Association between systemic immune-inflammation index and symptoms of depression and anxiety in patients with type 2 diabetes mellitus

doi:10.5498/wjp.124037

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 16, Issue 11

This Article

(4)

(5)

(0)

(211)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Psychiatry

ISSN

2220-3206

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Nov 19, 2026; 16(11): 124037
Published online Nov 19, 2026. doi: 10.5498/wjp.124037

Association between systemic immune-inflammation index and symptoms of depression and anxiety in patients with type 2 diabetes mellitus

Xiao-Yu Pan, Yi-Kun Wang, Ya-Qin Ding, Nuo-Jin Wang, Tian-Rong Pan, Xing Zhong

Xiao-Yu Pan, Yi-Kun Wang, Ya-Qin Ding, Nuo-Jin Wang, Tian-Rong Pan, Xing Zhong, Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China

Co-first authors: Xiao-Yu Pan and Yi-Kun Wang.

Author contributions: Pan XY, Wang YK, Ding YQ, Wang NJ, and Pan TR designed the research, performed data curation and formal analysis, developed the methodology, managed resources, and utilized software; Pan XY, Wang YK, and Ding YQ also wrote the original draft of the manuscript; Zhong X reviewed and edited the manuscript to ensure its scientific rigor and clarity and provided critical input in refining the final draft; Pan XY and Wang YK contributed equally as co-first authors. All authors approved the final version for publication.

AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.

Supported by the Health Research Program of Anhui, No. AHWJ2023BAc10010; the Clinical and Translational Research Project of Anhui Province, No. 202427b10020055; and the National Natural Science Foundation of China, No. 32571507.

Institutional review board statement: This study was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University, No. YX2024-210.

Informed consent statement: Written informed consent for publication was obtained from all patients included in this study and/or their families.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data sets generated and analyzed during this study are not publicly available but can be provided by the corresponding author upon reasonable request.

Corresponding author: Xing Zhong, Professor, Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, Anhui Province, China. zhongxing@ahmu.edu.cn

Received: June 4, 2026
Revised: July 13, 2026
Accepted: August 28, 2026
Published online: November 19, 2026
Processing time: 147 Days and 11.2 Hours

Abstract

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder prevalent worldwide, often accompanied by exacerbated symptoms of depression and anxiety, which can affect treatment adherence, glycemic control, and quality of life.

AIM

To investigate the association between the systemic immune-inflammation index (SII) and depressive and anxiety symptoms, as well as their comorbidity, in patients with T2DM.

METHODS

A cross-sectional study was conducted using consecutive sampling, enrolling 402 hospitalized patients with T2DM. The SII was calculated as platelet count × neutrophil count/lymphocyte count. Depressive and anxiety symptoms were screened using the validated Chinese versions of the 9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder scale, with a score ≥ 5 defined as elevated symptoms. Multivariable logistic regression, subgroup interaction analysis, and restricted cubic spline analysis were performed to estimate independent associations.

RESULTS

The prevalence of elevated depressive symptoms, elevated anxiety symptoms, and their comorbidity increased significantly with ascending SII tertiles (all P < 0.001). In fully adjusted models, the highest SII tertile was associated with higher odds of elevated depressive symptoms [odds ratio (OR) = 3.93, 95% confidence interval (95%CI): 2.18–7.08, P < 0.001], elevated anxiety symptoms (OR = 9.21, 95%CI: 4.16–20.39, P < 0.001), and their comorbidity (OR = 5.41, 95%CI: 3.21–9.11, P < 0.001) compared with the lowest tertile. Subgroup analysis identified significant interactions between alcohol consumption and the SII on depressive symptoms (P for interaction = 0.010) and between stroke history (P for interaction = 0.018) and BMI (P for interaction = 0.024) and the SII on anxiety symptoms. Restricted cubic spline analysis confirmed a significant nonlinear dose–response relationship between the SII and elevated depressive and anxiety symptoms (all P for nonlinearity < 0.05).

CONCLUSION

An elevated SII is independently associated with a higher prevalence of elevated depressive symptoms, elevated anxiety symptoms, and their comorbidity in hospitalized patients with T2DM in a nonlinear pattern.

Keywords: Anxiety; Depression; Systemic immune-inflammation index; Type 2 diabetes mellitus; 9-item Patient Health Questionnaire; 7-item Generalized Anxiety Disorder

Core Tip: Chronic inflammation is implicated in the psychological comorbidities of type 2 diabetes mellitus. This cross-sectional study enrolling 402 hospitalized patients with type 2 diabetes mellitus reveals that an elevated systemic immune-inflammation index is independently associated with a higher prevalence of elevated depressive symptoms, anxiety symptoms, and their comorbidity, presenting a significant nonlinear dose-response pattern. The systemic immune-inflammation index may act as an auxiliary inflammatory biomarker for psychological symptom stratification in hospitalized patients with type 2 diabetes mellitus.