title: Relationships among depression, anxiety, self-care behaviour and diabetes education difficulties in patients with type-2 diabetes: a cross-sectional questionnaire survey.
abstract: BACKGROUND
  Since psychosocial issues appear to be common among people with diabetes, addressing these problems may improve outcomes. Specifically, it is important to understand the factors associated with anxiety and depression in patients with diabetes.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the relationships between self-care behaviour, diabetes education difficulties, depression and anxiety among patients with type-2 diabetes in Taiwan.
  
  
  METHODS
  This study was cross-sectional and consisted of descriptive statistics and correlations in terms of analyses.
  
  
  METHODS
  Three teaching hospitals, one from each of the northern, middle and southern parts of Taiwan, were selected for data collection.
  
  
  METHODS
  A total of 312 patients diagnosed with type-2 diabetes were recruited to participate in this study. The inclusion criteria of the study subjects included a diagnosis of type-2 diabetes beyond the age of 18 years and the ability to communicate in Mandarin.
  
  
  METHODS
  Various questionnaires were used to assess demographic, disease characteristics, self-care behaviour, diabetes education difficulty, depression and anxiety data.
  
  
  RESULTS
  (1) Rates of disturbance for depression (10.6%) and anxiety (20.5%) among type-2 diabetes patients were lower than those in Western countries. (2) Anxiety was positively correlated with age (r=0.15, p<0.01), complications (r=0.27, p<0.01), diabetes education difficulty (r=0.39, p<0.01) and depression (r=0.54, p<0.01), but negatively correlated with body mass index (BMI) (r=0.20, p<0.01). (3) A total of 50.5% of variance in anxiety was explained by age, complications, BMI, diabetes education difficulty and depression. (4) A total of 42.8% of variance in depression was explained by BMI, diabetes education difficulty and anxiety.
  
  
  CONCLUSIONS
  Depression and anxiety are common among patients with diabetes and can have significant effects on the outcome of their medical illness. Addressing psychosocial factors of people with diabetes may improve effects of patient education and disease self-management.
authors.affiliation: School of Nursing, National Taipei University of Nursing and Health Sciences, Peitou 112, Taipei, Taiwan. shufang@ntunhs.edu.tw
authors.forename: Shu-Fang Vivienne
authors.initials: SF
authors.lastname: Wu
authors.forename: Yi-Ching
authors.initials: YC
authors.lastname: Huang
authors.forename: Shu-Yuan
authors.initials: SY
authors.lastname: Liang
authors.forename: Tsae-Jyy
authors.initials: TJ
authors.lastname: Wang
authors.forename: Mei-Chen
authors.initials: MC
authors.lastname: Lee
authors.forename: Heng-Hsin
authors.initials: HH
authors.lastname: Tung
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000150:complications / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000592:standards*; D012648:Self Care; D011795:Surveys and Questionnaires; D013624:Taiwan