"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. Indias 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 Organizations 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.