Diabetes distress, depressive, and anxiety symptoms in people with type 2 diabetes: a network analysis approach to understanding comorbidity

McInerney, Amy M, Lindekilde, Nanna, Nouwen, Arie ORCID: https://orcid.org/0000-0002-0609-4082, Schmitz, Norbert and Deschenes, Sonia S. (2022) Diabetes distress, depressive, and anxiety symptoms in people with type 2 diabetes: a network analysis approach to understanding comorbidity. Diabetes Care . ISSN 0149-5992 [Article] (Accepted/In press)

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Abstract

Objective
This study aimed to explore interactions between diabetes distress, depressive, and anxiety symptoms in a cohort of adults with type 2 diabetes using network analysis.
Research design and methods
Participants (N = 1,796) were from the Evaluation of Diabetes Insulin Treatment (EDIT) study from Quebec, Canada. A network of diabetes distress symptoms was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the 17 items of the DDS-17, the 9 depressive items of the Patient Health Questionnaire (PHQ-9), and the 7 anxiety items of the Generalized Anxiety Disorder Assessment (GAD-7). Network analysis was used to identify central symptoms, clusters of symptoms, and symptoms that may bridge between diabetes distress, depressive, and anxiety symptoms.
Results
Regimen-related and physician-related diabetes distress symptoms were amongst the most influential (most positive connections to others) in the diabetes distress network. Feeling like a failure (depression) was identified as a potential bridge between depression and diabetes distress, being highly connected to symptoms of diabetes distress. The anxiety symptoms of worrying too much and being unable to stop worrying were found to be bridge symptoms between both anxiety and depression symptoms, and anxiety and diabetes distress symptoms, respectively.
Conclusions
These findings suggest individual symptoms that might be influential to the development and maintenance of diabetes distress and mental health comorbidity in diabetes and warrant further investigation. Study limitations and potential for clinical applicability are discussed.

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