Anxiety and depression prevalent in primary care

The presence of coexisting clinical depression and anxiety (DA) is not uncommon in the primary care setting, particularly among younger individuals, patients with diabetes, and women, a Singapore study has shown.

“We propose that mental health screening programs in the community should include screening for both depression and anxiety, rather than either of these only,” said lead author Dr Eugene Chua, Hougang Polyclinic, Singapore. “Mental health screening should target at-risk groups, such as younger individuals and patients with diabetes.”

Chua and colleagues conducted this cross-sectional study using stratified sampling by age with a self-administered questionnaire survey in Singapore’s National Healthcare Group Polyclinics from December 2021 to April 2022. Clinical depression was defined as a total score of Patient Health Questionnaire-9 (PHQ-9) ≥10 and anxiety as a total score of Generalized Anxiety Disorder-7 (GAD-7) ≥10.

Finally, the authors identified the factors associated with depression and anxiety using multivariate logistic regression.

A total of 5,694 patients were surveyed, of whom 3,505 (61.6 percent) consented to the study. DA was more prevalent than clinical depression only and clinical anxiety only (5.4 percent vs 3.3 percent and 1.9 percent, respectively). [Ann Acad Med Singap 2024;53:293-305]

DA was more prevalent among individuals aged 21‒39 years (odds ratio [OR], 13.49, 95 percent confidence interval [CI], 5.41‒33.64) and 40‒64 years (OR, 2.28, 95 percent CI, 1.03‒5.03) than those aged ≥65 years. Women were also more likely to have DA (OR, 2.33, 95 percent CI, 1.54‒3.50) than men.

Diabetes

In addition, patients with diabetes had a higher likelihood of having DA (OR, 1.78, 95 percent CI, 1.07‒2.94) than those without.

Diabetes has a complex relationship with anxiety and depression, according to Chua. People with diabetes are at increased risk of developing anxiety and depression, and those with anxiety and depression are at greater risk of developing diabetes. [Psychosom Med 2016;78:233-241; BMC Public Health 2019;19:1268]

Many Asian studies also report greater odds of depression in diabetic individuals, with a fivefold higher likelihood in a study conducted in Malaysia (OR, 5.05, 95 percent CI, 2.08‒12.27), a 1.3-fold higher likelihood in Hong Kong (OR, 1.35, 95 percent CI, 1.25‒1.46), and a 2.22-fold higher likelihood in Thailand (OR, 2.22, 95 percent CI, 1.28‒3.84). [Singapore Med J 2021;62:653-658; J Nutr Health Aging 2011;15:751-755; Int J Environ Res Public Health 2022;19:10574]

Notably, treating depression in people with diabetes results in improved glycaemic control and quality of life, while the use of metformin helps reduce the risk of depression. [Int J Integr Care 2022;22:12; J Affect Disord 2022;318:380-385]

Social support

Furthermore, studies have shown that having social support can improve mental health function and may even provide protective benefits against the onset of mental health problems. [Electron Physician 2017;9:5212-5222; Psychiatry Res 2020;293:113452]

“In managing depression and anxiety in the community, efforts to improve social support should be considered,” Chua said. “Further research to understand the specific social support that has the highest influence on depression and anxiety will guide resource planning and improve the availability of this support system.”