What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type II diabetes (n=2508). Primary outcome: Depression symptoms (associated with family history of psychiatric illness) (aOR 2.8, 95% CI 1.1-7.0, p=0.030).

May 27, 2013Open Access

Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting

Key Result

Among Type II diabetics in Malaysia, the prevalence of depression, anxiety, and stress symptoms was 11.5%, 30.5%, and 12.5%, with a family history of psychiatric illness being the strongest predictor.

Study Design

Type

Cross-Sectional (n=2,508)

Multicenter

Yes

Structured PICO

Population

2,508 adults (age ≥30 years) with Type II diabetes for at least 6 months, attending 12 government primary care clinics in the urban Klang Valley, Malaysia. Mean age 56.6, 61.1% female. Excluded: known medically diagnosed psychiatric illness, cognitive impairment, and post-partum females.

Outcome

Prevalence and predictors of depression, anxiety, and stress symptoms measured by the Depression, Anxiety and Stress Scale (DASS) 21 questionnairepatient reported

There is a high prevalence of anxiety, stress, and depression symptoms among Type II diabetics in urban Malaysia, highlighting the need for routine psychological screening in primary care.

Main Result

Effect estimate: aOR 2.8 (95% CI 1.1-7.0)

p-value: p=0.030

Limitations

Cross-sectional design does not allow for cause and effect relationships to be studied
DASS 21 questionnaire is only a screening tool and not diagnostic of specific psychiatric disorders
Possibility of recall biases from respondents
Possible under-reporting of family history of psychiatric illness due to societal stigma

Abstract

BACKGROUND: Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, Malaysia. METHODS: The study was cross sectional in design and carried out in 12 randomly selected primary care government clinics in the Klang Valley, Malaysia. A total of 2508 eligible consenting respondents participated in the study. The Depression, Anxiety and Stress Scale (DASS) 21 questionnaire was used to measure depression, anxiety and stress symptoms. Data was analyzed using the SPSS version 16 software using both descriptive and inferential statistics. RESULTS: The prevalence of depression, anxiety and stress symptoms among Type II diabetics were 11.5%, 30.5% and 12.5% respectively. Using multiple logistic regression, females, Asian Indians, marital status (never married, divorced/widowed/separated), a family history of psychiatric illness, less than 2 years duration of diabetes and current alcohol consumption were found to be significant predictors of depression. For anxiety, unemployment, housewives, HbA1c level of more than 8.5%, a family history of psychiatric illness, life events and lack of physical activity were independent risk factors. Stress was significantly associated with females, HbA1c level of more than 8.5%, presence of co-morbidity, a family history of psychiatric illness, life events and current alcohol consumption. For depression (adjusted OR 2.8, 95% CI 1.1; 7.0), anxiety (adjusted OR 2.4, 95% CI 1.1;5.5) and stress (adjusted OR 4.2, 95% CI 1.8; 9.8), a family history of psychiatric illness was the strongest predictor. CONCLUSION: We found the prevalence of depression, anxiety and stress symptoms to be high among Type II diabetics, with almost a third being classified as anxious. Screening of high risk Type II diabetics for depression, anxiety and stress symptoms in the primary care setting is recommended at regular intervals.

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