“If I am free from diabetes, that itself will be the happiest thing”: A convergent mixed methods study of the lived experiences of young adults with type 2 diabetes in Mysore district, India

Type 2 diabetes (T2D) has been occurring at younger ages of onset around the world. India’s population accounts for nearly 20% of the global disease burden. This study investigated the occurrence of depressive symptoms and qualitatively explored the lived experiences of 20 young adults living with T2D under the age of 35. We conducted a convergent mixed-methods study with the Patient Health Questionnaire (PHQ-9) and semi-structured interviews from June 2022 to July 2022 in Mysore district, India. Guided by the World Health Organization’s Commission on Social Determinants of Health conceptual framework and biopsychosocial frameworks, areas of inquiry included knowledge and perception about T2D, accessibility of healthcare resources, T2D-related self-care activities, and the impact of the condition on their daily life. Interviews were debriefed by the research team and analyzed thematically using NVivo 12. Participants were aged between 21 and 35 (mean: 30.8, SD: 4.2) and the majority were female (75%). Overall, 55% reported mild depression symptoms, 15% reported moderate to moderately severe depression symptoms; 5 participants (25%) reported suicidality. Sex, living in rural Mysore district, socioeconomic status, T2D duration, family history of T2D, T2D-induced complications, and T2D-related self-care behaviors were associated with depressive symptoms. Thematic analysis revealed 1) low knowledge about T2D, 2) substantial interpersonal and internalized stigma for having T2D at a young age, 3) financial and time constraints to seek and receive care, 4) self-perception as burdens to family members due to the cost and stress of living with T2D, 5) competing priorities with work and family, and 6) the power of social support in managing T2D. These themes were consistent across the sample, regardless of severity of depressive symptoms. Awareness campaigns and peer support programs may help reduce depressive symptoms and increase self-efficacy in this population. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project was funded by the Paul Farmer Global Health Fieldwork Grant (Duke Global Health Institute), Janet B. Chiang Grant (Duke University Asian/Pacific Studies Institute), Human Rights Summer Research Grant (Duke Human Rights Center at the Franklin Humanities Institute), Undergraduate Summer Award (Duke University Center for International & Global Studies), and Undergraduate Research Support Independent Study Grant (Duke University Undergraduate Research Support Office). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval was obtained from Duke Campus Institutional Review Board (2022-0358) and the Public Health Research Institute of India’s Institution Ethics Review Board (2022-01-29-64). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The availability of the full data set is not publicly available in a repository due to ethical restrictions. Ethical approval for the study was received from Duke Campus Institutional Review Board (2022-0358) and the Public Health Research Institute of India’s Institution Ethics Review Board (2022-01-29-64). When applying for ethical approval we did not specify that the data would be made publicly available in a repository. As part of the written and verbal consent we assured participants that all data would be confidential and access to the recordings would be restricted to the research team. We did specify that “some of their words” may be used in reporting the findings of the study, which we have done within the manuscript as non-identifiable quotes).