Examining the mental health impact of the COVID-19 pandemic on people living with diabetes in the Western Cape, South Africa.

People living with diabetes (PLWD) faced heightened biomedical and psychosocial risk during the COVID-19 pandemic, yet little is known about their mental health in South Africa. This study examined whether COVID-19 threat appraisals (fear of COVID-19, perceived vulnerability to disease, and COVID-19-related worry) predicted depression, anxiety, posttraumatic stress, and alcohol use among PLWD, and described the prevalence of these outcomes in a post-peak phase of the pandemic. Participants (n = 266) were recruited from public hospitals in the Western Cape and completed sociodemographic and standardised measures. Grounded in Lazarus and Folkman's Stress and Coping theory, hierarchical regression analysis showed that fear of COVID-19 was the most consistent predictor of psychological distress, explaining between 9 and 20% of the variance across outcomes. Study participants reported on average elevated levels of psychological distress, suggesting the need to integrate routine mental health assessment and referral into diabetes care.