{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:45:11Z","timestamp":1792565111963,"version":"4.5.0"},"reference-count":34,"publisher":"Belitung Raya Foundation","issue":"5","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"award":[""],"award-info":[{"award-number":[""]}]}],"content-domain":{"domain":["belitungraya.org"],"crossmark-restriction":true},"short-container-title":["Belitung Nurs J"],"abstract":"<jats:p>Background: Psychological distress, including stress and depressive symptoms, is common among people with diabetes and may negatively influence self-management and clinical outcomes in primary care settings.\nObjective: To assess and compare levels of perceived stress and depression among patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).\nMethods: This cross-sectional study included 297 patients with diabetes recruited using convenience sampling from eight primary care centers in Prishtina, Kosovo, between March 2025 and August 2025. Perceived stress was measured using the Perceived Stress Scale (PSS), while depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Demographic characteristics and selected clinical parameters, including waist circumference and systolic and diastolic blood pressure, were obtained from medical records. Categorical and continuous variables were analyzed using chi-square and Mann\u2013Whitney U tests, with Cram\u00e9r\u2019s V measuring categorical effect size. Statistical significance was set at p &lt; 0.05.\nResults: Patients with type 1 diabetes mellitus (T1DM) were significantly younger than patients with type 2 diabetes mellitus (T2DM). Exploratory item-level analysis of perceived stress did not demonstrate consistent differences between the groups; however, interpretation of stress-related findings should be approached cautiously due to the low internal consistency of the PSS in the present sample. Depressive symptom severity differed significantly between groups (p = 0.005, Cram\u00e9r\u2019s V = 0.224).\nConclusion: Significant differences were observed in depressive symptom severity between patients with T1DM and T2DM, whereas interpretation of perceived stress findings remains limited. Although these findings support the importance of psychological assessment in diabetes care, they should be interpreted cautiously given the cross-sectional design and methodological limitations of the study. Healthcare professionals, including physicians and nurses, \u00a0should routinely screen for depression in diabetes care and provide appropriate follow-up or referral based on symptom severity.<\/jats:p>","DOI":"10.33546\/bnj.4667","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T05:53:38Z","timestamp":1792562018000},"page":"643-652","update-policy":"https:\/\/doi.org\/10.33546\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Levels of stress and depression among patients with type 1 and type 2 diabetes mellitus in primary care in Kosovo: A cross-sectional study"],"prefix":"10.33546","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7521-5634","authenticated-orcid":false,"given":"Elvana","family":"Podvorica","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2903-8853","authenticated-orcid":false,"given":"Edmond","family":"Zaimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9033-6568","authenticated-orcid":false,"given":"Elizana","family":"Petrela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8802-3685","authenticated-orcid":false,"given":"Musa","family":"Oruqi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"19163","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"163601","doi-asserted-by":"crossref","unstructured":"Aekplakorn, W., Chariyalertsak, S., Kessomboon, P., Assanangkornchai, S., Taneepanichskul, S., & Putwatana, P. (2018). Prevalence of diabetes and relationship with socioeconomic status in the Thai population: National health examination survey, 2004\u20132014. Journal of Diabetes Research, 2018, 1654530. https:\/\/doi.org\/10.1155\/2018\/1654530","DOI":"10.1155\/2018\/1654530"},{"key":"163602","doi-asserted-by":"crossref","unstructured":"Alateeq, F. A. (2020). Prevalence of major depression among types II diabetes: A cross-sectional study in Riyadh, Saudi Arabia. Majmaah Journal of Health Sciences, 8(1), 36\u201344. https:\/\/doi.org\/10.5455\/mjhs.2020.01.005","DOI":"10.5455\/mjhs.2020.01.005"},{"key":"163603","doi-asserted-by":"crossref","unstructured":"Albasheer, O. B., Mahfouz, M. S., Solan, Y., Khan, D. A., Muqri, M. A., Almutairi, H. A., Alelyani, A. M., & Alahmed, H. A. (2018). Depression and related risk factors among patients with type 2 diabetes mellitus, Jazan area, KSA: A cross-sectional study. Diabetes & Metabolic Syndrome, 12(2), 117\u2013121. https:\/\/doi.org\/10.1016\/j.dsx.2017.09.014","DOI":"10.1016\/j.dsx.2017.09.014"},{"key":"163604","doi-asserted-by":"crossref","unstructured":"Alhunayni, N. M., Mohamed, A. E., & Hammad, S. M. (2020). Prevalence of depression among type II diabetic patients attending the diabetic clinic at Arar National Guard Primary Health Care Center, Saudi Arabia. Psychiatry Journal, 2020, 9174818. https:\/\/doi.org\/10.1155\/2020\/9174818","DOI":"10.1155\/2020\/9174818"},{"key":"163605","doi-asserted-by":"crossref","unstructured":"Aljohani, W., Algohani, L., Alzahrani, A., Bazuhair, M., Bawakid, A., Aljuid, L., & Al-Ahdal, A. (2021). Prevalence of depression among patients with type 2 diabetes at King Abdullah Medical City. Cureus, 13(10), e18447. https:\/\/doi.org\/10.7759\/cureus.18447","DOI":"10.7759\/cureus.18447"},{"key":"163606","doi-asserted-by":"crossref","unstructured":"Alzahrani, A., Alghamdi, A., Alqarni, T., Alshareef, R., & Alzahrani, A. (2019). Prevalence and predictors of depression, anxiety, and stress symptoms among patients with type II diabetes attending primary healthcare centers in the western region of Saudi Arabia: A cross-sectional study. International Journal of Mental Health Systems, 13, 48. https:\/\/doi.org\/10.1186\/s13033-019-0307-6","DOI":"10.1186\/s13033-019-0307-6"},{"key":"163607","doi-asserted-by":"crossref","unstructured":"American Diabetes Association [ADA]. (2018). Classification and diagnosis of diabetes: Standards of medical care in diabetes\u20142018. Diabetes Care, 41(Supplement_1), S13\u2013S27. https:\/\/doi.org\/10.2337\/dc18-S002","DOI":"10.2337\/dc18-S002"},{"key":"163608","doi-asserted-by":"crossref","unstructured":"Brali\u0107 Lang, V., Bergman Markovi\u0107, B., & Vrdoljak, D. (2015). The association of lifestyle and stress with poor glycemic control in patients with diabetes mellitus type 2: A Croatian nationwide primary care cross-sectional study. Croatian Medical Journal, 56(4), 357\u2013365. https:\/\/doi.org\/10.3325\/cmj.2015.56.357","DOI":"10.3325\/cmj.2015.56.357"},{"key":"163609","doi-asserted-by":"crossref","unstructured":"Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385\u2013396. https:\/\/doi.org\/10.2307\/2136404","DOI":"10.2307\/2136404"},{"key":"163610","doi-asserted-by":"crossref","unstructured":"Eeg-Olofsson, K., Cederholm, J., Nilsson, P. M., Zethelius, B., Nunez, L., Gudbj\u00f6rnsd\u00f3ttir, S., & Eliasson, B. (2009). Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: An observational study in 13,087 patients. Diabetologia, 52(1), 65\u201373. https:\/\/doi.org\/10.1007\/s00125-008-1190-x","DOI":"10.1007\/s00125-008-1190-x"},{"key":"163611","doi-asserted-by":"crossref","unstructured":"Farooqi, A., Gillies, C., Sathanapally, H., Abner, S., Seidu, S., Davies, M. J., Polonsky, W. H., & Khunti, K. (2022). A systematic review and meta-analysis to compare the prevalence of depression between people with and without Type 1 and Type 2 diabetes. Primary Care Diabetes, 16(1), 1\u201310. https:\/\/doi.org\/10.1016\/j.pcd.2021.11.001","DOI":"10.1016\/j.pcd.2021.11.001"},{"key":"163612","doi-asserted-by":"crossref","unstructured":"Fisher, L., Gonzalez, J. S., & Polonsky, W. H. (2014). The confusing tale of depression and distress in patients with diabetes: A call for greater clarity and precision. Diabetic Medicine, 31(7), 764\u2013772. https:\/\/doi.org\/10.1111\/dme.12428","DOI":"10.1111\/dme.12428"},{"key":"163613","doi-asserted-by":"crossref","unstructured":"Gonzalez, J. S., Peyrot, M., McCarl, L. A., Collins, E. M., Serpa, L., Mimiaga, M. J., & Safren, S. A. (2008). Depression and diabetes treatment nonadherence: A meta-analysis. Diabetes Care, 31(12), 2398\u20132403. https:\/\/doi.org\/10.2337\/dc08-1341","DOI":"10.2337\/dc08-1341"},{"key":"163614","doi-asserted-by":"crossref","unstructured":"Grigsby, A. B., Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2002). Prevalence of anxiety in adults with diabetes: A systematic review. Journal of Psychosomatic Research, 53(6), 1053\u20131060. https:\/\/doi.org\/10.1016\/S0022-3999(02)00417-8","DOI":"10.1016\/S0022-3999(02)00417-8"},{"key":"163615","doi-asserted-by":"crossref","unstructured":"Harding, J. L., Backholer, K., Williams, E. D., Peeters, A., Cameron, A. J., Hare, M. J., Shaw, J. E., & Magliano, D. J. (2014). Psychosocial stress is positively associated with body mass index gain over 5 years: Evidence from the longitudinal AusDiab study. Obesity (Silver Spring), 22(1), 277\u2013286. https:\/\/doi.org\/10.1002\/oby.20423","DOI":"10.1002\/oby.20423"},{"key":"163616","unstructured":"Holt, R. I. (2025). Diabetes and depression. In K. R. Feingold, R. A. Adler, & S. F. Ahmed (Eds.), Endotext MDText.com, Inc. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK498652\/"},{"key":"163617","doi-asserted-by":"crossref","unstructured":"Inga-Britt, L., & Kerstin, B. (2019). Challenges faced in daily life by persons with type 2 diabetes: A meta-synthesis. Chronic Illness, 15(3), 167\u2013186. https:\/\/doi.org\/10.1177\/1742395318757852","DOI":"10.1177\/1742395318757852"},{"key":"163618","doi-asserted-by":"crossref","unstructured":"Kaur, G., Tee, G. H., Ariaratnam, S., Krishnapillai, A. S., & China, K. (2013). Depression, anxiety and stress symptoms among diabetics in Malaysia: A cross sectional study in an urban primary care setting. BMC Family Practice, 14, 69. https:\/\/doi.org\/10.1186\/1471-2296-14-69","DOI":"10.1186\/1471-2296-14-69"},{"key":"163619","doi-asserted-by":"crossref","unstructured":"Khalangot, M., Tronko, M., Kravchenko, V., Kulchinska, J., & Hu, G. (2009). Body mass index and the risk of total and cardiovascular mortality among patients with type 2 diabetes: A large prospective study in Ukraine. Heart, 95(6), 454\u2013460. https:\/\/doi.org\/10.1136\/hrt.2008.150524","DOI":"10.1136\/hrt.2008.150524"},{"key":"163620","doi-asserted-by":"crossref","unstructured":"Khaledi, M., Haghighatdoost, F., Feizi, A., & Aminorroaya, A. (2019). The prevalence of comorbid depression in patients with type 2 diabetes: An updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetologica, 56(6), 631\u2013650. https:\/\/doi.org\/10.1007\/s00592-019-01295-9","DOI":"10.1007\/s00592-019-01295-9"},{"key":"163621","doi-asserted-by":"crossref","unstructured":"Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606\u2013613. https:\/\/doi.org\/10.1046\/j.1525-1497.2001.016009606.x","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"163622","doi-asserted-by":"crossref","unstructured":"Nanayakkara, N., Pease, A., Ranasinha, S., Wischer, N., Andrikopoulos, S., Speight, J., de Courten, B., & Zoungas, S. (2018). Depression and diabetes distress in adults with type 2 diabetes: Results from the Australian National Diabetes Audit (ANDA) 2016. Scientific Reports, 8(1), 7846. https:\/\/doi.org\/10.1038\/s41598-018-26138-5","DOI":"10.1038\/s41598-018-26138-5"},{"key":"163623","doi-asserted-by":"crossref","unstructured":"Reimer, A., Schmitt, A., Ehrmann, D., Kulzer, B., & Hermanns, N. (2017). Reduction of diabetes-related distress predicts improved depressive symptoms: A secondary analysis of the DIAMOS study. PloS One, 12(7), e0181218. https:\/\/doi.org\/10.1371\/journal.pone.0181218","DOI":"10.1371\/journal.pone.0181218"},{"key":"163624","doi-asserted-by":"crossref","unstructured":"Roy, T., & Lloyd, C. E. (2012). Epidemiology of depression and diabetes: A systematic review. Journal of Affective Disorders, 142 Suppl, S8\u201321. https:\/\/doi.org\/10.1016\/S0165-0327(12)70004-6","DOI":"10.1016\/S0165-0327(12)70004-6"},{"key":"163625","doi-asserted-by":"crossref","unstructured":"Sendhilkumar, M., Tripathy, J. P., Harries, A. D., Dongre, A. R., Deepa, M., Vidyulatha, A., Poongothai, S., Venkatesan, U., Anjana, R. M., & Mohan, V. (2017). Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India. Indian Journal of Endocrinology and Metabolism, 21(1), 56\u201363. https:\/\/doi.org\/10.4103\/2230-8210.196006","DOI":"10.4103\/2230-8210.196006"},{"key":"163626","doi-asserted-by":"crossref","unstructured":"Siddharthan, G. M., Reddy, M. M., & Sunil, B. N. (2021). \"Perceived stress\" and its associated factors among diabetic patients receiving care from a rural tertiary health care center in South India. Journal of Education and Health Promotion, 10, 11. https:\/\/doi.org\/10.4103\/jehp.jehp_388_20","DOI":"10.4103\/jehp.jehp_388_20"},{"key":"163627","doi-asserted-by":"crossref","unstructured":"Sopjani, I., & Elezi, S. (2021). Prevalence of hypertension and diabetes in the population of Kosovo. Frontiers of Nursing, 8, 261\u2013267. https:\/\/doi.org\/10.2478\/fon-2021-0027","DOI":"10.2478\/fon-2021-0027"},{"key":"163628","unstructured":"Tan, K. C., Chan, G. C., Eric, H., Maria, A. I., Norliza, M. J., Oun, B. H., Sheerine, M. T., Wong, S. J., & Liew, S. M. (2015). Depression, anxiety and stress among patients with diabetes in primary care: A cross-sectional study. Malaysian Family Physician, 10(2), 9\u201321."},{"key":"163629","doi-asserted-by":"crossref","unstructured":"Tran, N. M. H., Nguyen, Q. N. L., Vo, T. H., Le, T. T. A., & Ngo, N. H. (2021). Depression among patients with type 2 diabetes mellitus: Prevalence and associated factors in Hue City, Vietnam. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 14, 505\u2013513. https:\/\/doi.org\/10.2147\/dmso.S289988","DOI":"10.2147\/DMSO.S289988"},{"key":"163630","unstructured":"Vasanth, R., Ganesh, A., & Shanker, R. (2017). Impact of stress on type 2 diabetes mellitus management. Psychiatria Danubina, 29(Suppl 3), 416\u2013421."},{"key":"163631","unstructured":"World Health Assembly. (2012). Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA65\/A65_R4-en.pdf"},{"key":"163632","doi-asserted-by":"crossref","unstructured":"Young-Hyman, D., de Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., & Peyrot, M. (2016). Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(12), 2126\u20132140. https:\/\/doi.org\/10.2337\/dc16-2053","DOI":"10.2337\/dc16-2053"},{"key":"163633","doi-asserted-by":"crossref","unstructured":"Zhang, W., Xu, H., Zhao, S., Yin, S., Wang, X., Guo, J., Zhang, S., Zhou, H., Wang, F., Gu, L., Zhu, L., Yu, H., Qu, Z., & Tian, D. (2015). Prevalence and influencing factors of co-morbid depression in patients with type 2 diabetes mellitus: A general hospital based study. Diabetology & Metabolic Syndrome, 7, 60. https:\/\/doi.org\/10.1186\/s13098-015-0053-0","DOI":"10.1186\/s13098-015-0053-0"},{"key":"163634","doi-asserted-by":"crossref","unstructured":"Zhao, F. F., Suhonen, R., Katajisto, J., & Leino-Kilpi, H. (2018). The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: A cross-sectional study. Patient Preference and Adherence, 12, 1677\u20131686. https:\/\/doi.org\/10.2147\/ppa.S169826","DOI":"10.2147\/PPA.S169826"}],"container-title":["Belitung Nursing Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4667\/1453","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4667\/1465","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4667\/1453","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:07:16Z","timestamp":1792562836000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/view\/4667"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,10,21]]}},"URL":"https:\/\/doi.org\/10.33546\/bnj.4667","relation":{},"ISSN":["2477-4073"],"issn-type":[{"value":"2477-4073","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]},"assertion":[{"value":"2026-02-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-31","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}