title: Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors.
abstract: BACKGROUND
  Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes.
  
  
  METHODS
  We conducted a cross-sectional, multi-center study in four out-patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and depression, while adjusting for confounding variables.
  
  
  RESULTS
  Overall, 57.9% (95% CI = 54.7%, 61.2%) and 43.5% (95% CI = 40.3%, 46.8%) study participants had anxiety and depression respectively. Factors found to be independently associated with anxiety were physical inactivity, having hypertension and ischemic heart disease. For depression, being female, of older age, having hypertension and ischemic heart disease were significantly associated. Metabolic components found to be independently associated with both anxiety and depression were systolic blood pressure, fasting blood glucose and fasting blood triglycerides. Body mass index was independently associated with depression but not with anxiety.
  
  
  CONCLUSIONS
  This study identified that a large proportion of adults with diabetes had anxiety and/or depression, and identified factors associated with these entities. These results alert clinicians to identify and treat anxiety and depression as common components of diabetes care. Additional studies are needed to establish the directional nature of this relationship and to test interventions.
authors.affiliation: Department of Family Medicine, Aga Khan University, Karachi - 74880, Pakistan. ali.khuwaja@aku.edu.
authors.forename: Ali Khan
authors.initials: AK
authors.lastname: Khuwaja
authors.forename: Saima
authors.initials: S
authors.lastname: Lalani
authors.forename: Raheem
authors.initials: R
authors.lastname: Dhanani
authors.forename: Iqbal Syed
authors.initials: IS
authors.lastname: Azam
authors.forename: Ghazala
authors.initials: G
authors.lastname: Rafique
authors.forename: Franklin
authors.initials: F
authors.lastname: White