Mental Health Among Adults with Diabetes in Spain: A Population-Based Matched Study of Emotional Well-Being, Depressive Symptoms, and Psychiatric Medication Use

Abstract

Background/Objectives: The objectives of this study were to compare emotional well-being, depressive symptoms, and psychiatric medication use between adults with and without diabetes in Spain and to identify sex-specific factors associated with these outcomes among individuals with diabetes. Methods: A population-based matched study was conducted using data from the 2023 Spanish National Health Survey (SNHS 2023). Adults aged ≥35 years with physician-diagnosed diabetes were individually matched (1:1) to controls without diabetes according to sex, exact age, and autonomous community of residence. Low emotional well-being (WHO-5 score < 50), clinically relevant depressive symptoms (PHQ-8 ≥ 10), and psychiatric medication use were assessed. Conditional logistic regression and sex-specific multivariable logistic regression models were fitted. Results: The study included 3710 participants (1855 with diabetes and 1855 matched controls without diabetes). The prevalence of low emotional well-being was significantly higher among participants with diabetes than among matched controls in both men (16.4% vs. 11.6%; p = 0.004) and women (28.8% vs. 21.6%; p < 0.001). Likewise, clinically relevant depressive symptoms were more frequent among individuals with diabetes (men: 32.7% vs. 24.9%, p < 0.001; women: 54.4% vs. 40.2%, p < 0.001), as was psychiatric medication use (men: 20.5% vs. 15.2%, p = 0.005; women: 39.5% vs. 30.2%, p < 0.001). After full adjustment, diabetes remained independently associated with low emotional well-being (men: aOR 1.48, 95% CI 1.03–2.13; women: aOR 1.43, 95% CI 1.14–1.78), depressive symptoms (men: aOR 1.31, 95% CI 1.02–1.69; women: aOR 1.38, 95% CI 1.08–1.77), and psychiatric medication use (men: aOR 1.34, 95% CI 1.02–1.75; women: aOR 1.35, 95% CI 1.06–1.73). Poor social support, physical inactivity, and several chronic comorbidities emerged as the factors most consistently associated with adverse mental health outcomes among individuals with diabetes. Conclusions: Adults with diabetes in Spain experience a substantially greater burden of adverse mental health than matched individuals without diabetes. Integrating routine mental health assessment and psychosocial support into diabetes care may help improve both psychological well-being and disease management.