Association of diabetic neuropathy with depression and anxiety in type 2 diabetes mellitus: A cross-sectional study

Abstract

Psychological burden of diabetic neuropathy has received less attention than its physical consequences, particularly in Southeast Asia. Sociocultural factors, healthcare access, and differences in diabetes management may influence psychological outcomes, yet data from Indonesia remain scarce. The aim of this study was to evaluate the association of diabetic neuropathy severity with symptoms of depression and anxiety among patients with type 2 diabetes mellitus (T2DM). A cross-sectional study was conducted among adult patients with T2DM attending Endocrinology Outpatient Clinic of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Diabetic neuropathy was assessed using Total Neuropathy Score (TNS), while depressive and anxiety symptoms were evaluated using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. A total of 102 patients were included in the final analysis. TNS scores were significantly higher in patients with depression than in those without depression (p=0.007). Similarly, TNS scores were significantly higher in patients with anxiety than in those without anxiety (p=0.040). Neuropathy severity demonstrated a weak positive correlation with depression severity (r=0.332, p<0.001) and a weak positive correlation with anxiety severity (r=0.200, p=0.044). Linear regression analysis showed that greater neuropathy severity was significantly associated with higher PHQ-9 scores, with each one-point increase in TNS corresponding to a 0.230-point increase in depression score (B=0.230; p=0.013; R²=0.060). No significant association was observed between TNS and GAD-7 scores (B=0.129; p=0.141; R²=0.022), despite a positive trend. In conclusion, greater diabetic neuropathy severity was associated with depressive symptoms, while the association with anxiety was weaker and lost significance after linear regression. Incorporating routine depression screening into the clinical evaluation of diabetic neuropathy may facilitate more comprehensive patient management.