Date: 28 Apr 2009

Association between diagnosed diabetes and serious psychological distress among U.S. adults: the Behavioral Risk Factor Surveillance System, 2007

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To estimate the prevalence of serious psychological distress (SPD) according to diabetes status and to assess the association of diabetes-related risks and conditions with SPD among U.S. adults.


We analyzed data from the Behavioral Risk Factor Surveillance System, 2007. SPD was determined by a score of ≥ 13 on the Kessler-6 scale. We used log-binomial regression analysis to estimate prevalence ratios (PRs) and 95 % confidence intervals (CIs).


We estimated the prevalence of SPD to be 7.6 % and 3.6 % among U.S. adults with and without diagnosed diabetes (unadjusted PR: 2.09; 95 % CI: 1.87, 2.34). The association of diagnosed diabetes with SPD was attenuated after adjustments for potential confounding effects of cardiovascular risk factors and cardiovascular comorbid conditions (adjusted PR, 1.12; 95 % CI: 0.99, 1.27). Significant correlates of SPD among persons with diagnosed diabetes were young age, low education levels, low household income, obesity, current smoking, no leisure-time physical activity, presence of one or more micro- or macro-vascular complications, and disability.


The crude prevalence of SPD among adults with diagnosed diabetes was twice as high as that among those without diabetes. The increased prevalence of SPD may be accounted for by the excessive rates of cardiovascular risks and comorbid conditions among people with diagnosed diabetes.

Submitted: 29 August 2008; revised: 13 January 2009; accepted: 14 January 2009