Association of depression, anxiety and quality of life in patients with diabetes mellitus: a systematic review
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20263222Keywords:
Anxiety, Depression, Diabetes mellitus, Quality of life, Type 1 diabetes, Type 2 diabetes, Psychological distress, Systematic review, ComorbidityAbstract
Diabetes mellitus (DM) is frequently associated with psychological comorbidities such as depression and anxiety, both of which may adversely affect quality of life (QoL). This systematic review aimed to evaluate the association between depression, anxiety, and QoL among patients with DM. A systematic literature search was conducted in PubMed/MEDLINE, Google Scholar, DOAJ, and the Cochrane Library according to PRISMA 2020 guidelines. Only studies that used validated instruments to measure depression, anxiety, and QoL in adult patients with type 1 or type 2 DM were included. Data extraction and risk-of-bias assessment were performed independently by two reviewers using ROBINS-I and RoB 2 tools. A total of 17 studies with 45 to 5,259 participants were included. The rate of depression varied from 8% to 57.8% and the rate of anxiety varied from 9% to 57.9%. QoL scores were consistently reported as being significantly negatively related to depression and anxiety across studies. Included data demonstrated strong negative correlations between wellbeing scores and depression (p=-0.579) and anxiety (p=-0.632). Significant inverse correlations between depression and QoL (r=-0.690, p<0.001) and anxiety and QoL (r=-0.646, p<0.001) were also observed. Many studies indicated that the combination of depression and anxiety was linked to physical, psychological, and social impairments. A reduction in depressive and anxiety symptoms was associated with improvement in the dimensions of QoL in intervention studies. There is a strong correlation between depression and anxiety with patient QoL in individuals with diabetes, highlighting the need to incorporate psychological assessment and mental health management into general diabetes care.
References
IDF: Diabetes facts and figures. 2025. Avaiable at: https://idf.org/about-diabetes/diabetes-facts-figures/ Accessed on 14 June 2026.
IDF: Diabetes global report 2000-2050. 2025. Avaiable at: https://diabetesatlas.org/data-by-location/global/. Accessed on 14 June 2026.
Yang K, Fang Y, He J, Li J. Prevalence and risk factors of depression in patients with diabetes mellitus: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2025;16:1660478.
Bădescu SV, Tătaru C, Kobylinska L, Georgescu EL, Zahiu DM, Zăgrean AM, Zăgrean L. The association between diabetes mellitus and depression. J Med Life. 2016;9(2):120-5.
Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K, Pouwer F. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010;53(12):2480-6.
Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res. 2002;53(6):1053-60.
Mersha AG, Tollosa DN, Bagade T, Eftekhari P. A bidirectional relationship between diabetes mellitus and anxiety: A systematic review and meta-analysis. J Psychosom Res. 2022;162:110991.
Latoo J, Khan YS, Latoo A, Majid A, Farida J, Nasseer M, et al. The psychological burden of diabetes: common mental health disorders, their impact on disease outcomes and strategies for intervention. J Diabetes Metabolic Disord. 2026;25(1):105.
Schram MT, Baan CA, Pouwer F. Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium. Curr Diabetes Rev. 2009;5(2):112-9.
Ajele KW, Idemudia S. The role of depression and diabetes distress in glycemic control: A meta-analysis. Diabetes Res Clin Pract. 2025;221:112014.
Liu X, Haagsma J, Sijbrands E, Hanneke B, Laura B, Johan PM, et al. Anxiety and depression in diabetes care: longitudinal associations with health-related quality of life. Sci Rep. 2020;10(1):8307.
Lloyd CE, Dyer PH, Barnett AH. Prevalence of symptoms of depression and anxiety in a diabetes clinic population. Diabet Med. 2000;17(3):198-202.
Mosaku K, Kolawole B, Mume C, Ikem R. Depression, anxiety and quality of life among diabetic patients: a comparative study. J Natl Med Assoc. 2008;100(1):73-8.
Khuwaja AK, Lalani S, Dhanani R, Azam IS, Rafique G, White F. Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors. Diabetol Metab Syndr. 2010;2:72.
Papelbaum M, Lemos HM, Duchesne M, Kupfer R, Moreira RO, Coutinho WF. The association between quality of life, depressive symptoms and glycemic control in a group of type 2 diabetes patients. Diabetes Res Clin Pract. 2010;89(3):227-30.
de Ornelas Maia AC, Braga Ade A, Paes F, Machado S, Carta MG, Nardi AE, et al. Comorbidity of depression and anxiety: association with poor quality of life in type 1 and 2 diabetic patients. Clin Pract Epidemiol Ment Health. 2013;9:136-41.
Ramkisson S, Pillay BJ, Sartorius B. Anxiety, depression and psychological well-being in a cohort of South African adults with Type 2 diabetes mellitus. S Afr J Psychiatr. 2016;22(1):935.
Martino G, Catalano A, Bellone F, Giuseppina TR, Carmelo MV, Antonino L, et al. As time goes by: Anxiety Negatively Affects the Perceived Quality of Life in Patients With Type 2 Diabetes of Long Duration. Front Psychol. 2019;10:1779.
Ranjan R, Nath S, Sarkar S. Association between depression, anxiety and quality of life among patients with diabetes mellitus and/or hypertension in a tertiary care railway hospital in India: A cross-sectional study. Indian J Psychiatry. 2020;62(5):555-8.
Woon LS, Sidi HB, Ravindran A, Paula JG, Roslyn LM, Emily SK, et al. Depression, anxiety, and associated factors in patients with diabetes: evidence from the anxiety, depression, and personality traits in diabetes mellitus (ADAPT-DM) study. BMC Psychiatry. 2020;20(1):227.
Sharma K, Dhungana G, Adhikari S, Bista Pandey A, Sharma M. Depression and anxiety among patients with type II diabetes mellitus in Chitwan Medical College Teaching Hospital, Nepal. Nurs Res Pract. 2021;2021:8846915.
Shen Y, Chen Y, Huang S, Yao X, Kanwar YS, Zhan M. The association between symptoms of depression and anxiety, quality of life, and diabetic kidney disease among Chinese adults: a cross-sectional study. Int J Environ Res Public Health. 2022;20(1):475.
Alwhaibi M. Depression, anxiety, and health-related quality of life in adults with type 2 diabetes. J Clin Med. 2024;13(20):6028.
Herhaus B, Kruse J, Hinz A, Brähler E, Petrowski K. Depression, anxiety, and health-related quality of life in normal weight, overweight and obese individuals with diabetes: a representative study in Germany. Acta Diabetol. 2024;61:725-34.
Bubulac L, Dobjanschi CG, Zivari M, Constantin E, Viorica T, Arsenie DS, et al. Psychological distress and health-related quality of life in Romanian adults with diabetes mellitus: a cross-sectional study. Healthcare (Basel). 2026;14(2):158.
Bogner HR, Morales KH, de Vries HF, Cappola AR. Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial. Ann Fam Med. 2012;10:15-22.
Abbas Q, Latif S, Ayaz Habib H, Salman S, Uzma S, Mafia S, et al. Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence among patients with type-II diabetes mellitus: a randomized control trial. BMC Psychiatry. 2023;23(1):86.
Aschner P, Gagliardino JJ, Ilkova H, Fernando L, Ambady R, Jean CM, et al. High prevalence of depressive symptoms in patients with type 1 and type 2 diabetes in developing countries: results from the International Diabetes Management Practices Study. Diabetes Care. 2021;44(5):1100-7.
Alzoubi A, Abunaser R, Khassawneh A, Alfaqih M, Khasawneh A, Abdo N. The bidirectional relationship between diabetes and depression: a literature review. Korean J Fam Med. 2018;39(3):137-46.
Bodnaruc AM, Roberge M, Giroux I, Aguer C. The bidirectional link between major depressive disorder and type 2 diabetes: the role of inflammation. Endocrines. 2024;5:478-500.
Luo C, Yu XM, Zeng MQ, Cheng-Zheng D, Shi-Yu X, Chun-Yan Z, et al. Breaking the diabetes-depression cycle: exploring shared mechanisms, neuroinflammation, and emerging interventions for metabolic-mood comorbidities. World J Diabetes. 2025;16(7):107406.
Borbjerg MK, Wegeberg A-M, Nikontovic A, Carsten DM, Lars AN, Niels E, et al. Understanding the impact of diabetic peripheral neuropathy and neuropathic pain on quality of life and mental health in 6,960 people with diabetes. Diabetes Care. 2025;48(1):588-95.
Saitakis G, Roukas D, Hatziagelaki E, Efstathiou V, Theodossiadis P, Rizos E. Evaluation of quality of life and emotional disturbances in patients with diabetic retinopathy. Eur J Investig Health Psychol Educ. 2023;13(11):2516-28.
Habib S, Sangaraju SL, Yepez D, Grandes XA, Talanki Manjunatha R. The nexus between diabetes and depression: a narrative review. Cureus. 2022;14(6):e25611.
Vlachou E, Ntikoudi A, Owens DA, Nikolakopoulou M, Chalimourdas T, Cauli O. Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: An update review of randomized controlled trials. J Diabetes Complicat. 2022;36(5):108185.
Franquez RT, de Souza IM, Bergamaschi CC. Interventions for depression and anxiety among people with diabetes mellitus: Review of systematic reviews. PLoS One. 2023;18(2):e0281376.
Noroozi Z, Hamidian S, Khajeddin N, Mehrabi Zadeh Honarmand M, Zargar Y, Rashidi H, et al. Improving depression, and quality of life in patients with type 2 diabetes: using group cognitive behavior therapy. Iran J Psychiatry. 2017;12(4):281-6.
Li Y, Buys N, Ferguson S, Li Z, Shi YC, Li L, Sun J. The evaluation of cognitive-behavioral therapy-based intervention on type 2 diabetes patients with comorbid metabolic syndrome: a randomized controlled trial. Diabetol Metab Syndr. 2023;15(1):158.
Mosili P, Mkhize BC, Sibiya NH, Ngubane PS, Khathi A. Review of the direct and indirect effects of hyperglycemia on the HPA axis in T2DM and the co-occurrence of depression. BMJ Open Diabetes Res Care. 2024;12(1):e003218.
Busili A, Kumar K, Kudrna L, Rabbani U. Examining the impact of the COVID-19 pandemic on mental health among adults with type 2 diabetes: A systematic review of pre and during pandemic insights. Medicine (Baltimore). 2025;104(26):e43112.
Duarte-Díaz A, Perestelo-Pérez L, Rivero-Santana A, Wenceslao P, Yolanda ÁP, Vanesa RG, et al. The relationship between patient empowerment and related constructs, affective symptoms and quality of life in patients with type 2 diabetes: a systematic review and meta-analysis. Front Public Health. 2023;11:1118324.
Ranjan S, Thakur R. The effect of socioeconomic status, depression, and diabetes symptoms severity on diabetes patient's life satisfaction in India. Sci Rep. 2024;14(1):12210.
Sachar A, Breslin N, Ng SM. An integrated care model for mental health in diabetes: recommendations for local implementation by the Diabetes and Mental Health Expert Working Group in England. Diabetic Medicine. 2023;40(4):e15029.
Kassem S, Samuels N, Ben-Arye E. Integrative medicine for patients with diabetes and mental health disorders: a narrative review. Curr Psychiatry Rep. 2025;27(9):509-18.
Shimu SJ, Akter S, Rahman MM, Mohammad SM, Sadman S, Mahjabin R, et al. Integrating mental health into diabetes care: closing the treatment gap for better outcomes-a systematic review. Med Sci (Basel). 2025;13(4):259.
Downloads
Published
How to Cite
Issue
Section
