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

Abstract Background 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. Methods 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. Results The model demonstrated good fit with the data (comparative fit index >0.99, χ 6 2  = 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. Conclusions Anxiety symptoms and functioning seem to be reciprocally related among individuals with T2D, independent of depressive symptoms.