In this paper, from the International Diabetes MILES study, we consider the relationship between depression, anxiety and diabetes self-care
Diabetes is a life-changing condition, which places an ongoing practical and emotional burden on the person affected. Therefore, the relationship between mental health and self-care is at the forefront of the ACBRD’s research. Earlier this year, we published a new study to update what is known about depression, anxiety and self-care in relation to diabetes.
Past research has produced clear evidence of a two-way link between diabetes and depression. Diabetes increases a person’s risk of depression. In turn, depression results in worsened diabetes-related health outcomes. Anxiety and diabetes also appear to be related, but exactly how they interact is not certain. While some have found anxiety increases long-term risk of complications, others suggest that anxiety may play a protective role, potentially due to greater attention to health status and self-care. Yet, for many people, depression and anxiety are inextricably linked. This makes it necessary to consider the two mental health issues in chorus. This is where our study comes in.
We analysed data from 6,590 adults who participated in the Diabetes MILES Study, a large international survey of people living with type 1 or type 2 diabetes, in Australia and The Netherlands:
- First, we looked at prevalence. Overall, in this cohort, 9% experienced combined anxiety-depression symptoms, and 2% experienced anxiety-alone symptoms. Depression-alone symptoms were more common in those with type 2 (11%) than type 1 (8%) diabetes.
- Second, we looked at demographic and clinical characteristics as potential markers for anxiety and depressive symptoms. The only characteristic found to be relevant was diabetes duration (in those with type 1 diabetes only): those with a more recent diagnosis were more likely to have combined anxiety-depression symptoms than those with longer-standing diabetes.
- Finally, we looked at self-care and health behaviours. People with high levels of combined anxiety-depression symptoms were more likely to report sub-optimal diabetes self-care and health behaviours than people with no symptoms or minimum levels. This means that they engaged in less healthy eating patterns, less physical activity, more likely to smoke and less likely to take medications as recommended, as well as less frequent self-monitoring of blood glucose and foot care.
In conclusion, we found that 1 in 10 adults with diabetes are affected by both anxiety/depression symptoms, and they have increased odds of suboptimal diabetes self-care. Those with shorter duration of type 1 diabetes may be at increased risk. This study illustrates that we need to look beyond depression and anxiety as discrete mental health issues in people with diabetes. We also need to consider their combined effect. Addressing mental health in this way may be key to promoting optimal diabetes self-care.
Check out our other blogs on mental health and depression.
Nefs G, Hendrieckx C, Reddy P, Browne JL, Bot M, Dixon J, Kyrios M, Speight J and Pouwer F. Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study. Journal of Diabetes and its Complications. 2019; https://doi.org/10.1016/j.jdiacomp.2019.04.013
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