Dr. Gaurav Mehta, Medical Director of Psychiatry at Southlake Regional Health Centre in Ontario, will explore diabetes distress and how it is different from depression, the tools used to make a diagnosis, and strategies that can help with managing your mental health.
Speaker: Dr. Gaurav Mehta, MBS, MSc, FPCPC
Speaker: Dr. Gaurav Mehta, MBS, MSc, FPCPC
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]
[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]
Category Tags: General Tips, Management, Healthy Living;