title: Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting.
abstract: BACKGROUND
  Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, Malaysia.
  
  
  METHODS
  The study was cross sectional in design and carried out in 12 randomly selected primary care government clinics in the Klang Valley, Malaysia. A total of 2508 eligible consenting respondents participated in the study. The Depression, Anxiety and Stress Scale (DASS) 21 questionnaire was used to measure depression, anxiety and stress symptoms. Data was analyzed using the SPSS version 16 software using both descriptive and inferential statistics.
  
  
  RESULTS
  The prevalence of depression, anxiety and stress symptoms among Type II diabetics were 11.5%, 30.5% and 12.5% respectively. Using multiple logistic regression, females, Asian Indians, marital status (never married, divorced/widowed/separated), a family history of psychiatric illness, less than 2 years duration of diabetes and current alcohol consumption were found to be significant predictors of depression. For anxiety, unemployment, housewives, HbA1c level of more than 8.5%, a family history of psychiatric illness, life events and lack of physical activity were independent risk factors. Stress was significantly associated with females, HbA1c level of more than 8.5%, presence of co-morbidity, a family history of psychiatric illness, life events and current alcohol consumption. For depression (adjusted OR 2.8, 95% CI 1.1; 7.0), anxiety (adjusted OR 2.4, 95% CI 1.1;5.5) and stress (adjusted OR 4.2, 95% CI 1.8; 9.8), a family history of psychiatric illness was the strongest predictor.
  
  
  CONCLUSIONS
  We found the prevalence of depression, anxiety and stress symptoms to be high among Type II diabetics, with almost a third being classified as anxious. Screening of high risk Type II diabetics for depression, anxiety and stress symptoms in the primary care setting is recommended at regular intervals.
authors.affiliation: Institute for Public Health, Ministry of Health, Jalan Bangsar, Kuala Lumpur 50590, Malaysia. dr.gurpreet@iku.moh.gov.my
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Kaur
authors.forename: Guat Hiong
authors.initials: GH
authors.lastname: Tee
authors.forename: Suthahar
authors.initials: S
authors.lastname: Ariaratnam
authors.forename: Ambigga S
authors.initials: AS
authors.lastname: Krishnapillai
authors.forename: Karuthan
authors.initials: K
authors.lastname: China
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D013315:Stress, Psychological / Q000453:epidemiology*; D013383:Suburban Population; D014505:Urban Population