Rudy Bilous, MD, FRCP
Richard Donnelly, MD, PHD, FRCP, FRACP
Particular groups of patients with diabetes are at risk of different psychological problems (Table 25.1). Many children show remarkable resilience to the diagnosis of diabetes, but about one-third have some temporary psychological distress, mostly ‘adjustment disorders’ such as difficulty in sleeping, depression, social withdrawal and anxiety. This generally subsides within 6 months. Surprisingly, little is known about psychological problems in adults with recent-onset diabetes.
Psychological problems in diabetes
Most children and adolescents function well psychologically during the course of their diabetes, although there is an increased frequency of psychiatric disorders by 10 years’ diabetes duration, mainly severe depression and anxiety. Prevalence studies in adults with diabetes have revealed that depression and anxiety are about twice as high as in the general population and affect between 15% and 25%. The highest rates are in hospitalized patients, those with macrovascular disease, chronic foot ulceration, proliferative retinopathy and previous psychopathology; females are more susceptible than males. A longitudinal study of 500 type 2 patients who were seen three times over 18 months suggested that depressive symptoms remained relatively stable and were treated, but diabetes-related distress fluctuated and was not as well recognised or addressed. There is a weak relationship between metabolic control and mood disorder (Table 25.2). Depression may precede and predict the development of type 2 diabetes (Figure 25.1).
The features of moderate or severe depression should be recognised by diabetologists (Box 25.1), although cases are often missed in the setting of a diabetic clinic and because some symptoms of depression overlap with those of diabetes (e.g. weight loss, lethargy and loss of libido).