Prevalence of depression in Type 1 diabetes and the problem of over‐diagnosis

Abstract

We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology.

Stress and A1c Among People with Diabetes Across the Lifespan

“…For adults with T2D, the most common areas of DRS involve the treatment regimen and the emotional burden of diabetes [18], while people with T1D describe feelings of powerlessness, hypoglycemia, self-management, and eating as areas of greatest stress [19]. The prevalence of elevated DRS ranges from 20 to 40 % in people with T1D and T2D—these rates tend to be stable and show little change over time without intervention [20, 21, 22•]. This speaks to the chronic and persistent nature of DRS.…”

T1resources.uk; rated, reviewed, reliable. A co-created website for people affected by type 1 diabetes.

“…The prevalence of depression is high amongst adults with T1DM, with 3.5-10% being classified as depressed, depending on diagnostic criteria. 2,3 More than 90% of those classified as depressed, according to the eight-item Patient Health Questionnaire (PHQ8), also meet diagnostic criteria for diabetes distress. 2 However, these are separate entities; the prevalence of distress is much higher, with almost half of adults with T1DM exhibiting at least moderate diabetes distress.…”

“…2,3 More than 90% of those classified as depressed, according to the eight-item Patient Health Questionnaire (PHQ8), also meet diagnostic criteria for diabetes distress. 2 However, these are separate entities; the prevalence of distress is much higher, with almost half of adults with T1DM exhibiting at least moderate diabetes distress. 2 Diabetes distress is broadly defined, reflecting an emotional response (worry, concern and stress) associated with living with a demanding long-term condition.…”

“…2 However, these are separate entities; the prevalence of distress is much higher, with almost half of adults with T1DM exhibiting at least moderate diabetes distress. 2 Diabetes distress is broadly defined, reflecting an emotional response (worry, concern and stress) associated with living with a demanding long-term condition. 4 It is not considered psychopathological, but 'part of the spectrum of diabetes'.…”

“…5,6 These distinct emotional states have different effects on diabetes self-care outcomes; higher HbA1c is associated with diabetes distress, whilst the relationship with depression is still indeterminate in spite of its negative impact on self-care processes, particularly concordance with treatment. 2,4,6,7 Despite recognition of the high prevalence of psychological issues and the potential to impact on diabetes selfcare, it is estimated that 85% of people in the UK have no defined access to psychosocial support. 8 Peer support may fill this gap in service provision.…”