Anxiety disorders increase hospital visits, costs in type 2 diabetes

Adults with type 2 diabetes who are diagnosed with an anxiety disorder visit the hospital emergency department more frequently and spend more on hospitalization than those without such diagnoses, according to findings published in Diabetes Care.

“Anxiety disorders are serious. They cause extreme distress and harm people’s abilities to live fulfilling lives,” Esti Iturralde, PhD, a mental health researcher in the division of research at Kaiser Permanente Northern California in Oakland, told Endocrine Today. “Doctors who treat diabetes might miss the importance of anxiety disorders because these patients often do not appear ‘sicker’ in a medical sense—but we found that anxiety disorders contribute to problematic health care use that exposes patients to unnecessary medical risks and impacts the whole health care system.”

Iturralde and colleagues searched for diagnoses of anxiety disorders such as obsessive compulsive disorder, PTSD and agoraphobia along with diagnoses of depression in electronic health records of 143,573 adults (mean age, 64 years; 48.1% women) with type 2 diabetes who were members of Kaiser Permanente Northern California from 2008 to 2012. A database provided information on ED visit frequency and hospitalization costs in 2012. The researchers defined chronic visitation as three ED visits in each of the previous 3 years.

An anxiety disorder was diagnosed in 12.9% of the study population and 52.9% of those with an anxiety disorder were diagnosed with depression, according to the researchers. Of those with an anxiety disorder, 35.2% visited the ED at least once vs. 23.6% of those without an anxiety disorder (P .001). The rate at which a participant with anxiety would visit the ED was 27% higher compared with those without anxiety (incidence rate ratio [IRR] = 1.27; 95% CI, 1.21-1.34), according to the researchers, who added that the rate at which a participant with depression would visit the ED was 13% higher vs. the rate for a participant without depression (IRR = 1.13; 95% CI, 1.09-1.18).


Chronic visitation was reported in 1.5% of those with anxiety disorders compared with 0.2% of those without such conditions (P .001), with the researchers noting that the risk for chronic visitation was more than double for those with anxiety (OR = 2.55; 95% CI, 1.9-3.44) and 1.66 times higher for those with depression (OR = 1.66; 95% CI, 1.29-2.14). Iturralde added that “anxiety disorder was associated with 255% higher odds of visiting the emergency department multiple times a year for multiple years in a row.”

Individuals with anxiety disorders spent an average of $5,790.45 on hospitalization in 2012 while those without such conditions spent an average of $4,105.89 (P .001). According to the researchers, being among the top 20% of spenders in the Kaiser Permanente Northern California system was 29% more likely for those with anxiety (OR = 1.29; 95% CI, 1.23-1.36) or depression (OR = 1.29; 95% CI, 1.24-1.34).

“Anxiety causes physiological symptoms that resemble physical symptoms in diabetes — so it may cause people to overtreat or undertreat their diabetes condition. Anxiety also causes people to engage in unhelpful behaviors, such as avoiding daily diabetes management tasks, or becoming ‘burned out’ through excessive worrying or even checking their blood sugars too often,” Iturralde said. “Therefore, because the two problems are so intertwined, it makes sense for anxiety treatment to be integrated more closely with diabetes treatment.” – by Phil Neuffer

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Esti Iturralde, PhD, can be reached at

Disclosures: The authors report no relevant financial disclosures.