Anxiety symptoms and functioning in a community sample of individuals with type 2 diabetes: A longitudinal study

Type 2 diabetes (T2D) is associated with limitations in day-to-day functioning and with symptoms of anxiety. Although cross-sectional associations between anxiety and functioning in individuals with T2D have been reported, the temporal dynamics of these associations are unclear. The present study examined the longitudinal cross-lagged associations between anxiety symptoms and functioning in a community sample of individuals with T2D.

Data were from the Evaluation of Diabetes Treatment Study, a community-based observational study of 1691 adults with T2D. Anxiety symptoms and functioning were assessed with the Generalized Anxiety Disorder Scale-7 and the World Health Organization Disability Assessment Schedule 2.0, respectively, at baseline and every following year for 3 years. A cross-lagged path analysis accounting for autoregressive effects, sociodemographic factors, and health-related covariates was conducted using structural equation modeling.

The model demonstrated good fit with the data (comparative fit index >0.99, χ62 = 11.44, P = 0.08, root mean square error of approximation = 0.02). Path coefficients indicated that elevated anxiety was associated with subsequent poor functioning (β-values ranging from 0.05 to 0.16; P-values <0.04) and that poor functioning was associated with subsequent elevated anxiety (β-values ranging from 0.13 to 0.19; P-values <0.001). The addition of depressive symptoms as a covariate did not affect model fit, although not all cross-lagged path coefficients remained statistically significant; paths were strongest and most consistent between poor functioning and subsequent elevated anxiety.

Anxiety symptoms and functioning seem to be reciprocally related among individuals with T2D, independent of depressive symptoms.