25 years of psychosocial research has improved understanding and treatments, but how can we put the evidence into practice?
By Dr Edith Holloway 
Depression is a serious and relatively common mental health problem among people living with diabetes . Depressive symptoms occur more frequently in people with type 1 or type 2 diabetes compared to those without diabetes. Leading researcher Professor Frans Pouwer  and colleagues have published a narrative review highlighting the important advances made in understanding the link between depression and diabetes in the past quarter of a century.
How has our understanding of depression and diabetes advanced over the past 25 years? Studies have shown that, among people with diabetes, depression can reduce quality of life, self-management behaviours and increase a person’s risk of diabetes-related complications.
The good news is that clinical trials show that treatment for depression is effective in people with diabetes. For example, studies have shown that antidepressant medication, cognitive–behavioural therapy  and mindfulness‐based cognitive therapy are all effective in reducing depressive symptoms in people living with diabetes. In a recent article, Petrak and colleagues  recommended a stepped care model, whereby the intensity of intervention (or treatment) is matched to the individual’s needs.
However, Professor Pouwer  and colleagues also highlight the importance of taking diabetes distress into account when managing depressive symptoms. Diabetes-specific distress often co-occurs with, and can be mistaken for, depressive symptoms in people living with diabetes. Diabetes distress refers to the emotional burden of managing diabetes, including feelings of frustration, worry and helplessness. You can read more about diabetes distress here .
Where to from here? This review highlights the important advancements that have been made in the past 25 years with regards to our knowledge and understanding of depression and diabetes. However, more work is still needed to develop evidence-based interventions that address both depression and diabetes-distress. This could include integrated treatment, in which the diabetes professionals (general practitioners, endocrinologists) and mental health professionals (psychologists and psychiatrists) collaborate closely in a multidisciplinary context. There also needs to be greater awareness of depression in people living with diabetes. This could be achieved through implementing routine assessments for psychological problems in clinical practice and providing pathways for treatment if needed.
Health professionals can access the NDSS practical guide  on ‘Diabetes & Emotional Health’, which includes a chapter on supporting people with diabetes experiencing depression.
People with diabetes can access the NDSS factsheet  on ‘Diabetes and Depression’.
If this topic interests you, you can read more about depression in our other blogs .
Pouwer F, Schram M.T, Iversen M, Nouwen A, Holt R. How 25 years of psychosocial research has contributed to a better understanding of the links between depression and diabetes . Diabetic Medicine, 2020; 37 (3): 383-392.