors in patients with diabetes: evidence from the anxiety, depression, and personality traits in diabetes mellitus (ADAPT-DM) study
Woon, L. S.-C., Sidi, H. B., Ravindran, A., Gosse, P. J., Mainland, R. L., Kaunismaa, E. S., Hatta, N. H., Arnawati, P., Zulkifli, A. Y., Mustafa, N., et al. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02615-y · Cited by 63
Do Web-Based Interventions Improve Well-Being in Type 2 Diabetes? A Systematic Review and Meta-Analysis
Hadjiconstantinou, M., Byrne, J. L., Bodicoat, D. H., Robertson, N., Eborall, H., Khunti, K., & Davies, M. J. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5991 · Cited by 64
“The prevalence of poor psychological health is evident, with depression twice as common in people with type 2 diabetes, than those without the condition [13-16], and with distress affecting 10-30% of people with type 2 diabetes [17], leading to poor glycemic control, medication adherence, and overall low health outcom…”
A predictive model of anxiety and depression symptoms after a lower limb amputation
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Single-Session Acceptance and Commitment Therapy (ACT) Interventions for Patients with Chronic Health Conditions: A Systematic Review and Meta-Analysis
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Interaction between psychiatric and autoimmune disorders in coeliac disease patients in the Northeastern United States
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Inflammation, negative affect, and amyloid burden in Alzheimer’s disease: Insights from the kynurenine pathway
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“Future work in rodent models should determine if these correlations are meaningful and relevant to common comorbid negative affect in MCI and AD (Grigsby et al., 2002; Ryan et al., 2012).”
Prevalence of depression and anxiety among children with type 1 and type 2 diabetes: a systematic review and meta-analysis
Akbarizadeh, M., Naderi far, M., & Ghaljaei, F. (2022) · World Journal of Pediatrics · doi:10.1007/s12519-021-00485-2 · Cited by 60
“Unlike in the case of children, the results of a systematic review study showed that the prevalence of anxiety in adults with diabetes was 14%, suggesting that adults experienced less anxiety than children [42].”
BackgroundResult
Substance use and mental diagnoses among adults with and without type 2 diabetes: Results from electronic health records data
Wu, L.-T. T., Ghitza, U. E., Batch, B. C., Pencina, M. J., Rojas, L. F., Goldstein, B. A., Schibler, T., Dunham, A. A., Rusincovitch, S. A., & Brady, K. T. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.09.003 · Cited by 61

Authors: Grigsby, A. B., Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J.
Affiliations: Washington University in St. Louis (US)
Corresponding author: Lustman, Patrick J
ORCID: Freedland, Kenneth E
Lustman, Patrick J
Venue: Journal of Psychosomatic Research
Publisher: Elsevier BV
Published: 2002-12
Volume: 53
Issue: 6
Pages: 1053-1060
ISSN: 0022-3999 (ISSN-L)
DOI: 10.1016/s0022-3999(02)00417-8
OpenAlex: W1986668408
Cited by: 609
References: 78
Citations by year: 2026: 21 · 2025: 30 · 2024: 27 · 2023: 26 · 2022: 36 · 2021: 44 · 2020: 38 · 2019: 24 · 2018: 31 · 2017: 25 · 2016: 44 · 2015: 35 · 2014: 34 · 2013: 32 · 2012: 29
FWCI: 0.83
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychosomatic Research (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r01dk053060-05)
National Institute of Diabetes and Digestive and Kidney Diseases (DK59364, DK-36452, DK20579, DK53060, K24DK059364, R01DK036452)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: anxiety, diabetes mellitus, prevalence, generalized anxiety disorder, type 1 diabetes, type 2 diabetes, sex differences, glycemic control, medication adherence, quality of life
MeSH terms: Adult, Aged, Anxiety Disorders, Clinical Trials as Topic, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Severity of Illness Index, Prevalence, Epidemiologic Studies, Diabetes Complications

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Prevalence of anxiety in adults with diabetes

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