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

Objective

This study aimed to explore interactions between individual items assessing diabetes distress, depressive symptoms, 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 was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the 17 DDS-17 items, the 9 items of the Patient Health Questionnaire, and the 7 items of the Generalized Anxiety Disorder Assessment. Network analysis was used to identify central items, clusters of items, and items that may act as bridges between diabetes distress, depressive symptoms, and anxiety symptoms. 

Results

Regimen-related and physician-related problems were amongst the most central (highly connected) and influential (most positive connections) in the diabetes distress network. Failure (depressive symptom) was found to be a potential bridge between depression and diabetes distress, being highly connected to diabetes distress items. The anxiety symptoms of worrying too much, uncontrollable worry, and trouble relaxing were identified as bridges linking both anxiety and depressive items, and anxiety and diabetes distress items, respectively.

Conclusions

Regimen-related and physician-related diabetes-specific problems may be important in contributing to the development and maintenance of diabetes distress. Feelings of failure and worry are potentially strong candidates for explaining comorbidity. These individual diabetes-specific problems and mental health symptoms could hold promise for targeted interventions for people with type 2 diabetes.