Does Diabetes Increase the Risk of Depression?

Depression is defined as a group of conditions associated with the elevation or lowering of a person’s mood and can present itself in a number of ways (1). Depression can range from mild to severe and often shows up as feelings of sadness or a decreased interest in activities that previously brought an individual joy (2). Diabetes has been shown to have a bidirectional link to depression with no clear indication of which condition influences the greater risk. Some research has suggested that depression as the primary condition is more greatly associated with an increased risk of diabetes, however, there is no current consensus on the matter, and as it stands preventative measures should be put in place either way (3). Depression can have a great influence on outcomes in diabetes and can also have a large impact on the way an individual navigates daily life. There is a significant connection between the mind and the body and when one is at peace then, generally, the other follows. But when one is in turmoil the effect can also be widespread. Because depression has such a large impact on mood and disposition it can affect the way an individual may show up in the world, interact with others, handle stress, and the choices that one may make. The thoughts, feelings, beliefs, and attitudes that an individual may have under the influence of depression can play a significant and impactful role on health and outcomes (2)

It is reported that people with diabetes are 2-3 times more likely to develop depression and 20% more likely to develop anxiety than people without diabetes. It is estimated that only 25-50% of people with diabetes are diagnosed and treated for depression, which leaves a large number of people that go undiagnosed and thus untreated (2). Diabetes distress is an emotional response that is specifically linked to the diagnosis and day to day demands of managing diabetes. Studies have shown that diabetes distress can be the result of the pressures and emotional burdens associated with self-managing care of a chronic condition. Diabetes distress can manifest itself in feelings of anxiety, anger, or depression (4).  It is estimated that up to 45% of individuals may suffer from diabetes distress though most of those individuals may not meet the criteria to be diagnosed with a major depressive disorder like depression (5)

In order to prevent further complications, it is important to understand how both diabetes distress and depression can impact health outcomes, recognize when an individual may be depressed or at risk, and how to seek support if needed. 

How Can Depression Affect Diabetes Outcomes?

If an individual is feeling sad, discouraged, or anxious it can become burdensome or overwhelming to manage a condition like diabetes in a productive way. A patient may be frustrated by current status or outcomes and may be led to believe that their health is not worth the effort so they may give up trying under the emotional mask of depression which can cloud judgment or lead one to make poor decisions (4). People with diabetes and depression may experience stress, guilt, or denial in association with their condition. Diabetes distress and depression can lead to uncontrolled blood sugar levels, worsened diabetic status, complications from diabetes, and increased risk for mortality (5). One study explored the idea that there is a significant relationship between diabetes distress and decisional conflict as a result of diabetes distress. The study suggested that the strain of self-managed care led to poor emotional health and quality of life, which contributed to poor decision making that resulted in poorer glycemic control (6). Appropriate management of diabetic distress and depression has been associated with improved outcomes inclusive of but not limited to improved self-care, better control of blood sugars, reduced risks associated with cardiovascular complications, and reduced risk for mortality (5)

Are You At Risk for Depression?

Depression and diabetes distress manifest themselves in many different ways. Some key symptoms of depression include feelings of sadness, feeling empty, losing interest in past activities that brought joy, overeating or loss of appetite, feeling restless or being unable to sleep, sleeping excessively, having trouble concentrating or making decisions, feeling tired, hopeless, irritable, anxious, or guilty, headaches, cramps, digestive issues, thoughts of harming yourself or harming others (2). If you are feeling any of these symptoms it is crucial to understand that these feelings are quite common and you are not alone. Thankfully, there are a number of resources that you can turn to in order to access support and care. 

Ways to Seek Support

If you are feeling any symptoms associated with depression it is important to have a conversation with your primary care physician or seek alternative care from a specialist in mental health. Understanding that you are not alone and that your condition can be managed successfully is a great first step that should be acknowledged.

Some ways to manage mild anxiety are increasing your physical activity level, adopting a practice of meditation or yoga, limiting alcohol and caffeine, eating a healthy diet, getting enough sleep, or taking some time for yourself (2)

Managing diabetes distress is just as important to treat even though it is not considered to be a major depressive disorder. It is important to communicate your symptoms with your primary care physician and ask for a referral to a specialist. You can also request further support from a diabetes educator or sign up for a diabetes support group to help manage the emotional burdens and expectations of self-care (2)

Take Away

With 1 in 5 adults with T2D experiencing depression and 1 in 3 adults with T2D experiencing diabetes distress it is crucial that these conditions are recognized and addressed. While routine screenings for these conditions may not be standard in every healthcare setting it is important to be aware of the signs and symptoms of these conditions so that you can advocate for yourself and prevent further complications related to your condition. You can start by paying attention to your feelings or any changes in your normal mood or disposition. It is also important to communicate openly with your healthcare practitioner and make sure you are playing an active and participatory role in your care. Additionally, you may want to consider checking out these 10 tips from the CDC on coping with diabetes distress.

References

  1. Sartorius N. Depression and diabetes. Dialogues Clin Neurosci. 2018 Mar;20(1):47-52. doi: 10.31887/DCNS.2018.20.1/nsartorius. PMID: 29946211; PMCID: PMC6016052.
  2. CDC. (2018). Diabetes and Mental Health. Retrieved from https://www.cdc.gov/diabetes/managing/mental-health.html
  3. Mezuk, B., Eaton, W., Albrecht, S., & Golden, S. (2008). Depression and Type 2 Diabetes Over The Lifespan: A meta-analysis. Diabetes Care, 21, 2383-2390. Doi: https://doi.org/10.2337/dc08-0985 
  4. Kreider, K. (2017). Diabetes Distress or Major Depressive Disorder? A Practical Approach to Diagnosing and Treating Psychological Comorbidities of Diabetes. Diabetes Theory, 8, 1-7. Doi: 10.1007/s13300-017-0231-1
  5. Bruno, A., Choi, D., Thorpe, K, and Hu, C. (2019). Relationship Among Diabetes Distress, Decisional Conflict, Quality of Life, and Patient Perception of Chronic Illness Care in a Cohort of Patients With Type 2 Diabetes and Other Comorbidities. Diabetes Care, 42, 1170-1177. Doi: https://doi.org/10.2337/dc18-1256
  6. CDC. (2019). 10 Tips for Coping with Diabetes Distress. Retrieved from https://www.cdc.gov/diabetes/managing/diabetes-distress/ten-tips-coping-diabetes-distress.html
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