SARAH: Welcome back to the Qi Hub videos, and today I'm joined by Dr. Liz Beverly. 

LIZ: Hello Dr. Atkins. 

SARAH: How are you today? 

LIZ: I'm good. How Are you? 

SARAH: It's lovely. It's a lovely day. Thank you so much for joining us today. 

LIZ: Thanks for having me. 

SARAH: So we are going to continue talking about behavioral health in diabetes, and our first episode was on diabetes distress, and we're gonna follow this with our episode number two on depression. 

LIZ: Yes. 

SARAH: Alright. So Liz, Beverly, talk to me about what defines depression. 

LIZ: Okay. So most of you are already familiar with what depression is. So, you know, when we're talking about diabetes and depression, we're following what the DSM five says as their definition for depression. So it's the same nine criteria. So if you're thinking about it, it has to be at least one of the two symptoms of persistent sadness or loss of pleasure in things that you used to find pleasure in. And then there's a list of other criteria that you have to have at least, um, you know, four of those criteria. And it's like no, you know, problem sleeping, either not enough sleep or too much sleep. Weight gain or weight loss, some of those things. Okay. So those are the criteria for meeting depression. Um, but I also wanted to mention, you know, people with diabetes are at increased risk for depression, but also depressive symptoms and just experiencing higher depressive symptoms can also have the same effect as a major depressive disorder.

SARAH: That's so interesting. Mm-hmm. How common is this? 

LIZ: It's actually much more common than the general population. So in people with diabetes Yeah. There's actually a recent systematic review in meta-analysis. Which we know is the highest form of evidence. And what they found by using all of the studies with all of the prevalence rates out there. They found that in people with type two diabetes. The prevalence rate is 19%. So that's one outta every five people with type two diabetes. And keep in mind, this is factoring in the research all across the globe. So regionally you can have differences where it might be a little bit higher in some places than in others. And then for people with type 1 diabetes, it was slightly higher. It was 22%. 

SARAH: Wow. That is sad. Okay. 

LIZ: Yeah, it's, it's difficult. So it's much higher. It's 2 to 4 times higher than the general population that you will find. 

SARAH: Yeah. Diabetes can be a lot. 

LIZ: Diabetes is a lot. 

SARAH: Okay. Yeah. Thank you. That's really helpful. So we know about how common it is. So what do we do about it? What do we do now? 

LIZ: Well, I think awareness is key. So just knowing that people with diabetes are at increased risk for depression. Um, and thinking about it, it's really important to know that people who have diabetes or increased risk for developing depression. But then people who have depression are also at increased risk of developing type 2 diabetes. 

SARAH: Oh, that's so interesting. 

LIZ: Interesting, right? So knowing that there's this bi-directional relationship between the two is really important. So being aware of it is key. Because once you know, and then you understand what is the effect of having diabetes and depression. So I know when we talked about distress, we talked about the ways that affects a person. Well, depression does very similar things. It affects abilities to perform self-care behavior. So a person will perform fewer self-care behaviors. It does increase someone's A1C. 

SARAH: That's interesting. 

LIZ: It tends, if you have depression, you're also more likely to have a co-occurring mental health condition. So like diabetes, distress, anxiety. Um, some other ones. You're also much more likely to have microvascular complications, macrovascular complications, lower quality of life. And there's data that shows it increases your risk for mortality. 

SARAH: All ties in together. 

LIZ: It all ties together. 

SARAH: Excellent. That was really informative. Is there anything else that you would like to share with us? 

LIZ: Yeah. 

SARAH: About diabetes and depression? 

LIZ: Sure. So the most important thing is being aware, right? And just acknowledging that diabetes comes with emotions and to kind of normalize that diabetes is an emotional condition as well. And to not make anyone feel blamed or bad for experiencing these feelings. And then just knowing that perhaps screening is ideal for screening for depression. So the American Diabetes Association. Okay. Also the United States Preventive Services Task Force. We all recommend annual screening. So it's not just the ADA, but the U-S-P-S-T-F also recommends annual screening for depressive symptoms. So I'm sure most of you are already doing this, so awesome job. Um, I would say, you know, use the PHQ 2 uh, too. You know, patient health questionnaire 2. Yep. Um, you could also use the patient health questionnaire 9 if that's, you know, what your EHR or what your healthcare system would prefer. I recommend using the screener if you have someone who screens positive. First keep in mind it's just a screener, it's not a diagnostic tool. But if someone does, you know, screen positive, that's when you know, think about referring. Right, so depression isn't something that'll get better on its own. Right? And of course there are different treatments for it, you know, you can do pharmacologic. So you hit up Sarah, talk to Sarah about the pharmacologic piece. If you wanna talk to me about some other options. You know, I know where we are. We have limited access to behavioral health. But referral is ideal, um, for treating major depressive disorder and even clinically high depressive symptoms. But what we know for evidence-based treatments. We know cognitive behavioral therapy is one of the most effective. 

SARAH: Yep. 

LIZ: We also know mindfulness-based therapy is really key. And then something that's really interesting is physical activity. So if you're able to incorporate physical activity and the interventions that have been done for research. Physical activity for treating depression is the only intervention that improves suppressive symptoms and A1C. 

SARAH: Oh. 

LIZ: So there you go. 

SARAH: Hashtag time of win-win. 

LIZ: But We have to...

SARAH: Winning. 

LIZ: Yes. But you have to keep in, you know, I mean it's, for some people it's really hard to do physical activity at the same time, so you just have to figure out what's best for the person. 

SARAH: Right. And because it's depression, it's hard to get up and move and then to try to include in physical activity I can see where that would be difficult. 

LIZ: Right, it's very hard. 

SARAH: Yeah. I think that would be difficult. But good.  

LIZ: Yeah. And one thing that we've known from research in depression and diabetes is that people with diabetes and depression, the episode of depression lasts a lot longer for people with diabetes compared to a person without diabetes. You know, so the average person who's experiencing a depressive episode, that might be about three months. A person with diabetes, it can last like two years, so it lasts a lot longer. A person who's had one depressive episode is much more likely to have a second and a third. And then the time in between episodes becomes shorter and shorter. So just be aware. So like if you have a patient with type two diabetes has a history of depression, they're at increased likelihood of having it again. So just be aware that maybe for that individual you'd wanna rescreen or just keep your eye on that individual. 

SARAH: That's fantastic. Thank you so much for all this. 

LIZ: Yeah, sure. 

SARAH: It's, I think it's so important we forget about it a lot. 

LIZ: Yeah. And just to point out May is mental health awareness one, So 

SARAH: Oh, fantastic. Good timing for our topics then. 

LIZ: Yeah. I'm glad to shine a light on this topic. So yeah. 

SARAH: Fantastic. Just a reminder too, if you wanna look up any of these, these are in section five of the American Diabetes Association Standards of Care, um, that they covered these as well. So we did our diabetes distress and now we have covered depression. Thank you Liz, for the, the summary of all this information and, and what to do next. Thank you so much for joining us today for the video series. And we have covered diabetes distress. We have covered depression. We have two more videos coming for you in this behavioral health series. We have anxiety and disordered eating behaviors. So we hope to see you on those next videos.