Mental Health and Diabetes

Major depressive disorder is one of the most serious mental health comorbidities associated with diabetes and it effects 6.7% of US adults 18 years or older is more likely to be diagnosed in US adults with diabetes. Individuals with type 1 or type 2 diabetes are at increased risk for depression, anxiety, and eating disorder diagnoses. Young adults are more prone to mental health comorbidities.  Due mental health, patient may not comply with the treatment which can lead to short- and long-term complications  such as, blindness, amputations, stroke, cognitive decline, decreased quality of life, and premature death. Mental health comorbidities among patients with diabetes should be a public health priority.

//www.ncbi.nlm.nih.gov/pmc/articles/PMC4439400/

Worldwide, the prevalence of type 1 and type 2 diabetes in adults is expected to increase from approximately 415 million in 2015 to 642 million by 2040.

Around one in five people (19.7%) with diabetes have depression in India, compared to 15.1% of people in the general population. In the UK more than 4.5 million people are impacted with diabetes. That’s more than any other serious health condition in the UK.

Diagnosis of diabetes can be a life-changing event. This could mean changes in your lifestyle for which you may not be ready and strained relationships with friends or family. As you establish a new routine it is important to establish good habits in managing your mental health. Proper diabetes management requires awareness of your symptoms. Just as you take insulin to ensure your blood glucose levels are where they should be, it’s important to take measures to prevent mental health crises by being aware of how you are feeling mentally and emotionally. 

People with diabetes are 2 to 3 times more likely to have depression than people without diabetes. Only 25% to 50% of people with diabetes who have depression get diagnosed and treated. 

Symptoms of depression can be mild to severe, and include: 

• Feeling sad or empty 
• Losing interest in favourite activities 
• Overeating or not wanting to eat at all 
• Not being able to sleep or sleeping too much 
• Having trouble concentrating or making decisions 
• Feeling very tired 
• Feeling hopeless, irritable, anxious, or guilty 
• Having aches or pains, headaches, cramps, or digestive problems 
• Having thoughts of suicide or death 

If you’re stressed, you may not take as good care of yourself as usual. Your blood sugar levels can be affected too—stress hormones make blood sugar rise or fall unpredictably, and stress from being sick or injured can make your blood sugar go up. Being stressed for a long time can lead to other health problems or make them worse.

Less than 25% of people with diabetes receive emotional and psychological treatment from the NHS and, in 2017, 33% of people who called the Diabetes UK helpline were looking for psychological support.

64% of people sometimes or often feel down because of their diabetes, parents of children with Type 1 diabetes were most likely to feel down and to want more support.

//jamanetwork.com/journals/jamanetworkopen/fullarticle/2786132?resultClick=1

//www.cdc.gov/diabetes/managing/mental-health.html  

//mhanational.org/diabetes-and-mental-health  

//www.diabetes.org.uk/resources-s3/2017-11/1111B%20The%20future%20of%20diabetes%20report_FINAL_.pdf  

//pharmaceutical-journal.com/article/ld/diabetes-mental-health-considerations-in-adults

One of the biggest challenges for people with diabetes is to get the mental health conditions detected and treated. Up to 45 percent of mental health conditions and cases of severe psychological distress go undetected among diabetic patients. It is estimated that only around 1/3 of people with diabetes and mental health conditions receive a diagnosis and proper treatment. People experience when their blood sugar is too high or too low can be confused for depression or anxiety. People with diabetes also may face stigma in talking about their feelings of depression.

Diabetes can cause a condition called diabetes distress which shows some traits of stress, depression and anxiety and it is linked to the causative factors of diabetes. It can also be affected by external factors like family and societal support and health care services. Regular screening, proper consultation, medication is required to provide behavioral change services and stress reduction, talk therapy and support groups can be helpful. Some of the therapies could be:

• Cognitive-behavioral therapy (CBT): CBT has two main aspects. First one is the cognitive part that works to develop helpful beliefs about life. The behavioral side helps you learn to take healthier actions. It is mainly used for depression, anxiety and bipolar disorder
• Family therapy helps family members communicate, handle conflicts and solve problems better. It is often used for treating eating disorders and bipolar disorder.
• Dialectical- behavioral therapy (DBT) focuses on teaching skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

References:

1. //mhanational.org/diabetes-and-mental-health
2. //www.cdc.gov/diabetes/managing/mental-health.html

mental health is a major challenges in the world. people with 2 or 3 times more likely to have depression than people without diabetes . Only 25% to 50% people with diabetes who have depression get diagnosed and treated . But treatment therapy and medicine or both is usually very effective .And without treatment depression often gets worse ,not better.

symptoms of depression can be mild to severe ,and include :

1. Losing interest in favorite activities.
2. Feeling very tiered.
3. Feeling hopeless, guilty.
4. Having pains and digestive problems.
5. Overeating or not wanted to eat at all .
6. Feeling sad or empty.

                              Importance of DSMES :-

• People who have knowledge and support to manage their diabetes are healthier and who do not .
• learning how to control diabetes when to medication ,how to monitor blood sugar .
• managing our diabetes will  help us to avoid serious health complications .
• diabetes management starts with us .  

REFERENCES :- 

//www.cdc.gov/diabetes/managing/education.html

1. //mhanational.org/diabetes-and-mental-health

Diagnosis of a chronic illness can have a negative impact on patients’ perception of their well-being (“labeling” effect). In the study they sought to determine the effects of a new diagnosis of diabetes, discovered by systematic screening, on patients’ health-related quality of life (HRQoL) 1 year after diagnosis. 

Conclusion: For patients with a new diagnosis of diabetes discovered through systematic screening, HRQoL is similar to patients found not to have diabetes. Furthermore, HRQoL scores remain stable over the year after screening. This suggests that screening for diabetes has minimal, if any, “labeling” effect with respect to HRQoL.

//care.diabetesjournals.org/content/25/6/1022.short

Individuals living with type 1 or type 2 diabetes are at increased risk for depression, anxiety, and eating disorder diagnoses. Mental health comorbidities of diabetes compromise adherence to treatment and thus increase the risk for serious short- and long-term complications, which can result in blindness, amputations, stroke, cognitive decline, decreased quality of life, and premature death. When mental health comorbidities of diabetes are not diagnosed and treated, the financial cost to society and health care systems is substantial, as are the morbidity and health consequences for patients.

A bidirectional relationship might exist between type 2 diabetes and depression: just as type 2 diabetes increases the risk for onset of major depression, major depressive disorder signals increased risk for onset of type 2 diabetes. Moreover, diabetes distress is now recognized as an entity separate from a major depressive disorder. Diabetes distress occurs because virtually all diabetes care involves self-management behavior—requiring a balance of a complex set of behavioral tasks by the person and family, 24 hours a day, without “vacation” days. Self-management tasks for type 1 diabetes involve carefully checking blood glucose levels to adjust multiple doses of insulin needed day and night. This is balanced with food and physical activity decisions that influence blood glucose levels, most immediately to prevent hypoglycemia, which can lead to seizures and coma.

Living with diabetes is associated with a broad range of diabetes-related distresses, such as feeling overwhelmed with the diabetes regimen; being concerned about the future and the possibility of serious complications, and feeling guilty when management is going poorly. This disease burden and emotional distress in individuals with type 1 or type 2 diabetes, even at levels of severity below the threshold for a psychiatric diagnosis of depression or anxiety, are associated with poor adherence to treatment, poor glycemic control, higher rates of diabetes complications, and impaired quality of life.

Many persons with diabetes and depression also have comorbid anxiety disorders, such as generalized anxiety disorder, panic disorder, or posttraumatic stress disorder. Anxiety disorders also can occur in persons with diabetes but without comorbid depression. Increased anxiety in persons with type 1 or type 2 diabetes can occur when diabetes is first diagnosed and when diabetes complications first occur. Anxiety disorders complicate living with diabetes and its management in at least 3 ways: (1) serious anxiety disorders largely overlap with the symptoms of hypoglycemia, making it difficult for the person with diabetes to differentiate between feelings of anxiety and symptoms of low blood glucose that require immediate treatment; (2)preexisting anxiety about injections or blood draws may lead to severe anxiety or panic disorders when a person is diagnosed with diabetes; and (3) fear of hypoglycemia, a common source of severe anxiety for persons with diabetes, can lead some patients to maintain blood glucose levels at above target levels. Parents of children with type 1 diabetes are also at high risk for extreme fear of hypoglycemia.

Women with type 1 diabetes have a 2-fold increased risk for developing an eating disorder and a 1.9-fold increased risk for developing subthreshold eating disorders than women without diabetes. Less is known about eating disorders in boys and men with diabetes. Disturbed eating behaviors in women with type 1 diabetes include binge eating and caloric purging through insulin restriction, with rates of these disturbed eating behaviors reported to occur in 31% to 40% of women with type 1 diabetes aged between 15 and 30 years. Moreover, disordered eating behaviors persist and worsen over time. Women with type 1 diabetes and eating disorders have poorer glycemic control, with higher rates of hospitalizations and retinopathy, neuropathy, and premature death compared with similarly aged women with type 1 diabetes without eating disorders.

The experience of living with diabetes is often associated with concerns specific to the illness and can cause conditions, such as diabetes distress,
psychological insulin resistance, and the persistent fear of hypoglycemic episodes. A wide range of psychiatric disorders, including major depressive disorder, bipolar and related disorders, schizophrenia spectrum and other psychotic disorders, anxiety disorders, sleep disorders, eating disorders, and stress-related disorders are more prevalent in people with diabetes compared to the general population. People living with diabetes and depressive disorders are at increased risk for earlier all-cause mortality compared to people living with diabetes without a history of depression. All individuals with diabetes should be regularly screened for the presence of diabetes distress, as well as symptoms of common psychiatric disorders. Compared to those with diabetes only, individuals with diabetes and mental health concerns have decreased participation in diabetes self-care, a decreased quality of life, increased functional impairment, increased risk of complications associated with diabetes, and increased health-care costs. Cognitive behavior therapy, patient-centered approaches (e.g. motivational interviewing), stress management, coping skills training, family therapy, and collaborative case management should be incorporated into primary care. Self-management skills, educational interventions that facilitate adaptation to diabetes, addressing co-occurring mental health issues, reducing diabetes-related distress, fear of hypoglycemia, and psychological insulin resistance are all helpful. Individuals taking psychiatric medications, particularly (but not limited to) atypical antipsychotics, benefit from the regular screening of metabolic parameters to identify glucose dysregulation, dyslipidemia, and weight gain throughout the course of the illness so that appropriate intervention can be instituted.

Therapy is an extremely helpful treatment option and people with and without mental health conditions can benefit from it. Talk therapy is not only for discussing your problems, it is also for finding solutions. Professionals can help you work through the many things that may be causing you stress, understand your mental health condition and identify triggers that may make things worse, and learn coping skills. Common types of therapy include:

• Cognitive-behavioral therapy (CBT). CBT has two main aspects. The cognitive part works to develop helpful beliefs about your life. The behavioral side helps you learn to take healthier actions. CBT often works well for depression, anxiety, and bipolar disorder, but it can also be used for other various conditions.
• Family therapy helps family members communicate, handle conflicts, and solve problems better. Forms of family therapy often are used for treating eating disorders and bipolar disorder.
• Dialectical-behavioral therapy (DBT) focuses on teaching skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

In addition to therapy, there are a number of different medications that can help. When deciding on a mental health treatment plan involving medication, talk to your mental health care provider about your family history of mental health and your own diabetic condition.

Some evidence suggests that antidepressants like SSRIs may help control blood sugar for people who already have type 2 diabetes. In fact, one study found that taking antidepressants is linked to 95 percent higher odds that a person with diabetes’ blood pressure will be controlled. Other research suggests that taking tricyclics and SSRIs may increase your chances of developing diabetes due to side effects of weight gain.

From economic, public health, and humanitarian perspectives, identifying and treating the mental health comorbidities among patients with diabetes should be a priority. Young adults with diabetes are especially vulnerable to mental health comorbidities as they experience multiple transitions—geographically, socially, and between pediatric and adult care—that may place them at risk for loss to medical follow-up and poor health outcomes. The high prevalence and costs of depression in the context of diabetes, combined with evidence that behavioral factors are important for effective diabetes self-management, create an important opportunity to integrate mental health screening and treatment into multidisciplinary team diabetes care, to improve patient and public health outcomes, and to help decrease health care expenditures.