Diabetes and Depressive Symptoms Before and in 2021-2023 among U.S. Adults

Abstract

Diabetes is a major chronic disease in the United States, and the psychological burden of long-term disease management may increase vulnerability to depressive symptoms. Changes in social and healthcare environments may also have affected mental health in recent years. Using data from U.S. adults, we evaluated whether self-reported diabetes was related to clinically relevant depressive symptoms and whether the magnitude of this relationship varied between the 2015–2018 and 2021–2023 survey periods. We analyzed National Health and Nutrition Examination Survey data for 12,653 participants aged ≥20 years who had nonmissing information on self-reported diabetes, all nine PHQ-9 items, prespecified covariates, and the variables required for survey-design adjustment. Participants with a total PHQ-9 score ≥10 were classified as having clinically relevant depressive symptoms. Descriptive estimates and logistic regression analyses incorporated the NHANES sampling weights, strata, and primary sampling units. The adjusted models accounted for demographic and socioeconomic factors, BMI, and smoking status. Adults with self-reported diabetes had a higher burden of clinically relevant depressive symptoms. Depressive symptom prevalence was also higher in 2021-2023 than in 2015-2018 in both diabetes groups. However, the diabetes-by-period interaction was not statistically significant, indicating insufficient evidence that the diabetes–depression association changed between the two periods. Sensitivity analyses using continuous PHQ-9 scores and nonlinear covariate specifications produced consistent findings. These results support continued depression screening and integrated mental-health care in diabetes management.