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Q&A: Understanding the link between diabetes, mental health disorders
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Adolescents with common health conditions, such as diabetes, asthma and obesity, are at a higher risk for depression and major depressive episodes, compared to their peers without these conditions, according to a new report from the Substance Abuse and Mental Health Services Administration.
Among all adolescents, there has been a significant rise in the overall rates of major depressive episodes from 8.8% in 2005 to 12.5% in 2015, according to data from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health. The survey also revealed that between 2005 and 2014, one in seven adolescents with diabetes experienced a major depressive episode within the past year, compared with one in 11 adolescents without diabetes.
National Children’s Mental Health Awareness Day is observed this year on May 4 to highlight the importance of integrating behavioral health and primary care for children, adolescents and young adults with mental and/or substance disorders, according to a press release.
Healio Internal Medicine spoke with Maureen Monaghan, PhD, CDE, assistant professor of psychology and behavioral health at the Children’s National Health System in Washington, D.C., about the connection between diabetes and mental health illnesses in youth and how PCPs play a pivotal role in screening, diagnosing and caring for these patients.
What is the connection between physical and mental health in youth?
We strive to promote comprehensive well-being for youth, including both physical health and mental health. When youth are sick or physically don’t feel well, this can influence their mood and mental health. However, when youth are struggling with mood or mental health symptoms, this can also affect their physical health and their behavior related to caring for their health. For this year’s National Children’s Mental Health Awareness Day, SAMHSA is highlighting these links and the importance of promoting positive mental health as a part of overall health and development.
What is the connection between diabetes and mental health?
Diabetes is a demanding chronic illness and burdens associated with daily management can contribute to feelings of diabetes burnout or distress in both youth and their families. Youth with diabetes are also at higher risk for experiencing symptoms of anxiety and depression. For example, constant attention to symptoms of high and low blood glucose levels and meeting the daily challenges of keeping glucose levels in range can make youth feel anxious or hypervigilant about their health. High blood glucose levels can also cause symptoms of irritability, tearfulness or fatigue. Research suggests that up to 40% of youth with diabetes are at risk for depressive symptoms during adolescence and early adulthood and rates of depressive symptoms are higher in youth with type 2 diabetes as compared to type 1 diabetes. It is important to note that these youth do not necessarily meet the full diagnostic criteria for depression or anxiety; however, symptoms of depression or anxiety likely influence how they care for their diabetes and impact their overall health and quality of life and, thus, require attention.
What is the importance of screening or diagnosing mental health disorders in youth with diabetes?
We know that adolescence is a time when mental health symptoms first present in many youth, and youth with diabetes are no exception. Mental health disorders are associated with poorer diabetes outcomes in youth with diabetes, including poorer glycemic control and increased risk for acute complications. Therefore, to fully understand and address factors influencing diabetes health and provide comprehensive care for youth with diabetes, it is critical to screen for mental health concerns as part of routine diabetes care. The American Diabetes Association recommends that all adolescents are screened annually for symptoms of depression. Youth with diabetes are seen for medical visits with their diabetes care provider three to four times per year and these visits offer an important opportunity to identify and address mental health concerns. By using validated screening measures at routine diabetes visits, diabetes care providers can quickly and proactively identify mental health symptoms in youth and help youth and families access mental health treatment to improve overall health and wellbeing.
What is the role of PCPs in helping youth get the support they need?
Youth grow up with their primary and specialty care providers, and pediatric providers often have a close, trusted relationship with their patients. Primary care providers also routinely monitor growth and development and may be the first to identify changes in mood or behavior that signify potential mental health concerns. Further, scheduling an appointment with the pediatrician may be the first step a parent takes when noticing a change in their child’s mood and behavior. Thus, primary care providers play a critical role in both early identification of mental health concerns and addressing mental health concerns as part of overall health and development. However, for primary care providers to be successful in helping youth get the support they need, they need to know what to do after a mental health concern is identified. Thus, partnerships with mental health providers are essential for care. As highlighted in SAMHSA’s National Children’s Mental Health Awareness Day panel, models of integrated care that bring together medical and mental/behavioral care providers are highly successful in connecting youth with evidence-based mental health care and improving health outcomes.
How can PCPs communicate with behavioral health providers to improve care?
Integrated models of care offer the most efficient methods for communication, where providers are located within the same practice and share the same medical record system. This model also offers frequent opportunities for consultation and collaboration among providers. Families report high levels of satisfaction with integrated care models, and youth are more likely to engage with mental health services through integrated care models. The SAMHSA-HRSA Center for Integrated Health Solutions (http://www.integration.samhsa.gov/) offers a wealth of resources on integrated care models on their website and strategies for improving communication among providers.
What else is important to note on this year’s National Children’s Mental Health Awareness Day?
The Child and Adolescent Diabetes team at Children’s National Health System in Washington, D.C., includes physicians, diabetes nurse educators, dieticians, social workers, and psychologists to provide integrated, comprehensive diabetes care. We routinely screen for depressive symptoms in all youth with diabetes aged 13 and up, allowing diabetes care providers to quickly connect youth with diabetes and mental health concerns with behavioral health providers who have specialized knowledge in diabetes and mental health. Approximately 15% of youth with diabetes indicate moderate depressive symptoms using a validated depression screener (Patient Health Questionnaire-9 for Adolescents), and youth with identified concerns are immediately provided with behavioral health resources and referrals. Youth and families report high satisfaction with this screening.
Disclosure: Monaghan reports no relevant financial disclosures.