Depression and anxiety among patients with type 2 diabetes mellitus in Ibadan, Oyo State


Background: The psychosocial burden of Diabetes Mellitus (DM) and its debilitating consequences could result in depression and anxiety. Several studies had been conducted on depression alone among diabetics in Nigeria. However, only few studies in addition to depression have explored the prevalence of anxiety and anxiety comorbidity with depression.

Aim: To determine the prevalence and factors associated with anxiety or depression among Type 2 DM patients.

Methods: This was a hospital based cross-sectional survey. Systematic random technique was used to select 273 Type 2DM patients aged 40 years and above attending a secondary health facility in Ibadan, Nigeria. Depression and anxiety were assessed by using Zung’s Self Depression Rating Scale and Beck Anxiety Inventory respectively. Data was analyzed using the Chi square test and multivariate logistic regression with a P value set at 0.05.

Results: The mean age of the respondents was 62.1 (+10.2) years and majority were female (85.3%). The prevalence of depression, anxiety and comorbidity of depression and anxiety were 27.5%, 16.5% and 4.4% respectively. Physical inactivity and uncontrolled blood glucose were found among 48.4% and 61.5% respondents respectively. Depression was significantly associated with physical inactivity [OR=0.58; 95% CI=0.34-0.93] and low-moderate social support [OR=1.85; 95% CI=1.08-3.17], while anxiety was significantly associated with religion. The predictors of depression and anxiety were low social support (OR=0.58; 95% CI=0.33-0.95 p=0.04) and Christianity (OR=2.25; 95% CI=1.10-4.61, P=0.03) respectively.

Conclusion: We recommend that clinicians should screen Type 2 DM patients for depression and anxiety, assess their level of social support, educate on the importance of physical activity and encourage physical activity.

Keyword: Depression, Anxiety, Type 2 Diabetes Mellitus, Comorbidity, Social support.

Contexte: Le fardeau psychosocial du diabète sucré (DM) et ses conséquences débilitantes pourraient entraîner la dépression et l’anxiété. Plusieurs études ont été menées sur la dépression seule chez les diabétiques au Nigeria. Cependant, seulement peu d’études en plus de la dépression ont exploré la prévalence de l’anxiété et l’anxiété comorbidité avec la dépression.

Objectif: Déterminer la prévalence et les facteurs associés à l’anxiété ou à la dépression chez les patients atteints de DM de type 2.

Méthodes: Il s’agissait d’une enquête transversale en milieu hospitalier. Une technique aléatoire systématique a été utilisée pour sélectionner 273 patients de type 2DM âgés de 40 ans et plus fréquentant un établissement de santé secondaire à Ibadan, au Nigéria. La dépression et l’anxiété ont été évaluées en utilisant l’échelle d’évaluation de l’autodéfré dépression de Zung et l’inventaire de l’anxiété Beck respectivement. Les données ont été analysées à l’aide du test chi carré et de la régression logistique multivariée avec une valeur P fixée à 0,05.
Résultats: L’âge moyen des répondants était de 62,1 ans (+10,2 ans) et la majorité était une femme (85,3 %). La prévalence de la dépression, de l’anxiété et de la comorbidité de la dépression et de l’anxiété était de 27,5 %, 16,5 % et 4,4 % respectivement. L’inactivité physique et la glycémie incontrôlée ont été trouvées parmi 48,4 % et 61,5 % des répondants respectivement. La dépression était significativement associée à l’inactivité physique [OR=0,58; IC à 95 %=0,34-0,93] et à un soutien social faiblement modéré [OR=1,85; IC à 95 %=1,08-3,17], tandis que l’anxiété était significativement associée à la religion. Les prédicteurs de la dépression et de l’anxiété étaient un faible soutien social (OR=0,58; IC à 95 %=0,33-0,95 p=0,04) et christianisme (OR=2,25; IC à 95 %=1,10-4,61, P=0,03) respectivement.

Conclusion: Nous recommandons aux cliniciens de dépister la dépression et l’anxiété chez les patients de type 2, d’évaluer leur niveau de soutien social, d’éduquer sur l’importance de l’activité physique et d’encourager l’activité physique.

Mots-clés: Dépression, Anxiété, Diabète sucré de type 2, Comorbidité, Soutien social.

Correspondence: Prof. Olufunmilayo I. Fawole, Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Email address:; Tel:08032180302



World Health Organization. Global report on diabetes. Geneva 2016. Accessed on 12/4/17.

International Diabetes Federation, Diabetes atlas, 7th edition. Brussels 2015.

Diabetes Association of Nigeria. Clinical practice guidelines for diabetes management in Nigeria, 2nd Edition. 2013. Available at: Accessed on 24/5/2017.

World Health Organization. Depression Factsheet. WHO Geneva, Media centre Feb 2017. Accessed on 15/3/17. 5. Bickett A, Tapp H. Anxiety and diabetes: Innovative approaches to management in primary care. Exp Biol Med (Maywood). 2016; 241(15): 1724–1731.

Holt RI, de Groot M and Golden SH. Diabetes and depression. Curr Diab Rep. 2014;14(6):491.

Faravelli C, Lo Sauro C, Lelli L. et al. The role of life events and HPA axis in Anxiety disorders: A Review. Curr Pharm Des. 2012; 18(00):1-11.

Berge LI and Riise T. Comorbidity between type 2 diabetes and depression in the adult population: directions of the association and its possible pathophysiological mechanisms. Inter J Endocrinol. 2015; 2015:164-760.

Rajput R, Gehlawat P, Gehlan D, Gupta R and Rajput M. Prevalence and predictors of depression and anxiety in patients of diabetes mellitus in a tertiary care center. Indian J Endocrinol Metab. 2016;20(6):746–751.

Collins MM., Corcoran P and Perry IJ. Anxiety and depression symptoms in patients with diabetes. Diabet Med. 2009; 26(2):153-161.

Mossie TB, Berhe GH, Kahsay G.H and Minale T. Prevalence of Depression and Associated Factors among Diabetic Patients at Mekelle City, North Ethiopia. Indian J Psychol Med. 2017;39(1): 52–58.

Egede LE and Ellis C. Diabetes and depression: Global perspectives. Diabet Res & Clin Pract. 2010;87: 302 – 312.

Vermani M, Marcus M and Katzman MA. Rates of Detection of Mood and Anxiety Disorders in Primary Care: A Descriptive cross-sectional study. Prim Care Companion CNS Disord. 2011;13.2

Mosaku K, Kolawole B, Mume C and Ikem R. Depression, Anxiety and quality of life among diabetic patients: A comparative study. J Nat Med Ass. 2008;100:173-178.

Zung WW. A self-rating depression scale. Arch Gen Psychiatry. 1965; 12:63-70.

Zung WW, Magruder-Habib K, Velez R and Alling W. The comorbidity of anxiety and depression in general medical patients: a longitudinal study. Clin Psychiatry. 1990; 15:77-80.

Beck AT, Epstein N, Brown G and Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988; 56:893–897.

Zimet GD, Dahlem NW, Zimet SG and Farley GK. The Multidimensional Scale of Perceived Social Support. J Pers Assess. 1988;52(1):30–41.

Odume BB, Ofoegbu OS, Aniwada EC and Okechukwu EF. The influence of family characteristics on glycaemic control among adult patients with type 2 diabetes mellitus attending the general outpatient clinic, National Hospital, Abuja, Nigeria. South Afri Fam Prac. 2015;57 (6):347-352.

World Bank. Nigeria poverty rate. Available at: 848651492188167743/mpo-nga.pdf. Accessed on 10/10/2017

Nouwen A, Winkley K, Twisk J, et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010; 53:2480–2486.

Anderson RJ, Grigsby AB, Freedland KE et al. Anxiety and poor glycaemic control: a meta-analytic review of the literature. Int J Psychiatry Med. 2002;32(3):235-47.

Koopman B, Pouwer F, de Bie RA, et al. Depressive symptoms are associated with physical inactivity in patients with type 2 diabetes. The DIAZOB Primary Care Diabetes study. Fam Pract. 2009; 26:171-173.

Lysy Z, Da Costa D and Dasgupta K. The association of physical activity and depression in Type 2 diabetes. Diab Med. 2008;25(10):1133-1141.

Colberg SR, Sigal RJ, YardleyJE, et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016; 39(11): 2065-2079.

Rizvi S and Khan AM. Physical activity and its association with depression in the diabetic Hispanic population. Cureus. 2019;11(6):e4981.

Zhang W, Xu H, Zhao S. et al. Prevalence and influencing factors of co-morbid depression in patients with type 2 diabetes mellitus: A General Hospital based study. Diabetol & Metab Syndr. 2015; 7:60.

Lee JY, Wong CP, Tan CS, Nasir NH and Lee SW. Type 2 diabetes patient’s perspective on Ramadan fasting: a qualitative study. BMJ Open Diabet Res Care. 2017; 5:e000365.

Amin A, Kumar SS, Mishra S, et al. Effects of fasting during Ramadan month on depression, anxiety and stress and cognition. Int J Med Res & Rev; 2016;4(5):771-777.