Academic journal article South African Journal of Psychiatry

Anxiety, Depression and Psychological Well-Being in a Cohort of South African Adults with Type 2 Diabetes Mellitus

Academic journal article South African Journal of Psychiatry

Anxiety, Depression and Psychological Well-Being in a Cohort of South African Adults with Type 2 Diabetes Mellitus

Article excerpt


There has been an alarming increase in diabetes mellitus (DM) prevalence rates globally. The International Diabetes Federation (IDF) revealed that in 2014 the global prevalence rate was estimated to be 8.2%, with about 382 million people living with the disease. This figure is projected to increase to 592 million by 2035. (1) The IDF projects that the global figure of 21.5 million people estimated to be living with diabetes in 2014 will increase dramatically to 41.5 million in 2035. In Africa, the prevalence rate is estimated to be 5.1%. (2) South Africa has a prevalence rate of 9.27% and has the second highest number of people in Africa living with the disease--an estimate of 2.6 million. (3) In 2012, DM was the fifth leading cause of death in South Africa and the third leading cause of death in KwaZulu-Natal. (4)

In recent years, much attention has been paid to the psychological well-being of patients with diabetes. (5) The cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study, conducted by Peyrot et al. (6) in Asia, Australia, Europe and North America in 2005, found that 41% of patients with DM reported poor psychological well-being. Furthermore, they found that 61%-72% of health-care providers reported that their patients with DM had psychological problems, which included depression, anxiety, stress and burnout. Karlsen et al. (7) found that poor psychological well-being was more prevalent among people with Type 2 diabetes compared with people with Type 1 diabetes.

The high levels of poor psychological well-being thus become an important issue to be addressed in the management of diabetes. However, Pouwer et al. (8) state that while psychological well-being is understood to be an important goal in diabetes management, often little attention is paid to addressing these psychological aspects of the disease.

Most studies using the Hospital Anxiety and Depression Scale (HADS) found that DM is associated with increased levels of anxiety and depression. (9,10,11,12) Longitudinal studies done by Engum (13) and Fisher et al. (14) also found that patients with DM have elevated levels of anxiety and anxiety symptoms.

Anderson et al. (15) and Ali et al. (16) report that the odds of depression in diabetic groups were twice those of the non-diabetic comparison groups, and this did not differ by sex, type of diabetes, subject source or assessment method. Coexisting depression in people with DM is associated with decreased adherence to treatment, poor metabolic control, higher complication rates and decreased quality of life. (17) As a result, patients with DM often experienced feelings of poor well-being, stress and anxiety. (18) Studies also show that women report higher levels of depression, anxiety and stress compared with men. (12,19)

From the above discussion, it can be seen that there is a growing body of evidence to support the view that, in addition to the medical/pharmacological management of people with diabetes, the management of psychological, psychiatric and social aspects is also essential. This is necessary given the high levels of anxiety and depression found in people with diabetes.

In South Africa, there is a paucity of studies on the psychological issues associated with DM. We hypothesise that the presence of anxiety and depressive features decreases the well-being of patients with Type 2 diabetes. To our knowledge, a study of this nature has not been done in South Africa.


Patients with Type 2 DM were recruited from two public facilities and five private general medical practices situated on the North Coast of KwaZulu-Natal, South Africa.


Patient volunteers, 18 years and older, diagnosed with Type 2 DM at least 6 months previously and able to speak either English or isiZulu, were included in the study. Patients who were intellectually impaired and/or who had serious medical complications that decreased their quality of life (e. …

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