The risk factors for mental health disorders in patients with type 2 diabetes: An umbrella review of systematic reviews with and without meta-analysis

Background: Patients with type 2 diabetes have a nearly twofold higher rate of diagnosed mental disorders than those without diabetes. The association between type 2 diabetes and mental disorders is well established in the literature and recognized as a bidirectional relationship. This study aims to conduct an umbrella review of risk and protective factors for mental health disorders in patients with type 2 diabetes and assess the credibility of the evidence for the association between each factor and mental health disorders. Methods: A comprehensive search was conducted of Medline via PubMed, Web of Science, EMBASE, CINHAL, and PsycINFO from inception to November 17, 2022, to identify systematic reviews with and without meta-analyses examining associations of factors with mental health disorders in patients with type 2 diabetes. For each association, we recalculated the summary effect size and 95% confidence intervals using random-effects models. We also reported the 95% prediction interval and between-group heterogeneity. Results: The study included 11 systematic reviews that met the inclusion criteria, comprising eight meta-analyses and three without meta-analyses. This involved approximately 489,930 participants and encompassed 26 unique factors. Six factors were rated as having suggestive evidence at the Class III level. These factors were obesity (n = 18,456, OR 1.75 [1.2 to 2.59], I 2 97.7%), neuropathy (n = 3898, OR 2.01 [1.60 to 2.54], I 2 44.5%), diabetes complications (n = 1769, OR 1.90 [1.53 to 2.36], I 2 39.3%), peripheral blood concentrations of CRP (n = 1742, SMD 0.31 [0.16 to 0.45], I 2 84.1%), female sex (n = 35,162, OR 1.36 [1.19 to 1.54], I 2 64.5%), and social support (n = 3151, OR 2.02 [1.51 to 2.70], I 2 87.2%). Conclusions: Several factors associated with mental health disorders in patients with type 2 diabetes were identified with varying degrees of supporting evidence. Significantly, obesity, neuropathy, complications, peripheral blood CRP concentrations, female sex, and social support emerged with suggestive evidence. An investigation of these factors should be conducted to target interventions accordingly. It may be helpful to prioritize patients who have these risk factors as high-risk groups and to implement plans and policies to enhance support before mental health disorders occur.