CoChat
Sign Up
Cited by 132Diabetes Management and EducationMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Prevalence and determinants of depressive and anxiety symptoms in adults with type 2 diabetes in China: a cross-sectional study

Open access
Sun, Nianquan, Lou, Peian, Shang, Yan, Zhang, Pan, Wang, Jian, Chang, Guiqiu, Shi, Chunlei·2016·BMJ Open
DOI 10.1136/bmjopen-2016-012540PMC PMC5013513
Open this paper in CoChat — free account

Abstract

Objectives: To evaluate the prevalence and determinants of anxiety and depression and to assess their impact on glycaemic control in participants with type 2 diabetes mellitus. Design: A cross-sectional study. Setting: Community-based investigation in Xuzhou, China. Participants: 893 Chinese men and women aged 18–84 years who fulfilled the inclusion criteria. Methods: People with type 2 diabetes completed the Pittsburgh Sleep Quality Index and the Zung Self-Rating Anxiety and Depression Scales. Demographic and physiological characteristics were recorded. Multiple logistic regression was used to evaluate the combined effect of factors associated with anxiety and depression and to assess the effects of anxiety and depression on glycaemic control. Results: The prevalence of depressive symptoms and anxiety symptoms was 56.1% and 43.6%, respectively. Multivariate logistic regression analysis indicated that anxiety symptoms were associated with being woman, low income, chronic disease, depressive symptoms and poor sleep quality. Depressive symptoms were associated with being woman, older age, low education level, being single, diabetes complications, anxiety symptoms and poor sleep quality. Glycaemic control was not related to anxiety symptoms (OR=1.31, 95% CIs 0.94 to 1.67) or depressive symptoms (OR=1.23, 95% CI 0.85 to 1.63). A combination of depressive symptoms and anxiety symptoms was associated with poor glycaemic control (relative excess risk due to interaction: 4.93, 95% CI 2.09 to 7.87; attributable proportion due to interaction: 0.27, 95% CI 0.12 to 0.45). Conclusions: There was a high prevalence of depressive and anxiety symptoms in this Chinese sample of participants, although depression and anxiety were not singly associated with glycaemic control. However, a combination of depressive and anxiety symptoms was negatively correlated with glycaemic control in participants with type 2 diabetes.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1136/bmjopen-2016-012540

Cites

0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Approximately 10%-40% of patients with diabetes experience depression, anxiety, or psychological distress due to worry when complications progress, self-care tasks become demanding, and frustration grows regarding uncontrolled blood glucose.

    “Approximately 10%-40% of patients with diabetes experience depression, anxiety, or psychological distress due to worry when complications progress, self-care tasks become demanding, and frustration grows regarding uncontrolled blood glucose (IDF, 2021;Sun et al., 2016).”

    From Effectiveness of acceptance and commitment therapy in people with type 2 diabetes mellitus: A systematic review and meta‐analysis. (2024) · cites this paper as Sun et al., 2016

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 48

  1. [2]National Diabetes Prevention and Control Cooperative Group. A mass survey of diabetes mellitus in a population of 300,000 in 14 provinces and municipalities in China. Zhonghua Nei Ke Za Zhi 1981; 20: 678– 83. 7341098
  2. [3]Xu Y, Wang L, He J, 2010 China Noncommunicable Disease Surveillance Group. Prevalence and control of diabetes in Chinese adults. JAMA 2013; 310: 948– 59. 10.1001/jama.2013.168118 24002281 · DOI
  3. [4]Diabetes in China: mapping the road ahead. Lancet Diabetes Endocrinol 2014; 2: 923 10.1016/S2213-8587(14)70189-5 25218726 · DOI
  4. [5]Lloyd CE, Pambianco G, Orchard TJ Does diabetes-related distress explain the presence of depressive symptoms and/or poor self-care in individuals with Type 1 diabetes? Diabet Med 2010; 27: 234– 7. 10.1111/j.1464-5491.2009.02896.x 20546270 PMC3093054 · DOI · Paper page
  5. [6]Roy T, Lloyd CE Epidemiology of depression and diabetes: a systematic review. J Affect Disord 2012; 142 (Suppl): S8– 21. 10.1016/S0165-0327(12)70004-6 23062861 · DOI · Paper page
  6. [7]Bouwman V, Adriaanse MC, van 't Riet E Depression, anxiety and glucose metabolism in the general Dutch population: the new Hoorn study. PLoS One 2010; 5: e9971 10.1371/journal.pone.0009971 20376307 PMC2848610 · DOI
  7. [8]Oztürk ZA, Yesil Y, Kuyumcu ME Association of depression and sleep quality with complications of type 2 diabetes in geriatric patients. Aging Clin Exp Res 2015; 27: 533– 8. 10.1007/s40520-014-0293-0 25409860 · DOI
  8. [9]Wang L, Song R, Chen Z Prevalence of depressive symptoms and factors associated with it in type 2 diabetic patients: a cross-sectional study in China. BMC Public Health 2015; 15: 188 10.1186/s12889-015-1567-y 25884919 PMC4349459 · DOI
  9. [10]Mikaliūkštienė A, Žagminas K, Juozulynas A Prevalence and determinants of anxiety and depression symptoms in patients with type 2 diabetes in Lithuania. Med Sci Monit 2014; 20: 182– 90. 10.12659/MSM.890019 24492643 PMC3930682 · DOI
  10. [12]Santos MA, Ceretta LB, Réus GZ Anxiety disorders are associated with quality of life impairment in patients with insulin-dependent type 2 diabetes: a case-control study. Rev Bras Psiquiat 2014; 36: 298– 304. 10.1590/1516-4446-2013-1230 25003555 · DOI
  11. [13]Kohen D, Burgess AP, Catalán J The role of anxiety and depression in quality of life and symptom reporting in people with diabetes mellitus. Qual Life Res 1998; 7: 197– 204. 10.1023/A:1008817812520 9584549 · DOI
  12. [15]Verma SK, Luo N, Subramaniam M Impact of depression on health related quality of life in patients with diabetes. Ann Acad Med Singapore 2010; 39: 913– 19. 21274488
  13. [17]Lee S, Chiu A, Tsang A Treatment-related stresses and anxiety-depressive symptoms among Chinese outpatients with type 2 diabetes mellitus in Hong Kong. Diabetes Res Clin Pract 2006; 74: 282– 8. 10.1016/j.diabres.2006.03.026 16701917 · DOI
  14. [18]Zhang CX, Chen YM, Chen WQ Association of psychosocial factors with anxiety and depressive symptoms in Chinese patients with type 2 diabetes. Diabetes Res Clin Pract 2008; 79: 523– 30. 10.1016/j.diabres.2007.10.014 18023910 · DOI
  15. [19]Zhang Y, Ting RZ, Yang W, China Depression in Chinese Patients with Type 2 Diabetes (DD2) Study Group. Depression in Chinese patients with type 2 diabetes: associations with hyperglycemia, hypoglycemia, and poor treatment adherence. J Diabetes 2015; 76: 800– 8. 10.1111/1753-0407.12238 PMC4964948 25349949 · DOI
  16. [20]Lou P, Qin Y, Zhang P Association of sleep quality and quality of life in type 2 diabetes mellitus: a cross-sectional study in China. Diabetes Res Clin Pract 2015; 107: 69– 76. 10.1016/j.diabres.2014.09.060 25458325 · DOI
  17. [21]Chinese Medical Association Diabetes Branch. Chinese Type 2 diabetes prevention and control guidelines (2010 edition). Chin J Diabetes 2012; 201: s1– 36.
  18. [22]Zung WW A rating instrument for anxiety disorders. Psychosomatics 1971; 12: 371– 9. 10.1016/S0033-3182(71)71479-0 5172928 · DOI · Paper page
  19. [24]Zhang J, Xu CP, Wu HX Comparative study of the influence of diabetes distress and depression on treatment adherence in Chinese patients with type 2 diabetes: a cross-sectional survey in the People's Republic of China. Neuropsychiatr Dis Treat 2013; 9: 1289– 94. 10.2147/NDT.S49798 24039431 PMC3770889 · DOI
  20. [26]Cooperative Meta-analysis Group of China Obesity Task Force. Predictive values of body mass index and waist circumference to risk factors of related disease in Chinese adult population. Zhonghua Liu Xing Bing Xue Za Zhi 2002; 23: 5– 10. 12015100
  21. [27]Buysse DJ, Reynolds CF III, Monk TH The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193– 213. 10.1016/0165-1781(89)90047-4 2748771 · DOI · Paper page
  22. [28]Liu X, Tang M, Hu L Reliability and validity of the Pittsburgh sleep quality index. Chin J Psychiatry 1996; 29: 103– 7.
  23. [29]Ahlbom A, Alfredsson L Interaction: a word with two meanings creates confusion. Eur J Epidemiol 2005; 20: 563– 4. 10.1007/s10654-005-4410-4 16119427 · DOI
  24. [31]Knol MJ, VanderWeele TJ, Groenwold RH Estimating measures of interaction on an additive scale for preventive exposures. Eur J Epidemiol 2011; 26: 433– 8. 10.1007/s10654-011-9554-9 21344323 PMC3115067 · DOI · Paper page
  25. [32]Khuwaja AK, Lalani S, Dhanani R Anxiety and depression among outpatients with type 2 diabetes: a multi-centre study of prevalence and associated factors. Diabetol Metab Syndr 2010; 2: 72 10.1186/1758-5996-2-72 21171976 PMC3022608 · DOI
  26. [33]Liu Y, Maier M, Hao Y Factors related to quality of life for patients with type 2 diabetes with or without depressive symptoms—results from a community-based study in China. J Clin Nurs 2013; 22: 80– 8. 10.1111/jocn.12010 23134147 · DOI
  27. [34]Mezuk B, Chen Y, Yu C Depression, anxiety, and prevalent diabetes in the Chinese population: findings from the China Kadoorie Biobank of 0.5 million people. J Psychosom Res 2013; 75: 511– 17. 10.1016/j.jpsychores.2013.09.008 24290039 PMC3919064 · DOI
  28. [35]Jiang Y, Dong W, Mao F Evaluation on the status quo of self monitoring of blood glucose and self-efficacy of diabetes patients in community. Zhonghua Yu Fang Yi Xue Za Zhi 2014; 48: 710– 14. 25388468
  29. [37]Li Y, Zhang S, Zhu J Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case-control study. Arthritis Res Ther 2012; 14: R215 10.1186/ar4054 23058191 PMC3580527 · DOI
  30. [38]Trento M, Trevisan M, Raballo M Depression, anxiety, cognitive impairment and their association with clinical and demographic variables in people with type 2 diabetes: a 4-year prospective study. J Endocrinol Invest 2014; 37: 79– 85. 24464454
  31. [39]Al-Tuwijri A, Al-Doghether M, Akturk Z Quality of life of people with diabetes attending primary care health centres in Riyadh: bad control good quality? Qual Prim Care 2007; 15: 307– 14.
  32. [40]Lord C, Buss C, Lupien SJ Hippocampal volumes are larger in postmenopausal women using estrogen therapy compared to past users, never users and men: a possible window of opportunity effect. Neurobiol Aging 2008; 29: 95– 101. 10.1016/j.neurobiolaging.2006.09.001 17030472 · DOI
  33. [42]Ryu YJ, Chun EM, Lee JH Prevalence of depression and anxiety in outpatients with chronic airway lung disease. Korean J Intern Med 2010; 25: 51– 7. 10.3904/kjim.2010.25.1.51 20195403 PMC2829416 · DOI
  34. [44]Mirza I, Jenkins R Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ 2004; 328: 794 10.1136/bmj.328.7443.794 15070634 PMC383372 · DOI
  35. [45]Khowaja LA, Khuwaja AK, Cosgrove P Cost of diabetes care in out-patient clinics of Karachi, Pakistan. BMC Health Serv Res 2007; 7: 189 10.1186/1472-6963-7-189 18028552 PMC2206019 · DOI
  36. [46]Tovilla-Zárate C, Juárez-Rojop I, Peralta Jimenez Y Prevalence of anxiety and depression among outpatients with Type 2 diabetes in the Mexican population. PLoS One 2012; 7: e36887. 22629339 PMC3356343
  37. [47]Almawi W, Tamim H, Al-Sayed N 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. J Endocrinol Invest 2008; 31: 1020– 4. 10.1007/BF03345642 19169060 · DOI
  38. [48]Ganatra HA, Zafar SN, Qidwai W Prevalence and predictors of depression among an elderly population of Pakistan. Aging Ment Health 2008; 12: 349– 56. 10.1080/13607860802121068 18728948 · DOI
  39. [49]Bensbaa S, Agerd L, Boujraf S Clinical assessment of depression and type 2 diabetes in Morocco: economical and social components. J Neurosci Rural Pract 2014; 5: 250– 3. 10.4103/0976-3147.133576 25002763 PMC4078608 · DOI
  40. [51]van Steenbergen-Weijenburg KM, van Puffelen AL, Horn EK More co-morbid depression in patients with Type 2 diabetes with multiple complications. An observational study at a specialized outpatient clinic. Diabetes Med 2011; 28: 86– 9. 21210541
  41. [52]Fisher L, Skaff MM, Mullan JT A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabetes Med 2008; 25: 1096– 101. 10.1111/j.1464-5491.2008.02533.x PMC2635496 19183314 · DOI · Paper page
  42. [53]Bot M, Pouwer F, de Jonge P Differential associations between depressive symptoms and glycaemic control in outpatients with diabetes. Diabetes Med 2013; 30: e115– 22. 10.1111/dme.12082 23181742 · DOI
  43. [54]Schmitt A, Reimer A, Kulzer B Negative association between depression and diabetes control only when accompanied by diabetes-specific distress. J Behav Med 2015; 38: 556– 64. 10.1007/s10865-014-9604-3 25326733 · DOI
  44. [56]Paschalides C, Wearden AJ, Dunkerley R The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus. J Psychosom Res 2004; 57: 557– 64. 10.1016/j.jpsychores.2004.03.006 15596162 · DOI
  45. [58]Alonso-Morán E, Satylganova A, Orueta JF Prevalence of depression in adults with type 2 diabetes in the Basque Country: relationship with glycaemic control and health care costs. BMC Public Health 2014; 14: 769 10.1186/1471-2458-14-769 25073532 PMC4129099 · DOI
  46. [59]Soravia LM, Heinrichs M, Aerni A Glucocorticoids reduce phobic fear in humans. Proc Natl Acad Sci USA 2006; 103: 5585– 90. 10.1073/pnas.0509184103 16567641 PMC1414637 · DOI
  47. [60]Oliver G, Wardle J Perceived effects of stress on food choice. Physiol Behav 1999; 66: 511– 15. 10.1016/S0031-9384(98)00322-9 10357442 · DOI
  48. [61]Sanchez-Villegas A, Henriquez P, Bes-Rastrollo M Mediterranean diet and depression. Public Health Nutr 2006; 9: 1104– 9. 10.1017/S1368980007668578 17378948 · DOI

Cited by

Sorted by citations

Authors
Sun, N., Lou, P., Shang, Y., Zhang, P., Wang, J., Chang, G., & Shi, C.
Affiliations
  • Xuzhou Cancer Hospital (CN)
  • Xuzhou Medical College (CN)
Corresponding author
Lou, Peian
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2016-08
Volume
6
Issue
8
Pages
e012540
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2016-012540
PMC
PMC5013513
OpenAlex
W2511420167
Cited by
132
References
62
Citations by year
2026: 4 · 2025: 9 · 2024: 23 · 2023: 19 · 2022: 17 · 2021: 15 · 2020: 11 · 2019: 19 · 2018: 6 · 2017: 8 · 2016: 1
FWCI
11.39
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
Government of Jiangsu Province
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
type 2 diabetes, depressive symptoms, anxiety symptoms, comorbid depression and anxiety, glycemic control, sleep quality, socioeconomic factors, diabetes complications, prevalence, Chinese adults
MeSH terms
Aged, Anxiety, China, Chronic Disease, Cross-Sectional Studies, Depression, Diabetes Mellitus, Type 2, Educational Status, Female, Glycated Hemoglobin, Humans, Income, Male, Middle Aged, Surveys and Questionnaires, Risk Factors, Sex Factors, Sleep, Sleep Wake Disorders, Prevalence, Multivariate Analysis, Logistic Models, Marital Status

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review