1. Proudly sponsored by:
Dr Alan Headey (with thanks to Dr. William Polonsky)
Clinical Psychologist
Scaling the highs and lows: Identifying and dealing
with diabetes burnout and depression
5. Proudly sponsored by:
Forms of depression
Major depression Dysthymia
Bipolar disorders Adjustment disorder
(depressed mood)
6. Proudly sponsored by:
Symptoms
Emotional - 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
7. Proudly sponsored by:
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
9. Proudly sponsored by:
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
10. Proudly sponsored by:
Newer Data
• 18% (Nichols and Brown, 2003)
• 10% (Fisher et al, 2007)
• 50% increased risk in people with diabetes
11. Proudly sponsored by:
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!
12. Proudly sponsored by:
What impact?
• Data is mixed on whether:
- Depression worsens glycaemic control
- Treating depression improves control?
- Could even be that depression leads to T2 DM
15. Proudly sponsored by:
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
16. Proudly sponsored by:
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!
17. Proudly sponsored by:
How might we help Jim?
Job Stress,
Seperation,
Medical
Illness
Not
Sleeping
Not
Exercising
not seeing
friends
Stressed
and
Sad
Work
harder
18. Proudly sponsored by:
“You can’t stop the birds from circling your head,
but you can stop them from nesting in your hair.”
Martin Luther 1483-1546
21. Proudly sponsored by:
Diabetes Distress
• “It’s 24 / 7” (Parental constant vigilance)
• “…it controls my life”
• “I will end up with complications no matter
what I do.”
30. Proudly sponsored by:
Restore Control – Make life sustainable
• Sleep
• Diet (carbohydrate)
• Exercise
• Social
• Spiritual
31. Proudly sponsored by:
So, what can you do to help
1. There is no such thing as “just listening”
2. Find ways to give hope
3. Think about daily routines. They need to be
sustainable.
