WASHINGTON, DC—It is recommended that physicians screen for depression in diabetic patients because the combination of diabetes and depression can be dangerous. “When a person has diabetes and they experience depression, there is a whole host of complications that can occur if the depression is not treated,” said Dr Michelle Owens-Gary, PhD, a behavioral health scientist in the Centers for Disease Control and Prevention’s Division of Diabetes Translation.

Someone who is depressed has feelings of sadness or anxiety that last for weeks at a time. In addition, research shows that depression is about 2 times more common in people with diabetes than in the general population. When a diabetic patient is depressed, the danger is that they may not take their medications or monitor their glucose levels as recommended by their physicians. Poor control of diabetes leads to an increased risk of avoidable complications such as heart disease, blindness, amputations, stroke, erectile dysfunction and kidney disease.

Depression and Type 2 Diabetes

Does depression result in a person developing diabetes, or does diabetes cause depression? “The research tells us that there is a link between diabetes and depression, but it isn’t really clear right now which one comes first,” Dr Owens-Gary explained. A patient who is diagnosed with type 2 diabetes may become depressed due to the challenges of managing their diabetes. Dietary modifications and fitness recommendations are just a few of the lifestyle changes involved with this diagnosis. These changes can be a difficult adjustment for a patient, in addition to learning they have diabetes. While diabetics may become depressed, research also indicates that those who are depressed are at a 37% increased risk for developing type 2 diabetes. “A depressed person may tend to not eat healthy foods. They may also choose to lead a sedentary lifestyle and reduce their physical activity levels and all of that can contribute to obesity, which we know can increase the risk for diabetes,” said Dr Owens-Gary.

CDC has been conducting research to better understand the association between diabetes and depression. One 2005 study published in the American Journal of Epidemiology titled “Depressive Symptoms and Mortality among Persons with and without Diabetes” found that the presence of severe depressive symptoms significantly elevated mortality risk among US adults with diabetes. This pattern was not found among the study participants who did not have diabetes. That study concluded that “depression should probably be considered a target for diabetes management interventions,” and that more investigation is needed to “clarify the nature and etiology of the interaction between diabetes and depression.” CDC researchers are also studying topics such as undiagnosed depression among adults who have diabetes, diabetes and anxiety, and the overall prevalence of depression among adults with diabetes.

Treating Depression

Depression is a treatable condition. Reaching a diagnosis is important on two counts: reducing the risk of the depressed individual developing diabetes, and reducing the risk of the depressed diabetic developing serious complications. Sometimes, however, patients may not realize they are depressed. In these cases, a family member or health care provider might be first to observe symptoms. In addition to being evaluated by their physician, diabetic patients who are found to be depressed should be prescribed medications and referred for psychotherapy. “The research is telling us that the combination of medications as well as psychotherapy are more effective than just one by themselves,” said Owns-Gary.

CDC is also working to educate employers on diabetes and depression. The National Diabetes Education Program, which is cosponsored by CDC, the National Institutes of Health, and a host of partners, collaborated on a web-site to achieve this goal. The website, www.diabetesatwork.org, has a sub-page titled “Diabetes at Work: What’s depression got to do with it.” This section provides information about the association between diabetes and depression and what employers should know about the co-morbidity of these conditions. It reminds employers to be conscious of depression in diabetics because of the impact it can have on health care costs. The site states that, “total health care expenditures for individuals with depression was 4.5 times higher than for individuals without depression.” Finally, Dr Owens-Gary concludes that, “we know that people spend a lot of time on the worksite, and employers need to know what roles they can play with their employees to deal with depression.”

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