World-class health care can’t ignore mental health

A holistic approach to diabetes requires honest conversation about mental health issues, argues Justin Thomas

Samples are checked and processed in the diabetes labratory at Imperial College London Diabetes Center in Abu Dhabi.  Delores Johnson / The National
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All too often mental health services are left to languish while physical health commands a disproportionate share of the attention and funding.

However, this perception is changing – and rightly so. Globally, governments have slowly woken up to the economic implications of mental health problems, which often afflict the young and are typically recurrent and frequently debilitating.

Research by the World Health Organisation suggests that mental health problems are among the most costly in terms of treatment and lost work days.

Another factor is a growing appreciation of the link between the physiological and psychological aspects of illness. This mind-body connection is particularly obvious in the case of diabetes, an illness with a disconcertingly high prevalence in the UAE.

The first thing to note about the relationship between depression and diabetes is the high rate of comorbidity. In other words, the elevated frequency that the two conditions occur together in the same person.

Analysis published by the American Diabetes Association explored 42 previous studies and concluded that depression was twice as common in individuals with diabetes than the general population. Around 20 per cent of all diabetes patients also experienced clinical depression.

The consequences of this relationship are negative. Depression in diabetic patients is associated with poorer glycaemic control, poorer self-management, in terms of diet and exercise and an increased likelihood of diabetic complications. Many of these findings are also true for even mild depression.

In other words, even the presence of depressive symptoms (eg, guilt, loss of interest, sadness) tends to be associated with poorer diabetes management.

We might assume that this relationship between diabetes and depression is born of the life-changing implications of receiving diabetes diagnosis. On any bad-news scale, the diagnosis of a disease that you may have to live with for the rest of your life must rate pretty highly.

Counter-intuitively however, it is not the diagnosis of Type 2 diabetes that gives rise to depression. In fact, research has shown that in most cases, depression precedes diabetes by several years. If anything, this suggests that depression is a risk factor for the onset of diabetes rather than a subsequent complication.

Depression among diabetics is responsive to all the usual treatments. The one most commonly used is antidepressant medication. The widespread use of antidepressants has more to do with the ease of availability than long-term effectiveness. For long-term effectiveness the most successful intervention to date is cognitive behavioural therapy (CBT), a type of psychological therapy designed to explore beliefs and attitudes, and empower patients with the skills to prevent future low moods spiralling into full-blown depressive episodes.

The evidence suggests that the successful treatment of depression improves diabetic outcome, increases adherence to self-care regimes and reduces the rate of diabetic complications.

This is all undoubtedly very valuable. However, there is a chronic lack of psychological therapists. If we are to have a holistic approach to the treatment of diabetes, then employing, educating and training adequate numbers of mental health professionals is a must.

A world-class health care service cannot ignore mental health.

Diabetes is not the only chronic physical complaint associated with depression. Heart disease is another prime example and treating co-morbid depression always leads to better outcomes.

If we truly want to improve our health and reduce the burden of chronic physical health problems, then we seriously need to improve mental health services.

To echo the World Health Organisation: "There is no health without mental health.”

Dr Justin Thomas is an associate professor of psychology at Zayed University and author of Psychological Well-Being in the Gulf States

On Twitter: @DrJustinThomas