Diet and Activity Related Factors of Depression and Anxiety Symptoms in Adults With Diabetes During COVID-19: An Online Survey in India

OBJECTIVES: Depression affects people with diabetes twice as frequently as compared to normoglycemic individuals. The changes in eating habits and physical activity levels during COVID-19 could have primed the comorbidity of depression and diabetes. Hence, this cross-sectional study was conducted to 1) assess the eating habits, physical activity levels, and risk of depression among Indians with type 2 diabetes during the COVID-19 and 2) examine the association of diet and activity patterns with symptoms of depression, anxiety and stress. METHODS: Adults (n = 158) with type 2 diabetes completed an online survey including socio-demography, eating habits, snacking patterns, and physical activity levels. Dietary intakes were assessed using a validated food frequency questionnaire and three 24-hour diet recalls. The mental health problems were self-reported on the Depression, Anxiety, and Stress Scale (DASS-21). Linear regression analyses were performed to examine factors associated with depression, anxiety, and stress. RESULTS: The mean age of the participants was 48.2(18.9) years. Overall, 21.8% reported having depression, 33.2% had mild to moderate anxiety and 18.9% had experienced stress symptoms in the past week. The prevalence of anxiety was higher in females (38.6%) than males (28.3%, p < 0.001) and in those with diabetes duration >10 years (36.1%) than those with <10 years (30.3%, p = 0.036). Participants with anxiety had a higher frequency of fast-food consumption and lower dietary diversity and physical activity scores. The mean intakes of protein, vitamin C, vitamin E, folic acid, iron, and magnesium and the frequencies of fruit, nut, and fish consumption were lower in adults with depression. The duration of diabetes (β = 0.12, p = 0.029), frequency of breakfast (β = 0.37, p < 0.001) and fruit consumption (β = 0.268, p = 0.012), and total carbohydrate intake (β = −0.203, p = 0.043) were associated with depression. No associations were observed between physical activity and stress symptoms. CONCLUSIONS: This is the first study to investigate the diet and activity-related factors of depression in people with diabetes in India during COVID 19. The findings highlighted an inverse association between diet quality and risk of depression, though further investigations are required to establish the relationship between diet, depression, and diabetes. FUNDING SOURCES: None.