Prevalence and factors associated with comorbid depression and anxiety in patients with diabetes mellitus attending a national referral hospital in Uganda

Abstract

Comorbid depression and anxiety in patients with diabetes mellitus (DM) is associated with poor disease outcomes, yet its burden and associated factors are not well-characterized in low-resource settings like Uganda. This study aimed to determine the prevalence and factors associated with comorbid depression and anxiety among patients with DM in Uganda. A cross-sectional study was conducted at the diabetes clinic of Mulago National Specialised Hospital. The study consecutively enrolled 223 adult patients (≥18 years) with DM. The Mini-International Neuropsychiatric Interview (MINI) was used to diagnose depression and anxiety disorders. Data on socio-demographics, clinical characteristics, alcohol use (AUDIT-C), social support (MSPSS), and quality of life (WHOQOL-BREF) were collected. Logistic regression was used to identify factors associated with comorbid depression and anxiety. The mean age of participants was 54.6 years (SD = 13.1), and 72.2% were female. The prevalence of comorbid depression and anxiety was 14.3% (95% CI: 10.3-19.6). In the multivariable analysis, factors significantly associated with increased odds of comorbidity included having a higher number of children (Adjusted Odds Ratio, aOR=1.15, 95% CI: 1.02-1.32), longer duration since DM diagnosis (aOR=1.07, 95% CI: 1.01-1.12), high blood pressure (aOR=2.19, 95% CI: 1.94-5.08), and moderate/high alcohol use (aOR=1.46, 95% CI: 1.09-5.14). Conversely, diagnosis of Type II DM (aOR=0.40, 95% CI: 0.16 - 0.91), older age (aOR=0.97, 95% CI: 0.94-0.99) and higher scores across all WHOQOL-BREF domains (physical, psychological, social, environmental) were associated with significantly reduced odds of comorbidity. Nearly one in seven patients with DM in this Ugandan cohort had comorbid depression and anxiety. The findings underscore the need for integrated mental health screening and intervention within diabetic care services, particularly targeting younger patients, those with Type 1 DM, longer disease duration, hypertension, and hazardous alcohol use.