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Diabetes drain
How to help patients cope with the emotional aspects of diabetes.
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If you ask one of your patients how they’re feeling, you’ll likely hear if they’re tired, if their blood glucose levels are high or if they’re feeling under the weather.
For many patients, the emotional effects of diabetes are just as important as the physical ones — but they are often reluctant to talk about their feelings. Depression, anger and guilt are commonly seen in people with chronic diseases like diabetes. Consider these statistics:
- A study published in the June 2005 issue of Diabetes Care showed that depression increased the risk of mortality in people with diabetes by 30%.
- The June 2008 edition of the Journal of the American Medical Association showed proof that diabetes plays a role in depression and depression plays a role in diabetes.
Research shows that diabetes can be a main cause of mental health issues and that, in turn, these issues make it even more difficult for your patients to manage their diabetes. Coupled with what we’ve seen in practice, these statistics show that many of our patients have difficulty coping, whether because of their disease or for other reasons. It is imperative that we, as part of the diabetes care team, learn to identify these issues so we can care for our patients’ whole health and wellness.
Coping with mental health issues
 Amparo Gonzalez |
We have standards that define good blood glucose levels and the amount of carbohydrates our patients should eat. But how can we measure how someone is coping with the stress, depression or other mental health issues that are linked to their disease? This issue is compounded by the short amount of time that health care professionals are allowed to spend with patients. With so much other information that patients need to absorb during their appointment, it is easy to focus on the things that can be measured and quantified. However, with the link between depression and diabetes, health care professionals must take the time to evaluate a patient’s ability to cope with their disease.
When I talk with a patient who is reluctant to discuss his/her mental health, I take the extra time to ask questions and listen closely to the answers. These questions provide a starting point to determine a patient’s emotional well-being. I’ve found that many patients don’t admit to being depressed. But by asking a variety of questions, I can begin a dialogue with my patient and sense the patient’s true feelings by reading non-verbal communication and listening closely. The nine item depression scale of the Patient Health Questionnaire (PHQ-9) and the two item depression scale of the Patient Health Questionnaire (PHQ-2) symptom checklists are helpful when evaluating a patient’s mental health and screening for depression. You can get a copy of the questionnaires from the MacArthur Foundation Initiative on Depression and Primary Care. The checklists ask the patient to evaluate their interest in certain activities during the last two weeks, such as: sleep patterns, eating habits, lack of interest in activities.
These questions will prompt a conversation with your patient that will give you a better idea of their mental health status. If a patient answers in a way that causes you to pause, recommend that the patient reaches out to members of their care team to make a plan for improving their attitude and dealing with the stress of diabetes. We all know that proper diabetes management will only be enhanced when the person is able and willing to take charge of his/her situation.
Perhaps your patient is having a difficult time dealing with the management of diabetes. Day-to-day life with a chronic disease can be tiresome and frustrating, and it’s easy to get sick of being sick. Show that you understand this, and work with your patient to establish ways to cope. For example, find out what the patient likes to do and encourage him/her to engage in that activity before your next appointment. If they like to go to the movies, be sure to follow-up about that activity the next time you see the patient. If your patient hasn’t been going to see movies, ask some follow-up questions, since a symptom of depression is withdrawing from things you enjoy doing. These actions are valuable to patients and may motivate them to work harder to pull themselves out of a temporary down episode. Talk with your patient about involving their friends and family. They are an important part of the extended care team because they know the patient the best and can help engage him/her in a brighter outlook.
Help your patients prepare for the unexpected. Perhaps they’re feeling anxious about an upcoming vacation, feeling worried about traveling with insulin and embarrassed about dealing with security. Come up with a plan with various scenarios and role play how they will deal with different situations. Some patients will find that once they realize they have options, they will feel less stress and anxiety about their disease.
Healthy Coping is an essential part of your patients’ self-management, and it is one of the AADE7 Self-Care Behaviors. Diabetes educators and other health care providers are encouraged to incorporate coping skills into their diabetes education curriculum and to help their patients set and achieve goals for dealing with the emotional effects of diabetes. Teaching your patients how to cope with their emotional behaviors will help them become better managers of their diabetes. Healthier patients are always the goal, and with the help of a network of professionals, family and friends, your patients will learn to live and thrive with their diabetes.
For more information:
- For more information and educational videos about the AADE7 Self-Care Behaviors, visit www.mydiabetespartner.org.