Depression Literacy and Its Relationship with Psychological Status among Patients with Type 2 Diabetes Mellitus at Indonesia: A Community Mental Health Perspective
Keywords:
Type 2 Diabetes Mellitus; Mental health literacy; Depression Literacy; Psychological Distress; Community health
Abstract
The aim of this study was to determine the relationship between depression literacy and psychological status among T2DM patients in primary health care services in Indonesia, which are still limited. This study analyzed this relationship among T2DM patients at the Kabila Community Health Center, Bone Bolango Regency, Gorontalo. A cross-sectional design was applied to 74 T2DM patients (from a population of 292; Slovin's formula, e = 10%) recruited by random sampling in January 2025. Depression literacy was measured using the Depression Literacy Questionnaire (D-Lit; 18 valid items; Cronbach's alpha = 0.799) and psychological status with the General Health Questionnaire (GHQ-12; Likert 0-3; alpha = 0.648). Data were analyzed using Spearman correlation, Kruskal-Wallis, and the Holm-corrected Mann-Whitney test. The mean depression literacy score was 7.20 (SD = 2.63), with the majority at a moderate level (67.57%); The mean GHQ-12 score was 19.12 (SD = 4.51), with 93.24% showing mild to severe levels of stress. Depression literacy scores did not significantly correlate with stress scores (rho = -0.17; 95% CI -0.38 to 0.07; p = 0.156), but stress levels differed across literacy categories (rho = 7.49; p = 0.024): the low literacy group showed higher stress than the moderate literacy group (median 26.0 vs. 18.0; Holm p = 0.021). More severe stress levels alleviated patients with the lowest levels of depression literacy, thus supporting community-based stress screening and targeted depression literacy education as social interventions in primary care.
References
1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119.
2. Wahidin M. Projection of diabetes morbidity and mortality till 2045 in Indonesia based on risk factors and NCD prevention and control programs. [BUTUH KONFIRMASI: journal, volume, pages] 2024.
3. Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006;23(11):1165-73.
4. Al-Mamun F, Hasan M, Quadros S, Kaggwa MM, Mubarak M, Sikder MT, et al. Depression among Bangladeshi diabetic patients: a cross-sectional, systematic review, and meta-analysis study. BMC Psychiatry. 2023;23:369.
5. Nouwen A, Adriaanse MC, van Dam K, Iversen MM, Viechtbauer W, Peyrot M, et al. Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis. Diabet Med. 2019;36(12):1562-72.
6. Li G, Yu Y, Lin C, Zheng S, Tu H, Xu W. Association between major depressive disorder or depressive symptoms and the risk of vascular complications among patients with type 2 diabetes: an analysis of the UK Biobank cohort. eClinicalMedicine. 2025;79:102982.
7. Enevoldsen FC, [BUTUH KONFIRMASI: full author list]. Diabetic complications and risk of depression and anxiety among adults with type 2 diabetes. Diabet Med. 2024;41:e15272.
8. Sharma K, Dhungana G, Adhikari S, Pandey AB, Sharma M. Depression and anxiety among patients with type II diabetes mellitus in Chitwan Medical College Teaching Hospital, Nepal. Nurs Res Pract. 2021;2021:8846915.
9. Karki A, Vandelanotte C, Rawal LB. Depressive symptoms, perceived stress, and associated socio-demographic and diabetes-related factors in people with type 2 diabetes in Nepal. Asia Pac J Public Health. 2024;36(7):719-29.
10. Elnaem MH, Bukhori NAS, Tengku Mohd Kamil TK, Rahayu S, Ramatillah DL, Elrggal ME. Depression and anxiety in patients with type 2 diabetes in Indonesia and Malaysia: do age, diabetes duration, foot ulcers, and prescribed medication play a role? Psychol Health Med. 2025;30(3):555-71.
11. Sayed Ahmed HA, Fouad AM, Elotla SF, Joudeh AI, Mostafa M, Shah A, et al. Prevalence and associated factors of diabetes distress, depression and anxiety among primary care patients with type 2 diabetes during the COVID-19 pandemic in Egypt. Front Psychiatry. 2022;13:937973.
12. Busili A, Kumar K, Kudrna L, Rabbani U. Examining the impact of the COVID-19 pandemic on mental health among adults with type 2 diabetes: a systematic review. Medicine (Baltimore). 2025;104:e43112.
13. American Diabetes Association Professional Practice Committee. Summary of revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Suppl 1):S6-13.
14. American Diabetes Association Professional Practice Committee. Summary of revisions: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Suppl 1):S6.
15. Perkumpulan Endokrinologi Indonesia (PERKENI). Pedoman pengelolaan dan pencegahan diabetes melitus tipe 2 dewasa di Indonesia 2021. Jakarta: PB PERKENI; 2021.
16. Oswald TK, Nguyen MT, Mirza L, Lund C, Jones HG, Crowley G, et al. Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Eur Psychiatry. 2024;67(1). doi:10.1192/j.eurpsy.2024.591
17. Jorm AF. Mental health literacy: public knowledge and beliefs about mental disorders. Br J Psychiatry. 2000;177(5):396-401.
18. Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry. 2004;185(4):342-9.
19. Wei Y, McGrath PJ, Hayden J, Kutcher S. Measurement properties of mental health literacy tools measuring help-seeking: a systematic review. J Ment Health. 2017;26(6):543-55.
20. Lee YJ. Depression literacy, associated factors, and correlation of related variables in middle-aged Korean adults: a cross-sectional study. Int J Environ Res Public Health. 2023;20(11):6021.
21. Al-Shannaq Y, Jaradat D, Ta’an WF, Jaradat D. Depression stigma, depression literacy, and psychological help-seeking attitudes among school and university students. Arch Psychiatr Nurs. 2023;46:98-106.
22. Zeng F, John WCM, Qiao D, Sun X. Association between psychological distress and mental help-seeking intentions in international students of the National University of Singapore: a mediation analysis of mental health literacy. BMC Public Health. 2023;23:2358.
23. Yao ZY, Wang T, Yu YK, Li R, Sang X, Fu YN, et al. Mental health literacy and suicidal ideation among Chinese college students: the mediating role of depressive and anxiety symptoms. J Affect Disord. 2023;339:293-301.
24. Kim E. Exploring the relationship between health literacy and depression among individuals with chronic conditions: insights from the KCHS. Healthcare (Basel). 2024;12(19):1927.
25. Jafari A, Moshki M, Naddafi F, Ghelichi-Ghojogh M, Armanmehr V, Kazemi K, et al. Depression literacy, mental health literacy, and their relationship with psychological status and quality of life in patients with type 2 diabetes mellitus. Front Public Health. 2024;12:1421053.
26. Tehrani H, Vali M, Nejatian M, Moshki M, Charoghchian Khorasani E, Jafari A. The status of depression literacy and its relationship with quality of life among the Iranian public: a cross-sectional study. BMC Psychiatry. 2022;22:469.
27. Tehrani H, Nejatian M, Moshki M, Jafari A. Psychometric properties of the Persian version of the depression literacy (D-Lit) questionnaire among the general population. Int J Ment Health Syst. 2022;16:39.
28. Idaiani S, Suhardi. [BUTUH KONFIRMASI: title, journal, volume—Indonesian GHQ-12 validation source; verify year 2006 vs 2019]. 2019.
29. Abbas, Q., Latif, S., Ayaz Habib, H., Shahzad, S., Sarwar, U., Shahzadi, M., Ramzan, Z., & Washdev, W. (2023). Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence among patients with type-II diabetes mellitus: a randomized control trial. BMC Psychiatry, 23(1). https://doi.org/10.1186/s12888-023-04546-w
30. Kintzoglanakis K, Gkousiou A, Vonta P, Sagmatopoulos A, Copanitsanou P. Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: different roles for glycemic control and self-care. SAGE Open Med. 2022;10:20503121221096605.
31. Shao Y, Hu H, Liang Y, Hong Y, Yu Y, Liu C, et al. Health literacy interventions among patients with chronic diseases: a meta-analysis of randomized controlled trials. Patient Educ Couns. 2023;114:107829.
32. Krisnadewi at al. Implementation of the preventive program for diabetes mellitus (PROLANIS) at a community health center in Indonesia: a qualitative study. 2024.
2. Wahidin M. Projection of diabetes morbidity and mortality till 2045 in Indonesia based on risk factors and NCD prevention and control programs. [BUTUH KONFIRMASI: journal, volume, pages] 2024.
3. Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006;23(11):1165-73.
4. Al-Mamun F, Hasan M, Quadros S, Kaggwa MM, Mubarak M, Sikder MT, et al. Depression among Bangladeshi diabetic patients: a cross-sectional, systematic review, and meta-analysis study. BMC Psychiatry. 2023;23:369.
5. Nouwen A, Adriaanse MC, van Dam K, Iversen MM, Viechtbauer W, Peyrot M, et al. Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis. Diabet Med. 2019;36(12):1562-72.
6. Li G, Yu Y, Lin C, Zheng S, Tu H, Xu W. Association between major depressive disorder or depressive symptoms and the risk of vascular complications among patients with type 2 diabetes: an analysis of the UK Biobank cohort. eClinicalMedicine. 2025;79:102982.
7. Enevoldsen FC, [BUTUH KONFIRMASI: full author list]. Diabetic complications and risk of depression and anxiety among adults with type 2 diabetes. Diabet Med. 2024;41:e15272.
8. Sharma K, Dhungana G, Adhikari S, Pandey AB, Sharma M. Depression and anxiety among patients with type II diabetes mellitus in Chitwan Medical College Teaching Hospital, Nepal. Nurs Res Pract. 2021;2021:8846915.
9. Karki A, Vandelanotte C, Rawal LB. Depressive symptoms, perceived stress, and associated socio-demographic and diabetes-related factors in people with type 2 diabetes in Nepal. Asia Pac J Public Health. 2024;36(7):719-29.
10. Elnaem MH, Bukhori NAS, Tengku Mohd Kamil TK, Rahayu S, Ramatillah DL, Elrggal ME. Depression and anxiety in patients with type 2 diabetes in Indonesia and Malaysia: do age, diabetes duration, foot ulcers, and prescribed medication play a role? Psychol Health Med. 2025;30(3):555-71.
11. Sayed Ahmed HA, Fouad AM, Elotla SF, Joudeh AI, Mostafa M, Shah A, et al. Prevalence and associated factors of diabetes distress, depression and anxiety among primary care patients with type 2 diabetes during the COVID-19 pandemic in Egypt. Front Psychiatry. 2022;13:937973.
12. Busili A, Kumar K, Kudrna L, Rabbani U. Examining the impact of the COVID-19 pandemic on mental health among adults with type 2 diabetes: a systematic review. Medicine (Baltimore). 2025;104:e43112.
13. American Diabetes Association Professional Practice Committee. Summary of revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Suppl 1):S6-13.
14. American Diabetes Association Professional Practice Committee. Summary of revisions: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Suppl 1):S6.
15. Perkumpulan Endokrinologi Indonesia (PERKENI). Pedoman pengelolaan dan pencegahan diabetes melitus tipe 2 dewasa di Indonesia 2021. Jakarta: PB PERKENI; 2021.
16. Oswald TK, Nguyen MT, Mirza L, Lund C, Jones HG, Crowley G, et al. Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Eur Psychiatry. 2024;67(1). doi:10.1192/j.eurpsy.2024.591
17. Jorm AF. Mental health literacy: public knowledge and beliefs about mental disorders. Br J Psychiatry. 2000;177(5):396-401.
18. Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry. 2004;185(4):342-9.
19. Wei Y, McGrath PJ, Hayden J, Kutcher S. Measurement properties of mental health literacy tools measuring help-seeking: a systematic review. J Ment Health. 2017;26(6):543-55.
20. Lee YJ. Depression literacy, associated factors, and correlation of related variables in middle-aged Korean adults: a cross-sectional study. Int J Environ Res Public Health. 2023;20(11):6021.
21. Al-Shannaq Y, Jaradat D, Ta’an WF, Jaradat D. Depression stigma, depression literacy, and psychological help-seeking attitudes among school and university students. Arch Psychiatr Nurs. 2023;46:98-106.
22. Zeng F, John WCM, Qiao D, Sun X. Association between psychological distress and mental help-seeking intentions in international students of the National University of Singapore: a mediation analysis of mental health literacy. BMC Public Health. 2023;23:2358.
23. Yao ZY, Wang T, Yu YK, Li R, Sang X, Fu YN, et al. Mental health literacy and suicidal ideation among Chinese college students: the mediating role of depressive and anxiety symptoms. J Affect Disord. 2023;339:293-301.
24. Kim E. Exploring the relationship between health literacy and depression among individuals with chronic conditions: insights from the KCHS. Healthcare (Basel). 2024;12(19):1927.
25. Jafari A, Moshki M, Naddafi F, Ghelichi-Ghojogh M, Armanmehr V, Kazemi K, et al. Depression literacy, mental health literacy, and their relationship with psychological status and quality of life in patients with type 2 diabetes mellitus. Front Public Health. 2024;12:1421053.
26. Tehrani H, Vali M, Nejatian M, Moshki M, Charoghchian Khorasani E, Jafari A. The status of depression literacy and its relationship with quality of life among the Iranian public: a cross-sectional study. BMC Psychiatry. 2022;22:469.
27. Tehrani H, Nejatian M, Moshki M, Jafari A. Psychometric properties of the Persian version of the depression literacy (D-Lit) questionnaire among the general population. Int J Ment Health Syst. 2022;16:39.
28. Idaiani S, Suhardi. [BUTUH KONFIRMASI: title, journal, volume—Indonesian GHQ-12 validation source; verify year 2006 vs 2019]. 2019.
29. Abbas, Q., Latif, S., Ayaz Habib, H., Shahzad, S., Sarwar, U., Shahzadi, M., Ramzan, Z., & Washdev, W. (2023). Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence among patients with type-II diabetes mellitus: a randomized control trial. BMC Psychiatry, 23(1). https://doi.org/10.1186/s12888-023-04546-w
30. Kintzoglanakis K, Gkousiou A, Vonta P, Sagmatopoulos A, Copanitsanou P. Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: different roles for glycemic control and self-care. SAGE Open Med. 2022;10:20503121221096605.
31. Shao Y, Hu H, Liang Y, Hong Y, Yu Y, Liu C, et al. Health literacy interventions among patients with chronic diseases: a meta-analysis of randomized controlled trials. Patient Educ Couns. 2023;114:107829.
32. Krisnadewi at al. Implementation of the preventive program for diabetes mellitus (PROLANIS) at a community health center in Indonesia: a qualitative study. 2024.
Published
2026-07-27
How to Cite
Zainuddin, Mihrawaty S. Antu, & Herlina Irmayanti Putri N. (2026). Depression Literacy and Its Relationship with Psychological Status among Patients with Type 2 Diabetes Mellitus at Indonesia: A Community Mental Health Perspective. International Journal of Health, Economics, and Social Sciences (IJHESS), 8(3), 944~949. https://doi.org/10.56338/ijhess.v8i3.11775
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Articles
Copyright (c) 2026 zainuddin, Mihrawaty S. Antu, Irmayanti Putri N
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
