Depression and diabetes: what should nurses do?
Depression is more common in patients with diabetes than in the general population so nurses should be aware of this and screen for it routinely
In this article…
- The impact of depression on a person with diabetes
- Course of depression
- Screening and management
Kirsty Winkley is a diabetes specialist nurse, National Institute for Health Research post-doctoral fellow and lecturer in diabetes at the Institute of Psychiatry, King’s College London.
Winkley K (2013) Depression and diabetes: what should nurses do? Nursing Times; 109: 45, 20-22.
Depression is recognised as a major health problem for people with diabetes and is associated with morbidity, mortality and a poor quality of life. This article outlines how depression is diagnosed, its consequences and how to screen for and treat it. It also gives some practical tips that nurses can use to support patients with diabetes who have depression.
- This article has been double-blind peer reviewed
- Figures and tables can be seen in the attached print-friendly PDF file of the complete article in the ‘Files’ section of this page
5 key points
- It is thought that 5-30% of people with diabetes also have depression
- Nurses are well placed to screen for depression and coordinate subsequent management
- Low mood, loss of interest in everyday activities and fatigue are the three main symptoms of depression
- People with depression may drastically increase or decrease their contact with health services
- Patients with depression and diabetes need increased input into their diabetes treatment
Depression is common in people with diabetes. It is thought that 5-30% of people with diabetes are affected - in general, double the number of people usually affected by depression who have no long-term illness (Anderson et al, 2001). These higher rates of depression have been found in studies using self-reporting measures, rather than the psychiatric interview techniques often used by mental health professionals.
Diagnosis of depression
According to criteria from the 10th edition of the International Classification of Diseases depression has three main symptoms:
- Low mood;
- Loss of interest in everyday activities;
- Fatigue or low energy.
If one or more of these symptoms are present, it is important to find out if there are any additional symptoms to determine the severity of depression. These include:
- Disturbed sleep;
- Poor concentration;
- Low self-confidence;
- Poor or increased appetite;
- Ideas or acts of self-harm or suicide;
- Slowing of movements;
- Guilt or self-blame (National Institute for Health and Clinical Excellence, 2009).
Severity of depression is assessed by determining the number and severity of the depressive symptoms outlined above, usually over a minimum of two weeks:
- <4 - no depression;
- ≥4 - mild depression;
- 6-7 - moderate depression;
- ≥8 - severe depression.
Categorising in this way may direct the type of treatment that is provided. As a rule of thumb, a depressive episode can be distinguished from a period of sadness by symptoms lasting longer than two weeks, occurring on most days of the week and there being a distinct loss of functioning.
Risk factors for depression
Risk factors for depression in people with diabetes are often similar to those for the general population. For example, depression is more common in women, younger people, those who have had stressful life events, people who live alone or have low levels of social support, those with lower socioeconomic status and those with additional health problems (usually affecting older people) (Winkley, 2008).
In addition to these common risk factors, particular factors are associated with depression in people with diabetes:
- Diabetes complications;
- Longer duration of diabetes;
- Severe diabetes;
- Little physical activity;
- Dependency on others;
- Persistent poor glycaemic control;
- Problems with hypoglycaemia;
- Patients with type 2 diabetes who are treated with insulin (Winkley, 2008).
Depression is a risk factor for type 2 diabetes but diabetes 