Diabetes has a profound effect on many areas of an individual’s life, so it is unsurprising it also impacts one’s mental health. Living with this chronic condition, requiring a great deal of self-management, dealing with biological and hormonal factors, and the constant pressure of having to look after yourself, is emotionally demanding and can take its toll.
Up to 50% of people living with diabetes are thought to also have a mental illness. Compared to the general population, depression is believed to occur at 3 times the rate for those with Type 1 diabetes, and 2 times the rate among those with Type 2 diabetes. Both anxiety and eating disorders have also been associated with diabetes.
Of course people can face difficulties with their mental wellbeing for a myriad of reasons, and mental illness has been linked to placing people at a higher risk of developing diabetes. However, research into the unique experiences of people living with diabetes helps us understand the emotional demands this condition has, and helps us see why mental illness may be occurring at a higher rate among this group. Some of these diabetes-specific reasons include:
- Difficulty Accepting & Dealing with Type 2 Diabetes Diagnosis
Many individuals describe difficulty adjusting to their recent Type 2 diabetes diagnosis, and accepting they now have a lifelong condition requiring constant self-management to avoid complications down the track. It can result in depressive, grief-like reactions as one mourns their previous ‘non-diabetic life’.
- Fear of Hypoglycaemia
Hypoglycaemia is an unpleasant experience, and people living with diabetes disclose worry over their wish to avoid its recurrence causing stress and anxious feelings. This becomes further complicated by their anxiety affecting their blood glucose levels, which can lead to greater struggles with glycaemic control and more worry; a cycle they are often very aware they are stuck in.
- Fear of Complication
For some people with Type 2 diabetes, the fear of future health complications linked to the condition (e.g. kidney failure, blindness, amputations) can be extremely fear-inducing. Whilst many people are motivated to look after themselves to minimise or prevent the likelihood of this occurring, for some they experience a sense of helplessness and feel no matter what they do they can’t completely control their diabetes so complications are inevitable. Paradoxically, this can lead to choosing not to manage the condition or take appropriate self-care, to avoid feeling like a failure.
- Difficulties and Guilt regarding Adherence
The demands of self-managing diabetes at home can be difficult to incorporate into anyone’s lifestyle, and many people know what they should be doing, but the challenges of daily life get in the way. When they know aren’t adhering to their ‘full regime’ for optimal diabetes control, it can lead to guilt, frustration and stress.
- Burn Out
Often seen in people with Type 1 diabetes, it can be difficult to maintain motivation at certain times in regards to managing their condition. Many people describe experiencing ‘burn out’ due to the never-ending monitoring and unpredictable nature of this type of diabetes.
What can I expect if myself, or someone I know, is diagnosed with diabetes?
Dealing with the diagnosis of diabetes can be a very difficult time, there is a lot of information to take in and of course the realisation you have a lifelong condition. It is not uncommon for people to feel shocked, angry, sad, fearful or anxious – some may experience denial and need time to mourn their previous ‘non-diabetic lifestyle’, it is not dissimilar to a grieving experience.
All reactions to diagnosis are valid, and it is important to express these emotions and appreciate the emotional impact of diabetes on yourself, or a loved one. It is helpful to talk about this with family, friends, health professionals, and to let yourself know this is a difficult time but to appreciate your ability to develop new coping skills, and recognise you’ve overcome challenges in the past and you can do the same. Research also suggests learning about the condition can be extremely helpful – understanding the diagnosis and seeking out information and resources allows you to become an expert of your experience, and feel more empowered to manage the condition.
How can I support my own mental well being if I have diabetes?
Poor mental wellbeing has been associated with poor adherence to medication, physical inactivity, poor glycaemic control, and poorer quality of life among people with diabetes – so supporting your mental wellbeing is important.
Management of any mental health problem for people with diabetes is not dissimilar to those without diabetes; however, the effect of diabetes on and individual’s life must be taken into consideration to improve both mental and physical health.
A great place to start if you feel you need support would be speaking to family or friends, so they know how you are feeling, and by visiting your GP to enquire about professional help just like you would for any other medical condition.
It can also be beneficial to check with your diabetes care-providers, local hospital, or community centre for diabetes support groups in your area, or contacting organisations such as Diabetes Australia.
How can I support friends and family with Type 2 diabetes and related mental health concerns?
If you have a family member or close friend with diabetes, the best thing you can do is offer support! As a lot of their self-management happens at home or at work (e.g. glucose monitoring, healthy eating, exercise), family, friends and colleagues can all play a role and have a significant impact on emotional wellbeing.
A recent study has found depressive symptoms, stressors and medication adherence among people with diabetes were related to the quality and quantity of social support they received. Harmful ‘supportive behaviours’ such as questioning the need for medication, nagging or arguing over non-adherence to medication/self-management regime, were associated with poorer adherence to medication and linked to more adverse effects of stressors. These behaviours can lead to feeling criticised, guilty, or embarrassed, so it is important your involvement is positive and support is expressed correctly.
Gaining knowledge about the disease, and taking part in a joint, proactive role in regards to implementing strategies at home to support self-management can be essential to ease the strain and assist the person with diabetes adjust and succeed at self-management. By understanding why certain changes at home are necessary, and the symptoms and impacts of the disease, families are more likely to support their loved one, and ‘sabotaging’ behaviours such as questioning the need for medication, or refusing to eat healthy meals are less likely to occur.
Some other simple ways of offering support can be purely logistical, such as offering to drive to medical appointments, or helping with insulin injections and glucose monitoring, or by offering social support in regards to attending appointments with them, exercising together, or helping problem-solve when side effect or hypoglycaemic event occurs.
- The SANE Guide to Good Mental Health for people affected by diabetes
- Diabetes Australia Helpline on 1300 136 588 or www.diabetesaustralia.com.au
- Baig, A. A., Benitez, A., Quinn, M. T., & Burnet, D. L. (2015). Family interventions to improve diabetes outcomes for adults. Annals of the New York Academy of Sciences, 1353(1), 89-112. doi:10.1111/nyas.12844
- Doherty, A. M., Gayle, C., Morgan-Jones, R., Archer, N., Laura-Lee, Ismail, K., & Werner, A. (2016). Improving quality of diabetes care by integrating psychological and social care for poorly controlled diabetes: 3 dimensions of care for diabetes. The International Journal of Psychiatry in Medicine, 51(1), 3-15. doi:10.1177/0091217415621040
- Garrett, C., & Doherty, A. (2014). Diabetes and mental health. Clinical Medicine, 14(6), 669-672. doi:10.7861/clinmedicine.14-6-669
- Mayberry, L., Egede, L., Wagner, J., & Osborn, C. (2015;2014;). Stress, depression and medication nonadherence in diabetes: Test of the exacerbating and buffering effects of family support. Journal of Behavioral Medicine, 38(2), 363-371. doi:10.1007/s10865-014-9611-4
- Nash, J. (2013). Diabetes and wellbeing: Managing the psychological and emotional challenges of diabetes types 1 and 2 (2nd ed.). New York: Wiley.
- Rosland, A.-M., Heisler, M., Choi, H., Silveira, M. J., & Piette, J. D. (2010). Family Influences on Self-Management Among Functionally Independent Adults with Diabetes