About 1 in 6 US adults with type 1 diabetes may report moderate or severe symptoms of depression or anxiety, with a higher prevalence than among adults with type 2 diabetes or no diabetes.
Investigators analyzed data from the 2019 and 2022 National Health Interview Survey, including 58,106 adults, 326 of whom had type 1 diabetes and 5,802 of whom had type 2 diabetes. Diabetes classification was based on self-reported diagnosis and current insulin use.
Depressive symptoms were assessed using the 8-item Patient Health Questionnaire, while generalized anxiety disorder symptoms were assessed using the 7-item Generalized Anxiety Disorder scale (GAD-7). Scores of 10 to 14 indicated moderate symptoms, and scores of 15 or higher indicated severe symptoms. Exploratory subgroup analyses were conducted by age, sex, race and ethnicity, and educational attainment.
Moderate or severe depressive symptoms were reported among 17% of participants with type 1 diabetes vs. 12% of those with type 2 diabetes and 7% of those without diabetes. Similarly, moderate or severe generalized anxiety disorder symptoms were reported among 16% of those with type 1 diabetes vs. 9% of those with type 2 diabetes and 6% of those without diabetes. Both outcomes showed statistically significant differences.
Severe depressive symptoms were reported among 10% of participants with type 1 diabetes vs. 5% of those with type 2 diabetes and 3% of those without diabetes. Severe generalized anxiety disorder symptoms were reported by 8%, 4%, and 3%, respectively.
Moderate or severe depressive and general anxiety disorder symptoms were reported among 22% and 19% of female participants vs. 11% and 13% of male participant, respectively.
Among participants with type 1 diabetes, moderate or severe generalized anxiety disorder symptoms were most prevalent among those aged 18 to 44 years (22%), followed by those aged 45 to 64 years (16%) and those aged 65 years or older (5%). Depressive symptoms were most prevalent among participants aged 45 to 64 years (20%), compared with 16% among those aged 18 to 44 years and 14% among those aged 65 years or older.
Educational attainment was associated with differences in symptom prevalence. Among adults with type 1 diabetes who had less than a high school education, 24% reported moderate or severe depressive symptoms and 32% reported moderate or severe generalized anxiety disorder symptoms. Corresponding estimates among those with a college education or higher were 16% and 13%, respectively.
Depression and anxiety among patients with diabetes have been associated with poorer glycemic control and an increased risk of complications. The American Diabetes Association's 2026 recommendation for annual screening for depression and anxiety using validated instruments emphasized the importance of improving early detection among patients with type 1 diabetes.
Diabetes subtype was based on self-report, introducing possible misclassification. The relatively small sample of adults with type 1 diabetes limited the precision of subgroup estimates. Additionally, the survey did not assess diabetes-specific psychosocial burdens, which may overlap with depressive and anxiety symptoms and potentially inflate prevalence estimates. Symptoms were assessed over the preceding 2 weeks and were not confirmed through clinical interviews.
"Better mental health screening, especially in high-risk populations, is essential for improving diabetes management and quality of life,” wrote lead study author TianyuCao, ScM, of the Johns Hopkins Bloomberg School of Public Health, and colleagues.
Full disclosures of the study authors can be found in the study.
Source: Annals of Internal Medicine
