Mental Wellness in Diabetes

From diabetesselfmanagement.com
By Laura Hieronymus, DNP, MSEd, RN, MLDE, BC-ADM, CDCES, FADCES, Katy Walker, LCSW

Your thoughts, feelings and beliefs affect your happiness and health — especially if you’re dealing with a chronic illness. Diabetes is hard. Taking care of yourself with diabetes is even harder. When trying to keep up with self-care demands, the amount of stress that comes with dealing with a chronic illness can be overwhelming. If left unchecked, such mental fatigue can lead to burnout. Symptoms of diabetes burnout include negative feelings about diabetes (“why me?”), avoiding diabetes self-care (for example, skipping medication or not checking your blood glucose levels), feeling isolated due to diabetes, and feeling like your life is controlled by diabetes. In fact, people with diabetes are two to three times more likely to deal with mental health issues like anxiety and depression. Unfortunately, only 50% of patients with diabetes are properly diagnosed and treated for mental health concerns. This means that understanding the link between diabetes and mental health and being able to advocate for yourself is more important than ever.

Hopefully, this article will help you navigate mental wellness and also give you information on how you can be an advocate for your mental health — information about what mental health treatment means when managing a chronic illness, different types of mental health professionals, what concerns may alert you to mental health issues, and how to discuss your concerns with your diabetes care provider will all be discussed.

What is mental health treatment?

What is “mental health treatment” all about? A vision of a person lying on a couch and talking about his childhood often comes to mind, but this is far from the truth. Although a mental health provider may help you open up about issues that began in your youth, mental wellness is all about helping you navigate how to lead a healthier and happier life now. Assessing and addressing psychosocial issues is a standard part of optimal diabetes care. A clinical professional who is credentialed to focus on mental health is considered an essential member of the diabetes care team.

Who is a mental health professional?

The two most common clinical mental health professionals are therapists and psychiatrists.

Therapists

To put it simply, a therapist is someone who helps you talk through your problems, adjust negative thinking patterns and manage stress using evidence-based interventions. “Therapist” is a broad term that includes several different titles or professions. Therapists include clinical professionals such as psychologists, counsellors (both individual and marriage/family) and social workers. Therapists have specialized mental health training and are educated at a master’s level or above; however, they do not prescribe medication. Specific education required for therapists varies by state.

Beyond therapy, you may also be referred to a psychiatrist to help you address symptoms when medication is needed. 

Psychiatrists

The primary function of a psychiatrist is assessing mental health issues and prescribing medicine for those diagnoses. A psychiatrist is a physician who studied general medicine and then decided to specialize in mental health issues. Advanced practice nurses and physician assistants may specialize in mental health medication management as well. After your initial assessment, you will usually see your psychiatrist no more than once a month. It is not common in most practices for a psychiatrist to provide “therapy;” rather, these specialists typically provide medication management for any identified mental health concerns. 

How do I know if I need mental health treatment?

Depression and anxiety are two of the most common issues that people with diabetes face. And who could blame them? Diabetes requires a lot of work. The most common assessments used to determine if someone may be experiencing a mental health issue are the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder 7 (GAD-7). The PHQ-9 assesses depression symptoms, and the GAD-7 evaluates symptoms of anxiety disorders. Neither is meant to be a definitive diagnosis or outline treatment plans. However, both tools can act as a starting point for taking control of your mental health (see below).

Keep in mind that treatment recommendations are not one-size-fits-all, and referral to a mental health professional is sometimes needed. Both of these tools should be administered or evaluated by healthcare professionals.

How do I ask for help? 

Sometimes it can be difficult to admit you’re going through a hard time. But don’t let that discourage you. Everyone needs a little help sometimes, and health issues are hard for anyone. Mental well-being should be a focus in diabetes management, and your diabetes care provider has heard it before. Here are some suggestions on what to talk to your diabetes care provider about if you have some of the symptoms above:

Tell your diabetes care provider how you feel. Be honest. Let the provider know that diabetes can be overwhelming, and strategies for dealing with the stress (or other negative emotions) would be helpful. It may be useful to bring your results from the PHQ-9 and the GAD-7 to give you reminders of specific issues to discuss. Most providers understand that diabetes self-management is both physical and mental.

Ask if there are any mental health resources available. Many diabetes clinics have a therapist who can be utilized by patients (even if they are not in the clinic full-time). Whether you are having trouble affording your medicine or feeling overwhelmed with caring for your health, be sure to speak up. Knowing your options puts you in a better position to take charge of your mental health.

Takeaways

The bottom line is that YOU are in charge of your own well-being — including your mental health. You should feel comfortable speaking to your diabetes care provider about your mental well-being. To locate a therapist in your area, start with the following organizations, adding your zip code or city/state, insurance provider and therapy needs:

psychologytoday.com

professional.diabetes.org/ada-mental-health-provider-directory

You are in charge of your life, so exercise your right to help yourself by seeking out any mental health resources that may be helpful.

https://www.diabetesselfmanagement.com/healthy-living/emotional-effects/mental-wellness-in-diabetes/