The Centers for Disease Control and Prevention reported that in 2014, diabetes affected approximately 29.1 million people or 9.3 percent of the United States population.
Additionally, another 86 million Americans suffer with pre-diabetes, a condition that increases the risk of developing diabetes. While the condition imposes some medical challenges, it has also been found to cause psychological difficulties, according to some researchers.
Julie Wagner, Ph.D., professor of Behavioral Sciences and Community Health at UConn Health, was part of a team that examined the “psychological conditions, defined as syndromes, disorders and diabetes-specific psychological issues” that impact a significant portion of individuals with type 1 and type 2 diabetes when compared to the general population.
Some studies have determined that patients with diabetes have an increased risk of developing mental health issues, Wagner noted. “At the same time, prospective research shows that depression is a stronger risk factor for developing diabetes than diabetes is a risk factor for developing depression. It’s a bi-directional relationship,” she explained.
Wagner pointed out that there could be a third common underlying factor though, such as a genetic predisposition or chronic inflammation that contributes to both diabetes and depression.
Anxiety may also present in a patient with diabetes and Wagner reported that many symptoms common to diabetes overlap with psychological issues. For example, symptoms of hypoglycemia and anxiety can mimic each other. “Teasing out the biological and psychological symptoms should be at the fore,” she said.
“Sometimes it’s both. This is why it’s important that mental health providers be included on the diabetes care team.”
Wagner also noted that patients with diabetes may have problems with eating and body image. “You may see binge eating in type 2. And the modal age of onset for type 1 is during puberty, which is an age when kids focus on their bodies. This may help explain higher rates of anorexia, bulimia and unique compensatory behaviors in patients with type 1,” she said.
“Patients are asked to focus on food and numbers, testing blood sugar to manage the disease, so preoccupation builds with food and body and can lead to disordered eating.”
According to Wagner, diabetes is a chronic burden. “Living with diabetes changes over the course of a life span. In each stage, there is a risk for psychological distress,” she said. “You may be managing well, but over time, day-to-day management is intense. There is no relief, no vacation. This can lead to ‘diabetes burnout’ and to depression, demoralization and lack of self care.”
Christine M. Hunter, Ph.D., ABPP, CAPT USPHS, director of behavioral research, Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, pointed out that physical and mental health are not independent, so optimal treatment needs to be mindful of the integration.
“Psychologists have many important skills for improving both the mental and physical health of people with diabetes, including assisting with lifestyle change and adherence to a medication and self-management regimen, providing tools for dealing with coping and distress related to living with and managing a chronic disease and identifying and treating mental health conditions, such as depression, that occur with greater frequency in individuals with diabetes.”
Hunter added, “To most effectively integrate mental health and medical treatment and more fully meet all the behavioral health needs of our patients, we need more psychologists trained to understand the self-management demands, symptoms, and treatment of diabetes and understand how those interact with mental health symptoms or conditions,” she said.
“This training might include continuing education opportunities, seeking consultation from another psychologist with diabetes expertise and interacting with the patient’s primary care provider to understand the treatment plan and health status.”
Wagner said, “[Patients] are living with a chronic disease. There is a good deal of mental effort and psychological resources needed every day,” she said. “There are a lot of questions we haven’t answered.”