Independent Associations of Diabetes Stigma and Perceived Social Support with Depression and Anxiety Among Adults with Type 2 Diabetes

Background/Objectives: Depression and anxiety are common among individuals with type 2 diabetes mellitus (T2DM) and are associated with poorer clinical outcomes. Although diabetes stigma and perceived social support have been linked to psychological distress in T2DM, they have largely been investigated separately and with limited adjustment for potential confounders. This study aimed to examine whether diabetes stigma and perceived social support are independently associated with depression and anxiety after adjustment for sociodemographic and clinical confounders and, secondarily, to evaluate the association of insulin use with these psychological outcomes. Methods: In this single-center, cross-sectional study, 209 adults with T2DM attending a tertiary internal medicine outpatient clinic were enrolled. Diabetes stigma was assessed using the Type 2 Diabetes Stigma Assessment Scale (DSAS-2), depression using the Beck Depression Inventory (BDI), anxiety using the Beck Anxiety Inventory (BAI), and perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). Mann–Whitney U tests, Spearman correlation analyses, and two-step hierarchical linear regression models were performed. Results: Diabetes stigma was positively correlated with depression (ρ = 0.351) and anxiety (ρ = 0.432), whereas perceived social support was negatively correlated with both depression (ρ = −0.394) and anxiety (ρ = −0.275) (all p < 0.001). After adjustment for sociodemographic and clinical covariates, the addition of diabetes stigma and perceived social support explained an additional 21.4% of the variance in depression (ΔR2 = 0.214) and 17.9% of the variance in anxiety (ΔR2 = 0.179) (both p < 0.001). Both diabetes stigma and perceived social support remained independently associated with depression and anxiety, whereas insulin use was not independently associated with either outcome. Conclusions: Diabetes stigma and perceived social support exhibit independent and additive associations with depression and anxiety among individuals with T2DM. Integrating psychosocial assessment, stigma-reduction strategies, and interventions aimed at strengthening social support into routine diabetes care may contribute to improved psychological well-being in this population.