3x more! Diabetics are more likely to develop depression, and experts have proposed 6 interventions

Source: Health Circle - Clinical Frontline WeChat public account

Contributing expert: Wang Cuiling, Beijing Huilongguan Hospital

Special review expert: Wang Shaoli, Beijing Huilongguan Hospital

Diabetes and depression are two of the biggest public health problems facing modern society. Numerous studies have shown that the relationship between diabetes and depression is two-way and mutually reinforcing. The prevalence of depression increased 3-fold and 2-fold in people with type 1 diabetes and type 2 diabetes compared to normal people. Diabetic patients with depression will accelerate the progression of the disease course, increase the difficulty of treatment, and increase the mortality rate and suicide rate of the disease. The prevention and treatment of diabetic depression comorbidities has become an urgent problem for the social and medical communities.

The relationship between diabetes and depression has attracted the attention of countries around the world, and psychologist Snoek et al. published an article in the sub-journal of The Lancet calling on clinicians to pay attention to assessing the psychological conditions of diabetic patients and further improving the depression of diabetic patients. For the treatment of patients with diabetes mellitus and depression, it is not only necessary to strictly control the patient's blood glucose and make it meet the standard, but also to pay attention to the psychological state of the patient and treat the depressive disorder in a timely and thorough manner.

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Factors that trigger depression in people with type 1 diabetes

The incidence of type 1 diabetes is on the rise, is a major disease that seriously affects the health of children and adolescents, and also affects a considerable number of adults.

There are several factors that trigger depression in type 1 diabetes, which can be summarized as:

Diabetic patients and their families lack of awareness of diabetes, can not well understand the importance of blood glucose control, and complex diabetes treatment management makes blood glucose control unsatisfactory.

The long course of diabetes, complications, medical expenses, etc., may cause patients to feel anxious, helpless, guilty and so on.

Children with diabetes increase their age as the course of the disease is prolonged, especially after entering puberty, they often face significant changes in physiological and psychological aspects, with greater emotional fluctuations and enhanced self-awareness.

Diabetes disease problems bring inconvenience and restrictions to patients playing, learning, dating, and living with their classmates and friends.

Lack of disease resolution skills and communication skills lead to anxiety, diabetes-related pain, and depression.

The effects of depression on patients

First, depression itself can increase the risk of diabetes.

Secondly, depression has a certain impact on the social function of diabetic patients, which makes it difficult for patients to monitor daily blood glucose, exercise and diet control.

Patients in depressed states can develop helplessness, self-blame, and catastrophic thoughts about the disease, such as "feeling that diabetes consumes a lot of energy every day", "feeling that diabetes controls my life", "feeling that I can't test my blood sugar regularly", "feeling that I am not strictly adhering to a good diet plan", etc. All of the above will cause diabetic patients to pessimistically face the expected treatment, resulting in a decrease in their compliance and affecting the final glycemic control effect.

Interventions for patients with comorbidities with depression and diabetes

The primary problem in the intervention of patients with depression and diabetes comorbidity lies in early health education and psychological counseling. Medication, psychotherapy, or combination of medication and psychotherapy when necessary requires the collaboration of doctors, patients, and families.

1. Doctors and their families should strive to establish a good relationship of trust and cooperation with patients.

This is the basis of all treatments and is key to increasing patient adherence to treatment. Be gentle and cordial when communicating with patients, and patiently listen to the patient's confused feelings and needs. At the same time, it is necessary to increase the sensitivity to the patient's depressed mood, evaluate it in time, and negotiate a suitable personalized treatment plan with the patient.

2. Strengthen health education for patients and their families.

Improve the awareness of patients and their families about diabetes-related knowledge, correct cognitive biases, and encourage patients to actively face and face the disease. Avoid anxiety and depression caused by excessive attention to blood glucose changes, and also pay attention to the consequences of patients not paying attention to blood sugar control, and timely inform patients of the impact of blood sugar control on patients.

Health education and training for family members is also an important part of the implementation of home care measures.

Do a good job in self-management education for diabetics and their families.

The study found that by strengthening self-management education, it can improve their glucose metabolism and depressive symptoms, improve their quality of life, and alleviate the pain of diabetic patients, including good self-management content such as correct insulin injection, monitoring blood sugar, reasonable diet control and exercise. Ensure that patients and families learn the above operations and methods.

3. Guide patients and families to learn to recognize the common manifestations of depressed emotions, increase the awareness and ability of patients and families to identify depressed emotions, and do a good job in health education related to depressed emotions.

Family members should understand and listen to the patient's troubles and psychological needs as much as possible, accept the patient's feelings, understand the impact of diabetes on their lives, and give corresponding understanding and support. Adjust as soon as relevant symptoms or signs appear.

Strengthen and pay attention to the cognitive and behavioral training of patients. The aim is to help patients recognize irrational behaviors in the process of disease self-management, practice positive and effective coping skills to improve their disease self-management ability, and thus improve disease adaptation.

The content mainly includes problem-solving skills, social skills training, family, interpersonal conflict resolution and self-care goal setting.

Studies have shown that coping skills training has significantly improved patients' short- and long-term metabolic control status, and has higher self-efficacy and better quality of life, thereby reducing the incidence of depression.

4. Encourage patients to seek resources for external support.

External support resources include family, friends, classmates, patients, and supportive organizations. Among them, the family is one of the most important social support relationships for human beings. Studies have shown that in families with high levels of parental monitoring support, patients with type 1 diabetes have better disease management and glycemic control.

5. Actively seek professional help.

When problems are still not being dealt with through self-help and family support, whether it is diabetes or depression, it is recommended that patients and families seek professional help and get further professional diagnosis and treatment in a timely manner. Professional and systematic psychological intervention is of great significance for improving the quality of life, physical and mental health, and improving prognosis of patients with diabetes mellitus and depression. Cognitive behavioral therapy, mindfulness therapy, etc. can be very effective in controlling blood sugar and improving depressed mood.

6. The patient's family should maintain their mental health.

Family members of people with type 1 diabetes are prone to mental health problems due to various stresses and burdens. In particular, the onset age of type 1 diabetes patients is small, and there is a close relationship between the child's emotional disorder and the parent's mental health, and when the mental health of the parent's parent is not good, it will affect the child's emotional state, which will also indirectly affect the child's treatment effect and compliance. Therefore, in order to improve the treatment effect of patients, family members should actively adjust their psychological conditions and maintain their mental health.

Resources

1. Kong Lulu, Kong Liusha.Psychological conditions and diabetic pain in patients with type 1 diabetes[J].Chinese Journal of Gerontology, 2021, 2(41):864-866.2. LI Qing, ZHOU Xiaoai, WANG Xiaojing, et al. Follow-up study on depressive states in diabetic patients[J].Modern Chinese Physicians, 2018,v.56(11):83-85.3. Roy T, Lloyd CE. Epidemiology of depression and diabetes, a systematic review [j]. Affect Discord,2012,142 Suppl:S8-21.