Patients with diabetes mellitus almost always develop certain emotional and mental disorders. Depressive disorders are especially common in older people with type 2 diabetes. According to Hoy-Ellis and Fredriksen-Goldsen (2016), “minority stressors and chronic physical health conditions independently and collectively predict depression” (p. 1119). The presence of depression concomitant to diabetes mellitus prevents the adaptation of the patient and negatively affects the course of the underlying disease. For example, depression worsens the implementation of medical recommendations, including those related to adherence to diet, taking antihyperglycemic drugs, and self-monitoring of blood sugar levels. The very fact of a diagnosis of diabetes mellitus – a painful condition, the need to take medications, and changes in lifestyle – leads to the mental regression of many patients.
Depression in diabetes patients not only occurs more often than in the overall population but also has a more protracted course. When diabetes is combined with depression, their course and prognosis (severity, complications, treatment efficacy, and mortality) are worse than for each of the diseases separately (Coleman et al., 2013). On the other hand, diabetes is also more severe in depressed patients for many reasons. Depression worsens patients’ compliance – they are less likely to self-control glycemia and often refuse a healthy lifestyle. Patients do not follow dietary recommendations, overeat or, conversely, reduce food intake, suffer from physical inactivity, and abuse tobacco and alcohol. Thus, both the physical and psychological well-being of patients with diabetes and depression and their quality of life are significantly worse than in patients with each of these diseases separately.
Depression itself is one of the most disabling chronic diseases, but the resulting impairment of mental and physical functioning is greatly exacerbated if depression develops in a patient with another chronic disease, such as diabetes. According to Gehlert and Browne (2019), “people with diabetes commonly develop an array of complications that can include cardiovascular disease, vision problems (including blindness), amputations, kidney failure, and nerve damage” (p. 468). The combination of depression with diabetes disrupts the performance, ability to work, and productivity of patients. The next important potential common link in the pathogenesis of type 2 diabetes and depression may be systemic inflammation that accompanies diabetes. The direct depressogenic effect of cytokines on the brain has been known for a long time – depression is even listed in the “side effects” section of interferon drugs for parenteral administration. Elevated concentrations of pro-inflammatory cytokines, such as C-reactive protein and interleukin-6, are accompanied by both metabolic disorders and depression. Thus, it creates a vicious circle, where diabetes causes inflammation, inflammation produces depression, and depression enhances diabetes.
References
Coleman, S. M., Katon, W., Lin, E., & Von Korff, M. (2013). Depression and death in diabetes; 10-year follow-up of all-cause and cause-specific mortality in a diabetic cohort.Psychosomatics, 54(5), 428–436. Web.
Gehlert, S., & Browne, T. A. (2019). Handbook of Health Social Work. John Wiley & Sons, Inc.
Hoy-Ellis, C. P., & Fredriksen-Goldsen, K. I. (2016). Lesbian, gay, & bisexual older adults: Linking internal minority stressors, chronic health conditions, and Depression. Aging & Mental Health, 20(11), 1119–1130. Web.