Gender Differences in Type 1 Diabetes Management and Mental Health Burden: Findings from a National Survey in Saudi Arabia.

Background: T1D is generally associated with increased psychological burden, but evidence from Middle Eastern populations remains scarce. The present study assessed the gender differences in management, prevalence, and risk factors of perceived depression and anxiety among people with T1D in Saudi Arabia. Methods: A cross-sectional online survey was conducted among people withT1D across Saudi Arabia to collect demographic, clinical, and diabetes management data. Perceived depression and anxiety symptoms were assessed using a validated questionnaire. Multinomial logistic regression was used to identify risk factors of severe depression and anxiety. Results: Among 1073 PwT1D (303 males and 770 females), perceived depressive and anxiety symptoms were highly prevalent. Females had higher perceived anxiety compared with males (p = 0.003). Age- and BMI-adjusted regression analysis showed that, overall, higher income (p = 0.008), no neuropathy (p = 0.002), above-average benefit from the diabetes education clinic (p = 0.02), practicing carbohydrate counting (p = 0.002), and HbA1c < 7.0% (p = 0.01) were protective against perceived severe depression. Friends with T1D as the preferred education source (odds ratio [OR] = 2.8, p = 0.04) and a rejected request for continuous glucose monitoring (CGM) (OR = 1.88, p = 0.02) or insulin pump (OR = 2.8, p = 0.001) were significant risk factors. Perceived severe anxiety was associated with insulin pump rejection (OR = 2.4, p < 0.001) and self-reading as the preferred education source (OR = 2.0, p = 0.03). Being male (p = 0.02), no neuropathy (p = 0.01), practicing carbohydrate counting (p < 0.001), and HbA1c < 7.0% (p = 0.001) were protective. Conclusions: Symptoms of depression and anxiety are highly prevalent among people with T1D in Saudi Arabia, with females and socioeconomically disadvantaged individuals at greater risk. The findings highlight an urgent need for integrated mental health support within diabetes care and improved access to resources.