Each and every day, individuals with diabetes have a lot to contend with: finger pricks, keeping careful track of all the carbs they eat, taking pills or doing injections. Besides paying constant attention to their physical well-being, they frequently must contend with mental health issues as well.
A host of psychological problems, from depression to anxiety, can co-occur with diabetes, according to the American Psychological Association, and it’s estimated that one-quarter of people with diabetes will experience depression at some point, according to American Psychologist.1
“It’s a growing problem that is often unrecognized by health care professionals,” says Amy Hess-Fischl, MS, RDN, LDN, BC-ADM, CDE, a dietitian and certified diabetes educator.
Any chronic condition can make a person feel depressed, but in particular, diabetes can result in depression because it has such negative connotations, according to Robert Courgi, MD, an endocrinologist at Northwell Health’s Southside Hospital in Bay Shore, New York. “It’s stressful because every bite of food you eat is important,” he says. “Also, the average person with type 2 diabetes is on four medications.”
A person who has diabetes and depression may decide to take control of the situation by choosing not to comply with treatment recommendations, he says. “The blood sugar can be unstable when the person puts his head in the sand,” Dr. Courgi says. “This is how depression can lead to bad outcomes with diabetes.”
Besides depression, anxiety and eating disorders also affect those with diabetes. “Anxiety rates, like depression, have also been shown to be higher in patients with diabetes,” notes Deidre Edwards, MS, PhD, attending clinical psychologist in the division of pediatric endocrinology and diabetes at Montefiore Medical Center in New York City. “And research suggests that patients with type 1 diabetes are also at an elevated risk of developing eating disorders.”
Diabetes distress is very prevalent, with 18 to 45% of individuals with diabetes reporting some degree of this condition, Hess-Fischl says. “People with diabetes are asked to do so much for their self-care that inevitably, anyone is bound to crack,” she says.
Psychosocial services could help those with diabetes to manage their illness better, Dr. Edwards says. “Mental health professionals can work with patients on changing long-standing behavior patterns that impact their health and diabetes management,” she explains. “They play an important role in helping patients cope with mental health difficulties and in adjusting to life with diabetes.”
Helping individuals with diabetes develop coping skills for dealing with the stressors that go hand in hand with diabetes, educating them about warning signs of complications, and screening them for depression and anxiety are some ways that mental health professionals can help, Dr. Edwards says.
“A central component of managing type 1 diabetes is being thoughtful about when and how much a person plans to eat, as this plays a role in insulin administration,” Edwards says. “It changes what was once a rather thoughtless task into a more complex decision-making situation.” A mental health provider can help the person learn the skills needed to adjust to these life changes, hopefully preventing non-compliance with diabetes management and staving off depression and anxiety, Dr. Edwards says.
Some experts believe that everyone with diabetes should be offered psychosocial services. In a position statement from the American Diabetes Association on psychosocial care for individuals with diabetes, the authors wrote, “Psychosocial care should be integrated with collaborative, patient-centered medical care and provided to all people with diabetes, with the goals of optimizing health outcomes and health-related quality of life.” 2
“Seeing a mental health expert should be a standard part of their care, just like seeing a diabetes educator at least annually,” says Hess-Fischl, who is also a member of the OnTrack Diabetes editorial advisory board.
Not every person with diabetes needs ongoing therapy, Dr. Edwards says, but each patient should know that psychosocial support is available if desired. She encourages caregivers to be on the alert for symptoms of a mental health issue like depression. Family members, too, should be aware of any notable changes in mood or behavior in the person with diabetes.
Symptoms of depression include:
“If an individual is concerned about these symptoms or has other concerns, he or she should speak to their provider for further assessment,” Dr. Edwards advises.
If you or a family member has diabetes and you would like to be in contact with a mental health professional, Hess-Fischl recommends checking out the Substance Abuse and Mental Health Services Administration (SAMHSA) website.
“Just input your zip code or address and then you can filter the services you need and find mental health experts in your area,” Hess-Fischl says.