Depression May Really Be Diabetes-Related Distress

Diabetes related depression symptoms may be reduced through diabetes management programs

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) People with diabetes are twice as likely as the average person to have depression. Research, however, indicates that what may be labeled as “depression” is actually disease-related distress.

While the National Institute for Mental Health and other professional organizations say that diabetes raises the risk of depression, investigators now question whether these patients have actual clinical depression.

A new study has found that many patients said to have depression may in reality have depression-like symptoms related to the stress of managing the disease, and programs that help patients manage diabetes can alleviate this distress.

"Follow diabetes management programs to help lower diabetes-related distress."

Lawrence Fisher, PhD, professor of Family and Community Medicine at the University of California, San Francisco, and colleagues followed 392 patients with type 2 diabetes to assess if symptoms of depression could be reduced by methods used to treat “diabetes distress.”

Patients, who were all 21 or older, were randomly assigned to one of three programs to help manage their diabetes. One group was only given information on diabetes management. Another group followed a specially designed web-based diabetes improvement program. A third group followed the web-based program along with problem-solving therapy (receiving individual assistance to solve problems).

A component of the web-based program, for example, was designed to help patients target physical activity, diet and/or medication adjustment.

Using a patient health questionnaire and measures from the Diabetes Distress Scale (an instrument for the assessment of diabetes-related emotional distress), scientists evaluated patients at the start of the study, at four months, and at one year.

They observed that all three interventions reduced distress and depressive symptoms over 12 months.

Overall, about eight in 10 patients whose scores showed them having moderate depression or greater at the beginning of the study  lowered their depression levels to less than moderate depression levels.

“Many of the depressive symptoms reported by people with type 2 diabetes are really related to their diabetes, and don't have to be considered psychopathology,” said Dr. Fisher in a press release. “So they can be addressed as part of the spectrum of the experience of diabetes and dealt with by their diabetes care team.”

In an interview with dailyRx News, he added, “The essential message is that many patients who we consider clinically depressed are not. What the emotional side of diabetes is reflecting is the distress of managing a demanding, chronic, progressive disease. Rather than call it depression, call it what it really is. They‘re not clinically depressed—they’re upset and distressed. Patients with high levels of diabetes-related distress don’t do very well. But it’s not depression.”

The study was presented June 16 at American Diabetes Association's 74th Scientific Sessions in San Francisco.

Review Date: 
June 16, 2014
Last Updated:
June 16, 2014