By: Lcda. Somayra Rodríguez Valdés, LMSW FHC Clinical Social Worker and MCS Collaborator
People with diabetes are 2 to 3 times more likely to develop depression, and only 25% to 50% of these patients are diagnosed and treated.
Diabetes is a chronic condition that affects the normal or expected functioning of the body, causing the person to feel they are losing control of their life. And because diabetes management involves commitment, decision-making and lifestyle changes, it can trigger the development of mental health illnesses such as depression, anxiety, diabetic burnout, and eating disorders. Therefore, identifying and treating these disorders from a primary care standpoint is essential for improving the quality of life for all patients with diabetes.
People with diabetes are 2 to 3 times more likely to develop depression; however, only between 25% and 50% of these patients are diagnosed and treated. According to the 2020 National Diabetes Statistics Report, Diabetes Estimates and Its Burden on the United States, as of 2016, 10.5% of the general U.S. population had diabetes, including 13% of adults age 18 and older1. However, its prevalence is much higher in Puerto Rico, with approximately 2 out of 10 adults age 18 or older living with diabetes, which represents 19.7%2. This in turn reveals a great opportunity to improve its management at the primary care level.
Between 14% and 19% of patients with type 1 and type 2 diabetes suffer from generalized anxiety or diabetic burnout.3 In both diagnoses, cortisol, known as the stress or anxiety hormone, has a direct impact on blood glucose, increasing levels and producing glucose excessively. Cortisol also contributes to insulin resistance and increased appetite. Therefore, learning to manage stress and anxiety is essential for someone with diabetes to maintain good physical health.
In recent years, the incidence of eating disorders in adolescents and young adults has increased, with this population facing the challenge of weight gain at the beginning of insulin use. This in turn may lead to the patient manipulating or avoiding doses to control his or her weight, thus developing a serious eating disorder, including glycemic imbalance and other long-term complications.
Treating diabetic patients without addressing their mental health can aggravate both their physical and emotional health. This can lead to deterioration in treatment adherence, thus resulting in an increase of existing physical health complications and the development of new diseases. To improve the detection and management of mental health problems for diabetic patients, the use of standardized screening tools is recommended, with validated tests implemented to identify symptoms of mental disorders. These include:
PHQ-9 (Patient Health Questionnaire) to evaluate symptoms of depression
GAD-7 (Generalized Anxiety Disorder Scale) para evaluar síntomas de ansiedad.
PAID (Problem Areas in Diabetes Scale) mide el estrés emocional específico relacionado con la diabetes.
These tools can be easily administered at the primary care clinic, and if the results indicate risk, further evaluations should be carried out. The primary care physician also has the advantage of providing care with greater familiarity and confidence, creating a safe space for patients to voice concerns about diabetes management. This in turn increases the chance of identifying changes in behavior, such as social isolation, lack of motivation, excessive tiredness, and complaints about managing the condition. In addition, the integration of motivational support techniques or brief interventions during the consultation can be key to improving adherence and reducing the emotional impact.
It’s also essential to recognize when mental health disorders exceed the scope of primary care, and require the intervention of a specialized mental health professional. Some criteria that should be taken into consideration when making the decision to refer someone to a psychologist, clinical social worker or psychiatrist may include:
Persistent symptoms, even after recommendations are made
The presence of cognitive impairment
The risk of self-harm or suicide
Primary health care plays a crucial role in the early management of mental health disorders for people with diabetes. The use of screening tools, monitoring for symptoms of mental health impairment, and timely referral of these patients to mental health professionals are essential strategies for improving the patient’s physical and mental health clinical outcomes.
At MCS, we’re committed to promoting complete health for our members, and our goal is to continually share clinical education content on mental health to help our network of providers expand their knowledge. Through our MCS Centro Educativo de Salud, you’ll be able to access other content related to mental health care, as well as additional clinical topics to improve patient outcomes.
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