Most mental health and substance abuse disorders emerge before age 25, so understanding and treating the mental health of young adults is a recognized priority for most health care systems around the world.
Health and medical research and treatment often happens in isolation– with progress in one area not always informing developments in others. This disjointed approach is a problem, because mood and anxiety disorders frequently co-occur with chronic physical health conditions.1 We need to devote more time and energy to understanding the challenges of living with symptoms of depression or anxiety in combination with managing a chronic physical health condition. My research interests are focused on diabetes in particular, and this has led me to try to understand and address some of the emotional and psychological challenges that can go hand-in-hand with living with diabetes as a young adult.
Looking at Diabetes
Before we can delve the relationship between mental health and diabetes, we must take a look at diabetes itself and understand the basics about what this condition is. There are different types of diabetes, each of which has multiple potential causes and sometimes different treatments. The two most common types are:
- Type 1 diabetes: A non-preventable, autoimmune condition as part of which the insulin-making cells in the pancreas are attacked by the body’s own immune system. People with type 1 diabetes need to use injections or a pump to obtain the insulin they need. Although type 1 diabetes is one of the most common chronic illnesses of childhood, approximately 50% of cases are diagnosed in adulthood.
- Type 2 diabetes: This is caused by one of three conditions: (1) the pancreas does not produce enough insulin, (2) the insulin does not work effectively, or (3) the body does not respond well enough to the insulin production. Type 2 diabetes results from a combination of genetic and environmental factors but is often referred to as a lifestyle condition because risk is greatly increased by being overweight and/or inactive. Maintaining a healthy lifestyle (e.g., healthy diet and regular physical activity) is essential for managing type 2 diabetes, and many people also take tablets; around 25% of people with type 2 diabetes use insulin injections. Traditionally, type 2 diabetes has been thought of as a condition of older age; however, more and more young people are now developing the condition.
Diabetes is a challenging condition to live with. The daily self-care tasks associated with managing blood glucose levels (such as taking insulin or medication, making dietary modifications, and checking and recording blood glucose) are unrelenting and can be burdensome. Other demands like juggling multiple medical appointments, keeping up-to-date with various health screens (e.g., blood tests and eye checks), dealing with ‘hypos’ (i.e., low blood glucose reactions), and negotiating awkward or unpleasant social situations (e.g., needing to inject insulin during a work meeting, people judging your food choices) also contribute to the burden of diabetes on the individual.
It is perhaps unsurprising then that people with diabetes are more likely to experience depression and anxiety than the general population.2-4 Further, many people with diabetes will experience diabetes-specific emotional distress (e.g., worrying about complications, feeling burned out from taking care of diabetes) at some point in their journey.5
Emotional Challenges for Young Adults with Diabetes
The challenges of the day-to-day management of diabetes can be even more pronounced in young people as compared to older adults with diabetes. Young adults often have complex lives and are balancing many competing priorities such as romantic relationships, starting a family, work/career, travel, and financial responsibilities. This can make it even more difficult to do all of the necessary tasks to effectively manage diabetes, and the emotional burden may be felt more acutely.
My colleagues and I recently compared depression and anxiety symptoms of young adults (18-39 years) with type 2 diabetes against those of young adults with type 1 diabetes, and against older adults (40 years or over) with type 2.6 We found that, when it comes to mental health problems, the young adults with type 2 diabetes were more similar to people their age with type 1 diabetes than older people with type 2 diabetes. The rates of moderate to severe depressive symptoms were equivalent between the two young adult groups, but the young adults with type 2 had significantly higher rates than did the older adults with type 2. Although there were no statistically significant differences between the groups on anxiety symptoms, a higher proportion of young adults with type 2 diabetes had moderate to severe anxiety symptoms as compared to the other groups. Overall, 22% of study participants with diabetes had moderate to severe depressive symptoms, and 15% had moderate to severe anxiety symptoms.
Young Adults with Type 2 Diabetes Need Tailored Care
There are two key take-home messages from these findings. First, young adults with type 2 diabetes may need tailored diabetes care and mental health support because they have different needs and face different challenges than older people with type 2 diabetes. As the number of young adults with type 2 diabetes continues to rise, there will be a growing need for specialty, multi-disciplinary services that address both diabetes education and emotional well-being in an age-appropriate environment.
Diabetes is Often Coupled with Depression and/or Anxiety
Findings from our study also reinforce what has been seen in previous studies: a substantial number of people with diabetes have clinically significant depression and/or anxiety symptoms. Online resources can be useful starting points for people with diabetes who are experiencing emotional and psychological difficulties. However, there is a need for more resources that specifically address how diabetes can impact mental health, and vice versa. Organizations such as The Australian Centre for Behavioural Research in Diabetes and the Behavioral Diabetes Institute in the US are striving to fill this gap by generating knowledge about and providing tools that address the psychological demands of diabetes.
1. Scott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC, et al. Depression–anxiety relationships with chronic physical conditions: Results from the World Mental Health surveys. Journal of Affective Disorders 2007;103:113-20.
2. Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabetic Medicine 2006;23:1165-73.
3. Barnard KD, Skinner TC, Peveler R. The prevalence of co-morbid depression in adults with Type 1 diabetes: systematic literature review. Diabetic Medicine 2006;23:445-8.
4. Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: A systematic review. Journal of Psychosomatic Research 2002;53:1053-60.
5. Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful? Diabetes Care 2012 February 1, 2012;35:259-64.
6. Browne JL, Nefs G, Power F, Speight J. Depression, anxiety and self-care behaviours of young adults with type 2 diabetes: Results from the international Diabetes MILES Study. Diabetic Medicine 2014;in press.
Jessica Browne, Ph.D., is a health psychologist specializing in type 2 diabetes research. Based in Australia, she leads a diverse program of research at The Australian Centre for Behavioural Research in Diabetes. Her work aims to understand the challenges faced by unique groups with diabetes and the social impact of the condition. Dr. Browne collaborates with national and international health experts, contributes to training and information dissemination, and uses her findings to improve the lives of people affected by diabetes.