Although some studies have been conducted on the association between diabetes and anxiety symptoms, the data on this association remain controversial. The purpose of this meta-analysis was to examine the association between diabetes and anxiety symptoms. The authors systematically searched PubMed, Scopus, and Google Scholar databases until July 2018. After the screening process, 23 studies were included in the meta-analysis. Stata-14 was used for meta-analyzing. Forest plot was calculated for the whole 23 studies and subgroups, and publication bias was also examined. Overall, diabetes was positively associated with anxiety; pooled odds ratio was equal to1.48; 95% confidence interval was 1 .27–1.74. In cross-sectional study, the result was odds ratio = 1.50; 95% confidence interval = 1.26–1.77, and in prospective-cohort study, the result was odds ratio = 1.34; 95% confidence interval = 1.21–1.49. There was small evidence of publication bias. Overall, our findings indicate that diabetes is a risk factor for anxiety symptoms. Therefore, having a healthy medical condition can be an anxiety prevention agent.
KesslerRCChiuWTDemlerOet al.
Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry2005;
62: 617–627.
2.
Anxiety Disorders Association of America. Facts & statistics.
Silver Spring:
Anxiety Disorders Association of America, 2012.
3.
AllgulanderC.Generalized anxiety disorder: What are we missing?Eur Neuropsychopharmacol2006;
16: S101–S108.
4.
KhuwajaAKLalaniSDhananiRet al.
Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors. Diabetol Metab Syndr2010;
2: 72.
5.
VenablesMCJeukendrupAE.Physical inactivity and obesity: links with insulin resistance and type 2 diabetes mellitus. Diabetes Metab Res Rev2009;
25: S18–S23.
6.
SevickMATrauthJMLingBSet al.
Patients with complex chronic diseases: perspectives on supporting self-management. J Gen Intern Med2007;
22: 438–444.
7.
AmericanDiabetesAssociation.Economic costs of diabetes in the U.S. in 2012. Diabetes Care2013;
36: 1033–1046.
8.
BarrELZimmetPZWelbornTAet al.
Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation2007;
116: 151–157.
9.
International Diabetes Federation. IDFDiabetes Atlas Fifth edition. Brussels: International Diabetes Federation, 2011.
10.
MaglianoDJBarrELZimmetPZet al.
Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care2008;
31: 267–272.
11.
AtlantisELangeKWittertGA.Chronic disease trends due to excess body weight in Australia. Obes Rev2009;
10: 543–553.
12.
CowieCCRustKFFordESet al.
Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. Diabetes Care2009;
32: 287–294.
13.
MurrayCJLopezAD.Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet1997;
349: 1498–1504.
14.
GreenbergPESisitskyTKesslerRCet al.
The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry1999;
60: 427–435.
15.
EngumA.The role of depression and anxiety in onset of diabetes in a large population-based study. J Psychosom Res2007;
62: 31–38.
16.
GrigsbyABAndersonRJFreedlandKEet al.
Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res2002;
53: 1053–1060.
17.
KesslerRCSonnegaABrometEet al.
Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry1995;
52: 1048–1060.
18.
WorldHealthOrganizationCross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology. Bull World Health Organ2000;
78: 413–426.
19.
ShabanMCFosburyJKerrDet al.
The prevalence of depression and anxiety in adults with Type 1 diabetes. Diabet Med2006;
23: 1381–1384.
20.
SmithKJBelandMClydeMet al.
Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res2013;
74: 89–99.
21.
BuchbergerBHuppertzHKrabbeLet al.
Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis. Psychoneuroendocrinology2016;
70: 70–84.
22.
RechenbergKWhittemoreRGreyM.Anxiety in youth with type 1 diabetes. J Pediatr Nurs2017;
32: 64–71.
23.
MoherDLiberatiATetzlaffJet al.
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med2009;
151: 264–269.
24.
Armijo-OlivoSStilesCRHagenNAet al.
Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract2012;
18: 12–18.
25.
World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee 854, pp. 1–452. Geneva: World Health Organization, 1995.
26.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association, 2013.
27.
World Health Organization. The ICD-10 classification of mental and behavioral disorders – clinical description and diagnostic guidelines.
Geneva:
World Health Organization, 1992.
28.
HigginsJPThompsonSG.Quantifying heterogeneity in a meta-analysis. Stat Med2002;
21: 1539–1558.
29.
IoannidisJPPatsopoulosNAEvangelouE.Uncertainty in heterogeneity estimates in meta-analyses. BMJ2007;
335: 914–916.
30.
AlmawiWTamimHAl-SayedNet al.
Association of comorbid depression, anxiety, and stress disorders with Type 2 diabetes in Bahrain, a country with a very high prevalence of Type 2 diabetes. J Endocrinol Invest2008;
31: 1020–1024.
31.
BenerAAl-HamaqAOAA, andDafeeahEE.High prevalence of depression, anxiety and stress symptoms among diabetes mellitus patients. Open Psychiatry J2011;
5: 5–12.
32.
BouwmanVAdriaanseMCvan 't RietEet al.
Depression, anxiety and glucose metabolism in the general dutch population: the new Hoorn study. PLoS One2010;
5: e9971.
33.
DeschenesSSBurnsRJSchmitzN.Associations between diabetes, major depressive disorder and generalized anxiety disorder comorbidity, and disability: findings from the 2012 Canadian Community Health Survey–Mental Health (CCHS-MH). J Psychosom Res2015;
78: 137–142.
34.
El-GabalawyRMackenzieCSShooshtariSet al.
Comorbid physical health conditions and anxiety disorders: a population-based exploration of prevalence and health outcomes among older adults. Gen Hosp Psychiatry2011;
33: 556–564.
35.
GaleCRSayerAACooperCet al.
Factors associated with symptoms of anxiety and depression in five cohorts of community-based older people: the HALCyon (Healthy Ageing across the Life Course) Programme. Psychol Med2011;
41: 2057–2073.
36.
GoodwinRDDavidsonJR.Self-reported diabetes and posttraumatic stress disorder among adults in the community. Prev Med2005;
40: 570–574.
37.
van DoorenFEDenolletJVerheyFRet al.
Psychological and personality factors in type 2 diabetes mellitus, presenting the rationale and exploratory results from The Maastricht Study, a population-based cohort study. BMC Psychiatry2016;
16: 17.
38.
BodenlosJLemonSSchneiderKet al.
Association of mood and anxiety disorders with diabetes among African Americans from a nationally representative sample. Obesity2009;
17: S145–S14S.
39.
Das-MunshiJStewartRIsmailKet al.
Diabetes, common mental disorders, and disability: findings from the UK National Psychiatric Morbidity Survey. Psychosom Med2007;
69: 543–550.
40.
de WinterCFHermansHEvenhuisHMet al.
Associations of symptoms of anxiety and depression with diabetes and cardiovascular risk factors in older people with intellectual disability. J Intellect Disabil Res2015;
59: 176–185.
41.
HasanSSClavarinoAMDingleKet al.
Diabetes mellitus and the risk of depressive and anxiety disorders in Australian women: a longitudinal study. J Womens Health (Larchmt)2015;
24: 889–898.
42.
HoltRIPhillipsDIJamesonKAet al.
The relationship between depression and diabetes mellitus: findings from the Hertfordshire Cohort Study. Diabet Med2009;
26: 641–648.
43.
KruseJSchmitzNThefeldW.On the association between diabetes and mental disorders in a community sample: results from the German National Health Interview and Examination Survey. Diabetes Care2003;
26: 1841–1846.
44.
LinEHVon KorffMAlonsoJet al.
Mental disorders among persons with diabetes–results from the World Mental Health Surveys. J Psychosom Res2008;
65: 571–580.
45.
LukaschekKBaumertJKruseJet al.
Relationship between posttraumatic stress disorder and type 2 diabetes in a population-based cross-sectional study with 2970 participants. J Psychosom Res2013;
74: 340–345.
46.
MeursMRoestAMWolffenbuttelBHet al.
Association of depressive and anxiety disorders with diagnosed versus undiagnosed diabetes: an epidemiological study of 90,686 participants. Psychosom Med2016;
78: 233–241.
47.
PetrakFHardtJWittchenHUet al.
Prevalence of psychiatric disorders in an onset cohort of adults with type 1 diabetes. Diabetes Metab Res Rev2003;
19: 216–222.
48.
ShahiMMohammadyfarMA.Comparison of depression, anxiety, stress, quality of life, and alexithymia between people with type II diabetes and non-diabetic counterparts. Personality and Individual Differences2017;
104: 64–68.
49.
StrineTWMokdadAHBalluzLSet al.
Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System. Psychiatr Serv2008;
59: 1383–1390.
50.
TuHPLinCHHsiehHMet al.
Prevalence of anxiety disorder in patients with type 2 diabetes: a nationwide population-based study in Taiwan 2000-2010. Psychiatr Q2017;
88: 75–91.
51.
WuLTGhitzaUEBatchBCet al.
Substance use and mental diagnoses among adults with and without type 2 diabetes: Results from electronic health records data. Drug Alcohol Depend2015;
156: 162–169.
52.
YoongRKMooppilNKhooEYet al.
Prevalence and determinants of anxiety and depression in end stage renal disease (ESRD). A comparison between ESRD patients with and without coexisting diabetes mellitus. J Psychosom Res2017;
94: 68–72.
53.
DuvalSTweedieR.Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics2000;
56: 455–463.
54.
HigginsJPThompsonSGDeeksJJet al.
Measuring inconsistency in meta-analyses. BMJ2003;
327: 557–560.
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