Cross-cultural comparisons of anxiety and depression in adults with type 1 diabetes

BACKGROUND: Symptoms of depression and anxiety may be more prevalent in individuals with diabetes; however, little is known about possible differences with respect to social or cultural environment. The aim of this study was to examine cross-cultural differences in prevalence and correlates of symptoms of anxiety and depression in two studies, one in the United Kingdom and one in the United States. METHODS: Adults with type 1 diabetes participating in two studies in Birmingham, UK, and Pittsburgh, US, completed psychosocial questionnaires including the Beck Depression Inventory and the Beck Anxiety Scale. RESULTS: UK subjects were significantly more likely to report moderate-severe levels of anxiety compared to US subjects (17% vs 5%; p <0.001). Similar proportions of UK and US subjects reported moderate-severe levels of depressive symptomatology (9% vs 7%). Gender differences in symptomatology were more apparent in the US sample than in the UK study population. Multiple regression analysis demonstrated that for the UK study, symptoms of depression, less physical activity and greater frequency of blood glucose monitoring were significantly associated with symptoms of anxiety. Symptoms of depression were also significantly associated with anxiety in the US sample. For UK subjects, depressive symptoms were significantly associated with higher anxiety scores, whereas in the US subjects, anxiety and smoking were significant independent correlates of depression. CONCLUSIONS: These data suggest that there may be cultural and/or gender differences in the experience of symptoms of anxiety and depression, and also differences in the relationship between psychological symptomatology and diabetes self-care. Our findings have implications for the understanding of the role psychosocial factors play in the management of diabetes.