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Diabetes, Common Mental Disorders, and Disability: Findings From the UK National Psychiatric Morbidity Survey

From the Institute of Psychiatry (J.D.-M., R.S., K.I.R.J., M.J.P.), King’s College London, London, UK, and the Department of Mental Health Sciences (P.E.B.), Royal Free and University College Medical School, London, UK.

Address correspondence and reprint requests to Jayati Das-Munshi, Section of Epidemiology, Institute of Psychiatry, King’s College London, PO 60, De Crespigny Park, London SE5 8AF, UK. E-mail: spsljdm{at}iop.kcl.ac.uk

Objectives: To determine a) the associations between diabetes and common mental disorders in a nationally representative sample and the effect of key covariates on such associations and b) the association of comorbid common mental disorders on the quality of life and diabetes self-care indicators.

Methods: In a cross-sectional survey, people with diabetes were identified from a sample of 8580 individuals aged 16 to 74 years, drawn from the 2000 UK National Psychiatric Morbidity Survey. Diabetes was ascertained by self-report and prescribed medications. Psychiatric morbidity was assessed using the Revised Clinical Interview Schedule. Quality of life was measured using the Short Form-12, and questions were asked regarding diabetes self-care and functioning.

Results: A total of 249 individuals were identified with diabetes. People with diabetes were more likely to suffer from common mental disorders (odds ratio (OR) = 1.5; 95% Confidence Interval (CI): 1.1–2.2; p < .05), and in particular mixed anxiety and depression (OR: 1.7; 95% CI: 1.1–2.6; p < .05), after controlling for age, gender, ethnicity, and socioeconomic status. The increased risk was uniform across diabetes subtypes. Among people with diabetes, common mental disorders were significantly associated with impaired health-related quality of life, more days off work, nonadherence, and difficulties with diabetes self-care.

Conclusions: People with diabetes are more likely to suffer from common mental disorders, a finding which is highly relevant, given that psychiatric comorbidity in people with diabetes is also associated with higher levels of functional impairment, impaired quality of life, and difficulties with diabetes self-care.

Key Words: diabetes • depression • anxiety • disability • diabetes self-care

Abbreviations: UK NPMS = United Kingdom National Psychiatric Morbidity Survey; ICD-10 = International Classification of Diseases-10; CIS-R = Clinical Interview Schedule-Revised; OCD = obsessive compulsive disorder; GAD = generalized anxiety disorder; MADD = mixed anxiety and depression disorder; ADLs = activities of daily living; SF-12 = Short Form-12 (Health-Related Quality of Life).