Depression, anxiety, and stress among type-2 diabetic patients in Afghanistan: A cross-sectional survey study

Background: Diabetic patients are prone to increased depression, anxiety, and stress. The main objective of this study was to assess the prevalence and associated factors of depression, anxiety, and stress among diabetic patients in Herat province of Afghanistan. Methods: This cross-sectional study was conducted in 2024 among 353 adult diabetic patients in Herat province of Afghanistan. To assess depression, anxiety, and stress, the Persian version of the 21-item Depression Anxiety Stress Scale (DASS-21) was used. Data were analyzed by using descriptive statistics, Chi-square tests, and multiple regression analysis. A two-tailed p-value below 0.05 was considered statistically significant. Results: Among the 353 diabetic patients, 95.2% were aged ³50 years, 61.8% were females, 62.0% were living in urban areas, 64.6% were illiterate, 75.1% had low economic status, and 62.9% were overweight/obese. Severe/extremely severe depression, anxiety, and stress were present in 73.9%, 84.1%, and 80.5% of the diabetic patients. The statistically significant predictors of depression were being female, having low economic status, and having had a bad event in the past month. The statistically significant predictors of anxiety were being female and having low economic status. The statistically significant predictors of stress were being female, being a widow/divorced, having low economic status, and having had a bad event in the past months. Being a female diabetic patient was a strong predictor for all three conditions of depression (adjusted odds ratio [AOR] = 11.01, p-value <0.001), anxiety (AOR = 4.53, p-value = 0.005), and stress (AOR = 6.77, p-value <0.001). Conclusion: Depression and anxiety are highly prevalent among diabetic patients in Herat province of Afghanistan.