The experience of living with diabetes is often associated with concerns specific to the illness and can cause conditions, such as diabetes distress, psychological insulin resistance and the persistent fear of hypoglycemic episodes.• A wide range of psychiatric disorders, including major depressive disorder, bipolar and related disorders, schizophrenia spectrum and other psychotic disorders, anxiety disorders, sleep disorders, eating disorders and stress-related disorders are more prevalent in people with diabetes compared to the general population.• People living with diabetes and depressive disorders are at increased risk for earlier all-cause mortality compared to people living with diabetes without a history of depression.• All individuals with diabetes should be regularly screened for the presence of diabetes distress, as well as symptoms of common psychiatric disorders.• Compared to those with diabetes only, individuals with diabetes and mental health concerns have decreased participation in diabetes self-care, a decreased quality of life, increased functional impairment, increased risk of complications associated with diabetes, and increased health-care costs.• Cognitive behaviour therapy, patient-centred approaches (e.g. motivational interviewing), stress management, coping skills training, family therapy and collaborative case management should be incorporated into primary care. Self-management skills, educational interventions that facilitate adaptation to diabetes, addressing co-occurring mental health issues, reducing diabetes-related distress, fear of hypoglycemia, and psychological insulin resistance are all helpful.• Individuals taking psychiatric medications, particularly (but not limited to) atypical antipsychotics, benefit from regular screening of metabolic parameters to identify glucose dysregulation, dyslipidemia and weight gain throughout the course of the illness so that appropriate interventions can be instituted. KEY MESSAGES FOR PEOPLE WITH DIABETES• Living with diabetes can be burdensome and anxiety provoking, with the constant demands taking a psychological toll. As a result, many people experience distress, decreased mood and disabling levels of anxiety. Diabetes is often associated with a significant emotional burden, distress over the self-care regimen and stress in relationships (with family and friends, as well as health-care providers).• It is important to recognize your emotions and talk to your friends, family and members of your diabetes health-care team about how you are feeling. Your team can help you to learn effective coping skills and direct you to support services that can make a difference for you.• Mood and anxiety disorders are particularly common in people with diabetes. Eating, sleeping and stress-related disorders are also common. Speak to your health-care providers about any concerns you have if you think you may be developing any of these problems.• Mental health disorders can affect your ability to cope with and care for your diabetes. In view of this, it is jus...
Although cognitiveϪbehavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective treatments for childhood anxiety disorders, the extent to which these interventions comprise usual care is unclear. This study evaluated the management of childhood anxiety in Ontario within 56 publicly funded community-and hospital-based mental health centers using a population survey. Psychologists and psychiatrists rated the frequency of interventions provided within their settings, with results highlighting only moderate access to evidence-based CBT and SSRI treatments. Exposure, a core component of CBT for anxiety, was underutilized. Usual care most often entailed psychoeducation, relaxation training, and family-based approaches. Consistent with established guidelines, combined interventions were typically used to treat moderate to severe levels of anxiety. Practitioners recommended similar care sequences, with the majority beginning with psychotherapy. Difficulties accessing CBT in publicly funded settings in Ontario may be due to the low number of practitioners with expertise in CBT. Implications for the translation and dissemination of evidence-based treatments into clinical settings are discussed.Substantial empirical data support the use of cognitiveϪbe-havioural therapy (CBT) and pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) in the treatment of childhood anxiety disorders (
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