title: Lifetime depression and anxiety increase prevalent psychological symptoms and worsen glycemic control in type 2 diabetes: The Fremantle Diabetes Study Phase II.
abstract: OBJECTIVE
  To determine the contribution of lifetime major depressive disorder (L-MDD) and lifetime generalized anxiety disorder (L-GAD) to current psychological symptom severity, health behaviour and glycaemic control in type 2 diabetes.
  
  
  METHODS
  1285 community-dwelling people with type 2 diabetes (Fremantle Diabetes Study Phase-II; FDS2) completed the PHQ-9 and Brief Life-Time Depression Scale (BLDS) to assess current and past MDD. The Generalized Anxiety Disorder Scale (GADS) and the Generalized Anxiety Disorder Scale-Lifetime (GAD-LT), designed for FDS2, assessed current and past anxiety. Data were analysed using analysis of covariance and multiple mediation models, controlling for age, gender, marital status, and diabetes duration.
  
  
  RESULTS
  L-MDD and L-GAD were independently associated with more severe current depression (both P<0.001) and anxiety (both P<0.001) symptoms. Mediation models revealed that, through increasing the severity of current depressive symptoms, L-MDD was associated with higher HbA1cand body mass index (BMI), greater likelihood of current smoking, and reduced self-monitoring of blood glucose (SMBG) (indirect regression path ab, all P<0.001). In combination, L-MDD+L-GAD additionally elevated the risk of higher HbA1cand worse diabetes management, by increasing the severity of current depressive symptoms (indirect regression path ab, all P<0.001).
  
  
  CONCLUSIONS
  Lifetime depression and anxiety increase risk of more severe psychological symptoms, hyperglycaemia, and difficulties with health behaviour in type 2 diabetes. Early screening for these disorders at diabetes diagnosis may be warranted to maximize long-term health outcomes.
authors.affiliation: School of Psychology, The University of Western Australia, Crawley, Western Australia, Australia. Electronic address: stephanie.whitworth@research.uwa.edu.au.
authors.forename: S R
authors.initials: SR
authors.lastname: Whitworth
authors.affiliation: School of Medicine & Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: D G
authors.initials: DG
authors.lastname: Bruce
authors.affiliation: School of Psychiatry & Clinical Neurosciences, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: S E
authors.initials: SE
authors.lastname: Starkstein
authors.affiliation: School of Medicine & Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: W A
authors.initials: WA
authors.lastname: Davis
authors.affiliation: School of Medicine & Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: T M E
authors.initials: TM
authors.lastname: Davis
authors.affiliation: School of Psychology, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: R S
authors.initials: RS
authors.lastname: Bucks
mesh_terms: D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology*; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D014904:Western Australia / Q000453:epidemiology
chemical_list: D001786:Blood Glucose
keywords: Anxiety; Behaviour; Depression; Diabetes