Mental Health Awareness Month is here again and, with it, a reminder of how important maintaining mental wellness is for all of us. Our mental health affects our physical health, our relationships, and our quality of life.1 It also has a huge impact on diabetes management – and people with diabetes who have depression or diabetes distress are at an increased risk for having elevated HbA1c levels.2-3
What is the Relationship Between Diabetes and Depression?
Studies have shown that for people with type 1 diabetes (T1D), the risk for experiencing depression is three times that of people without diabetes.4 For comparison, people with type 2 diabetes have a twofold increased risk for depression than healthy peers. Other contributing factors that increase the risk of depression include:4
- Being unemployed
- Having complications from T1D
- Not perceiving support from family or friends related to T1D
- High blood glucose levels
Since people with diabetes have the added burden of managing a chronic condition on top of all of life’s normal stressors, it should be no surprise that we are at increased risk for mental health challenges. There are also diabetes-specific mental health struggles such as Diabetes Distress and Diabetes Burnout, which can contribute to worse glycemic outcomes and lower quality of life.
As if managing blood glucose levels from any of the 42 Factors that can Affect Blood Glucose isn’t difficult enough, on top of that, people with diabetes have to worry about navigating the healthcare system, the financial burden of diabetes, and the added anxieties related to high and low blood sugars. No wonder we’re more depressed and anxious than our peers with fully functioning pancreases!
How do I know if I’m Depressed?
Depression is usually diagnosed when the symptoms of depression last for more than two weeks. The typical symptoms for depression include:5
- Loss of interest in activities
- Changes in appetite or eating habits
- Changes in sleep patterns
- Feelings of hopelessness
- Difficulty concentrating
- Trouble making decisions
- Thinking often about death or suicide*
*If you or your loved one are having thoughts about harming yourself or others, seek emergency help. You can go to an Emergency Room or call the Suicide Hotline: 1-800-273-8255.
Recent studies suggest that suicidal thoughts and suicide-related behaviors may be increased in youth and young adults with diabetes compared to peers who do not have diabetes, and more research ongoing to further gather evidence on suicidality related to diabetes.6
Some studies have shown that depression or diabetes distress are over diagnosed, where others suggest that it is under diagnosed. Either way, getting screened at your doctor’s office is one of the best and easiest way to figure out if you fall into the category of depression. Although you could do some of these screenings on your own, it is most helpful to get assistance from a medical professional to make sure you get the help you need.
There are a few different screening methods, the most common called the Patient Health Questionnaire-9 (PHQ-9), which tests for depression. There are also different diabetes-specific screenings including the Diabetes Distress Scale (DDS), a diabetes burnout scale, and a recently developed Depression Inventory for Type 1 Diabetes (DID-1).4 Your healthcare provider should know which scale would be most applicable for you.
What Helps Depression and Diabetes?
Much like diabetes, depression is not a one-size-fits-all condition. There are a variety of anti-depression medications as well as types of therapy that can help alleviate the symptoms of depression. Although some of the challenges with depression overlap with those of diabetes distress, this does not mean that getting treatment for depression in general versus finding a diabetes savvy psychologist will not be beneficial.
The American Diabetes Association does have a registry of mental health care professionals who have a good understanding of diabetes, if you feel that would be most helpful for you. You can also ask your primary health care provider or endocrinologist about getting treatment for depression, as they are also often knowledgeable about options. We also recommend resources such as the National Alliance on Mental Illness (NAMI) and MentalHealth.gov.
Managing Stress with Type 1 Diabetes is not an easy endeavor, and having Friends with Diabetes to talk to can be very helpful. When you’re having a day where your blood sugars are being stubborn no matter what you do, and it’s adding to your stress, talking to someone who really gets it can make all the difference.
On a personal note, I hope you feel comfortable asking for help – it can be hard to admit that you need help! But once you do, you will not regret it. I know I wish I had asked for help sooner but am so glad I finally did! I am also grateful to all of those who have helped me with my own struggle with depression and diabetes, and hope that you find the help you need also.
- What Is Mental Health?
- Longitudinal Changes in Depression Symptoms and Glycemia in Adults With Type 1 Diabetes
- Glycemic control, depression, diabetes distress among adolescents with type 1 diabetes: effects of sex, race, insurance, and obesity
- Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1)
- What Is Depression?
- Suicide Risk in Youth and Young Adults with Type 1 Diabetes: a Review of the Literature and Clinical Recommendations for Prevention
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES