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Dr Alan Headey (with thanks to Dr. William Polonsky)Clinical Psychologist

Scaling the highs and lows: Identifying and dealing with diabetes burnout and depression

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Aims• Definition: Depression vs Distress• Helping people in distress

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Definition

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Forms of depression

Major depression Dysthymia

Bipolar disorders Adjustment disorder (depressed mood)

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SymptomsEmotional - Cognitive Somatic Behavioural

Intense Sadness Appetite up / down Avoiding social interaction

Loss of interest or pleasure

Sleep up / down Avoiding sport, music, art and the WORLD.

Intense self-criticism/ Worthless

Low energy Staying up or sleeping in ++

Can’t concentrate Agitated or very slow Screen time up ++

Hopeless Thinking about death or suicide

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How common is “depression” in diabetes?• 33% or more of patients• About 20% - 25% of patients• About 10% - 15% of patients• Less than 10% of patients

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Prevalence in Diabetes – OLD Data• 32% (Gavard et al, 1993)• 41% (Peyrot and Rubin, 1997)• 45% (Gary et al, 2000)• 37% (Polonsky et al, 2000)• 23% (Anderson et al, 2000)

• Double the risk in people with diabetes

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Newer Data• 18% (Nichols and Brown, 2003)• 10% (Fisher et al, 2007)

• 50% increased risk in people with diabetes

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Newest Data• Type 1 diabetes (n = 6172): 4.6%• Type 2 diabetes (n = 503): 3.6%

• Point-wise prevalence in Australia 4-8% over a long period of time; Lifetime (20% women, 12-15% men)• No increased risk in people with diabetes!

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What impact?• Data is mixed on whether:- Depression worsens glycaemic control- Treating depression improves control?- Could even be that depression leads to T2 DM

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Confused?

Proudly sponsored by: Gonzalez et al, 2011

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Take away points• “Major Depression” in diabetes may be a lot

less common than we think.• The impact of depression on diabetes, or

diabetes on depression is unclear.• Depression does suck and requires treatment

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Treatment for “Major Depression”• Everyone should have a thorough assessment,

which includes a careful case formulation.• Case formulation should inform treatment.• Mild depression: Primum non nocere!

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How might we help Jim?

Job Stress,Seperation,

Medical Illness

Not Sleeping

Not Exercisingnot seeing

friends

Stressed and Sad

Work harder

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“You can’t stop the birds from circling your head, but you can stop them from nesting in your hair.”

Martin Luther 1483-1546

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Diabetes Distress

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“It’s not that I even want a cure, I’d settle for a break.”

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Diabetes Distress• “It’s 24 / 7” (Parental constant vigilance)• “…it controls my life”• “I will end up with complications no matter

what I do.”

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Distress Burnout• Distress: “It’s tough” (and it is)• Burntout: “I’m over it” (risk)

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What can we do to help?

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3 Steps• Listen• Build Hope• Restore control Make life sustainable

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LISTEN!

“If you listen long enough people will tell you what is wrong.”

AKA, Shut Up!

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“Statements of understanding must precede statements of advice.”Haim Ginnott 1922-1973

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Hope

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Give accurate feedback (HbA1c meaning)• Risk Destiny

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Restore Control – Make life sustainable• Sleep• Diet (carbohydrate)• Exercise• Social• Spiritual

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So, what can you do to help1. There is no such thing as “just listening”2. Find ways to give hope3. Think about daily routines. They need to be

sustainable.

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Thank you so much for listening….