Cross-cultural comparisons of anxiety and depression in adults with type 1 diabetes.
BACKGROUND
Symptoms of depression and anxiety may be more prevalent in individuals with diabetes; however, little is known about possible differences with respect to social or cultural environment. The aim of this study was to examine cross-cultural differences in prevalence and correlates of symptoms of anxiety and depression in two studies, one in the United Kingdom and one in the United States.


METHODS
Adults with type 1 diabetes participating in two studies in Birmingham, UK, and Pittsburgh, US, completed psychosocial questionnaires including the Beck Depression Inventory and the Beck Anxiety Scale.


RESULTS
UK subjects were significantly more likely to report moderate-severe levels of anxiety compared to US subjects (17% vs 5%; p < 0.001). Similar proportions of UK and US subjects reported moderate-severe levels of depressive symptomatology (9% vs 7%). Gender differences in symptomatology were more apparent in the US sample than in the UK study population. Multiple regression analysis demonstrated that for the UK study, symptoms of depression, less physical activity and greater frequency of blood glucose monitoring were significantly associated with symptoms of anxiety. Symptoms of depression were also significantly associated with anxiety in the US sample. For UK subjects, depressive symptoms were significantly associated with higher anxiety scores, whereas in the US subjects, anxiety and smoking were significant independent correlates of depression.


CONCLUSIONS
These data suggest that there may be cultural and/or gender differences in the experience of symptoms of anxiety and depression, and also differences in the relationship between psychological symptomatology and diabetes self-care. Our findings have implications for the understanding of the role psychosocial factors play in the management of diabetes.
Lloyd
Cathy E
CE
Birmingham Heartlands Hospital and University of Birmingham, Birmingham, UK. C.E.Lloyd@open.ac.uk
Zgibor
Janice
J
Wilson
Robb R
RR
Barnett
Anthony H
AH
Dyer
Philip H
PH
Orchard
Trevor J
TJ
D000328:Adult; D017668:Age of Onset; D001007:Anxiety / Q000453:epidemiology*; D016001:Confidence Intervals; D003431:Cross-Cultural Comparison; D003863:Depression / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D010414:Pennsylvania; D015995:Prevalence; D012648:Self Care; D012727:Sex Characteristics; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D006113:United Kingdom