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

Mohammad Nasir Naseri; Abdul Qadim Mohammadi; Mohib Rasuli; Nosaibah Razaqi; Mehrab Neyazi

doi:10.56101/rimj.v5i1.198

Authors

Mohammad Nasir Naseri Herat Regional Hospital
Abdul Qadim Mohammadi Herat Regional Hospital
Mohib Rasuli Ghalib University
Nosaibah Razaqi Khyber Medical University
Mehrab Neyazi Afghanistan Medical Students Association

DOI:

https://doi.org/10.56101/rimj.v5i1.198

Keywords:

Depression, Anxiety, Stress, Diabetic type-2, Afghanistan

Abstract

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.

Author Biographies

Mohammad Nasir Naseri, Herat Regional Hospital

Department of Internal Medicine, Herat Regional Hospital, Herat, Afghanistan

Abdul Qadim Mohammadi, Herat Regional Hospital

Department of Mental Health, Herat Regional Hospital, Herat, Afghanistan

Mohib Rasuli, Ghalib University

Department of Curative Medicine, Faculty of Medicine, Ghalib University, Herat, Afghanistan

Nosaibah Razaqi, Khyber Medical University

Khyber Girls Medical College, Khyber Medical University, Pakistan

Mehrab Neyazi, Afghanistan Medical Students Association

Medical Research Committee, Afghanistan Medical Students Association, Herat, Afghanistan

References

BBC News. Afghanistan country profile. 2023 Aug 15. Available from: https://www.bbc.com/news/world-south-asia-12011352

World Health Organization. Afghanistan: how WHO is driving impact on the ground—demonstrating greater accountability and transparency [Report on the Internet]. 2025. Available from: https://www.who.int/about/accountability/results/who-results-report-2020-2021/2021/afghanistan

Maizland L. The Taliban in Afghanistan. Council on Foreign Relations [Internet]. 2023 Jan 19. Available from: https://www.cfr.org/backgrounder/taliban-afghanistan

BBC News. Who are the Taliban? 2022 Aug 12. Available from: https://www.bbc.com/news/world-south-asia-11451718

Mapping Militants Project. Taliban. Mapping Militants Project [Internet]. 2022 Jan 11. Available from: https://mappingmilitants.org/profiles/taliban

Lancet T. Peace and health in Afghanistan. Lancet (London, England). 2020 Mar 21;395(10228):921.

Nature Editorial. How the world should oppose the Taliban’s war on women and girls. Nature. 2022 Aug 25;608(7923):648. doi:10.1038/d41586-022-02284-9.

Neyazi A, Padhi BK, Ahmadi M, Erfan A, Bashiri B, Neyazi M, Ishaqzada M, Noormohammadi M, Griffiths MD. Depression, anxiety and quality of life of Afghan women living in urban areas under the Taliban government: a cross-sectional study. BMJ open. 2023 Aug 1;13(8):e071939.

Neyazi A, Mohammadi AQ, Razaqi N, Rahimi BA, Sifat S, Rahimy N, Tareen Z, Mehmood Q, Satapathy P, Griffiths MD. Health survey on anxiety, depression, and stress in Afghanistan: A large-scale cross-sectional study amid ongoing challenges. Discover Mental Health. 2024 Sep 20;4(1):38.

Razjouyan K, Farokhi H, Qaderi F, Qaderi P, Masoumi SJ, Shah A, Pourhoseingholi MA, Ahmadi A, Lucero-Prisno DE, Ozaki A, Kotera Y. War experience, daily stressors and mental health among the inter-Taliban generation young adults in northern Afghanistan: A cross-sectional school-based study. Frontiers in psychiatry. 2022 May 17;13:877934.

Schwartz L, Lane H, Hassanpoor Z. Overview and understanding of mental health and psychosocial support in Afghanistan. International Health. 2023 Sep;15(5):601-7.

Mohammadsadeghi H, Bazrafshan S, Seify-Moghadam N, Mazaheri Nejad Fard G, Rasoulian M, Eftekhar Ardebili M. War, immigration and COVID-19: The experience of Afghan immigrants to Iran Amid the pandemic. Frontiers in psychiatry. 2022 Jul 28;13:908321.

Scholte WF, Olff M, Ventevogel P, de Vries GJ, Jansveld E, Cardozo BL, Crawford CA. Mental health symptoms following war and repression in eastern Afghanistan. Jama. 2004 Aug 4;292(5):585-93.

Cardozo BL, Bilukha OO, Gotway CA, Wolfe MI, Gerber ML, Anderson M. Report from the CDC: mental health of women in postwar Afghanistan. Journal of Women's Health. 2005 May 1;14(4):285-93.

Saleem SM, Shoib S, Dazhamyar AR, Chandradasa M. Afghanistan: decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population. Asian journal of psychiatry. 2021 Nov 1;65:102854.

Naghavi A, Afsharzada MS, Brailovskaia J, Teismann T. Mental health and suicidality in Afghan students after the Taliban takeover in 2021. Journal of affective disorders. 2022 Jun 15;307:178-83.

Neyazi A, Rahimi BA, Mohammadi AQ, Satapathy P, Shikhulislamy Y, Qaderi F, Qarizada BS, Afzali H, Neyazi M, Griffiths MD. Psychometric evaluation of the 21-item Depression, Anxiety and Stress Scale (DASS-21) among Afghans. BMC psychiatry. 2025 Nov 20.

Alzahrani A, Alghamdi A, Alqarni T, Alshareef R, Alzahrani A. Prevalence and predictors of depression, anxiety, and stress symptoms among patients with type II diabetes attending primary healthcare centers in the western region of Saudi Arabia: a cross-sectional study. International journal of mental health systems. 2019 Jul 16;13(1):48.

Chaturvedi SK, Gowda SM, Ahmed HU, Alosaimi FD, Andreone N, Bobrov A, Bulgari V, Carrà G, Castelnuovo G, de Girolamo G, Gondek T. More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus. General Psychiatry. 2019 Aug 9;32(4):e100076.

Maizland L. The Taliban in Afghanistan. Council on Foreign Relations [Internet]. 2023 Jan 19. Available from: https://www.cfr.org/backgrounder/taliban-afghanistan

Abd-Elgawad M, Abdelsattar NK, Genedy GT, Madeeh AK, Khamis M, Ryaad M, Hassaan WH, Abdullah EA, Mustafa MG, Assar A, Farhat AM. Prevalence of depression and anxiety among diabetic patients in Egypt: A cross-sectional study. Medicine. 2023 Nov 17;102(46):e35988.