A University of Michigan-led study reveals that people with diabetes face a higher risk of mental health disorders if they also suffer from chronic complications like heart attacks, strokes, or nerve damage. The study also found that this relationship is bidirectional, meaning mental health conditions can increase the likelihood of developing diabetes complications as well.
Brian Callaghan, M.D., senior author of the study, explained,
"We wanted to see if chronic diabetes complications led to mental health disorders or if mental health disorders led to those diabetes complications -- but we found that both relationships are true."
He emphasized the need for clinicians to screen for mental health issues in diabetes patients, as they already do for physical complications.
The study analyzed insurance data from over 500,000 people with diabetes and 350,000 without. Results showed that those with chronic diabetes complications were up to three times more likely to develop mental health conditions such as anxiety or depression, with this risk increasing with age. Similarly, people with mental health disorders were up to 2.5 times more likely to experience worsening diabetes complications. Type 1 diabetes was more strongly linked to physical complications in younger adults, while type 2 diabetes was more associated with mental health issues.
Researchers suggest that both direct and indirect factors contribute to this connection. Callaghan explained, "For instance, a stroke causes detrimental effects on the brain, which may directly lead to depression." Additionally, poor self-management of diabetes, such as neglecting medications, could worsen both mental and physical health.
The study also noted that common risk factors like obesity, poor glycemic control, and social determinants of health likely contribute to both conditions. First author Maya Watanabe pointed out,
"Diabetes care providers may be able to simultaneously prevent the risk of multiple complications by providing interventions to treat these shared risk factors."
Despite the clear need for mental health screenings in diabetes care, there is no universal screening process in place. Co-author Eva Feldman, M.D., emphasized the importance of developing systems to integrate mental health services into diabetes care, stating, "Primary care providers and endocrinologists are already overworked; therefore, systems of care need to be in place to help provide mental health care when needed." She called for better screening, insurance coverage for mental health services, and education for both doctors and patients, stressing that action is needed now to improve care for those with diabetes.
MQ Fellow, Dr Leslie Johnson, is investigating whether a treatment already found to be effective for reducing symptoms of depression and anxiety in patients with type 2 diabetes can be adapted for use with patients with type 1 diabetes
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