What’s Depression Got to Do With It?
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Research linking depression and diabetes is compelling -- and the likelihood of the conditions occurring simultaneously is particularly great in older women. Not only are women who have diabetes more likely to develop depression than are men with diabetes, but older women with diabetes are more likely to develop depression than are women who do not have this disease. This is a concern because the co-occurrence of diabetes and depression often results in people having a difficult time following a diabetes treatment plan, which in turn places them at risk for otherwise avoidable complications of diabetes, including heart disease, vision, and circulation problems. It can likewise increase their risk of premature death. Healthcare professionals must therefore be particularly attentive for signs of depression in older women with diabetes.
Why Older Women Are at Risk
Chronic or serious illness is the most common cause of depression among older adults. A physical illness affects how mobile people can be, whether they can manage daily tasks on their own, and their overall quality of life. People who feel that they are losing their sense of independence may experience depression. Beyond these basic facts faced by older adults in general, older women may be particularly at risk for depression for two reasons:
Socioeconomic Status. Women, older adults and people from racial and ethnic minority groups have the highest rates of poverty in the United States. Living in precarious economic conditions can lead to frustration and chronic stress, which in turn can make a person susceptible to depression.
Social Isolation. Social isolation is strongly correlated with depression. Researchers have found that older women without spouses are more likely to have multiple symptoms of depression than are older married women. Likewise, women who have support systems of friends and relatives exhibit fewer signs of depression than do those without good social support systems.
Screening and Treatment
There is a great need to raise awareness about the comorbidity of diabetes and depression in older women and to let people know that effective treatment options are available. Early assessment and interventions that address depressive disorders improve diabetes treatment adherence and outcomes -- and, as a result, measures to deal with depression in older women with diabetes may decrease their rate of mortality from diabetes. For this reason, it is important for healthcare professionals treating older women with both diabetes and depression to respond with appropriate interventions.
Treatment for major depression usually consists of antidepressant medication, cognitive behavioral therapy or both. When depression accompanies a physical health problem, the symptoms of depression may be similar to those of the physical illness and, thus, may be overlooked or misdiagnosed. Symptoms of depression also may be overlooked if the healthcare professional does not ask sufficient questions concerning depression or does not have the time to employ formal questionnaires related to depression. Brief screening instruments for detecting depression can help with this issue. Many can be self-administered, and they are easily scored.
A Multidisciplinary Approach
To address the links between diabetes and depression, diabetes care should be multidisciplinary: Involving mental health professionals in the treatment of people with diabetes increases the opportunity to accurately diagnose depression. Although depression is generally not listed as a complication of diabetes, it is, in fact, very commonly associated with the disease. More needs to be done to enhance education and training on the comorbidity of these two illnesses, particularly by increasing awareness among both healthcare professionals and people with diabetes. Given the data about older women with diabetes and depression, healthcare professionals who work with older women have an added reason to take a leadership role in addressing this crucial issue.
Laura Shea is director of public and professional education in the Diabetes Prevention and Control Program of the New York State Department of Health. She is currently chair-elect of the Women’s Health Council of the National Association of Chronic Disease Directors.
Michelle D. Owens is a behavioral scientist in the Division of Diabetes Translation at the Centers for Disease Control and Prevention, where her primary focus is women’s health and mental health issues.
Copyright © 2007 American Society on Aging; all rights reserved. This article may not be duplicated or distributed in any form without written permission from the publisher: American Society on Aging, 833 Market St., Suite 511, San Francisco, CA 94103-1824; e-mail: permissions@asaging.org.
