Depression, Anxiety and Stress Among Patients with Type 2 Diabetes Mellitus in Primary Health Care in Kosovo

Background: At a global level, over 300 million people are estimated to suffer from depression, equivalent to 4.4% of the world's population. The presence of depression, anxiety, and stress (DAS) has major consequences for individuals with diabetes. The aim of this study was to determine the prevalence of DAS among adult patients with T2DM in primary health care (PHC) settings in Kosovo and to determine any association between DAS, sociodemographic characteristics, and other risk factors.Methods and Results: This cross-sectional study was conducted in seven Main Family Medicine Centers in Kosovo (Prishtina, Mitrovica, Peja, Prizren, Ferizaj, Gjilan, and Gjakova) from November 2022 to February 2023. The study included 596 adult patients above 18 years of age who were diagnosed with T2DM at least one year ago. By gender, more respondents were female ((F 55.4% vs. M 44.6%); adults aged 30-59 accounted for 38.4%, aged 60+ - 57.7%. Anxiety was the most common type of psychological distress among the subjects (82.0%), depression was second with a prevalence of 74% and stress third with a prevalence of 43.0%. Females were predominant among respondents regarding the three forms of mental health problems: Depression (F 75.8% vs. M 71.8%), Anxiety (F 86.1% vs. M 77.1%), and Stress (F 48.5% vs. M 36.1%) Subjects with only primary education were more likely to be depressed (79.6%, P=0.007; OR=1.689, 95% CI: 1.153 - 2.477). HbA1C >6.5% was found to be strongly associated with depression (76.4%, P=0.002; OR=2.071, 95% CI: 1.305 - 3.284). Female gender and the presence of comorbidities were found to be significantly associated with anxiety. Female gender, level of education, history of DM in the family, presence of comorbidities, and HbA1c >6.5% were significantly associated with stress.Conclusion: Our study showed that the prevalence of DAS is high in patients with T2DM. Periodic screening of patients with diabetes in PHC settings for early signs of psychological distress using easy and inexpensive validated screening tools like the DASS-21 questionnaire is recommended.