Depression and Anxiety in Patients With Diabetes: A Q&A With Dr Saundra Jain
October 20, 2017 at 2:40pm
Many individuals with type 1 or type 2 diabetes also have various psychosocial comorbidities, such as depression, anxiety, and diabetes distress, according to Saundra Jain, MA, PsyD, LPC, Adjunct Clinical Affiliate at the School of Nursing at the University of Texas in Austin.
Psychosocial comorbidities often have a negative impact on adherence to treatment and self-care plans in patients with diabetes, said Dr Jain. This can lead to poor psychological wellbeing and worse outcomes, including higher hemoglobin A1c (HbA1c), poor dietary and exercise habits, and low self-efficacy.
Recently, Consultant360 spoke with Dr Jain, who will be presenting “The ADA Speaks Out: Psychosocial Care Promoting Optimal Outcomes and Psychological Well-Being” on October 20, 2017, at the Cardiometabolic Risk Summit in Dallas, Texas.1
Consultant360: How common are psychosocial comorbidities, such as depression, anxiety, and diabetes distress, among patients with diabetes?
Saundra Jain: Comorbidities are extremely common among patients with both type 1 and type 2 diabetes. Routinely screening for comorbidities is essential in taking care of this patient population. The estimated prevalence rate for depression among type 1 and type 2 patients is about 25%, and the estimated prevalence rate for generalized anxiety disorder among type 1 and type 2 patients is about 19.5%. For diabetes distress, it ranges from 18% to 45%. We simply cannot ignore these numbers. These comorbid conditions become barriers to our patients living successfully with diabetes.
C360: Do practitioners often account for these comorbidities when forming treatment plans, or are they sometimes overlooked?
SJ: Sadly, comorbidities are often overlooked. However, we are now beginning to routinely incorporate scales and screeners into practice, which helps identify these comorbid conditions. Some commonly used scales and screeners include the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, and the Diabetes Distress Scale (DDS) for diabetes distress.
The good news is that most of these tools are simple to use and do not require additional training.
C360: If these issues are not addressed, how can they impact or impede patients’ success with their treatment plans?
SJ: Unidentified comorbidities are definite barriers when it comes to achieving good outcomes. Effective management of diabetes requires a lot from our patients. I’ve been a type 1 diabetic for almost 31 years, and I know how much work and attention this illness requires. For patients burdened by depression and/or anxiety, following through with their care plan can become very difficult.
As an example, a patient with either type 1 or type 2 diabetes with unidentified depression may struggle with memory, concentration problems, and a loss of energy and motivation. Imagine how difficult it would be to implement a detailed care plan when struggling with memory, concentration problems, and a loss of energy and motivation. If our patient is also dealing with lack of social support or financial problems, the challenges become even greater.
C360: What are some common barriers that practitioners face in helping patients with diabetes adhere to their self-care plans?
SJ: As you might guess, this is very individualized. Not all patients deal with a diagnosis and the management of type 1 or type 2 diabetes in the same way. As practitioners, we must keep our eyes open to the many psychosocial factors that may negatively influence adherence. We often encounter patients who struggle with a lack of social and/or family support, limited financial resources, fear of diabetic complications, and treatment nonadherence.
C360: How can practitioners help their patients overcome these barriers? What strategies or tools do you use in your practice?
SJ: Be on the lookout for these barriers and engage patients in a conversation to better understand which psychosocial factors are present. I try to make treatment decisions based on patient-centered care. If I want to improve outcomes, no matter how strategic my treatment plan, if I don’t have patient buy-in, adherence most likely will suffer. We must understand our patients’ preferences, their individual needs, and their individual barriers, as well as make sure that their values help guide our treatment recommendations.
C360: In your opinion, are current clinical guidelines effective for the management and treatment of psychosocial comorbidities among patients with diabetes? If not, what needs to change?
SJ: The 2016 position statement from the American Diabetes Association (ADA), “Psychosocial Care for People with Diabetes,”2 is an absolute must-read. It provides an excellent review and recommendations regarding numerous psychosocial factors that influence our patients’ ability to successfully live with diabetes.
—Christina Vogt
References:
1. Jain S. The ADA Speaks Out: Psychosocial Care Promoting Optimal Outcomes and Psychological Well-Being. Presented at: Cardiometabolic Risk Summit; October 20-22, 2017; Dallas, TX. https://cardiometabolicrisksummit2017.sched.com/.
2. Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126-2140. https://doi.org/10.2337/dc16-2053.