# Uncovering distinct predictors of diabetes distress and depressive symptoms in a longitudinal survival analysis of incidence and remission: indication for diverging aetiological paths

## TL;DR

This study tracked diabetes distress and depressive symptoms in people with type 1 and type 2 diabetes over two years, finding different factors that predict their onset and remission.

## Contribution

The study identifies distinct predictors for diabetes distress and depressive symptoms, suggesting different underlying causes.

## Key findings

- Diabetes distress had a 21% incidence and 70% remission rate over 24 months.
- Depressive symptoms had a 33% incidence and 67% remission rate over 24 months.
- Higher HbA1c predicted both diabetes distress and depressive symptoms, but other predictors differed between the two.

## Abstract

The aim of the study was to examine the course of diabetes distress and depressive symptoms and their predictors of incidence and remission in individuals with type 1 and type 2 diabetes.

Data were collected every 6 months over a 24 month period. Participants (n=654) completed measures of diabetes distress (Problem Areas in Diabetes Scale) and depressive symptoms (Patient Health Questionnaire 8). Cox proportional hazards models were applied to examine predictors of incidence and remission, considering demographic, clinical and psychosocial factors. All predictors were assessed at baseline, except for HbA1c, which was modelled as a time-varying covariate.

Diabetes distress showed cumulative incident cases in 21% of the sample and a remission rate of 70% across 24 months. For depressive symptoms, cumulative 24 month incidence was 33% and remission was 67%. The median onset time was 18 months for diabetes distress and 24 months for depressive symptoms; the median remission time for both was 6 months. Higher HbA1c (HR=1.02, p=0.022), female gender (male gender HR=0.55, p=0.043), long-term complications (HR=2.11, p=0.009) and a history of anxiety disorders (HR=2.57, p=0.029) significantly predicted the incidence of diabetes distress, while no predictors were associated with remission. For depressive symptoms, higher HbA1c (HR=1.03, p<0.001), prior depression (HR=2.63, p=0.001) and eating disorders (HR=2.20, p=0.044) predicted incidence. Remission was significantly associated only with older age (HR=1.02, p=0.045).

Suboptimal glycaemic outcomes predicted both diabetes distress and depression; however, diabetes distress was associated with anxiety disorders, whereas depressive symptoms were linked to prior depression and eating disorders, hinting at distinct aetiologies.

The online version contains peer-reviewed but unedited supplementary material available at 10.1007/s00125-026-06666-w.