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:
Depression and Diabetes
Depression: What Every Woman Should Know
The American Diabetes Association (ADA) also addresses depression as a co-morbidity of diabetes in its publication. Click on:
Depression and Diabetes
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:
Recognizing and Handling Depression in People With Diabetes.
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
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
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:
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