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Prevalence and determinants of depressive and anxiety symptoms in adults with type 2 diabetes in China: a cross-sectional study
Open accessAbstract
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.
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“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
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“However, another study found that the prevalence of depression and anxiety in patients with diabetes was higher than that in our study [41].”
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“43,52 The score index of DRSCA in the study was similar to the results of some other studies.”
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“Less-educated individuals may lack the accessibility to reliable information about diabetes and its complications, and this may cause them to worry about their disease status, thereby increasing the risk of developing depression [9].”
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“More recent research has demonstrated a marked increase in the frequency, with between 48.27 and 57.9% suffering from anxiety and between 43.5 and 56.1% suffering with depression (Khuwaja et al., 2010; Sun et al., 2016; Tovilla-Zarate et al., 2012).”
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“The prevalence of such illnesses is high among patients with diabetes.(28) Moreover, resilience has been regarded as an essential factor contributing to longevity and well-being.”
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“*,P < 0.05 **,P < 0.01. increase tissue sensitivity to insulin action and help glucose control(Dominic, 2010; Timar et al., 2016).”
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“21 Some of studies suggested that depression has a direct impact on the index of diabetes self-care behavior, 22,23 especially diet, exercise and glucose self-testing.”
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Prevalence and Predictors of Anxiety and Depression in Indian Patients with Type 2 Diabetes
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“These findings align with previous research by Trento et al. and Sun et al. 38,39 In the current study, occupation and education status did not show any significant association with depression and anxiety.”
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“Some studies showed that female gender constituted a major risk factor for depression, anxiety and stress with a percentage of approximately 50%–60% in comparison with our study, in which we found a greater predominance.[16,18,27] Likewise, primary level of education was considered a significant risk factor for the th…”
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“108 Introduction According to a national survey, about 592 million people worldwide will be affected by diabetes mellitus by 2035 (1).”
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“However, the data we reviewed were scarce, and all of them were consistent with our findings[19,22,26,29] except for two studies from Tunisia and Guinea.”
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“[10,11] In this study, longer diabetes duration was associated with higher depressive symptoms.”
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“Numerous cross-sectional surveys of prevalence of depression in Chinese T2DM patients have been conducted [24, 25].”
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Anxiety and Depression Among Patients with Diabetes in Saudi Arabia and Egypt
Mahmoud, M. R., Aljadani, A., Mahmood, A. A. R., Alshammari, R. F., Shahien, M. M., Ibrahim, S., Khalik, A. A., Alenazi, F., Alreshidi, F. S., Nasr, F. M., et al. (2024) · Healthcare · doi:10.3390/healthcare12212159 · Cited by 6
“In Malaysian and Chinese patients with diabetes, the likelihood of anxiety was considerably increased by the presence of depression [34,45].”
BackgroundMohamed, N. A., Mohamud, R. Y. H., Hilowle, F. H., Mohamed, Y. A., & Mohamed, H. N. (2024) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s479583 · Cited by 8
“45 On the other hand, the findings of the current study were higher than those of the studies performed in southwest Ethiopia, 46 Bangladesh, 32 China, 47 and Sudan.”
ResultChireh, B., Essien, S. K., D’Arcy, C., Gyan, C., & Ankrah, M. (2024) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2024.100720 · Cited by 6
Shi, Q., Ding, J., Su, H., Du, Y., Pan, T., & Zhong, X. (2023) · Psychology Research and Behavior Management · doi:10.2147/prbm.s441058 · Cited by 10
Translation and localization the Persian version of diabetes distress scale among type 2 diabetes
Jafari, A., Tehrani, H., Mansourian, M., Nejatian, M., & Gholian‐Aval, M. (2023) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-023-01173-z · Cited by 6
“Introduction Diabetes has significant clinical concerns due to its high prevalence and its clinical relationship with disease management, drug adherence, blood sugar control and quality of life, and diabetes is associated with an increased risk of mental disorders [1, 2].”
BackgroundMaimaitituerxun, R., Chen, W.-H., Xiang, J., Xie, Y., Kaminga, A., Wu, X.-Y., Chen, L.-T., Yang, J.-Z., Liu, A.-Z., & Dai, W. (2023) · Psychiatric quarterly · doi:10.1007/s11126-023-10040-z · Cited by 6
“For example, in a study in China, the Zung Self-Rating Anxiety and Depression Scale were used to assess anxiety [21], while in studies of Kerman and Mexican, the Hamilton Anxiety Rating Scale was used to assess anxiety [32, 35].”
BackgroundMethodCampos, S., Araya, S. B., Masalán, P., Tobar, V. G., Arias-Ortiz, N. E., & Bobadilla-Beiza, L. (2022) · Enfermería Clínica (English Edition) · doi:10.1016/j.enfcle.2021.03.004 · Cited by 11
Tang, Y., Zhang, Y., Su, H., Lv, Y., Sun, M., & Yu, L. (2025) · Behavioral Sciences · doi:10.3390/bs16010015 · Cited by 5
“For instance, a cross-sectional study of Chinese patients with T2DM reported that 56.1% exhibited anxiety symptoms, while 43.6% presented with depressive symptoms (Sun et al., 2016).”
InfluentialKhiro, M. A. K., Alshahrani, A., Jabali, S. H., Alyahya, Y. A., & Alamri, M. (2024) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1174_23 · Cited by 5
Majeed, M., Gupta, R., Kumari, R., Langer, B., Mir, M. T., Mahajan, R., Gupta, R., Bala, J., Manhas, S., & Sumaira (2023) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_2178_22 · Cited by 5
“These results are in agreement with Sun N, et al.[10] and Mirzaei Table 2: Association of personal history with depression, anxiety and stress among the study population”
ResultCampos, S., Araya, S. B., Masalán, P., Tobar, V. G., Arias-Ortiz, N. E., & Bobadilla-Beiza, L. (2021) · Enfermería Clínica · doi:10.1016/j.enfcli.2021.03.002 · Cited by 7
Factors related to depressive symptoms in older adult patients with type 2 Diabetes Mellitus
Filho, B. F. D. L., Dias, V. D. N., Carlos, A. G., Fontes, F. P., de Sousa, A. G. P., & Gazzola, J. M. (2018) · Experimental Gerontology · doi:10.1016/j.exger.2018.11.006 · Cited by 7
“The association of DM2 with depressive symptoms may affect the quality of life of older adults and increase their risk of morbidity and deterioration in functional activities (Sun et al., 2016).”
Bagheri, S., Mosallanezhad, M., Barzgar, F., & Amiri, A. (2021) · Family Medicine & Primary Care Review · doi:10.5114/fmpcr.2021.108190 · Cited by 7
“The results of the studies indicate an increased risk of depression and anxiety in diabetic patients [7].”
BackgroundZu, W., Li, F., Ma, X., Zhang, S., Nie, W., & Wang, L. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100843 · Cited by 4
Patarathipakorn, O., Ruchiwit, M., & Smith, M. C. (2021) · The Open Public Health Journal · doi:10.2174/1874944502114010104 · Cited by 5
Ilori, H. T., & Ajetunmobi, O. (2019) · Journal of Advances in Medicine and Medical Research · doi:10.9734/jammr/2019/v29i230060 · Cited by 4
“1% [18,19] but higher than that observed previously among Nigerian with type 2 DM by Agbir et al (19.”
Predictors of Depressive Symptoms Among Mid-Aged and Older Men With Diabetes in China
He, P., Hu, Y., Li, C.-W., Wu, D.-M., Ge, S., & Liu, T. (2019) · Research and Theory for Nursing Practice · doi:10.1891/1541-6577.33.1.6 · Cited by 4
“Keywords: China; depression; diabetes; men China is now home to the world’s largest number of people with diabetes,and this diabetes epidemic will continue to increase (International DiabetesFederation, 2017).”
BackgroundInfluentialNiu, S.-L., Li, R., Yuan, L., & Huang, D. (2025) · Journal of Diabetes Research · doi:10.1155/jdr/9142949 · Cited by 3
“It may be attributed to the significant increase in the risk of complications associated with chronic disease, coupled with the burden of healthcare expenditure, treatment, societal judgment, and self-blame, all of which can profoundly impact the emotional well-being of patients [28 – 30].”
Effects of glycemic control on frailty: a multidimensional perspective
Abdelhafiz, A. H. (2023) · Hospital Practice · doi:10.1080/21548331.2023.2203622 · Cited by 3
“In addition, the cross-sectional design of both studies may have limited their conclusion of a causal relationship [80,85].”
BackgroundLiu, Y., Chen, L., Zhou, H.-W., Guan, H., Feng, Y.-Q., yangji, B., Liu, Q., Liu, X., Xia, J., Li, J.-Z., et al. (2022) · Journal of Affective Disorders · doi:10.2139/ssrn.4000669 · Cited by 3
Tip 2 diyabet hastalarında anksiyete ve depresyon riski ve ilişkili faktörler
Sayın, S., Sayın, S., Bursalı, B., & İpek, H. B. (2019) · Cukurova Medical Journal · doi:10.17826/cumj.463589 · Cited by 3
Liu, P., Zeng, T., Cai, L., Wang, J., & Xue, L. (2021) · Indian Journal of Pharmaceutical Sciences · doi:10.36468/pharmaceutical-sciences.spl.180 · Cited by 3
Self-citationMental Disorders in Subjects with Diabetes: A Systematic Review
Acc, O., Vm, A., Mg, C., Nardi, A., & Kinrys, G. (2017) · Health Care Current Reviews · doi:10.4172/2375-4273.1000216 · Cited by 3
“[32] studied 893 participants and found 56.”
BackgroundInfluentialBusili, A., Kumar, K., Kudrna, L., & Rabbani, U. (2025) · Medicine · doi:10.1097/md.0000000000043112 · Cited by 2
Xiao, W.-H., Yang, X., Xu, S., Bian, Y., & Zou, G.-Y. (2025) · World Journal of Diabetes · doi:10.4239/wjd.v16.i4.100638 · Cited by 2
Jiang, L., Yan, J., Yao, J., Xi, J., Chen, Y., Deng, Y., Zhang, W., Yuan, Y., & Yang, X. (2024) · Medicine · doi:10.1097/md.0000000000038094 · Cited by 2
Shang, W., Yan, L., Sun, Y., Pan, R., Dang, Y., Wen, J., & Wang, L. (2024) · PeerJ · doi:10.7717/peerj.16954 · Cited by 1
Sala-Cîrtog, M., & Sîrbu, I. O. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25021114 · Cited by 5
“Depression increases the risk of suicide but also of chronic disorders such as cardiovascular diseases, diabetes, or cancer [2–5].”
BackgroundGriffin, M. M., Mitchell-Gillespie, B., Hashim, H., & AlHeresh, R. (2021) · Disabilities · doi:10.3390/disabilities1040031 · Cited by 2
Heriningsih, W. P., Agustin, R., Badriyah, F. L., Priyono, D., Desriva, N., Rosyad, Y. S., & Rias, Y. A. (2021) · Jurnal Aisyah Jurnal Ilmu Kesehatan · doi:10.30604/jika.v6i2.478 · Cited by 1
“…well known that being female is significantly correlated within general populations (Biswas Gender Differences and White Blood Cells on Anxiety Symptoms in Type 2 Diabetes Mellitus: A Community-Based Study et al., 2020) and also among individulas with T2DM (Dehesh et al., 2020; Sun et al., 2016).”
BackgroundMethodInfluentialEarly Combination Therapy for Type 2 Diabetes Mellitus and Common Comorbid Mental Disorders
Bailey, R. K., Sharpe, D. K., Ringel, M., & Zeeshan, A. (2018) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20160048 · Cited by 2
Tamene, F. B., Moges, T. A., Tarekegn, G. Y., Dagnew, S. B., Zerihun, T. E., Kassaw, A. T., Mussie, D. A., Bekalu, A. F., Zewdu, W. S., & Wondm, S. A. (2026) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2026.101097 · Cited by 1
Upaphong, P., Choovuthayakorn, J., Choovuthayakorn, J., Phinyo, P., Patikulsila, D., Nanegrungsunk, O., Chaikitmongkol, V., Kunavisarut, P., Apivatthakakul, A., Wongpakaran, N., et al. (2025) · Clinical ophthalmology · doi:10.2147/opth.s524850 · Cited by 3
Ji, Y., He, P., Zhou, Y., Yao, H., Xue, Y., Jing, R., Zhang, T., Sun, W., Lu, P., Cui, B., et al. (2025) · Diabetes Epidemiology and Management · doi:10.1016/j.deman.2025.100259 · Cited by 1
Shevkunova, N., Butyugin, I., Bulycheva, E., Trezubov, V., & Valeev, E. (2024) · The actual problems in dentistry · doi:10.18481/2077-7566-2024-20-3-86-90 · Cited by 1
Rinaldi, M. R., & Yuniarti, K. W. (2023) · Proceedings of International Conference on Psychological Studies (ICPsyche) · doi:10.58959/icpsyche.v4i1.43
“Furthermore, specifically in several countries, such as 15.8% in Thailand (Veerabenjapol et al., 2010), 15.9% in Malaysia (Muthana et al., 2022), 25.9%-56.1% in China (Liu et al., 2022; Sun et al., 2016), and 19.9% in the Philippines (Victoria & Dampil, 2019).”
BackgroundInfluentialHà, H. X., Nguyễn, P. T. N., Nguyễn, D. K., & Thái, T. (2023) · Tạp chí Y Dược học Cần Thơ · doi:10.58490/ctump.2023i59.1678 · Cited by 1
Validity and reliability of an Emotional Thermometer tool: an exploratory cross-sectional study
Cheng, C., Yang, C.-Y., Zhou, M., Bai, J., Inder, K., & Chan, S. (2023) · Contemporary Nurse: health care across the lifespan · doi:10.1080/10376178.2023.2217952 · Cited by 1
“Considering the high prevalence of psychological symptoms among Chinese people with chronic diseases (Chen et al., 2015; Sun et al., 2016), a validated and convenient Chinese version of a screening instrument such as the ET is required for future healthcare.”
BackgroundHu, M.-Y., Shi, J., Wu, H., & Wang, Z.-Y. (2023) · Highlights in Science Engineering and Technology · doi:10.54097/hset.v45i.7329 · Cited by 1
Bakır, B., & Çalapkorur, S. (2023) · International Journal of Psychiatry in Medicine · doi:10.1177/00912174231164289 · Cited by 1
“There are inconsistent data in the literature about the relationship of glycemic control with anxiety and depression in diabetes.(14,16,25) Besides, patients with exercise habits had significantly lower anxiety/depression scores, but the physical activity level of participants could not be assessed with a more precise…”
BackgroundAnsiedade e/ou depressão em pessoas com diabetes mellitus tipo 2
Moreira, J. C., de Aguiar, A. S. C., Borges, C. B. C. S., Leite, P. A. R., Barros, K. V., & Lopes, T. S. D. S. (2022) · Revista Enfermagem Atual In Derme · doi:10.31011/reaid-2022-v.96-n.38-art.1318 · Cited by 2
“Em um estudo envolvendo 893 participantes com DM2, a taxa de bom controle glicêmico foi de 19,8% (99/501) em pacientes com sintomas de ansiedade e de 19,3% (75/389) em pacientes com sintomas de depressão, demonstrando um risco maior de controle glicêmico deficiente em comparação com pacientes sem sintomas depressivos…”
BackgroundInfluentialÇiçek, S. C., Coşkun, H., Ozdemir, S., Acikgoz, A., & Isko, S. (2021) · doi:10.5455/annalsmedres.2020.07.779 · Cited by 1
“In the literature, there have been different studies describing psychosocial problems seen in individuals with diabetes (6, 9-11, 17, 20).”
BackgroundThe Prevalence of Psychological Disorders among Diabetic Patients in Al-Madinah, Saudi Arabia
Aljohani, A., Al-Namlah, S. S., Fallatah, A., Sharif, S. A., Khayat, F. M., & Almaghrabi, R. Y. (2022) · Pharmacophore · doi:10.51847/jxdyxjdhwe · Cited by 1
The Adaptation of a Perceived Walkability Questionnaire for Adults Living in Northern Climates
Takacs, T. (2017) · doi:10.20381/ruor-21327 · Cited by 1
“However, with crosssectional studies, it is difficult to determine the direction of causality (Levin, 2006; Sun et al., 2016).”
BackgroundSilva, R. R., da Costa, M. S., Almeida, L. A. L., Cruz, P. P., Silva, R. R., Alves, A. C., de Sousa, R. D., & Cassilhas, R. C. (2026) · Journal of Diabetes and Metabolic Disorders · doi:10.1007/s40200-026-02079-z
“In another study, the analysis found that disease duration exceeding 10 years increased the odds of depression by 2.18 times compared with those with a duration of less than 5 years (adjusted OR = 2.18; 95% CI: 1.16–4.11) [42].”
InfluentialLatent profiles of diabetes distress and determinants in type 2 diabetes patients
Li, S.-Y., Zheng, P., Gao, J., Xia, L.-H., Liu, M., Zhang, Y.-H., & Di, Z. (2026) · BMC Psychology · doi:10.1186/s40359-026-05210-0
“For instance, research has revealed that among a cohort of 893 Chinese community-dwelling individuals with T2D, the rates of depressive symptoms and anxiety are markedly elevated, at 56.1% and 43.6%, respectively [8].”
InfluentialCai, S., Gu, H., Zhao, L.-H., & Chen, H. (2026) · World Journal of Psychiatry · doi:10.5498/wjp.v16.i4.115233
Amsah, N., Isa, Z., Ahmad, N., Kassim, Z., & Mohamad, S. N. A. (2026) · The Pan African Medical Journal · doi:10.11604/pamj.2026.53.116.47001
“Similar trends have been observed in studies from China and Pakistan, where older age was identified as a risk factor for depression among individuals with T2DM [19,20].”
Health risk behaviours, mental health and HbA1c: an overview of reviews of observational studies
Mazumdar, S., Almeda, N., Bagheri, N., Daniel, M., Tabatabaei‐Jafari, H., Leigh, G., Díaz-Milanés, D., & Salvador‐Carulla, L. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-092657
“30 36 These factors were chosen based on previous research on the taxonomy of health-related habits and lifestyles (eVITAL), 31 37 and analysis of the relationships between local characteristics and cardiometabolic health.”
Metadata
- 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)
- 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
- gold
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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
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