Written by: Mr. Alexius Cheang, Lecturer in Psychology, International Medical University

In conjunction with World Mental Health Day on 10th October 2022, this is an appropriate time to talk about the mental health of people who are diabetic or whom are their caregivers.

People who have diabetes are 2-3x more likely than the general population to develop mental illnesses such as depression as well as anxiety. In addition, they also have increased rates of developing eating disorders as well as to experience declines in cognitive functioning.

For the caregivers, the most common mental health conditions they tend to develop are depression and generalized anxiety disorder which affect up to 1 in 5 caregivers.

Since diabetes care involves constant self-management behavior by the person and caregiver, diabetes distress (a mix of depression and anxiety symptoms) may occur.

Living with diabetes is associated with a broad range of diabetes-related distresses:

In addition, this disease burden and emotional distress leads to poor outcomes as the presence of a mental illness like depression could interfere with the management of diabetes by influencing treatment adherence.

In fact, a bi-directional relationship exists between Type 2 diabetes and depression. Just as having Type 2 diabetes increases the risk for onset of major depression, a major depressive disorder also signals increased risk for onset of Type 2 diabetes.

To complicate matters further, a person with diabetes can easily confuse hypoglycemic episodes with anxiety disorders as both conditions share similar experiences of sweating, anxiety, tremor, tachycardia, and confusion. Therefore, chronically anxious individuals may be more likely either to fail to perceive the initial warning signs of hypoglycemia or to confuse these with anxiety.

Caregivers involved in the care of individuals with diabetes tend to feel tired, isolated, and overwhelmed. As the number of diabetes management tasks caregivers are responsible for increase, so do their reports of caregiver strain.

With the increase in caregiver strain, greater mental health symptoms develop among caregivers resulting in poorer diabetes management, which then further increases caregiver strain, making the situation progressively worse over time.

If you have been feeling really sad, blue, or down in the dumps, check for these symptoms:

• Loss of pleasure

You no longer take interest in doing things you used to enjoy.

• Change in sleep pattern

You have trouble falling asleep, you wake often during the night, or you want to sleep more than usual, including during the day.

• Early to rise

You wake up earlier than usual and cannot get back to sleep.

• Change in appetite

You eat more or less than you used to, resulting in a quick weight gain or weight loss.

• Trouble concentrating

You can't watch a TV program or read an article because other thoughts or feelings get in the way.

• Loss of energy

You feel tired all the time.

• Nervousness

You always feel so anxious you can't sit still.

• Guilt

You feel you "never do anything right" and worry that you are a burden to others.

• Morning sadness

You feel worse in the morning than you do the rest of the day.

• Suicidal thoughts

You feel you want to die or are thinking about ways to hurt yourself.

If you have three or more of these symptoms, or if you have just one or two but have been feeling bad for two weeks or more, it's time to get help.

Up to 45% of mental health conditions and cases of severe psychological distress go undetected among patients being treated for diabetes.

Diabetes treatment teams need to be aware of the mind-body connection and ensure whole person care. One way of doing this is by conducting regular screenings for mental health conditions during office visits.

As a person with diabetes, stress can make following your diabetes maintenance routine more difficult. Experts suggest looking for patterns; be aware of your stress level each time you log your blood sugar and see if a pattern emerges. If you notice a pattern, you can learn to spot your stress warning signs and take action to prevent stress and keep your blood sugar low. This may mean working with a professional to learn relaxation and coping techniques.

As a caregiver, the most important step you can take is to recognize that you need help and to reduce your own stress. It’s especially important that you set realistic goals and seek help when you can’t take care of another person and consider joining a support group. It’s also necessary that you are prepared to accept help if you need it, as this will result in better outcomes for both you and the person you are caring for.

Talk therapy is not only for discussing your problems, but also for finding solutions. Professionals can help you work through the many things that may be causing you stress, understand your mental health condition and identify triggers that may make things worse and learn coping skills. Common types of therapy include:

• Cognitive-behavioral therapy (CBT)

The cognitive part works to develop helpful beliefs about your life. The behavioral side helps you learn to take healthier actions. CBT often works well for depression and anxiety, but it can also be used for other various conditions.

• Family therapy

helps family members communicate, handle conflicts and solve problems better. Forms of family therapy often are used for treating eating disorders and bipolar disorder.

• Dialectical- behavioral therapy (DBT) 

focuses on teaching skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.