More than 40% of Australian adult diabetics also experience mental health problems, according to a report released by the government’s Australian Institute of Health and Welfare (AIHW).
More than 800,000 adult Australians are living with diabetes, which is caused when the body is unable to produce sufficient insulin to break down glucose.
Type 1 diabetics must take daily insulin injections to survive, while sufferers of type 2 diabetes – which is often associated with being older and overweight – can usually manage the disease with changes to diet and medication. Some women also develop gestational diabetes during pregnancy.
The report, Diabetes and poor mental health and wellbeing: an exploratory analysis, said that in 2007-08, 43.4% of adults with diabetes also experienced medium, high or very high levels of psychological distress, compared to 32.2% of non-diabetics.
More than 17% of diabetics aged between 16 and 85 also had an anxiety, affective or substance use disorder with symptoms in the past 12 months and people hospitalised with diabetes were more likely to have mental health problems than non-diabetics who were hospitalised.
“Substance use disorder, dementia or Alzheimer disease and depression were the most common mental health conditions also recorded for people hospitalised with diabetes,” said AIHW spokesperson Anne Broadbent.
The report noted previous studies had linked poor mental health and health risk factors for diabetes such as physical inactivity, poor diet, smoking and obesity.
“An individual with poor mental health may also have an increased risk of developing diabetes through the neuroendocrine system. A sustained stress level can influence the production of various hormones regulating cholesterol level, blood sugar levels and blood pressure,” the report said.
“Anti-psychotic drugs may also lead to an increased risk of developing diabetes through high blood sugar levels and weight gain.”
Professor Paul Zimmet, Director of International Research at the Baker IDI Heart and Diabetes Institute and a lecturer at Monash University, said he was surprised the level of depression among diabetics was not higher.
“The fact that they have a chronic disease means they have to follow a special dietary regimen and take daily medications. People with diabetes are more likely to have heart problems or complications from diabetes like eye disease, kidney disease,” he said.
“If you had all of those things, it becomes cumulative. You can be depressed because you have difficulty with vision or because of kidney failure or a range of issues.”
“If you are depressed from your diabetes you are more likely not to exercise, be overweight, to eat abnormally.”
Professor Jennie Brand-Miller from the University of Sydney’s Boden Institute of Obesity, Nutrition and Exercise and Eating Disorders said diabetics quickly learn that they have a very high risk of premature death, blindness, amputations and heart attack.
“Reducing the odds requires an enormous change in lifestyle, not the least of which is the perception that they will need to cut out all the things they love to eat, particularly sugar,” she said. “This perception is wrong but still widely held by health care providers as well as the person.”
Professor Brand-Miller said looking after mental health should be seen as just as important as physical health.
“In dietary guidelines, for example, we can emphasise the positive, rather than the negative. At the moment the dietary guidelines say ‘limit salt, limit fat, limit sugar, limit alcohol’,” she said.
“We should change this to ‘small amounts of salt, sugar, fat and alcohol can be used to increase your enjoyment of nutritious food’.”