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Diabet Med. 2008 Sep;25(9):1096-101. doi: 10.1111/j.1464-5491.2008.02533.x.

A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes.

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Department of Family & Community Medicine, School of Nursing, University of California, San Francisco, CA 94143, USA.



To report the prevalence and correlates of affective and anxiety disorders, depressive affect and diabetes distress over time.


In a non-interventional study, 506 patients with Type 2 diabetes were assessed three times over 18 months (9-month intervals) for: major depressive disorder (MDD), general anxiety disorder (GAD), panic disorder (PANIC), dysthymia (DYS) (Composite International Diagnostic Interview); depressive affect [Center for Epidemiological Studies-Depression (CES-D)]; Diabetes Distress Scale (DDS); HbA(1c); and demographic data.


Diabetic patients displayed high rates of affective and anxiety disorders over time, relative to community adults: 60% higher for MDD, 123% for GAD, 85% for PANIC, 7% for DYS. The prevalence of depressive affect and distress was 60-737% higher than of affective and anxiety disorders. The prevalence of individual patients with an affective and anxiety disorder over 18 months was double the rate assessed at any single wave. The increase for CES-D and DDS was about 60%. Persistence of CES-D and DDS disorders over time was significantly greater than persistence of affective and anxiety disorders, which tended to be episodic. Younger age, female gender and high comorbidities were related to persistence of all conditions over time. HbA(1c) was positively related to CES-D and DDS, but not to affective and anxiety disorders over time.


The high prevalence of comorbid disorders and the persistence of depressive affect and diabetes distress over time highlight the need for both repeated mental health and diabetes distress screening at each patient contact, not just periodically, particularly for younger adults, women and those with complications/comorbidities.

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