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For some people living with diabetes, the condition’s physical impact can be all-consuming to the point that they may not be aware of the condition’s psychological toll. Addressing these symptoms, though, can significantly improve your quality of life.
“Anyone dealing with chronic illness of any kind can really come up against challenges, particularly when there is no cure, or there’s uncertainty in the progression of the illness,” said Dr. Sarah Gray, a pain psychologist with Integrative Psychology in Arlington, Massachusetts, and an instructor of psychology at Harvard Medical School.
According to the National Institute of Mental Health (NIMH), people with chronic conditions are more likely to develop symptoms of depression than those who are not chronically ill. This also works the other way around, with mental well-being affecting disease activity. People who experience depression are at an increased risk for developing certain chronic illnesses, compared to those who are not depressed.
Anxiety is also common in people with chronic conditions as they face the unknowns of what might happen as a result of their disease. This can lead to associated conditions as well. For instance, researchers have found that sleep issues — including insomnia as well as extreme oversleeping — are associated with a lower health-related quality of life in people who have chronic conditions.
Members of DiabetesTeam often talk about the effects of diabetes on their mental health. “I am so depressed because I feel there are no foods I can eat,” one member noted.
Some people with diabetes may shy away from seeking treatment for mental health conditions, focusing instead on physical care. However, treating depressive symptoms, anxiety, or mood disorders with medication such as antidepressants or psychotherapy (also called “talk therapy”) may help improve your physical symptoms or reduce the risk of future problems, according to NIMH.
Your health care provider can work together with a mental health professional, such as a psychologist or psychiatrist, to ensure that you stay both mentally and physically healthy.
There are several reasons why having a chronic health condition may put people at a higher risk of mental health difficulties, according to Mental Health America. For example, you may be:
“My blood pressure has gone way up from my last checkup. I have anxiety issues too,” one DiabetesTeam member wrote. “I must do something to calm myself down.”
In some cases, you may feel depressed or anxious because you aren’t getting the right medical care. Research published in 2011 found that people who felt stigmatized by health care workers had a decreased quality of life, at least in part because they accessed health care services less frequently than people who did not internalize stigma and anticipate a negative response.
This situation can prevent some people from seeking care for their mental health conditions, Dr. Gray noted. “Unfortunately, sometimes there can still be a stigma around seeking help for mental health concerns,” she said. “Thankfully, that’s changing and continues to improve, but that can still exist.”
Depressive disorders are about twice as common in people with diabetes as they are in the general population, the authors of a 2018 study wrote. “Up to one-quarter of people with diabetes also experience depressive symptoms for which severity does not reach the threshold for diagnosis of the disorder,” they added.
These changes to your mental state can start to impact your relationships and support networks. In one study, participants who received a type 2 diabetes diagnosis were much more likely to report a significant decrease in their quality of life compared to before they had the diagnosis. Individuals who were diagnosed with diabetes also reported spending less time with family and friends, in community events, and on the telephone with loved ones.
In some cases, you may not recognize that you’re experiencing depression or anxiety because those feelings came on slowly and you didn’t notice how strong they’d become. Or perhaps you’ve gotten so accustomed to feeling blue or stressed that you now assume this is just a way of life now. But recognizing when you may actually have a condition that requires a professional evaluation is important.
“In my experience, and working with so many patients at different phases and stages, the type of stress that comes up early evolves over time,” Dr. Gray said. “Often, people along the way will find ways to cope, to draw on that inner strength that’s there, and hopefully get linked in with a number of supports, but the stressors change over time. And that requires ongoing support.”
Symptoms of depression may include:
Common symptoms of anxiety can include:
If you are experiencing these types of feelings, talk to your health care team or contact a mental health provider for help.
Your health care team will make the determination about what type of treatment you should pursue. In addition to the treatments that your physician recommends, you can find other ways of treating depression and anxiety with lifestyle changes and therapies that help in different ways than medication.
Dr. Gray recommends such tools as cognitive behavioral therapy and biofeedback for coping with the many unknowns inherent in having a chronic disease.
She also works directly with people to identify the specific stressors that may be troubling them. “For instance, if there’s a family member who is bringing up some conflict and the patient finds it particularly difficult to navigate setting boundaries with a certain person, then we might work on concrete, specific tools to address any troublesome interactions there,” she said.
It’s essential that you remain on your treatment regimen for diabetes as you treat your mental health condition, while also pursuing lifestyle modifications. One 2020 study found that for older adults with multiple chronic conditions, maintenance behaviors — such as physical activity and treatment adherence — were the most critical components of self-care to combat depression.
The researchers also found that even mild depressive symptoms could be associated with poor self-care maintenance. They emphasized how important it is for people with chronic conditions to be screened for depression of any severity.
In addition, make sure you have a supportive team around you, which can help when living with diabetes. A 2020 study found that people with certain chronic conditions reported family as the most important resource they had outside of themselves. Positive relationships with other people “are assumed to contribute to physical and mental health either directly by meeting basic human needs, or through enhancement of coping performance by buffering stress,” the study authors noted.
One member of DiabetesTeam pointed out the impact of social support from other people living with diabetes. “New restrictions on your lifestyle and diet are a legitimate reason to be depressed,” they acknowledged. “But this website can help you realize that you have company.”
Consider getting involved in diabetes advocacy work as a diabetes educator, or just meeting others who share the same diagnosis.
Remember that your health condition may have an effect on every area of your life, Dr. Gray said. “Relationships, activities that one may enjoy — they may be impacted by the chronic illness and the symptoms,” she noted. “Your sense of self can be affected by the change in activities and relationships, so that in and of itself can really, validly lead to feelings of loss and worry.”
Some risk factors for developing mental health issues — as well as for having chronic illnesses — are easier to manage and modify than others, according to the U.S. Centers for Disease Control and Prevention (CDC). Stressful life circumstances, a history of trauma, and a lack of social support may be out of an individual’s control. But diet, exercise, and drug use are among the modifiable risk factors the CDC identifies for reducing one’s risk of chronic disease.
One DiabetesTeam member encouraged another to take control of their lifestyle to improve their holistic wellness through healthy living. “The good thing about diabetes is that it is interactive, that we can control a good part of it, by diet, medications, and exercise,” they said. “We can have a good life and a healthier life at that.”
You can also consider using mindfulness — a type of meditation — as part of your road to alleviating mental health problems. “At its core, mindfulness is really approaching the present moment with openness, with curiosity, purposefully, and just being aware of what’s around you,” said Dr. Gray. “It takes a lot of practice, repetition, and time — it’s really important for people to know it doesn’t just happen.”
Through DiabetesTeam, you can join an online social network for those living with diabetes. In doing so, you will gain access to a social support group of people who are facing similar challenges and understand what you are going through.
How has diabetes affected your emotional health? How are you managing emotional changes as you work to control your blood sugar levels? Share your ideas in the comments below, or start a new conversation on DiabetesTeam.
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Sarah Gray, Psy.D.
is an Instructor of psychology at Harvard Medical School and a psychologist in the Department of Psychiatry at Massachusetts General Hospital.
Learn more about her here.
Anika Brahmbhatt
is an undergraduate student at Boston University, where she is pursuing a dual degree in media science and psychology.
Learn more about her here.
Scarlett Bergam, M.P.H.
is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa.
Learn more about her here.
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