For World Health Day 2017 with the theme “Depression, let’s talk” we have given carte blanche to Cristina Maria Petrut, IDF Europe Board Member and clinical psychologist and psychotherapist in Cluj-Napoca, Romania.
7 APRIL 2017 – WORLD HEALTH DAY
Carte blanche to….Cristina Maria Petrut
For World Health Day 2017 with the theme “Depression, let’s talk” we have given carte blanche to Cristina Maria Petrut, IDF Europe Board Member and clinical psychologist and psychotherapist in Cluj-Napoca, Romania:
My name is Cristina Maria Petrut and I am from Cluj-Napoca in Romania. Diabetes is an important part of my life since the age of 11, when I was diagnosed with type 1 diabetes. From then on, I have been active in local and national diabetes associations and I am now a member of the Board of the International Diabetes Federation European Region.
Diabetes, a major cause of depression
As a clinical psychologist and psychotherapist, I mostly work with people with diabetes and/or their families. I help them accept their medical condition, cope with it, improve their management of the disease; I also help my patients with burnout, anxiety, phobias, depression and other problems related or not to diabetes. The risk of depression is greater when you have diabetes: according to some studies, 3 out of 10 people with diabetes have depressive symptoms and one out of 10 have all the criteria to be diagnosed with a Major Depressive Episode[1].
Many factors can explain the relation between diabetes and depression, but even so there is no easy answer. People with diabetes often go through similar periods and transitions in their “diabetes life” which can lead to depression. These are sometimes called trigger points[2],[3] and typically include diagnosis, hospitalization, the birth of a first child, and first encounter with complications. Furthermore, many people have difficulty to manage efficiently their condition on a daily basis and can feel overwhelmed and unmotivated. This can become an emotional and cognitive vulnerability which can lead to depression symptoms.
In addition to “diabetes life,” external issues such as losing someone close, or a job, being unsatisfied with life can impact the mental health of people with diabetes and lead to depression.
Depression, an aggravating factor for diabetes management
If diabetes is not faced with an attitude of perseverance and defiance, depression will often prevail. Having diabetes and depression can be very challenging as one condition will affect the other one and vice versa. Depending on the severity and duration of the depression, it may have a significant impact on the physical health of people with diabetes and increase the risk of long lasting diabetes complications, which can also be another trigger for a major depression episode. Additionally, anti-depressants have been found to have hypoglycaemic effects causing serious problems for self-management[4].
Let’s take, for example, the situation of a woman who has been diagnosed with type 1 diabetes when she was a child. Being an adult, she starts to think that the daily management of her condition is made more complicated because of her work and social life and wrongly feels that her diabetes prevents her from having a romantic relationship. At some point, this situation becomes a trigger of a depressive episode. She stops her social life and at night, instead of resting, thinks for hours on end how miserable her life is. She feels that she is a burden for her loved ones, that she will never be happy. She blames her condition, her life and her destiny. As a consequence, she stops taking care of herself, being consumed by irrational thoughts and emotions. She stops checking her blood glucose, not injecting enough insulin…. In a nutshell, she is in a vicious circle of depression, continues hating everything related to diabetes and does not accept any help. What’s more, when she sees her physician she tries to avoid the subject and hides the fact that she is depressed. If she does not get help, her depression will lead to long lasting diabetes complications, or even coma or death.
Early detection of depression and treatment are key
We all know that prevention of diabetes and its complications is extremely important. Likewise, spotting depression is the first step to treating it. Symptoms include:
- Persistent sadness or anxiety, a feeling of hollowness
- An overriding feeling of hopelessness and negativity
- Feeling helpless and powerless to change the situation
- Loss of interest in activities or pleasure
- Low energy and increased fatigue
- Insomnia, oversleeping, awakening early in the morning
- Concentration problems, memory problems and indecisiveness
- Dwelling on death or suicide
- Restlessness
- Weight change and decreased or increased appetite
A diagnosis of depression is made if several of these symptoms are continuously present for a minimum of two weeks[5]. Research has shown that leaving depression unaddressed may result in additional complications because of the co-morbidity with diabetes.
The crucial role of the professional and personal entourage
Since the age of 11, I have adopted the following mantra “Life isn’t about waiting for the storm to pass… it is about learning to dance in the rain”. As a person with diabetes, I know that it is not easy to be Fred Astaire or Ginger Rogers every single day and that diabetes can be difficult to cope with. As a clinical psychologist and psychotherapist, I know that depression can be successfully treated with psychological intervention and/or medication. Nowadays, intervention protocols for depression are very well developed and it is scientifically proven that they are useful and have a positive impact on mental health. I strongly believe that each diabetes healthcare team should include a psychologist who is able to identify and deal with any psychological issue that may interfere with proper diabetes management.
As an active member of local, national and international diabetes related organisations, I am convinced that patient associations and initiatives can provide a protective and supportive environment for people with diabetes facing difficulties. The following testimony of Cajsa Lindberg, a young woman with type 1 diabetes and fellow advocate, is a great example of the positive impact of such initiatives:
“During my almost 15 years of living with diabetes I’ve had my ups and downs, as I believe most people with diabetes have. It was during a quite problematic down period five years ago that I joined Ung Diabetes, the youth organization of the Swedish Diabetes Association. Meeting other people with type 1 diabetes for the first time since my diagnosis was life changing. It made me feel less alone and ashamed, and helped me in learning to accept my disease. Today, as an international health advocate and President of Ung Diabetes, I have the fortune to help arrange meeting places for young adults to be together, share experiences and support each other.
Very often, when people attend a diabetes event or camp for the first time, they’re surprised to find that they enjoy it more than they thought. Meeting others that live with the same disease as you is, for most people, a relief. In a room full of people with diabetes, with insulin pumps and meters beeping, you’re not alone anymore. In fact, the odd one out is the person without diabetes, who doesn’t measure his or her blood sugar or count carbohydrates, because in that setting, that is what’s considered normal. Like myself, many people don’t realize they have a need to meet others with diabetes until they actually do, and after doing that, it’s hard to take a step back, a step away from that very special community. The only thing I regret about deciding to meet others with diabetes is that I didn’t do it sooner – that could have saved me many tears and lonely days.”
Always remember: there are many people dancing in the rain and waiting for you to join in!
[1] Hermanns et al “The Effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for Patients With Diabetes and Subclinical Depression: Results of a Randomized Controlled Trial” Diabetes Care 2015 Apr; 38(4): 551-560
[2] Bedfordshire Diabetes, Diabetes – Psychological Effects & Emotional Support. http://bedfordshirediabetes.org.uk/guidelines/psychological-issues.html (last accessed 8 Feb 2017)
[3] Nash J. (2014). “Understanding the psychological impact of diabetes and the role of clinical psychology” Journal of Diabetes Nursing, 18:137-142.
[4] http://www.diabetes.co.uk/diabetes-and-depression.html
[5] Ibid.
