Unpacking Diabetes Distress and Depression

0:00 [Music]0:07 welcome to the mental health video0:09 series for people living with diabetes0:11 my name is Candace and I'm from diabetes0:13 Canada diabetes distress and depression0:16 may look and feel similar but knowing0:18 how they are different will help you get0:20 the right care in this session we will0:22 explore diabetes distress and how it is0:25 different from depression the tools used0:27 to make a diagnosis and strategies that0:30 can help with managing your mental0:31 health with Dr gav Meta medical director0:35 of Psychiatry at South Lake Regional0:37 Health Center in Ontario Dr Meta is also0:40 one of the co-authors of the 20230:43 revision of the mental health chapter in0:45 diabetes Canada's clinical practice0:47 guidelines he's the founder of diabetes0:49 mental health clinic at South Lake0:51 Regional Health Center and served as an0:54 adviser for the mental health and0:56 diabetes training program a partnership0:58 between diabetes Canada and JDRF over to1:01 you Dr Meta thank you so much for your1:04 kind introduction in this presentation1:07 we'll give an overview of how the1:11 diabetes impacts the mental1:13 health of a person living with diabetes1:17 we will talk about the diabetes distress1:20 concept and the concept of major1:22 depressive disorder and what are the1:25 differences between them we'll talk1:27 about the screening tools avail aailable1:30 for diabetes distress as well as major1:33 depressive1:34 disorder we'll talk about the various1:36 modalities of Treatment available for1:39 these conditions whether it's talking1:42 therapy or medication or1:46 both living with diabetes is not easy1:49 for a person with diabetes as the1:52 diagnosis and the management of diabetes1:55 can be a significant life stressor for1:57 people and their families as it may be2:01 associated with challenges regarding the2:03 acceptance of the illness and the2:05 participation in the treatment2:08 addressing concerns regarding illness2:09 beliefs and participation in treatment2:12 recommendations can be helpful the lived2:15 experience of diabetes is often2:17 associated with the struggles specific2:19 to the illness and it can lead to2:21 significant concerns specifically2:23 diabetes distress the stigma2:26 perpetuation reluctance to start insulin2:30 recommended by Healthcare professionals2:32 and the persistent fear of hypoglycemic2:35 episodes there are wellestablished2:37 psychological reactions when a person is2:40 diagnosed first with2:42 diabetes it can be perception about the2:45 seriousness of the disease a person may2:48 discount the seriousness of diabetes2:50 which is often seen in patients or2:52 people with2:54 diabetes with type two diabetes which2:57 are not having any symptoms or2:58 asymptomatic Di3:00 or a person may become overwhelmed with3:03 the diagnosis which is often seen in3:05 person with diabetes and their families3:07 with type 13:09 diabetes not being able to comprehend3:11 the extent to which the diabetes can be3:14 managed3:15 successfully and the degree of personal3:17 responsibility required for the3:19 management by the person and the3:21 perceived benefits and the barriers to3:23 taking3:24 action professional support to address3:27 these reactions can be helpful in3:29 promoting the self-management of3:31 diabetes stigma associated with diabetes3:34 is3:35 huge weight based stigma is thought to3:39 be of quite value here the perception3:43 and the experience of being3:45 discriminated against due to one's body3:47 weight can be perpetuated by providers3:49 in healthare settings and when present3:52 this can lead to worsening distress3:54 diminished quality of life as well as3:57 decreased self-management of diabetes4:00 behaviors it is recommended that4:02 Healthcare professionals should be aware4:04 of their own biases and should be able4:07 to communicate in non-stigmatizing4:09 language about the weight related issues4:11 and diabetes4:13 management diabetes comes with a4:15 financial burden it is an expensive4:18 illness to live with and to manage4:21 well people living with diabetes should4:24 ask their Healthcare teams for help and4:26 the healthcare professional should4:27 recognize that the key role they play in4:29 in exising financial4:31 supports advocacy and activism are4:34 helpful and often necessary to manage4:37 the cost of people with with4:39 diabetes the cost associated with4:42 diabetes can be direct as well as4:45 indirect so diabetes distress refers to4:48 the negative emotions and the burden of4:51 self-management related to living with4:55 diabetes it describes the disp poeny and4:58 the emotional turmoil specifically5:00 related to people with diabetes in5:03 particular the need for continual5:05 monitoring and treatment persistent5:08 concerns about the complications and the5:11 potential erosion of the personal and5:14 professional relationships which is not5:17 easy it can induce the feelings of loss5:21 of power fear and shame in a person5:25 living with5:27 diabetes it is difficult to manage all5:30 the changes to the routine appointments5:33 or the doctor's appointments or5:35 medication5:39 compliance diabetes distress has5:41 received extensive research over last5:44 decade by Healthcare professionals and5:47 there's a lot of evidence that diabetes5:49 distress is common it can affect5:52 approximately onethird of people living5:54 with5:56 diabetes risk factors for developing5:59 diabetes distress include being younger6:01 being a female having a lower degree of6:04 Education living alone having a higher6:07 BMI or body mass index lower perceived6:12 self-efficacy lower perceived provider6:14 support poor quality of diet greater6:18 perceived impact of glycemic excursions6:21 and the greater number of diabetes6:24 complications a person with type 16:26 diabetes malius has to take6:28 approximately6:30 180 healthare decisions in a day which6:34 is not6:36 easy diabetes is a costly6:40 condition it is associated with6:42 significant direct costs such as6:44 medications diabetes supplies traveling6:47 to Physicians and Allied healthcare6:49 provider appointments food plans6:52 recommended for diabetes it can also be6:55 related with significant indirect costs6:58 such as decrease productivity7:00 management of complications of diabetes7:03 hospitalization related to7:05 diabetes it has been found that7:07 treatment participation in Diabetes Care7:10 is affected by these direct as well as7:12 indirect7:15 costs diabetes comes with a package of7:18 emotions the experience of threat which7:22 can cause feelings of anxiety in a7:24 person the experience of loss which can7:28 cause feelings of sadness or depression7:31 the experience of unfairness which can7:34 invoke feelings of anger in a person7:36 with7:37 diabetes major depressive disorder is a7:41 mental health condition described in the7:44 dsm57:47 TR which consist of either emotional7:50 symptoms such as low mood and reduced7:53 enjoyment of usual7:55 activities vegetative symptoms such as7:58 sleep appetite and energy level changes8:02 behavioral symptoms such as agitation or8:05 slowing of8:06 movements cognitive symptoms such as8:09 poor memory or reduced concentration or8:12 guiled8:13 feelings and thoughts of self harm may8:15 be8:17 seen so the prevalence of clinically8:20 impactful depressive disorders among8:22 people with diabetes is approximately8:25 30% the prevalence of major depressive8:28 disorder is approximately 10% which is8:31 double the overall prevalence in the8:32 general8:33 population it is important to remember8:36 that the risk of developing major8:38 depressive disorder increases the longer8:41 a person has had8:43 diabetes the risk factors for developing8:46 major depressive disorders in8:48 individuals with diabetes8:50 are female sex adolescents or young8:54 adults and older adults lower8:57 socioeconomic status9:00 having few or less social supports9:03 stressful life events instability with9:06 glycemic control particularly the9:09 recurrent hypoglycemic episodes higher9:12 illness burden longer duration of9:15 diabetes and the presence of long-term9:19 complications if a person is9:22 experiencing any symptom of9:24 distress or major depressive disorder or9:27 any health condition9:30 it is recommended to work closely with9:32 your Healthcare team talk about your9:35 symptoms the way you feel and the9:37 emotions share your concerns and discuss9:40 your options for the9:43 treatment screening is of very high9:47 value particularly in diabetes distress9:50 because it can lead to worse9:54 prognosis diabetes distress scale in9:57 type 1 diabetes consists of 28 items and10:01 there's a diabetes dis scale in type two10:04 diabetes which consists of 1710:07 items in type 1 diabetes mtis the10:11 diabetes dist sces considered domains10:14 such as10:15 powerlessness distress management eating10:19 distress negative social perceptions10:22 physician distress and the family or10:25 friends10:26 distress in type two diabetes diabet10:29 ities distress scale consist of10:31 measuring emotional burden physician10:34 related distress regimen related10:37 distress and the interpersonal10:40 distress also paid questionnaire is10:45 validated as well as the type one and10:47 type two diabetes distress10:49 questionnaire for screening of10:52 depression we use phq9 or the patient10:56 healthcare question9 for depression10:58 which consists of nine items it is a11:00 self-report scale which uses rating from11:03 0 to three based on the feelings and the11:05 experiences over the past two11:08 weeks anxiety questionnaire is the gad711:12 which consist of seven11:14 questions they are freely available on11:17 internet and they not cost any11:20 money these scales should be available11:23 with your Healthcare11:24 Providers these are validated tools for11:27 clinical as well as research11:30 purpose they are the screening11:32 instruments and the diagnosis can be11:34 confirmed by the healthc care providers11:37 by doing a detailed assessment following11:39 the screening and they can work with you11:42 closely to treat any condition if11:46 diagnosed11:48 treatment can consist of either11:50 behavioral therapy or medication or both11:55 for treatment of mild to moderate11:58 depression usually behavioral therapy or12:01 treatments are12:03 recommended it may consist of cognitive12:06 behavioral therapy the cognitive12:08 component includes record keeping to12:11 identify distressing automatic12:14 thoughts understanding the link between12:16 the thoughts and the feelings learning12:19 the common thinking errors that mediate12:22 distress like all or nothing thinking12:26 personalization magnification minim12:29 ization analyzing negative thoughts and12:32 promoting more functional ones12:35 identifying basic assumptions about12:38 oneself like unless I'm very successful12:41 my life is not worth living and being12:44 encouraged to adopt healthier ones like12:47 when I'm doing my best I should be proud12:49 of myself the behavior component12:52 includes strategies to help the person12:54 moving like behavioral activation12:57 scheduling Pleasant and and meaningful13:00 events learning assertive and effective13:03 communication skills focusing on the13:06 feelings of Mastery and13:08 accomplishment learning problem solving13:11 strategies exposure to new experiences13:15 shaping behaviors by breaking them down13:17 into smaller steps to develop13:20 skills motivational interviewing is to13:23 establish a change based relationship13:25 that is based on bond task and goal13:28 Alliance13:31 it is to demonstrate the non-judgmental13:33 Curiosity and comfort with13:37 ambivalence it uses the ask listen13:40 summarize invite framework to normalize13:43 the person's experience establish a13:45 collaboration seek the person's ideas13:48 and then ask permission to provide the13:51 ideas acceptance and commitment therapy13:54 focuses on the acceptance on the present13:57 moment experiences and chusing from the13:59 thoughts choosing not to be guided by14:02 present cognition or the scheme of14:04 thoughts commitment to flexibility in14:07 perspectives and determine the committed14:09 action based on14:11 values medications may include14:15 anti-depressants which is uh the most14:18 recommended treatment for major14:20 depressive14:21 disorder the choices can include SSRI14:25 medication or snri medication they work14:27 on various receptors in in the brain14:29 including14:31 serotonin noradrenaline and other14:35 receptors antic psychotic medications14:37 may be used in conditions like14:42 schizophrenia anxiety medications may be14:45 used for short-term management of14:47 anxiety or even long-term management of14:50 anxiety14:52 disorders even panic attacks mood14:55 stabilizer are used in conditions such14:58 as bipolar14:59 disorder sedatives or sleep aids can be15:02 of value stimulants such as medication15:07 for ADHD may be helpful for people who15:09 have coorbit attention deficit15:12 hyperactivity disorder along with15:15 diabetes so the takeaway message is a15:19 person with diabetes should expect to15:21 have feelings and emotions about15:27 diabetes person should be able to15:29 recognize when it is more than the15:31 diabetes15:33 distress ask to be15:35 screened for diabetes distress as well15:38 as major depressive disorder or anxiety15:41 disorder closely work with your15:43 Healthcare team to find out the best15:46 possible help that would work for you15:56 [Music]