Duration of Diabetes Predicts Severe Depression and Cognitive Decline in North Indian Adults With Type 2 Diabetes: A Mixed Methods Cross-Sectional Study

Abstract

Type 2 diabetes mellitus (T2DM) is associated with elevated rates of psychological comorbidity. The study examined the prevalence and correlates of psychological dysfunction among adults with T2DM in North India, focusing on disease duration and psychosocial factors. A convergent mixed-methods design was employed with 87 adults (ages 40–75) with T2DM for > 1 year, recruited from a tertiary care hospital. Quantitative assessments included the DASS-42, GHQ-12, MHQoL, MoCA and Bender Gestalt Test. Focus Group Discussions (n= 12 participants) explored lived experiences of emotional distress, coping, sleep and eating patterns. Pearson correlations and hierarchical regression analyses examined relationships between diabetes duration and psychological outcomes. Mean diabetes duration was 11.9 years. Participants exhibited severe depression mean = 21.05, SD= 4.19), moderate anxiety (mean= 12.95, SD= 4.74), moderate stress (mean= 18.35, SD= 5.59), compromised quality of life (mean= 4.26, SD= 0.15), psychological distress (mean= 5.79, SD = 1.5) and mild cognitive impairment (mean= 23.22, SD= 4.39) and visuomotor impairment (mean= 11.5, SD= 4.38). Diabetes duration correlated significantly with depression (r= 0.450, p<0.01), stress (r=0.365, p<0.01) and visuomotor impairment (r= 0.523, p<0.01) and inversely with quality of life (r= -0.648, p<0.01) and general health (r= -0.806, p<0.01). Qualitative findings revealed emotional repression, food-related shame, sleep disturbance and maladaptive coping. Psychological dysfunction is highly prevalent in T2DM, with longer disease duration predicting greater depression, cognitive decline and reduced quality of life. Findings underscore the necessity for routine mental health screening and integrated psychosocial care in diabetes management.