Understanding the Problem
There are a number of reasons to initiate program activity address depression as a co-morbidity of diabetes. The conditions affect so many Americans, particularly women and minorities. Through increasing public and professional awareness of this co-morbidity and fostering early detection and referral to appropriate care, there is an opportunity to help alleviate the suffering of depression and increase the effective management of diabetes. Consider the following:
- Almost 24 million Americans have depression1; more than 20 million have diabetes2
- Depression is estimated to be twice as prevalent among persons with diabetes1
- Women suffer twice as much depression as men3
- Minorities suffer disproportionately:
African American and Hispanic women suffer depression twice as much as men2
American Indians, Alaska Natives,Hawaiians, other Pacific Islanders, and Asian
Americans residing in Hawaii have more than twice the rate of diabetes than Whites2
African Americans and Hispanics all have significantly higher rates of diabetes than Whites2
- Depression is diagnosed in less than 25% of existing cases4
- Twenty-five percent of Americans with diabetes have yet to be diagnosed2
- There are pharmacological and non-pharmacological treatment options for both depression and diabetes2, 3
There exists a limited number of educational backgrounders or tools on depression as a co-morbidity, but a vast number of materials and Web sites addressing depression and diabetes, respectively, which significantly contribute to a better understanding of the problem.
You can access four documents on depression and diabetes simply by clicking on their respective titles.
Two are from the National Institutes of Mental Health (NIMH). One addresses the co-morbidity itself, and the other deals with depression in women. Both provide background and information on symptoms, prevalence, consequences, and treatment option. Simply click on:
The American Diabetes Association (ADA) also addresses depression as a co-morbidity of diabetes in its publication. Click on:
The ADA joined the American College of Cardiology and the Preventive Cardiovascular Nurses Association (PCNA) in addressing the co-morbidity which can be accessed by clicking on the title:
Key Resource Sites
There exists a number of Web sites maintained by organizations concerned with depression or diabetes or both that provide a wealth of information, education, and program tools. In the following, we identify many of them, provide a “Home Page” address and describe what the site offers.
American Association of Diabetes Educators (AADE)
Primarily a service site for its membership, the AADE home page includes the current position statements of the organization, including such topics as Special Considerations for the Education and Management of Older Adults With Diabetes, and Diabetes Education and Public Health. The site also maintains a listing of educators by state and zip code.
American Diabetes Association (ADA)
The ADA’s Web site reflects the organization leadership role in the advocacy arena and provides current updates on related research, policy, and legislative developments. It also provides access to useful information, professional guides and news and research reports in its Diabetes Today newsletter. Using the site’s search engine, you can focus on such topics as diabetes and depression and diabetes and women.
American Psychiatric Association
The home page primarily provides the latest news and developments for Association members. If one enters "depression and diabetes" into its search engine, the site provides references to APA articles and events related to the co-morbidity as well as links to other groups interested in depression and diabetes.
American Psychological Association
This home page features a study which found that Acceptance of Commitment Therapy (ACT)--which gets patients with diabetes to acknowledge negative thoughts about their disease--helps keep glucose levels stable. Under “Psychology Topics,” on the site, one can click on depression and be exposed to a range of relevant studies and news stories.
CDC’s Diabetes Public Health Resource
Operated by the Division of Diabetes Translation (DDT), this site provides a wide breadth of information, tools, and current developments. It includes updated prevalence statistics and highlights research findings and related reports in MMWR.
Depression and Bipolar Support Alliance
This is a patient-oriented organization engaged in research support, advocacy, and education. It has a grassroots network of more than 1,000 patient-run support groups which have formed a coalition to support a mass media campaign entitled “Depression Is Real.”
HRSA’s Health Disparities Collaborative (HDC)
The HRSA Health Disparities Collaboratives (HDC) is a national effort to achieve strategic system change in the delivery of primary health care. Starting with the Chronic Disease Care Model, the HDC focused on diabetes, depression, asthma, and cardiovascular disease—chronic conditions of highest importance to community health centers in terms of cost, volume, of patient visits and/or complexity of care needed. The site describes what elements and approaches went into the Chronic Care Model. The site also notes that the lessons learned from the chronic disease collaboratives will now be applied into a broader Primary Health Care Collaborative. Depression and diabetes will be addressed within this new collaborative and the emphasis of collaboratives relying on community partnerships will remain.
HRSA’s Pregnancy and Depression Initiative
HRSA’s Maternal and Child Health Branch has released a new publication entitled, Depression During and After Pregnancy: A Resource for Women. The booklet is designed to increase awareness among women and clinicians of perinatal depression’s impact and pervasiveness. According to HRSA, as many as 80 percent of women experience some type of depression during pregnancy or soon after the birth of a child. (Pregnant women are also at risk for gestational diabetes.) The booklet includes six simple steps a woman can take if she believes she is at risk of, or is experiencing, perinatal depression. The above-listed Web site provides easy-to-understand tools that can be downloaded for women, their families and health care professionals.
Joslin Diabetes Center (JDC)
Joslin Diabetes is a rare institution in that it provides leadership in three critical areas—research, patient care, and education. Its Web site provides basic information on diabetes, highlights research findings, and provides professional education. Once you are on the site, enter “depression and diabetes” in the search box and the site provides articles such as “Are Depression and Diabetes Linked?” and “Patient Care—Mental Health and Counseling Services.”
Macarthur Initiative on Depression and Primary Care
Funded by the Macarthur Foundation, this initiative carried out by Duke and Dartmouth strives to enhance the ability of primary care clinicians to recognize and manage depression. It supports research, develops and evaluates programs, and disseminates research findings and educational tools. One of its focuses is on the work place as a site for early detection and intervention.
National Alliance on Mental Health (NAMI)
Advocacy, patient support, and education are the main elements of NAMI, which claims itself to be the largest mental health grassroots organization in the country. It has offices in each state and in more than 1,100 communities. Its Web site includes a state-by-state “report card” on how well each states is providing mental health services. It also describes program activity underway in various states as well as the names of contacts in each state.
National Diabetes Education Program (NDEP)
The NDEP is jointly administered by NIH and CDC and has the partnership involvement of more than 200 public and private organizations. Its Web site includes special reports and educational tools geared to the health professional. It provides insights into working with managed care and employers, how to identify those with diabetes who are undiagnosed, and much more.
National Diabetes Information Clearinghouse
A service of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, the Clearinghouse’s Web site provides basic information on diabetes, its diagnosis, its complications, and its treatment. It also identifies clinical trials that are underway as well as guidelines and research reports on related studies.
National Institute of Mental Health (NIMH)
This is one of the few sites that provides fact sheets on the co-morbidity of depression and diabetes. In fact, it has fact sheets on depression as a co-morbidity for a number of chronic diseases. The site also lists research that is underway as well as guidelines and reports on recent research. As noted in another section of this resource guide, simply click on the title below to get the fact sheet on depression and diabetes:
National Mental Health Association (NMHA)
NMHA describes itself as the country’s oldest and larges nonprofit organization addressing all aspects of mental health and mental illness. With more than 340 affiliates nationwide, it works in the area of advocacy, education, and patient support. Through its Web site you can identify affiliate programs, treatment resources, and support groups in state and local areas. Fact sheets, Qs and As, can be downloaded in English and Spanish.
Partnership for Workplace Mental Health
A program of the American Psychiatric Foundation, this initiatives fosters a partnership between members of the American Psychiatric Association (APA) and employers on assisting employees with mental illness to return to work. It notes that employers providing higher quality evaluation and treatment of depression and anxiety will see overall medical costs fall, employees miss fewer days of work, and productivity rise. The site offers a Depression Tool Kit for employees and access to a Mental Health Works newsletter.
Robert Wood Johnson Foundation’s Diabetes Initiative
The Diabetes Initiative is dedicated to demonstrating that diabetes self management can be implemented successfully in real-world primary care and community settings. The site includes descriptions and stories from 14 funded programs that focused on the improvement of self-management. In development is a tool for program managers on the various levels of approaches to emotional health issues of patients with diabetes, from stress to clinical depression. When available, it will be uploaded on this Web-based resource guide.
Screening for Mental Health (SMH)
Both NAMI and NAMH, along with other major mental health organizations and agencies support National Depression Screening Day (NDSD) which was first introduced by SMH in 1991. The NDSD programs are implemented by local clinicians at mental health facilities, hospitals, primary care offices, social service agencies, colleges, worksites, and military posts. In 2005, 600,000 screenings were completed at some 12,000 facilities. The NDSD takes place in October during Mental Illness Awareness Week. The SMH site lists the NDSD year-round screening sites on a state by state basis.
1. National Institute of Mental Health fact sheet—Depression and Diabetes.
2. Centers for Disease Control and Prevention, National Diabetes Fact Sheet – United States, 2007.
3. National Institute of Mental Health fact sheet—Depression: What Every Woman Should Know.
4. Rubin RR, Ciehanowsku P, Egede LE, Lin EH, Lustman PJ, Recognizing and Treating Depression in Patients With Diabetes. Current Diabetes Report, 2004: 4:119-25