Email updates

Keep up to date with the latest news and content from Diabetology & Metabolic Syndrome and BioMed Central.

Open Access Highly Accessed Open Badges Research

Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors

Ali Khan Khuwaja1*, Saima Lalani2, Raheem Dhanani34, Iqbal Syed Azam5, Ghazala Rafique5 and Franklin White67

Author Affiliations

1 Department of Family Medicine, Aga Khan University, Karachi - 74880, Pakistan

2 Medical College, Aga Khan University, Karachi, Pakistan

3 Department of Family Medicine, Aga Khan University, East Africa

4 Department of Family Medicine, McGill University, Canada

5 Community Health Sciences, Aga Khan University, Pakistan

6 Pacific Health & Development Sciences Inc., Victoria, Canada

7 Community Health & Epidemiology, Dalhousie University, Halifax, Canada

For all author emails, please log on.

Diabetology & Metabolic Syndrome 2010, 2:72  doi:10.1186/1758-5996-2-72

Published: 20 December 2010



Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes.


We conducted a cross-sectional, multi-center study in four out-patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and depression, while adjusting for confounding variables.


Overall, 57.9% (95% CI = 54.7%, 61.2%) and 43.5% (95% CI = 40.3%, 46.8%) study participants had anxiety and depression respectively. Factors found to be independently associated with anxiety were physical inactivity, having hypertension and ischemic heart disease. For depression, being female, of older age, having hypertension and ischemic heart disease were significantly associated. Metabolic components found to be independently associated with both anxiety and depression were systolic blood pressure, fasting blood glucose and fasting blood triglycerides. Body mass index was independently associated with depression but not with anxiety.


This study identified that a large proportion of adults with diabetes had anxiety and/or depression, and identified factors associated with these entities. These results alert clinicians to identify and treat anxiety and depression as common components of diabetes care. Additional studies are needed to establish the directional nature of this relationship and to test interventions.