Baylor College of Medicine News

More mental health screening, treatment resources for people with diabetes needed

In a viewpoint published online today in Journal of the American Medical Association, mental health and diabetes experts and advocates describe  a critical need for more mental health screening and treatment resources for people with diabetes.

Led by senior author Dr. Barbara Anderson, a professor of pediatrics – psychology at Baylor College of Medicine and Texas Children’s Hospital, the experts pinpoint the increased risk of depression, diabetes distress, anxiety and eating disorders in people with diabetes.

“The incidence of both type 1 diabetes and type 2 diabetes is on the rise, so this is the right time to talk about the consequences of the mental health co-morbidities of diabetes before they lead to poor mental and physical health outcomes for increasing numbers of people with diabetes and bankrupt the healthcare system,” said Anderson, a clinical  psychologist and behavioral scientist who has worked with people and families living with diabetes for more than 30 years. “The mental health aspects of diabetes have been significantly overlooked in the setting of diabetes health care.”

Anderson authored the commentary with Lee Ducat, founder of The Mental Health Issues of Diabetes Foundation in Philadelphia, Juvenile Diabetes Research Foundation, and National Diabetes Research Interchange; and Dr. Louis H. Philipson, professor of medicine and pediatrics and director of the Kovler Diabetes Center University of Chicago.

The latest data from the Centers for Disease Control and Prevention estimated 29.1 million people, or 9.3 percent, of the United States population have diabetes.

Currently, only one-third of people with diabetes who also cope with a mental health comorbidity (simultaneous presence of two chronic diseases or conditions in a patient) of diabetes receive a diagnosis or treatment for mental health issues, according to the American Diabetes Association. Few diabetes clinics or centers provide mental health screenings or integrate mental health/behavioral health services into diabetes care, the authors noted.

Depression

Individuals with diabetes have two times greater the risk for depression. Young adults with type 1 diabetes are especially vulnerable to depression and consequent poor health outcomes, said the authors.

“Diabetes distress is now recognized as a mental /behavioral health condition separate from and more common than clinical depression. Diabetes distress occurs because virtually all of diabetes care is self-management behavior—requiring balance of a complex set of behavioral tasks by the person and family, 24 hours a day, without ‘vacation’ days,” said the authors.

Recent research has shown people with diabetes and depression as well as diabetes distress are at risk for poor adherence to treatment, poor glycemic control, higher rates of diabetes complications and impaired quality of life.

“Diabetes is a chronic and progressive condition; and the complex, daily treatment of diabetes is completely in the hands of the person and family living with diabetes in collaboration with a health care team.” said Anderson. “Cognitive behavioral therapy combined with psychotropic medication has been shown to help some people with diabetes who suffer from depression.”

“If a person with diabetes is depressed or struggling with diabetes distress, it is very difficult to be motivated and sustain the level of self-care needed to successfully manage diabetes,” said Anderson.

Anxiety

Many people with diabetes also suffer from anxiety associated with the initial diagnosis or when complications of diabetes first occur, the authors noted. 

“Anxiety disorders complicate living with diabetes and its management,” the authors wrote.

Fear of hypoglycemia, anxiety about maintaining blood glucose levels in a healthy range, as well as anxiety about injections and blood draws, can all compromise diabetes self-management.

Eating disorders

Additionally, women with type 1 diabetes have more than double the risk of developing an eating disorder than women without, they said.

Having an eating disorder in the context of type 1diabetes leads to poorer glycemic control, higher rates of hospitalization, increased risk for retinopathy and neuropathy and premature death, they said.

Identifying and treating mental health issues among patients should be a priority, they concluded.

“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 a unique opportunity to integrate mental health screening and treatment into multidisciplinary team diabetes care, to help improve patient and public health outcomes, and decrease health care expenditures,” said the authors.

The viewpoint will run in the Aug. 20 print edition of the journal.