Anxiety and depression in diabetes care: longitudinal associations with health-related quality of life

Abstract

Anxiety and depression are commonly found in patients with diabetes, but little is known about how the anxiety and depression symptoms of diabetes patients and the health-related quality of life (HRQoL) over time influence each other. Therefore, we conducted a survey among patients with diabetes (T1) and repeated the survey after 3 months (T2). Linear regression models and cross-lagged structural equation models were used to analyze the associations between anxiety and depression symptoms and HRQoL within and across time intervals. Correcting for baseline index and potential confounders, the HRQoL index at T2 reflected the change in anxiety/depression between T1 and T2 more than anxiety/depression at T1 (P < 0.05). Similarly, anxiety and depression at T2 reflected the change in the EQ-5D index over time more than the index at baseline (P < 0.05). Our longitudinal data fitted well in a cross-lagged model with bi-directional pathways of associations between anxiety and HRQoL, as well as depression and HRQoL, among adult patients with diabetes (x²/df = 1.102, P = 0.256; CFI = 1.000, RMSEA = 0.030). Our findings support early detection of anxiety and depression, as well as comprehensive efforts improving HRQoL for patients with diabetes.

Figure 1

The mean anxiety and depression subscale scores and its 95% confidence interval (CI) and the level of severity of problems (from left to right: weakest to strongest problems) for each of the EQ-5D dimensions and extended cognitive dimension at T1 and T2. Note: EQ-5D, the European Quality of Life at 5 dimensions.

Figure 2

The cross-lagged model hypothesized to analyze the longitudinal association among anxiety, depression and health-related quality of life (HRQoL) summary index. Note: HRQoL is measured by EQ-5D summary index with higher score on EQ-5D index indicating better quality of life in mobility, self-care, usual activities, pain/discomfort and anxiety/depression; Numbers above arrows indicate standardized correlation coefficients; Thick arrows indicate the paths of interest, which are the bidirectional, longitudinal paths between anxiety/depression and HRQoL. The overall model fit was x²/df = 1.102; CFI = 1.000, RMSEA = 0.030.