American Diabetes Month: What is the connection between the disease and mental health?
According to the CDC, 1 in 5 adults with type 2 diabetes has depression. 1 in 3 adults with type 2 diabetes experiences diabetes distress
Is mental health low on your list of priorities for managing diabetes? Experts advise caution as people with diabetes are 2 to 3 times more likely to have depression than people without diabetes. While therapy, medicine, or both are usually effective, only between 25% to 50% of people with diabetes who have depression get diagnosed and treated, according to the US Centers for Disease Control and Prevention (CDC).
“1 in 5 adults with type 2 diabetes has depression. 1 in 3 adults with type 2 diabetes experiences diabetes distress. Depression and diabetes distress often go unrecognized and unaddressed in patients with type 2 diabetes, resulting in poor health outcomes. Early identification and intervention for these mental health conditions can improve diabetes self-care. Healthcare providers can help close the gap by conducting regular mental health screenings and referring patients for additional care if needed,” suggests the agency.
What is diabetes distress and how does it affect people?
Managing the physical symptoms of diabetes can be all-consuming: the day-to-day demands can be a constant struggle affecting every aspect of a person’s life, including their emotional and mental health. A person may also develop a health problem related to diabetes despite his or her best efforts. Such feelings, known as diabetes distress, can cause one to feel overwhelmed and may lead a person to slip into unhealthy habits, stop checking their blood sugar or even skip doctor’s appointments. The CDC estimates that during any 18 months, 33% to 50% of people with diabetes have diabetes distress.
“Healthcare professionals should be aware that depression is more common in people with diabetes, and, when it’s present, it’s associated with poor health outcomes in people who have diabetes,” explains Dr Jeffrey Gonzalez. He is the co-author of the ‘Psychiatric and Psychosocial Issues among Individuals Living with Diabetes’ chapter in the NIDDK publication ‘Diabetes in America.’
According to Dr Gonzalez, research shows that people who report more diabetes distress are also more likely to report more problems with self-management and medication adherence and may also have higher blood glucose levels. “Some evidence suggests they may also be more likely to experience hypoglycemia and fear of hypoglycemia, which can affect their ability and willingness to take their medications,” he adds.
Dr Gonzalez says that diabetes distress is much more common than clinical depression among patients with diabetes. Depression is a medical illness that causes feelings of sadness and often a loss of interest in activities you used to enjoy. It can get in the way of how well a person functions at work and home, including taking care of the disease. And unless diabetes is managed properly, it can cause multiple complications such as heart disease, kidney damage, hearing and vision loss and nerve damage, among others.
The symptoms of depression can be mild to severe and can include feelings of sadness or emptiness, overeating or not wanting to eat, losing interest in favorite activities, change in sleep patterns such as lack of sleep or sleeping too much, feeling tired and facing trouble concentrating or making decisions. Feelings of hopelessness anxiety, guilt, or irritability; having aches or pains, headaches, cramps or digestive problems and gettings thoughts of suicide or death may also occur.
“Sometimes, there’s a sadness or an emotional flatness that just won’t go away. Sometimes, you just feel hopeless — and have no idea what comes next. However it shows up, depression can be hard to detect and can wreak havoc with your self-care. Spotting depression is important — and it’s important to check for symptoms,” emphasizes the American Diabetes Association (ADA).
Experts also caution that stress is not helpful for diabetes patients: stress hormones can make blood sugar rise or fall unpredictably. Anxiety is a person’s reaction to stress and data suggests that diabetic patients are 20% more likely than those without diabetes to have anxiety at some point in their life.
What are the barriers?
While patients may lack knowledge about depression symptoms and diabetes distress, healthcare providers could lack mental health training or think that mental health issues are outside of their scope, according to experts. Lack of access to mental health assessment tools, absence of reminder systems in place for screening, and little or no access to mental health specialists are other problems one may encounter.
What can be done?
Diabetes distress seems to respond to many different kinds of interventions, including educational and supportive interventions. Experts suggest that those with diabetes can improve their mental health by seeking professional help. They advise seeing an endocrinologist for diabetes care as he or she is likely to have a deeper understanding of diabetes challenges than a regular doctor. You may ask your doctor to refer you to a mental health counselor who specializes in chronic health conditions. You can also consult a diabetes educator so you can problem-solve together.
Health experts call for focusing on one or two small diabetes management goals instead of thinking one has to work on everything all at once. They recommend paying attention to one’s feelings and talking with family and friends about one’s feelings. Joining a diabetes support group so you can share your thoughts and feelings with people who have the same concerns, could be helpful.
“Tracking your blood sugar levels, dosing insulin, planning your meals, staying active — it’s a lot to think about. It can leave you feeling run down, emotionally drained, and completely overwhelmed. That’s why it’s important to stay in touch with your emotions as you manage your diabetes. Take time to take inventory of your emotions and reach out to those around you to talk honestly and openly about how you feel,” recommends the ADA.
To remove barriers, the CDC says patients should be educated about depression and diabetes distress. It asks healthcare providers to provide them with information resources and let them know about available mental health services. The agency also advises healthcare providers to identify and participate in mental health training, to use publicly available screening tools and to include alerts in electronic health records to trigger screening. Identifying mental health professionals who can collaborate as part of the care team and provide more specialized help when it is needed is another suggestion.
“Addressing the emotional side of living with diabetes should be part of comprehensive diabetes care. Providers can ask questions about how people are doing, how they’re feeling, and what aspects of their diabetes are causing stress. Providers can also acknowledge and normalize the idea that diabetes distress is common and could occur sometime in the course of the illness, perhaps with the onset of complications or with life changes that make following a diabetes self-management routine more difficult,” says Dr Gonzalez.